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BRS > injury and healing > Flashcards

injury and healing Flashcards

1
Q
  • What are the mechanisms of bone fracture?
A
  • Trauma
      Low energy or high energy transfer
    • StressAbnormal stresses on normal bone
    • PathologicalNormal stresses on abnormal bone
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2
Q
  • What are the weight bearing bones of the human body?
A

Femur, tibia, metatarsals and navicular

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3
Q
  • What is the female athlete triad?
A

Amenorrhoea - absence of periods; low oestrogen levels

Osteoporosis - Reduction in bone mineral density, thus increasing porous structure; susceptible to fracture

Disordered eating - Ca2+ deficiency
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4
Q
  • Give examples of conditions that can lead to a pathological/insufficiency fracture
A

Osteopenia and osteoporosis - Soft bone

Malignancy- primary or bone mets

Vitamin-D deficiency - Insufficient exposure to sunlight, reduced vitamin-D source → Osteomalacia + Ricket's 

Osteomyelitis 

Osteogenesis Imperfecta - Collagen deficiency 

Paget's disease
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5
Q
  • What causes osteopenia and osteoporosis?

- what is primary osteoporosis?

A

Bone remodelling imbalance → Osteoclast activity greater than osteoblast activity
Leads to disrupted microarchitecture

Osteoporosis due to age. senile osteoporosis- 70

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6
Q
  • What fractures is osteoporosis associated with?

- What can secondary osteoporosis be caused by?

A

Fragility fractures - Hip, spine, wrist
Low energy trauma fractures

Hypogonadism - low oestrogen. postmenopausal osteoporosis 50

Glucocorticoid excess - glucocorticoids inhibit insulin growth factor-1 which can directly or indirectly reduce osteoblast function

Alcoholism - increases PTH which leaches Ca2+ from the bone and excess alcohol can kill osteoblasts
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7
Q
  • What can inadequate calcium or phosphate lead to in bones?
A

Defect in osteoid matrix mineralisation, leads to soft bone, predisposed to fractures

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8
Q
  • Explain the pathogenesis of congenital OI

- what are the effects of OI?

A

Decreased type one collagen due to

  • Reduction in type I collagen secretion
  • production of abnormal collagen

causes insufficient osteoid production, so increased bone weakness

effects on heart, bone, hearing and sight.
blue schlera can be present
short stature

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9
Q
  • Explain what Paget’s disease is
A

Excessive bone degradation and disorganised bone remodelling → Deformity, pain, fracture or arthritis. bone turnover is disturbed

May transform into malignant disease
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10
Q
  • Outline the 4 stages of Paget’s disease
A
  1. Osteoclastic activity (Increased bone resorption)
    1. Mixed osteoclastic-osteoblastic activity (Imbalance) results in disorganised bone remodelling, considering the osteoid scaffold is disrupted and diverted through osteoclastic activity → Deformities arises
    2. Osteoblastic activity
    3. Malignant degeneration
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11
Q
  • List the primary bone cancers

- What is a secondary bone cancer?

A

Osteosarcoma
Chondrosarcoma
Ewing sarcoma
Lymphoma

Metastatic bone tumours from other tissues. other tissues have spread metastases to bone
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12
Q
  • How do we describe fractures?
    • Soft tissue integrity
    • Bony fragments
    • Movement
A

Open - Fracture in which at least one end of the bone penetrates the skin; presenting potential risk of infection
Closed - A fracture in which the skin remain intact

    Greenstick - Partial fracture in which one side of the bone is broken
    Simple
    Multifragmentory (comminuted)

 Displaced
 Un-displaced
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13
Q
  • What are the types of secondary bone cancers that can lead to a pathological bone fracture?
A

Lytic - Bone eating; Kidney, thyroid, lung and breast

Blastic - Bone forming; Prostate and breast
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14
Q

How do stress fractures occur

A 
Overuse of bone
stress exerted on bone is greater than the bones capacity to remodel 
leads to bone weakening 
stress fracture occurs
leads to risk of complete fracture
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15
Q
  • Outline the inflammation process of fracture healing
A

Bleeding/ Haematoma → Release of cytokines - Inflammation

Granulation (Connective/fibrotic) tissue deposited + blood vessel formation

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16
Q
  • Outline the Repair process of fracture healing
A

Fracture is bridged with soft callus (Type II collagen → Cartilage; fibroblasts, woven blood

Hard callus formation succeeds (laying down of osteoid → Type 1 collagen) facilitated by increased osteoblast activity (more like bone)

17
Q
  • Outline the remodelling process of fracture healing
A

3.Remodelling- Callus responds to activity, external forces, and the functional demands exerted onto bone; therefore this stimulates a balance of osteoblast and osteoclast activity to remodel bone (removal of excess)

18
Q
  • Outline the differences between primary and secondary bone healing
A

Primary: Intramembranous healing
Mesenchymal stem cell goes straight to the bone cells in fracture to start replacing bone cells
occurs when there is a very stable fracture that is almost completely back together

Secondary: Endochondral healing involving responses in the periosteum and external soft tissues + Relative stability; Endochondral ossification → More callus
Mesenchymal stem cell goes to the chondral precursor to start producing new bone cells
19
Q
  • When do you see signs of healing visibly on an X-ray?
A

From 7-10 days

20
Q
  • What is the duration for each step in fracture/bone healing?
A

Inflammatory - Hours to days

Repair - Days to weeks 

Remodelling - Months to years
21
Q
  • What are the general principles of fracture management?
A

Reduce → Closed, open (bringing both ends of fracture back together again)

Hold → Metal; no metal (hold fracture together)

Rehabilitate → Move, physiotherapy, use (because bone will probably be stiff or weak
22
Q
  • What is ‘reduction’ in terms of fracture management?
  • what are the closed methods
  • what are the open methods
A

Involves restoring the anatomical alignment of a fracture or dislocation of the deformed limbs

manipulation, traction

mini incision, full exposure

23
Q
  • What is skin and skeletal traction?
A

Skin - Wrap bandage around fracture and then add a weight to bring limb into natural alignment

Skeletal - Put a pin through bone and use a larger weight (you can apply more force to bone than skin)
24
Q
  • What are the different types of ‘hold’?
A

Fixation

Closed → Plaster and traction (skin; skeletal)
25
Q

what are the different types of fixation

A
  1. Plaster (Closed hold)
  2. Intra-medullary internal fixation- pins or nails
  3. Extra-medullary internal fixation - pins plates or screws
  4. Mono-planar external fixation
  5. Multi-planar external fixation
26
Q
  • What methods are there to rehabilitate (intensive period of physiotherapy following fracture management)?
A

Use - Pain relief and retrain (physio)

Move 

Strengthen (Muscles)

Weight-bear (for lower limbs)
27
Q
  • Give examples of soft tissue injury
A

Tendinopathy:

Tendinitis - Inflammation of tendon associated from overuse (In additions to infection or rheumatic disease). Swelling + pain → reduced mobility of tendon and muscle. 

Tendinosis - Caused by overuse of a tendon → Abnormal thickening. 

Rupture - (Mainly ligaments/tendons tearing)
28
Q
  • List and explain ligament injury classifications
A

Grade I - Slight incomplete tear → No notable joint instability.

Grade II - Moderate/severe incomplete tear → Some joint instability. One ligament may be complete torn.

Grade III - Complete tear of 1+ ligaments → Obvious indication of stability of instability surgical requirement.
29
Q
  • How can we treat tendon or ligament tears?
A

Immobilise - Plaster OR boot/brace

Surgical repair - Suture
30
Q
  • What are the good and bad effects of immobilisation on injured tissue?
A
  • Good
    Less ligament laxity (lengthening)
    • BadLess overall length of ligament repair scar
      Protein degradation exceeds protein synthesis
      Production of inferior tissue by blast cells
      Resorption of bone at site of ligament insertion
      Decreased tissue tensile strength (50% in 6-9 weeks)
31
Q
  • What are the benefits of mobilisation on injured ligamentous tissue?
A

Ligament scars are wider, stronger and more elastic

Better alignment/quality of collagen
32
Q
  • What factors affect tissue healing?
A

Mechanical environment - Movement and forces

Biological environment - Blood supply, immune function, infection, nutrition

BRS (41 decks)

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