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Musculoskeletal Y2 > Fractures through the Ages > Flashcards

Fractures through the Ages Flashcards

1
Q

Density of bone is greater pre or post birth?

A

Prebirth

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2
Q

At what age does bone start to become ordered and structured?

A
  • In a 1-year-old infant
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3
Q

What is the strength of bone dependant on? (2)

A

The strength of bone is dependent on the amount of tissue, but also the structure

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4
Q

What cells detect how bene is being loaded?

A

Osteocytes

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5
Q

Oestrogen effect of osteoclasts/blasts?

A

Oestrogen brings about osteoclast apoptosis and upregulates osteoblasts

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6
Q

Effect of bisphosphonates?

A

These kill osteoclasts – basically have the same purpose as oestrogen

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7
Q

Bisphosphonates with prolonged use cause … and why?

A

micro-fractures

- This happens because we don’t self-repair small fractures that happen due to everyday activities because of the drugs

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8
Q

What is denosumab? How does it work?

A

enosumab is a monoclonal antibody which mimics osteoprotegerin – this binds preferentially to RANKL molecules on osteoblasts, prevents them reaching osteoclasts and prevents osteoclast upregulation

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9
Q

What can mimic osteoprotegerin

A

denosumab

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10
Q

What does denosumab mimic

A

Osteoprotegerin

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11
Q

What does osteopretegrin do

A

this binds preferentially to RANKL molecules on osteoblasts, prevents them reaching osteoclasts and prevents osteoclast upregulation

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12
Q

Hip fracture mortality:

At 30 days?

At 1 year?

A

12% then 20%

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13
Q

When is peak bone mass?

A
  • Peak bone mass is somewhere in the late teenage years
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14
Q

What is essential for good bone health and to reach peak bone mass?

A
  • Good diet and exercise is essential for reach peak bone mass
  • Vitamin D and calcium regulation are also essential for good bone health
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15
Q

What is stage 1 of bone healing and how long does it last?

A

Up to 1 week:

 Haematoma and inflammation stage

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16
Q

What is stage 2 of bone healing and how long does it last?

A

1-4 weeks:

 Soft callus stage:

17
Q

What is stage 3 of bone healing and how long does it last?

A

– 1-4 months:

 Hard callus stage

18
Q

how long does stage 4 of bone healing last?

A

Up to several years

19
Q

What happens in stage 1 of bone healing?

A

 Haematoma and inflammation stage:

  • Macrophages, leukocytes, IL1-6, BMPs etc.
  • Granulation tissue forms
  • Progenitor cells invade
20
Q

What happens in stage 2 of bone healing?

A

 Soft callus stage:

  • Chondroblasts and fibroblasts differentiate and form collagen II and fibrous tissue
  • Proteoglycans produced – prevent mineralization
  • Chondrocytes release calcium into ECM and degrading enzymes to break down proteoglycans – allows mineralization
21
Q

What happens in stage 3 of bone healing?

A

 Hard callus stage:

  • Soft callus invaded by blood vessels
  • Chondroblasts break down calcified callus
  • Replaced by osteoid (type I collagen) from osteoblasts
  • Osteoid calcifies – woven bone
22
Q

What happens in stage 4 of bone healing?

A

 Remodeling
 Woven to lamellar bone
 Shape relative to stresses (Wolff’s law)
 Medullary canal reforms

23
Q

4 fracture patterns and when do they happen?

A

Spiral – Happens with arm wrestling etc.
Oblique – Blunt trauma to the bone (crush injury)
Comminuted – Blunt trauma where the force that caused the trauma continues even after the initial impact (causes butterfly fragments)
Transverse – Direct force through bone which is then immediately removed

24
Q

What is greenstick fracture? When is it common and why?

A

– Bone has been bent and caused an incomplete fracture These are much more common in paediatrics as children have a thick periosteum
- If a child has a completely snapped bone rather than a greenstick fracture, then suspect child abuse – ask them how the child did it

25
Q

A fracture in a child rather than a greenstick is a red flag for what?

A

Child abuse

26
Q

What is a red flag for child abuse

A

A fracture in a child rather than a greenstick

27
Q

When does a oblique fracture happen?

A

Blunt trauma to the bone (crush injury)

28
Q

When does a comminuted fracture happen?

A

Blunt trauma where the force that caused the trauma continues even after the initial impact (causes butterfly fragments)

29
Q

When does a transverse fracture happen?

A

Direct force through bone which is then immediately removed

30
Q

When does a spiral fracture happen?

A

Happens with arm wrestling etc.

Musculoskeletal Y2 (11 decks)

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