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General Anatomy > Fractures and Repair > Flashcards

Fractures and Repair Flashcards

1
Q

What are the bone parts

A

Epiphysis–> ends of bone
Medullary Cavity
Diaphysis–> shaft of bone
Metaphysis–> between diaphysis and epiphysis and growing part of bone (where new bone is added)

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2
Q

What does compact bone consist of

A 
Concentric Lamellae
Lacuna
Canaliculi
Osteocyte
Haversian canal/central canal
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3
Q

What does trabeculae consist of

A

Beams and struts

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4
Q

What is the remodelling daily turnover

A

1gm calcium per day

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5
Q

Where does trabeculae get its strength from

A

the structure of beams and struts

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6
Q

What is the periosteum

A

A dense, tough, irregular layer of fibrous connective tissue covering the bone except at surface of joints/epiphysis

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7
Q

What is the function of periosteum

A

Bone protection
Bone growth and repair (fracture repair)
Acts as a ligament and tendon attachment site

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8
Q

Is the periosteum vascular or avascular

A

vascular

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9
Q

How is the periosteum attached to bone

A

Sharpey’s fibres hold periosteum into bone

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10
Q

What is the endosteum

A

A membrane that lines the inside of the bone cavity and has stem cells which help produce more bone cells
Hence promoting bone healing during injury

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11
Q

What are osteobasts

A

bone builders–> produce osteoid matrix
Produce non-collagenous proteins
Get osteocalcin from osteoblasts (released into blood in bone turnover)
Osteonectin (secreted protein acid) binds collagen and hydroaxyapatite = mineralization

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12
Q

What does a disorder in synthesis of osteoid matrix produce?

A

Osteogenesis Imperfecta–> resulting in skeletal deformity “brittle bone”

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13
Q

What are osteocytes

A

Maintain bones and matured bone cells

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14
Q

What are Osteoclasts

A

breakdown bone and remodel it

Live along cortical endosteal surface and trabeculae where mineralised bone is actively reabsorbed

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15
Q

What is the mineralisation of bone

A

mature osteoid + calcium + fluroids

Matrix need to be minerlised

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16
Q

Why is vitamin D necessary for healthy bone and where is it obtained from

A

Allows/assists calcium reabsorption in intestine
Needed in bones, teeth and blood clotting
Obtained from nutrition and sunlight = vitamin D synthesis

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17
Q

Consequences on inadequate vitamin D supply

A

Decreased Vitamin D = decreased calcium absorbed = calcium mobilisation from bone = osteoporotic
Inadequate supply of Vitamin D produced rickets in kids, osteomalacia in adults = softening of bones
Rickets= defective minerlisation/calcification of bones which occurs due to deficiency/impaired metabolism of vitamin D and calcium

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18
Q

Importance of Vitamin C in bones

A

Needed for collagen synthesis by fibroblasts and osteoblasts
Wound healing
RBC production (hematopoiesis–> the production of all types of blood cells, including formation and development)
Blood cloting
WBC active
Iron and folic acid absorption
Acquire from fresh fruits and veges

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19
Q

Importance of vitamin K in bones

A

Needed for osteoid mineralisation and blood clotting

Found in leafy greens, canola/olive oil

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20
Q

What hormones are important in bone health and why

A 
Growth hormone (Anterior pituitary)
Thyroid Hormone = controls parathyroid balance
Parathyroid glands control calcium, and need calcium in blood for muscle contractions and nerve impulses hence thyroid hormone=calcium balance
Oestrogen/testosterone
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21
Q

How does oestrogen and testosterone affect bone health

A

Oestrogen controls osteoclasts
Osteoclasts come from the same family as inflammatory cells
Hence the reason why OA is most prevalent in women post menopause
With no/decreased oestrogen, osteoclasts continue to breakdown bone (as oestrogen is no longer available to control/stop it) and this activates the inflammatory cells

22
Q

Where does blood supply for bones enter from

A

All blood supply arteries enter/exit the bones before articular cartilage (otherwise get damaged in joint)

23
Q

What is the blood supply to the periosteum and outer compact bone

A

Periosteal artery

Accompanied by nerves, enter the diaphysis through perforating (Volkman’s) canals

24
Q

What is the blood supply to the inner part of compact cortical bone in diaphysis and cancellous bone/red marrow in epiphysis

A

Nutrient artery
Enters through nutrient foramen in centre of diaphysis and enters the medullary cavity\
Branches into proximal (ascending) and distal (descending) branches which supply the bone
Since shaft contains nutrient foramen = increased #’s

25
Blood supply to epiphysis and metaphysis
Metaphyseal arteries-->enter metaphysis of a long bone and branch out and supply inner part of compact bone Epiphyseal arteries--> underneath the articular surface and supply red bone marrow and bone tissue of epiphysis Metaphyseal and epiphyseal arteria both supply ends of bone, hence anastomosis of both arteries
26
What is a fracture
Break in the continuity of bone, or a soft tissue injury complicated by the presence of broken bone
27
What to include in a # description
Anatomical--> bones and parts of bones involved Descriptive--> loss of alignment (displacement), angulation, rotation, change of bone length Fragmentation
28
ABCD of identifying #'s
A-alignment B- Border C- Contrast D-Density
29
Types of sudden injury/trauma #'s
Closed/simple #--> no communication between # and exterior body Open/compound #--> direct communication between # and exterior of body (open wound), skin broken
30
Shape and pattern of #
Transverse # Compression # Oblique # (diagonal) Spiral # (encircles bone) Linear # Comminuted # (more than 2 fragments/pieces of bone) Greenstick # (occurs in children, # has a bend hence one side of bone cortex broken not other; outer surface disrupted and inner surface intact) Torus # (cortex buckles but doesn't break) Bowing # (2 bones involved, complete diaphyseal # of one bone and bowing of 2nd bone) Occult # (conditions with clinical signs of # but no radiographic evidence Avulsion # (force of muscle pulls a bit of muscle off bone, hence ligament/tendon injury also occurs)
31
What is a stress #
Occurs as a result of repeated strain and strain is cumulative
32
What is a fatigue #
Occurs in bones with normal ability to deform and recover (healthy bones) As a result of abnormal stress or torque ('too much too soon') The imbalance between muscle development and bone development causes microfractures to develop in cortex Muscle v/s bone strength development--> continuous stress on bones when developing results in bones growing differently --> Wolff's Law Bones grow in the direction of force, hence if too much stress in the wrong direction, can interfere with bone growth and direction of growth
33
What is a fragility #
Insufficiency--> bones lacking in normal ability to deform and recover hence unhealthy bones Bones have lost or decreased ability to deform therefore develop stress #'s Can occur with normal WB or activity Common in RA, OP paget disease, osteomalacia/rickets
34
What are pathological #'s
Caused as a result of a disease (secondary #) Break at the site of a pre-existing abnormality, usually by a weak force usually secondary to another disease that can cause tumour Can result from trivial trauma spontaneous (force that a normal person can withstand) Can be closed/simple or open/compund
35
What is paget's disease
disruption to normal bone remodelling which results in abnormal, enlarged/brittle bones a chronic condition of bone
36
incidences
old pts more common due to pathologies common body parts--> upper femurs, upper humerus, lower radius, vertebrae, pelvis Highest incidence in young males and older persons (>65yrs)
37
What is the difference in gender femur angles
Angle of inclination is between the shaft of femur and NOF axis in coronal plane Angle of inclination changes as we grow Angle of torsion between NOF axis and femoral condyle axis in transverse plane Females have a larger angle of inclination hence increased risk of NOF #
38
Factors affecting healing and repair of #
Pre-existing disease systemic derangements (OP, atherosclerosis- results in decreased nutrient supply to bone during healing) Extend and nature of # (closed heal quicker than open etc)
39
What is direct healing for #
occurs when adjacent bone cortices are in contact with one another and most often occurs when surgical fixation is used to repair a broken bone (no callus formation occurs)
40
What is indirect healing for #
Involved formation of callus with eventual remodelling of solid bone, usually treated with cast or non-surgical method
41
What is a primary haematoma
Formed from platelets sticking to themselves--> stops blood temporarily and takes minutes to form
42
What is a secondary haematoma
Formed from platelets and fibrin framework and takes a couple of days/weeks Plasma contains fibrogen which produces fibrin Fibrin creates a meshwork and contracts later on Pulls platelets together creating a thrombotic splint
43
What is transudate
fluid pushed through the capillary due to hig pressure within the capillary
44
what is exudate
fluid that leaks around the cells of capillaries caused by inflammation
45
How do WBC diffuse out of blood vessels during vasodilation
Increased intra-epithelial junction (space between cells) WBC's adhere to walls of blood vessels so they can exit during vasodilation and not let blood plasma out WBC's immigrate out (exudate) and migrate to site of degranulation Phagocytose--> enguld and digest
46
What are the steps of # healing
``` Fracture Primary haematoma Secondary Haematoma Inflammation Osteoblast and Osteoclast form pro-callus Fibrous callus Osseous callus Remodelling ```
47
What is the importance of a callus formation
It is the osteo-calcification around the part of bone that is moving, hence decreased movement allowing increased healing
48
Treatment sequence for #
Control haemorrhage and pain relief Decreased contamination potential (clean and debrief tissue) Aattend ot # (realign and immobilse) non-operative--> closed reduction, casting, traction Surgical--> ORIF, open reduction, OREF
49
What type of #'s need surgical intervention
``` compound displaced communated impacted crushed ```
50
Problems that can occur with repair
Mal-alignment comminuted- splintering therefore demineralizationn Infection--> osteomyelitis (infection of bone) Systemic derangements: OP Atherosclerosis hence decreased blood flow hence ischemia Inadequate calcium and phosphorus in blood Inadequate immunoglobulization (immune system) Wolff's law--> too musch stress too soon

General Anatomy (13 decks)

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