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Musculoskeletal Physiopathology > Fracture & Fracture Repair > Flashcards

Fracture & 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
What is delayed union?
Failure to heal up to 6 months post fracture
26
What is non-union?
Failure to heal after 6 months
27
What is pseudoarthrosis?
Non-union fracture healing with pseudojoint
28
How common is a transverse fracture?
Uncommon
29
What is a transverse fracture?
* About 90 degrees to long axis * High velocity injury * Often pathologic * Referred to as Paget's "banana" fracture
30
How common is an oblique fracture?
Very common
31
What is an oblique fracture?
* Shaft of tubular bone * About 45 degrees to long axis
32
What causes a spiral fracture?
Torsion and axial compression
33
What is a spiral fracture?
Angulated fracture; has pointed ends
34
What is a bone bruise?
Hemorrhage, edema, trabecular microfracture of bone
35
How is a bone bruise visualized?
Not seen on radiographs; best visualized on MRI
36
Incomplete vs. complete fracture refers to ___
discontinuities in the cortex of the bone
37
What is a Greenstick fracture?
Incomplete fracture in skeletally immature individuals where bending fractures bone on one side Often caused by falling on outstretched arm
38
What specific fracture is shown here?
Greenstick fracture | skeletally immature
39
What is a Torus fracture?
Incomplete fracture in skeletally immature individuals where buckling fractures bone on one side Often caused by falling on hand
40
What specific fracture is shown here?
Torus fracture | skeletally immature
41
What is a closed fracture?
Fracture that does not break the skin
42
What is an open fracture?
Fracture that breaks the skin
43
What is a comminuted fracture?
Three or more fragments that have separated from the bone: * Crushed or pulverized bone * "Butterfly fragment"
44
What is a noncomminuted fracture?
* One break * Two fragments
45
Compression and impaction fractures are frequently due to ___
axial compression
46
Compression almost exclusively refers to ___ fractures
vertebral
47
Impaction refers to ___ fractures
extremity
48
What is a Salter-Harris fracture?
Fractures involving the growth plate (physis) classified by location to or damage to the physeal region
49
What are the subcategories of stress fracture?
* Fatigue * Insufficiency
50
# stress fracture What causes fatigue fracture?
Abnormal repetitive stress on normal bone causing gradual formation of microfracture
51
What is a March fracture?
Stress fracture from fatigue of 2nd or 3rd metatarsal
52
# stress fracture What causes insufficiency fracture?
Normal stress through diseased bone; a form of pathologic fracture
53
What is an avulsion fracture?
Forcible ripping or tearing of tissue: * Tearing away of bone fragment * Pull from ligament, tendon, or muscle
54
What is a Clay Shoveler's fracture?
Avulsion fracture of a lower cervical segment spinous process
55
What specific fracture is shown here?
Clay shoveler's fracture | avulsion fracture
56
What is an occult fracture?
A radiographically invisible fracture; most common in scaphoid, also ribs
57
What is secreted by osteoblasts when depositing bone?
Alkaline phosphatase
58
In what situations or conditions would you expect to see an increase in alkaline phosphatase in the blood?
* Fast/aggressive bone building pathologies * Pathologies that involve a large portion of the skeleton
59
What is erythrocyte sedimentation rate?
Indicates inflammatory process by how quickly red blood cells settle to the bottom of a test tube
60
What may cause an elevated erythrocyte sedimentation rate?
* Bone conditions * Infection * Autoimmune diseases ie rheumatic fever, tuberculosis
61
What is radionuclide imaging?
Bone scan with a Gamma camera specific for areas of increased metabolic activity Overall, very sensitive, not specific

Musculoskeletal Physiopathology (34 decks)

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