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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
Q

Blood supply to epiphysis and metaphysis

A

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
Q

What is a fracture

A

Break in the continuity of bone, or a soft tissue injury complicated by the presence of broken bone

27
Q

What to include in a # description

A

Anatomical–> bones and parts of bones involved
Descriptive–> loss of alignment (displacement), angulation, rotation, change of bone length
Fragmentation

28
Q

ABCD of identifying #’s

A

A-alignment
B- Border
C- Contrast
D-Density

29
Q

Types of sudden injury/trauma #’s

A

Closed/simple #–> no communication between # and exterior body
Open/compound #–> direct communication between # and exterior of body (open wound), skin broken

30
Q

Shape and pattern of #

A

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
Q

What is a stress #

A

Occurs as a result of repeated strain and strain is cumulative

32
Q

What is a fatigue #

A

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
Q

What is a fragility #

A

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
Q

What are pathological #’s

A

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
Q

What is paget’s disease

A

disruption to normal bone remodelling which results in abnormal, enlarged/brittle bones
a chronic condition of bone

36
Q

incidences

A

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
Q

What is the difference in gender femur angles

A

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
Q

Factors affecting healing and repair of #

A

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
Q

What is direct healing for #

A

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
Q

What is indirect healing for #

A

Involved formation of callus with eventual remodelling of solid bone, usually treated with cast or non-surgical method

41
Q

What is a primary haematoma

A

Formed from platelets sticking to themselves–> stops blood temporarily and takes minutes to form

42
Q

What is a secondary haematoma

A

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
Q

What is transudate

A

fluid pushed through the capillary due to hig pressure within the capillary

44
Q

what is exudate

A

fluid that leaks around the cells of capillaries caused by inflammation

45
Q

How do WBC diffuse out of blood vessels during vasodilation

A

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
Q

What are the steps of # healing

A 
Fracture
Primary haematoma
Secondary Haematoma
Inflammation
Osteoblast and Osteoclast form pro-callus
Fibrous callus
Osseous callus
Remodelling
47
Q

What is the importance of a callus formation

A

It is the osteo-calcification around the part of bone that is moving, hence decreased movement allowing increased healing

48
Q

Treatment sequence for #

A

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
Q

What type of #’s need surgical intervention

A 
compound
displaced
communated
impacted
crushed
50
Q

Problems that can occur with repair

A

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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