Exam 4: Integumentary/MSK Flashcards
Complete fracture
Bone separates completely
Incomplete fracture
Bone fragments are still partially joined
Closed Fracture
Fracture that does not break the skin
Open Fracture
Fracture where bone breaks the skin
Comminuted Fracture
A fracture with more than one fracture line and more than two bone fragments, which may be shattered or crushed
Linear Fracture
Fracture of the long axis of bone
Oblique Fracture
Fracture at an angle
Spiral Fracture
Fracture encircling bone
Transverse Fracture
Fracture that is perpendicular to long axis, parts of the bone are separated but close to each other
Impacted Fracture
Bone fragments pushed into each other
Pathologic fracture
Break in bone integrity caused by extreme stress from a non-traumatic etiology. Bone is internally weakened by pre-existing condition and fractures easily without trauma or only slight trauma. Ex. Osteoporosis, neoplasms, metabolic conditions, or some other space occupying lesion
Avulsion
Separation of a small fragment of bone at the site of attachment of a ligament or tendon
Compression Fracture
A fracture that consists of the crushing of cancellous bone/spongy bone
Greenstick Fracture
Break in cortex of bone (children & elderly), incomplete with one side intact
Impacted Fracture
One part of the fracture is compressed into an adjacent part of the fracture
Stress Fracture
Caused by repetitive stress on bone. Commonly, stress fractures occur on the second and third metatarsals, tibia, and fibula. Stress fractures develop when extensive microdamage occurs before bone can be adequately remodeled. Bones prone to stress fractures are those constantly involved in weight-bearing activity, high impact activity, such as with walking or running
Transchondral
Separation of cartilaginous joint surface
Traction
Used to maintain alignment of bone
Dislocation
Displacement of one or more bones in a joint surfaces with loss of articulation
Subluxation
Opposing surfaces only partially lose contact (partial dislocation)
Sprain
Ligament damage. ligaments may be incompletely torn or completely torn, or ruptured
Strain
Stretching injury to muscle or musculotendinous unit by mechanical overloading
Malunion
Healing of bone in an unacceptable position
Tendinopathy
Painful thickening of tendons
Fracture blister
Skin blisters seen after fractures of severe twisting can be a precursor to compartment syndrome. Get epidermal necrosis with separation of the epidermis from underlying dermis by edema
Contracture (pathologic)
Permanent muscle shortening caused by muscle spasm or weakness seen with CNS injury, secondary to scar tissue
Contracture (physiologic)
Due to the absence of muscle action potential such as malignant hyperthermia or sarcolemma lack of ATP
Osteopenia
Thinning of the trabecular matrix of the bone before osteoporosis
Kyphosis
Excessive curvature in the thoracic spine sometimes called a dowager’s hump, forward curvature of spine tends to progress with age
Lordosis
Increased curvature of the lumbar spine
Scoliosis
Lateral curvature of the spine
Fibrosis
Replacement of damaged tissue with scar tissue composed mainly of collagen produced by fibroblast
Rash
Temporary eruption of the skin
Lesion
Traumatic or pathological loss of normal skin continuity, structure, or function
Bulla
Large blister
Crust
Dried yellowish and yellow-brown exudate on skin
Excoriation
Scratch that breaks the skin’s surface
Induration
Hardening or thickening of skin
Keloid
Irregular, elevated scar tissue
Macule
Defined flat area of altered pigmentation
Nodule
Solid lump greater than 0.5 cm in diameter
Papule
Raised, well-defined lesion, usually smaller than 0.5 cm in diameter
Pustule
Papule filled with pus
Ulcer
Loss of epidermal and dermal tissue
Vesicle (blister)
Blister smaller than 0.5 cm in diameter
Wheals/urticaria
Transient pink, itchy, elevated papules that evolve into irregular red maculopapular patches. Think hives with urticaria
Pruritus
Itching
What factors facilitate bone growth?
nutrition such as adequate calcium or vitamin D, physical activity like weight bearing to simulate bone growth and maintain bone strength. Age is another facilitator of bone growth more specifically at less than 30 years the body will make more bone than destroy. Hormones help facilitate bone growth like the thyroid for calcitonin, estrogen inhibits bone breakdown and stimulates bone formation, testosterone stimulates muscle growth which places stress on bones and facilitates bone formation.
What factors inhibit bone growth or increase risk for fractures?
like smoking, obesity, age, use of anti-inflammatory or cytotoxic medications, steroids, excess alcohol intake, excessive caffeine intake, excess carbonated soft drink intake, eating disorders, hyperthyroid, hyperparathyroidism (causes further CA to be reabsorbed from bone), and/or family history. Age and hormones also matter so postmenopausal women and after 30 years of age the amount of bone resorbed by the osteoclasts exceeds that which is formed by osteoblasts, resulting in a steady decrease in bone mass with age.
What are the 4 stages of bone healing?
Hematoma: 1-2 days disruption of blood flow can lead to death of bone cells
Inflammatory: 2-5 days hemorrhage forms and you get neovascularization clotting factors stay in place to build a fibrin meshwork…granulation tissue forms
Reparative: continued formation of the callus and cartilage
Remodeling bone is reconstructed
Fracture complications
Bleeding/arterial damage
Nerve damage
Nonunion and malunion
Infection (osteomyelitis)
Thromboemboli (DVT) & (PE)
Fat embolism
Compartment syndrome
Fracture blister
Types of osteomyelitis
Hematogenous - bacteria from bloodstream
Contiguous - direct bacterial infection of bone see with trauma or surgery
Chronic - occurs when infection persists longer than 6 to 8 weeks or fails to respond to appropriate antibiotic therapy
D-dimer
a fibrin degradation product, a small protein fragment seen when you have a clot present
Factors that delay wound healing
Age
Tissue oxygen tension/hypoxia
Vascular insufficiency
Severe anemia
Infection
Edema
Smoking
Pain/stress
Nutrition deficiencies
Bacterial colonization
Chronic diseases/DM
Pressure
Medications (e.g. steroids)
Phases of wound healing
Hemostasis
Inflammatory (healing can be delayed here)
Proliferative (and here)
Remodeling
What are clinical manifestations of an infection?
Fever, elevated WBC count
Increased amount and type of wound drainage
Heat at wound site, increased pain
Regression of wound healing
May send specimen for C & S/tissue biopsy
Pain: changing, increased pain; wound pain is often underestimated by healthcare professionals
