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Musculoskeletal Physiopathology > Fracture and Fracture Repair > Flashcards

Fracture and Fracture Repair Flashcards

1
Q

What is the most common lesion in bone?

A

Fracture

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2
Q

What is a pathological fracture?

A

Fracture through diseased bone

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3
Q

Are all fractures pathologies?

A

Yes

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4
Q

Are all fractures pathologic fractures?

A

No

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5
Q

What are the three phases of fracture repair?

A
  1. Inflammation phase
  2. Repair phase
  3. Remodeling phase
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6
Q

When does the inflammatory phase occur?

A

Onset to approximately 10 days

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7
Q

When does the reparative phase occur?

A

Approximately one week to a few months

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8
Q

When does the remodeling phase occur?

A

Several weeks on

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9
Q

inflammatory phase

What events occur between onset and two days post fracture?

A
  1. Rupture of blood vessels (in both soft tissue and bone)
  2. Hematoma
  3. Tearing of periosteum
  4. Necrosis of bone and soft tissue
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10
Q

What is the function of hematoma during the inflammatory phase?

A

Fills gaps, surrounds injury, seals off fracture

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11
Q

inflammatory phase

What events occur 2-5 days post fracture?

A
  1. Fibrin mesh develops
  2. Fibroblasts migrate into area
  3. Begins to form and lay down cartilage between bone ends
  4. Necrosis and macrophage activity continues
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12
Q

inflammatory phase

Which cells are involved in necrosis post fracture?

A

Macrophages and PMNs (neutrophils)

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13
Q

inflammatory phase

What events occur 5-10 days post fracture?

A
  1. Soft tissue callus (procallus) begins to form
  2. Macrophage activity is ongoing
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14
Q

The early part of the reparative phase occurs simultaneously with the….

A

later part of the inflammatory phase

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15
Q

What events occur during the reparative phase?

A
  1. Osteoclasts and mononuclear cells clean up debris
  2. Extensive neovascularization/angiogenesis
  3. Callus formation begins
  4. Significant osteoblastic activity occurs
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16
Q

reparative phase

How might a fracture appear on X ray ten days to two weeks post fracture?

A

Fracture appears wider

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17
Q

reparative phase

How might a fracture appear on X ray four weeks post fracture?

A

A hazy cloud is seen as callus formation begins

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18
Q

What events occur during the remodeling phase?

A
  1. Occurs as callus seals the bone
  2. Bone adjusts its strength and shape (Wolff’s Law)
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19
Q

remodeling phase

What is the state of the fracture as the callus seals the bone?

A

Fracture is stable depending on age, general health, and fracture location

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20
Q

What cells are involved in the inflammation phase?

A
  • PMNs
  • Macrophages
  • Osteoclasts (may be present)
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21
Q

What cells are involved in the reparative phase?

A
  • Chondrocytes
  • Osteoblasts
  • PMNs
  • Macrophages
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22
Q

What cells are involved in the remodeling phase?

A
  • Osteoblasts
  • Osteoclasts
  • Osteocytes
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23
Q

What is clinical union?

A

Point when cast is removed; implies fracture is stable

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24
Q

What is malunion?

A

Healing with residual deformity

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25
Q

What is delayed union?

A

Failure to heal up to 6 months post fracture

26
Q

What is non-union?

A

Failure to heal after 6 months

27
Q

What is pseudoarthrosis?

A

Non-union fracture healing with pseudojoint

28
Q

How common is a transverse fracture?

A

Uncommon

29
Q

What is a transverse fracture?

A
  • About 90 degrees to long axis
  • High velocity injury
  • Often pathologic
  • Referred to as Paget’s “banana” fracture
30
Q

How common is an oblique fracture?

A

Very common

31
Q

What is an oblique fracture?

A
  • Shaft of tubular bone
  • About 45 degrees to long axis
32
Q

What causes a spiral fracture?

A

Torsion and axial compression

33
Q

What is a spiral fracture?

A

Angulated fracture; has pointed ends

34
Q

What is a bone bruise?

A

Hemorrhage, edema, trabecular microfracture of bone

35
Q

How is a bone bruise visualized?

A

Not seen on radiographs; best visualized on MRI

36
Q

Incomplete vs. complete fracture refers to…

A

discontinuities in the cortex of the bone

37
Q

What is a Greenstick fracture?

A

Incomplete fracture in skeletally immature individuals where bending fractures bone on one side
Often caused by falling on outstretched arm

38
Q

What specific fracture is shown here?

A

Greenstick fracture

skeletally immature

39
Q

What is a Torus fracture?

A

Incomplete fracture in skeletally immature individuals where buckling fractures bone on one side
Often caused by falling on hand

40
Q

What specific fracture is shown here?

A

Torus fracture

skeletally immature

41
Q

What is a closed fracture?

A

Fracture that does not break the skin

42
Q

What is an open fracture?

A

Fracture that breaks the skin

43
Q

What is a comminuted fracture?

A

Three or more fragments that have separated from the bone:

  • Crushed or pulverized bone
  • “Butterfly fragment”
44
Q

What is a noncomminuted fracture?

A
  • One break
  • Two fragments
45
Q

Compression and impaction fractures are frequently due to…

A

axial compression

46
Q

Compression almost exclusively refers to ___ fractures

A

vertebral

47
Q

Impaction refers to ___ fractures

A

extremity

48
Q

What is a Salter-Harris fracture?

A

Fractures involving the growth plate (physis) classified by location to or damage to the physeal region

49
Q

What are the subcategories of stress fracture?

A
  • Fatigue
  • Insufficiency
50
Q

stress fracture

What causes fatigue fracture?

A

Abnormal repetitive stress on normal bone causing gradual formation of microfracture

51
Q

What is a March fracture?

A

Stress fracture from fatigue of 2nd or 3rd metatarsal

52
Q

stress fracture

What causes insufficiency fracture?

A

Normal stress through diseased bone; a form of pathologic fracture

53
Q

What is an avulsion fracture?

A

Forcible ripping or tearing of tissue:

  • Tearing away of bone fragment
  • Pull from ligament, tendon, or muscle
54
Q

What is a Clay Shoveler’s fracture?

A

Avulsion fracture of a lower cervical segment spinous process

55
Q

What specific fracture is shown here?

A

Clay shoveler’s fracture

avulsion fracture

56
Q

What is an occult fracture?

A

A radiographically invisible fracture; most common in scaphoid, also ribs

57
Q

What is secreted by osteoblasts when depositing bone?

A

Alkaline phosphatase

58
Q

In what situations or conditions would you expect to see an increase in alkaline phosphatase in the blood?

A
  • Fast/aggressive bone building pathologies
  • Pathologies that involve a large portion of the skeleton
59
Q

What is erythrocyte sedimentation rate?

A

Indicates inflammatory process by how quickly red blood cells settle to the bottom of a test tube

60
Q

What may cause an elevated erythrocyte sedimentation rate?

A
  • Bone conditions
  • Infection
  • Autoimmune diseases ie rheumatic fever, tuberculosis
61
Q

What is radionuclide imaging?

A

Bone scan with a Gamma camera specific for areas of increased metabolic activity
Overall, very sensitive, not specific

Musculoskeletal Physiopathology (13 decks)

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