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a10. MSK (Medical Knowledge) > Growth & Repair > Flashcards

Growth & Repair Flashcards

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USMLE® Step 1 flashcards
1
Q

Describe the parts of a long bone?

A

Diaphysis - Shaft
Metaphysis - Flare at the end of the shaft before epiphysis, contains growth plate
Epiphysis - Joint-end of the bone, after the epiphyseal plate
Medullary Cavity - Inside diaphysis, full of marrow

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2
Q

Whats the structural difference between cortical and cancellous bone?

A

Cortical is made of cylindrical osteons of concentric lamenae. They contain central canals of veins/arteries.

Spongy Bone contains marrow

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3
Q

What is the geographical difference between compact and spongy bone?

A

Cortical bone is found in the diaphysis of long bones

Trabecular is found in the metaphysis & growth plate of long bones

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4
Q

What is the functional difference between cortical and cancellous bone?

A

Compact resists bending & torsion

Cancellous resists compression

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5
Q

What are the stages of fracture repair?

A

1) Inflammation
2) Soft Callus
3) Hard Callus
4) Bone Remodelling

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6
Q

How might we intervene in stage 1 of fracture repair?

A

Inflammation
- NSAIDS for inflammation (there is debate as to whether they help the pain more or delay healing more)
- Plate Concentrates to improve healing e.g. Platelet derived growth factor (PDGF), IGF & VEGF

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7
Q

What is the soft callus stage of fracture repair?

A

The inflammation/swelling goes down
Cartilage and fibrous tissue start to unite the bony fragments.
It gives back some stability but angulation ca still occur

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8
Q

What interventions are possible for stage 2 of fracture healing?

A
  • Cartilage replacement with DMB (Demineralised Bone Matrix)
  • Bone Graft
  • Bone substitutes
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9
Q

Describe the types of bone graft?

A

Autogenous Cancellous Bone Graft (Gold standard). IS both osteoconductive and inductive.

Allograft - Osteoconductive but not inductive and risks transmission of disease

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10
Q

What happens during the 3rd stage of fracture repair?

A

Cartilage forms into woven bone

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11
Q

What happens during the 4th stage of fracture repair?

A

Woven bone forms into lamellar bone and the medullary canal is reconstituted

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12
Q

How is strain involved in fracture repair?

A

Mechanical strain induces tissue differentiation so if strain is too low you don’t grow fresh bone
If its too much then the healing process is interrupted

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13
Q

Describe the structure of a peripheral nerve?

A

Axon sheathed in endoneurium

Axons grouped into fascicles sheathed in perineurium

Fascicles grouped into a nerve sheathed in epineurium

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14
Q

In what situations might a peripheral nerve become entrapped?

A

Median nerve during carpal tunnel syndrome

Spinal root during intervertebral disc prolapse (i.e. sciatica)

Digital nerve in 2/3rd web spaces of foot during morton’s Neuroma

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15
Q

What are the different types of nerve trauma?

A

Direct (blow or laceration) vs indirect (Avulsion vs traction)

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16
Q

What is neurapraxia?

A

a temporary loss of motor/sensory function due to:
- Stretch/bruise –> Local ischaemia & Demyelination

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17
Q

Prognosis for neurapraxia?

A

Reversible, symptoms usually last 6-8wks

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18
Q

What is axonotmesis?

A

Damage to a nerve axon but not the sheath
Stretch/crush/direct blow leads to wallerian degeneration

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19
Q

Whats the prognosis for axonotmesis?

A

Fair but worse than neurapraxia
Usually good but not full sensory recovery and less motor recovery

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20
Q

Whats is Neurotmesis?

A

Completely divided axon and sheath due to laceration or avulsion

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21
Q

Prognosis for Neurotmesis?

A

Poor. Can only recover with suturing & grafting
Plus theres a high risk of miswiring during regeneration

22
Q

Clinical features of peripheral nerve injury?

A

Dysaesthesia
Paresis/paralysis +/- wasting
Dry skin
Diminished/absent reflexes
UMN/LMN signs

23
Q

Describe the process of nerve healing?

A

Distal axon dies via wallerian degeneration
Then proximal axonal budding occurs after roughly 4 days and the nerve regenerates at ~1mm/day

24
Q

How do you assess the healing of a nerve?

A

Nerve conduction studies
Tinel’s Sign - Tap over a nerve, you will feel paraesthesia as far distally as the regeneration has spread

25
Q

What methods are there for repairing a nerve injury?

A

Bundle repair & growth factor when no tissue is lost

Nerve grafting when nerve is lost

26
Q

Describe the surgical rule of 3?

A

Immediate surgery within 3 days for clean/sharp injuries

Early surgery within 3 wks for blunt/contusion injuries

Delayed surgery after 3 months for closed injuries if there’s no recovery

27
Q

What cells make up tendons

A

A longitudinal arrangement of cells, mainly tenocytes.

28
Q

Describe the arrangement of collagen in a tendon?

A

Mostly type 1 collagen bundle surrounded by endotendon.

Bundles arranged into fascicles surrounded by paratendon

Fascicles bundled into a tendon surrounded by epitendon

29
Q

What happens if a tendon is underused?

A

Immobility leads to a low water & glycosaminoglycan concentration
This leads to poor strength

30
Q

List some tendon pathologies?

A

Degeneration
Inflammation
Enthesiopathy
Traction Apophysitis
Avulsion +/- bone fragment
Tear
Laceration/Incision

31
Q

Example of a degenerative tendon disorder and presentation?

A

Intrasubstance Mucoid Degeneration - common in the achilles

Can be asymptomatic but may be swollen, painful or tender

32
Q

Example and presentation of an inflammatory tendon disorder?

A

De Quervain’s Stenosing Tendonitis

Tendons of the EPB & APL get swollen, tender, hot and red. +ve for finklestein’s test

33
Q

What is enthesiopathy?

A

Inflammation at the insertion of a tendon to bone or muscle

E.g. Lateral Humeral Epicondylitis aka tennis elbow

34
Q

Whats an example of a traction Apophysitis?

A

Osgood Schlatter’s Disease

A recurrent load in adolescent active boys leads to inflammation at the patellar tendon as it inserts onto the Ant. Tibial Tuberosity

35
Q

How do we treat an avulsion?

A

Conservative - Retraction
Operative - Reattachment & fixation of the bone fragment

36
Q

What are the types of tendon tear?

A

Intrasubstance e.g. achilles
Or at Musculotendinous junction

37
Q

When does an achillis tear and how do we tell?

A

Most happen when sprint starting or jumping. Weight bearing forefoot push off whilst extending the knee.

+ve simmonds squeeze test and a palpable tender gap

38
Q

How do we treat a tendon tear?

A

Conservative - Mobilise + splint/cast

Operative - If the ends can’t be opposed

39
Q

Whats the function of a ligament?

A

to provide joint stability whilst maintaining ROM

Attached to bone on either side of a joint

40
Q

Compare a tendon to a ligament?

A

Ligaments have:
- Less collagen
- More proteoglycans/water
- Less organized collagen
- Rounder fibroblasts

41
Q

Describe the structure of a ligament?

A

Type 1 collagen
Fibroblasts
Sensory fibres that carry proprioception, stretch & sensory

42
Q

What are the phases of ligament rupture healing?

A

1) Haemorhagic Phase
2) Proliferative Phase
3) Remodelling Phase

43
Q

What happens during the haemorrhagic phase of ligament healing?

A

First a blood clot that is then resobed & replaced by Heavy Cellular Infiltrate

44
Q

What happens during the proliferative phase of ligament healing?

A

Scar tissue forms (disorganised collagenous CT)

45
Q

What happens during the remodelling phase of ligament healing?

A

Matrix becomes more ligament like

46
Q

When would we care for a ligament rupture conservatively?

A

A partial rupture with no instability
Or a patient that isn’t fit for surgery

47
Q

When would we care for a ligament rupture operatively?

A

If theres instability, expectation e.g. sportsmen or multiple ruptures

48
Q

How would we operatively treat a ligament rupture?

A

Repair
Augmentation
Replacement

49
Q

Name reasons for a delayed union? (delayed healing of a fracture)

A
  • High energy Injury
  • Instability
  • Infection
  • Steroids/immunosuppressants
  • Smoking
  • Warfarin
  • NSAIDS
  • Ciprofloxacin
  • Age
  • Radiotherapy
50
Q

Name some results of a non-union (complete failure of healing)

A

Instability
Calcification
Abundent calluses
Pain/tenderness
Persistant fracture line
Bone sclerosis

a10. MSK (Medical Knowledge) (37 decks)

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