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MSK > Fracture Healing > Flashcards

Fracture Healing Flashcards

1
Q

Fracture

A

Breach in continuity of bone

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2
Q

When do fractures occur

A
  • non-physiological loads applied to normal bone
  • physiological loads applied to abnormal bome
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3
Q

Describing fractures

A

Site
Pattern
Displacement/angulation
Joint involvement
Skin involvement

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4
Q

Describing fractures - site

A

Bone
Part of bone - proximal, middle , distal

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5
Q

Describing fractures - patterns

A

Transverse
Oblique
Spiral
Comminuted
Segmented
Avuksed
Impacted
Torus
Greenstick

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6
Q

Describing fractures - displacement/angulation

A

Displacement %
Angulation of distal part

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7
Q

Describing fractures - joint involvement

A

Extra-articular
Intra-articular

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8
Q

Describing fractures - skin involvement

A

Open/closed

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9
Q

Open fracture

A

Breach in skin
-orthopaedic emergency
- requires urgent treatment
- soft tissue injury determines outcome

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10
Q

Fracture patterns unique to children

A

Epiphyses open and bone more plastic
Heal quickly
Increased deformity remodelling

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11
Q

Fracture healing stages

A

Haematoma
Inflammation
Repair
Remodelling

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12
Q

Fracture healing - haematoma

A

Bleeding - endosteal and periosteal vessels, muscles etc
Decreased blood flow
Periosteal stripping
Osteocyte death

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13
Q

Length of haematoma stage of fracture healing

A

Hours

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14
Q

Fracture healing - inflammation

A

Fibrin clot organisation - platelets rich in chemo-attractants
Neovascularisation
Cellular invasion
- haematopoeitic cells = clear debris and express repair cytokines
- osteoclasts = resorb dead bone
- mesenchymal stem cells = form osteoblasts for repair

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15
Q

Function of haematopoeitic cells in inflammation

A

Clear debris
Express repair cytokines

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16
Q

Function of osteoclasts in inflammation

A

Resorb dead bone

17
Q

Function of mesenchymal stem cells in inflammation

A

Differentiate into osteoblasts for bone repair

18
Q

Length of inflammation stage of fracture repair

A

Days

19
Q

Fracture healing - repair

A

Callus formation
Progressive matrix mineralisation
High vascukarity

20
Q

Callus formation

A

Fibroblasts produce fibrous tissue (high strain)
Chondroblasts form cartilage (strain <10%)
Osteoblasts form osteoid (strain <1%)

21
Q

Length of repair stage of fracture healing

A

Weeks

22
Q

Fracture healing - remodelling

A

Woven bone structure replaced by lamellar bone - osteonal remodelling
Increased bone strength
Vascularity returns to normal
Healing without scar- unique

23
Q

Length of remodelling stage of fracture repair

A

Months to years

24
Q

Principles of fracture management

A

Reduce the fracture
Immobilise the part
Rehabilitate the patient

25
Q

Types of fracture fixation

A

Slings
Casts and splints
Extra-medullary devices- plates and screws
Intra-medullary devices- nails
External fixation

26
Q

Factors the influence fracture healing - patient

A

Age
Nutrition
Smoking
Drugs – NSAIDs, steroids

27
Q

Factors the influence fracture healing - tissue

A

Bone type: cancellous vs. cortical
Bone site: upper limb vs. lower limb
Vascularity / soft tissue damage
Bone pathology - # in metastatic deposit does not heal
infection

28
Q

Factors the influence fracture healing - treatment

A

Apposition of fragments
Stability (ability to resist force without deforming)
Micromotion (<1mm)

29
Q

Types of fracture complications

A

Early/late
Local/general

30
Q

Early local fracture complications

A

Vessel damage
Nerve damage
Compartment syndrome
infection

31
Q

Early general fracture complications

A

Hypovolaemic shock
ARDS
VTE
Fat embolism

32
Q

Late local fracture complications

A

Malunion
Non-union
Avascular necrosis
Ischaemic contractures
Joint stiffness
Myositis ossificans
Complex regional pain syndrome
Osteoarthritis

33
Q

Late general fracture complications

A

Poor mobility
Functional disability and social isolation
Pressure sores
Disuse osteoporosis
Loss of income / job

34
Q

Myositis ossificans

A

reaction to a bruise in a muscle that has been injured. During the healing of the bruise, calcium can become deposited in the bruise causing a hard bone like structure within the muscle.

MSK (11 decks)

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