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Year 3 MSK > Injury and Healing > Flashcards

Injury and Healing Flashcards

1
Q

What occurs when the ACL is injured?

A

Wobbly knee

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2
Q

What are the three mechanisms of bone fracture?

A

Trauma- low/high energy
Stress- abnormal stresses on normal bone
Pathological- normal stresses on abnormal bone

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3
Q

How can you describe fracture patterns?

A

Soft tissue: Open or closed

Bony fragments: Greenstick/ Simple/ Comminuted

Displacement: Displaced/ Undisplaced

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4
Q

What is an example of high energy trauma?

A

Car crash

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5
Q

Give an example of low energy trauma?

A

Fall

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6
Q

How can a stress fracture occur?

A 
Overuse
Stress exerted on bone is greater than bones capacity to remodel
Bone weakening 
Stress fracture
Risk of complete fracture
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7
Q

Who is at risk of developing stress fractures?

A

Athletes

Military personnel

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8
Q

What is the female athlete triad?

A 
Regular strenuous exercise 
Insufficient calorie intake
Weight loss
Amenorrhoea 
Osteoporosis
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9
Q

Which bones a prone to stress fractures?

A

Weight baring bones

e.g. tibia, metatarsals, navicular

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10
Q

Give examples of pathological stresses?

A 
Osteoporosis
Malignancy 
Vit D deficiency
Osteomyelitis
Osteogenesis Imperfecta
Paget's disease
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11
Q

What conditions are caused by Vitamin D deficiency?

A

Osteomalacia

Ricket’s

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12
Q

What occurs when osteoclast activity > osteoblast activity?

A

Disrupted microarchitecture

More common in females 4:1

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13
Q

What are the different types of osteoporosis?

A

Postmenopausal Osteoporosis – Women 50-70
Senile Osteoporosis - > 70
Secondary osteoporosis: Any age, 60% Male
Hypogonadism
Glucocorticoid excess
Alcoholism

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14
Q

What are osteopenia and osteoporosis associated with?

A

Associated with ‘fragility fractures’ – hip, spine, wrist

Low energy trauma  fracture

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15
Q

What cancers are blastic?

A

Prostate

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16
Q

What cancers are lytic?

A

Kidney
Thyroid
Lung

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17
Q

What does Vit D deficiency cause in paeds?

A

Before physis closure

Rickets

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18
Q

What does Vit D deficiency cause in adults?

A

After physis closure

Osteomalacia

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19
Q

What are the main features of osteogenesis imperfecta?

A

‘Brittle Bone Disease’
Hereditary – autosomal dominant or recessive
↓ Type I Collagen due to:
Decreased secretion
Production of abnormal collagen
Results in insufficient osteoid production

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20
Q

What does OI effect?

A 
Bones
Hearing
Heart
Sight
Blue sclera
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21
Q

What are the main features of Paget’s disease?

A

Aetiology: Genetic & acquired factors
Excessive bone break down and disorganised remodeling  deformity, pain, fracture or arthritis
May transform into a malignant disease

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22
Q

What are the 4 stages of Paget’s?

A

Osteoclastic Activity
Mixed osteoclastic-osteoblastic activity
Osteoblastic activity
Malignant degeneration

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23
Q

What happens during week 1 of fracture healing?

A

Haematoma formation
Release of Cytokines
Granulation tissue

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24
Q

What happens during week 2- 4 months?

A

Soft Callus formation
(Type II Collagen - Cartilage)
Converted to hard callus
(Type I Collagen - Bone)

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25
Q

What happens during months 4-12?

A

Callus responds to activity, external forces, functional demands and growth
Excess bone is removed

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26
Q

What are the signs of fracture?

A

Oedema
Inflammation
Bleeding

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27
Q

What is primary bone healing?

A

Intermembranous healing

Absolute stability

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28
Q

What is the secondary bone healing?

A

Endochondral healing
Involves responses in the periosteum and external soft tissues
Relative stability

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29
Q

What are the different fracture healing times?

A

3-12 Weeks depending on site

Signs of healing visible on X-ray from 7-10 days

Phalanges: 3 weeks
Metacarpals: 4-6 weeks
Distal radius: 4-6 weeks
Forearm: 8-10 weeks
Femur: 12 weeks
Tibia: 10 weeks
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30
Q

What does healing time depend on?

A

Proximity to the heart

Depends on blood supply and soft tissue coverage

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31
Q

What is the secondary bone healing?

A

Endochondral healing
Involves responses in the periosteum and external soft tissues
Relative stability
greater Callous formation

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32
Q

What are three steps of fracture management?

A

Reduce
Hold
Rehabilitate

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33
Q

What is reducing?

A

Bring the two structures together
Closed: Manipulation or Traction
Open: Mini incision or Full exposure

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34
Q

How can you hold?

A

Without metal: Plaster or Traction

With metal: Fixation

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35
Q

What are the two types of fixation?

A 
Internal:
Intramedullary- Pins/Nails
Extramedullary- Plates and screws/Pins
External 
Monoplanar
Multiplayer
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36
Q

How can you rehabilitate?

A 
Move
Physiotherapy 
Use
Strengthen 
Weigh-bear
Retrain
Pain relief
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37
Q

What do ligaments do?

A

Connect bone to bone

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38
Q

What do tendons do?

A

Connect muscle to bone

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39
Q

What can happen to tendons?

A

Thickening
Inflammation
Rupture

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40
Q

What do you call abnormal thickening of the tendon?

A

Tendinosis

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41
Q

What do you call inflammation of the tendons?

A

Tendinitis

42
Q

How do you classify ligament injury?

A

Grade I
Grade II
Grade III

43
Q

What are the features of grade I?

A

Grade I – Slight incomplete tear – no notable joint instability

44
Q

What are the features of grade II?

A

Grade II – Moderate / Severe Incomplete Tear – Some joint instability. One ligament may be completely torn

45
Q

What are the features of grade III?

A

Grade III – complete tearing of 1 or more ligaments – Obvious instability. Surgery usually required

46
Q

What are the phases of ligament healing?

A

Inflammatory phase
Proliferation phase
Remodeling
Maturation

47
Q

What happens in the inflammatory phase?

A

1-7 days

Fibrin clot formed in ligament tears

48
Q

What happens in the proliferation phase?

A

7-21 days

Tendons and ligaments weakest, tensile strength builds

49
Q

What happens during remodelling phase?

A

> 14 days
Tendons and ligaments heal with scar tissue thatreduces ultimate strength
causes adhesions

50
Q

What happens during maturation?

A

Weeks to years

Max strength reached within a year.

51
Q

What factors affecting tissue healing?

A

Mechanical environment

  • movement
  • forces

Biological environment

  • blood supply
  • immune function
  • infection
  • nutrition
52
Q

What are the effects of immobilisation on injures ligamentous tissue?

A

GOOD
Less ligament laxity (lengthening)

BAD
Less overall strength of ligament repair scar
Protein degradation exceeds protein synthesis r net d in collagen quantity
Production of inferior tissue by blast cells
Resorption of bone at site of ligament insertion
Build tissue tensile strength (50% in 6 - 9 weeks)

53
Q

What are the benefits of mobilisation on injured ligamentous tissue?

A

Ligament scars are wider, stronger, and are more elastic

Better alignment / quality of collagen

54
Q

What is manipulation?

A

Movement in to place

55
Q

What is traction?

A

Put pin through the bone and pull with a weight/ sticky tape with weight

56
Q

What does intramedullary mean?

A

Within the medullary cavity

57
Q

What does extra-medullary mean?

A

Alongside the bone

58
Q

What is multiplanar fixation?

A

External hardware on all sides (cage-like)

Partly internal

59
Q

What is monoplanar fixation?

A

External hardware on one side of the limb

Partly internal

60
Q

What are the functions of the achilles tendon?

A

Connects the gastrocnemius and soleus to the calcaneus
Plantar flexes the foot
Tendon pulls the foot down

61
Q

What complications can result from surgery?

A

Damage to
Nerves
Vasculature
Surrounding tissues

Shortening of tendon: Stiffness/ restricted movement

Insufficient tightening: Persistent symptoms

Repair might fail: rerupture

Infection

62
Q

What is the ACL?

A

Anterior cruciate ligament

63
Q

What does the ACL do?

A

Stablises knee joint
Prevents forward movement of the tibia
Connects the femur to the tibia

64
Q

What should a patient do in the first 6 weeks of healing?

A 
Protect
Rest
Ice
Compression
Elevation
65
Q

What should a patient do from 6-9 months post-injury?

A

Physio:
movement
strengthen muscles
start walking normally

66
Q

What should the patient do post 9 months?

A

Training
Jumping
Improve balance and proprioception

67
Q

What are the different types of displacement (translation)?

A

Proximal/distal
Anterior/posterior
Medial /lateral

68
Q

What are the different types of displacement (angulation)?

A

Internal/external rotation
Dorsal/volar
Varus/valgus

69
Q

What are the general complications of fractures?

A

Fat embolus (hours - from bone marrow release)
DVT (days-weeks)
PE
Infection/sepsis
Prolonged immobility (UTI, chest infections, sores)

70
Q

What are urgent local complications of fractures?

A 
Local visceral
Vascular injury
Nerve injury
Compartment syndrome
Haemarthrosis
Infection 
Gangrene
71
Q

What are less urgent local complications of fractures?

A 
Fracture blisters
Plaster sores
Pressure sores
Nerve entrapment 
Myositis ossificans ligament injury
Tendon lesions
Joint stiffness
Algodystrophy
72
Q

What are the late local complications of fractures?

A 
Delayed union
Mal-union
Non-union
Avascular necrosis
Muscle contracture
Joint instability
Osteoarthritis
73
Q

What are the different NoF fractures?

A 
Subcapital
Transcervical
Intertrochanteric
Subtrochanteric 
3 part intertrochanteric
74
Q

What are the features of extra-capsular NoF fracture?

A

minimal risk to blood supply and AVN: fix with plate and screws (Dynamic hip screw)

75
Q

What are the features of intra-capsular NoF fracture?

A

if undisplaced: less risk to blood supply: fix with screws

If displaced: 25-30% risk AVN: replace in older patients; fix if young

76
Q

How are synovial joint stabilised

A

Muscles/tendons
Ligament
Bone surface congruity

77
Q

What are the components of a synovial joint?

A

Synovium
Synovial fluid
Articular cartilage

78
Q

What is cartilage composed of?

A

1) specialized cells (chondrocytes)

2) extracellular matrix: water, collagen and proteoglycans
mainly aggrecan

79
Q

What is aggrecan?

A
  • a proteoglycan that possesses many chondroitin sulfate and keratin sulfate chains
  • characterized by its ability to interact with hyaluronan (HA) to form large proteoglycan aggregates
80
Q

What is osteoarthritis?

A

Degenerative arthritis

81
Q

What is inflammatory arthritis?

A

Main type is rheumatoid

82
Q

What is the same in osteoarthritis and rheumatoid arthritis?

A

Joint space narrowing

Indicates articular cartilage loss

This can occur in osteoarthritis (primary abnormality) and in Rheumatoid Arthritis (secondary damage due to synovitis)

83
Q

What are features in osteoarthritis not present in rheumatoid arthritis?

A

Subchondral sclerosis

Osteophytes

84
Q

What are features of rheumatoid arthritis not present in osteoarthritis?

A

Osteopenia

Bony erosions

85
Q

What is the WHO definition of OA?

A

is a long-term chronic disease characterized by the deterioration of cartilage in joints which results in bones rubbing together and creating stiffness, pain, and impaired movement.

86
Q

What are the main OA risk factors?

A 
Age
Weight
Metabolic syndrome
Mechanical constraints (high levels of activity)
Hereditary
Female 
Post-menopause
87
Q

What are the radiographic changes of OA?

A

Joint space narrowing
Osteophytes
Subchondral cysts
Sclerosis

88
Q

What are the symptoms of OA?

A

Pain (exertional/rest/night)
Disability: walking distance/stairs/giving way
Deformity

89
Q

What comprises a limb assessment?

A

Look
Feel
Move
Special tests

90
Q

What is the conservative management of OA?

A 
Analgesics
Physiotherapy
Walking aids
Avoidance of exacerbating activity
Injections (steroid/viscosupplementation)
91
Q

What are the interventions for OA?

A 
Replace (knee/hip)
Realign (knee/big toe)
Excise (toe)
Fuse (big toe)
Synovectomy (Rheumatoid)
Denervate (wrist)
92
Q

What are the main features of osteomyelitis?

A 
Acute or chronic
Primary or secondary
Pain/swelling/discharge
Systemic signs:
Fevers, sweats wt loss
93
Q

What are the main features of septic arthritis?

A

Pain
Joint swelling/stiffness
Fevers, sweats, wt loss

94
Q

What causes septic arthritis?

A

Bacterial infection of a joint (usually caused by spread from the blood)

95
Q

What are the risk factors of septic arthritis?

A

Immunosuppressed, pre-existing joint damage, intravenous drug use (IVDU)

96
Q

Why is septic arthritis a medical emergency?

A

Untreated, septic arthritis can rapidly destroy a joint

97
Q

In who should you consider septic arthritis?

A

Consider septic arthritis in any patient with an acute painful, red, hot, swelling of a joint, especially if there is fever

98
Q

How is septic arthritis diagnosed?

A

Diagnosis is by joint aspiration. Send sample for urgent Gram stain and culture

99
Q

What commonly is responsible for septic arthritis?

A

Staphylococcus aureus, Streptococci, Gonococcus

100
Q

What is the treatment for septic arthritis?

A

Treatment is with surgical wash-out (‘lavage’) and intravenous antibiotics
Immobilise joint in acute phase
Physiotherapy once over acute phase

101
Q

What investigations are done with bone infection?

A 
Plain films
MRI scans: bony architecture/collections
CT if MRI not available
Bone scans: multifocal disease
Labelled White cell scans

CRP: acute marker
ESR slower response
WCC
TB culture/PCR

102
Q

What are the treatments for osteomyelitis?

A

Immobilise joint in acute phase

Physiotherapy once over acute phase

Year 3 MSK (8 decks)

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