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BRS MUSCULOSKELETAL And RHEUM > Injury And Healing > Flashcards

Injury And Healing Flashcards

1
Q

What are the three mechanisms of a fracture?

A

Stress, trauma and pathological

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2
Q

What are the two types of trauma fractures?

A

High energy and low energy

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3
Q

What is meant by a stress fracture?

A

When there is abnormal stress placed on normal bone

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4
Q

Which bones do stress fractures normally occur on?

A

Weight bearing bones

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5
Q

What activities are stress fractures related to.

A

Athletes, occupational, military

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6
Q

What is an insufficiency fracture?

A

When the bone may have been thinned or weakened, so is insufficiently strong

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7
Q

Describe the sequence of events that can result in a stress fracture becoming a complete fracture?

A

Overuse of the bone
Stress on bone > bones capacity to remodel
Bone weakens
Stress fracture
Many stress fractures leads to the risk of a complete fracture

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8
Q

What factors can cause bone weakening?

A

Disordered eating, osteoporosis, amenorrhea

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9
Q

What is meant by a pathological fracture?

A

Where NORMAL stresses are exerted in ABNORMAL bone

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10
Q

What are some causes of abnormal bone seen in pathological fractures?

A

POMOVO

Pagets
Osteogenesis Imperfecta
Malignancy
Osteomyelitis
Vitamin D deficiency
Osteoporosis

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11
Q

What is osteomyelitis?

A

Inflammation or swelling that occurs in the bone

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12
Q

What happens when osteoclast activity > osteoblast activity?

A

Bone micro architecture is disrupted

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13
Q

How is osteoporosis measured?

A

By having a bone density that is more then 2.5x standard deviations away from the mean (T score below -2.5)

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14
Q

Is osteoporosis more common in males or females?

A

Females

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15
Q

What is senile osteoporosis?

A

Primary osteoporosis that is linked to age

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16
Q

What is secondary osteoporosis?

A

Osteoporosis that occurs in any age,

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17
Q

What are three causes of secondary osteoporosis?

A

Hypogonadism
Glucocorticoid excess
Alcoholism

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18
Q

What type of fractures is secondary osteoporosis associated with?

A

Hip, spine and wrist fractures = fragility fractures

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19
Q

What minerals does vitamin D help absorb?

A

Calcium, magnesium and phosphate

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20
Q

How is vitamin D made?

A

Synthesized from the sun

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21
Q

What happens if you have inadequate calcium or phosphate?

A

Results in a defect in Osteoid matrix mineralization

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22
Q

What condition does vitamin D deficiency result in for children and adults?

A

Rickets for children’s
Osteomalacia for adults

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23
Q

What is reduced in osteogenesis imperfecta?

A

Type 1 collagen

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24
Q

Why are collagen levels lower in osteogenesis imperfecta patients?

A

Decreased secretion
Production of abnormal collagen

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25
Q

What does osteogenesis imperfecta impact?

A

Bones
Hearing
Heart
Sight

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26
Q

Blue sclera is a symptom of what condition?

A

Osteogenesis imperfecta

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27
Q

What is Paget’s disease?

A

Excessive bone breakdown and disorganized remodeling which leads to deformity

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28
Q

What are the four stages of Paget’s disease?

A
  1. Osteoclastic activity
  2. Mixed osteoclastic-osteoblastic activity
  3. Osteoblastic activity
  4. Malignant degeneration
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29
Q

Which cancers are blastic (endures bone growth)?

A

Prostate cancer and breast cancer

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30
Q

Which cancer are lytic (bone eating)?

A

Kidney, thyroid, lung and breast

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31
Q

What are the four primary bone cancers?

A

Osteosarcoma
Chondrocarcoma
Ewing sarcoma
Lymphoma

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32
Q

What are secondary bone cancers?

A

When cancers which originated in other tissues metastasize to the bone

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33
Q

What are the two types of fractures which affect the soft tissue integrity?

A

Open and close

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34
Q

What is a closed fracture?

A

Fractured under the skin

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35
Q

What is an open fracture?

A

One that pokes through the skin

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36
Q

What are the two types of fractures which involve the movement to the bone?

A

Displaced and undisplaced

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37
Q

What is an undisplaced fracture?

A

One that has hardly moves

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38
Q

What is a displaced fracture?

A

A fracture which has moved around alot

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39
Q

What are the three fractures associated with bony fragments?

A

Green stick, simple and comminuted

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40
Q

What is a green stick fracture?

A

When the bone fragments are bent

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41
Q

What is a multi fragmentary/ comminuted fracture?

A

When there are many fractures along the same bone resulting in many bone fragments

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42
Q

What are the 4 stages of general tissue healing?

A

Bleeding
Inflammation
New tissue formation
Remodelling

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43
Q

What cells are involved with remodeling?

A

Macrophages, osteoclasts and blast cells

44
Q

What is Wolff’s Law?

A

Bone grows and remodels in response to the forces that are placed on it

45
Q

What three things happen in the inflammation stage of fracture healing?

A

Haematoma formation
Cytokine release from the blood products
Granulation tissue and blood vessel formation

46
Q

What happens in the repair phase of fracture healing?

A

Soft callus formation (cartilage) which is then converted to hard callus (bone)

47
Q

What happens during the remodelling phase of fracture repair?

A

The hard callus responds to external forces, functional demands and growth

48
Q

What is the healing time of a phalange fracture?

A

3 weeks

49
Q

What is the healing time of a metacarpal fracture?

A

4-6 weeks

50
Q

What is the healing time of a distal radius fracture?

A

4-6 weeks

51
Q

What is the healing time of a forearm fracture?

A

8-10 weeks

52
Q

What is the healing time of a tibia fracture?

A

10 weeks

53
Q

What is the healing time of a femur fracture?

A

12 weeks

54
Q

From what point after a fracture can you see signs of visible healing?

A

7-10 days on the X Ray

55
Q

What mechanism does primary bone healing occur by?

A

Intramembranous healing

56
Q

When does primary bone healing occur?

A

When you have a stable fracture

57
Q

What bone is formed through primary bone healing?

A

Woven bone is formed directly from mesenchymal cells

58
Q

What is secondary bone healing?

A

When the mesenchymal cells form a chondral precursor which then produces bone cells

59
Q

What are the four principles to fracture management?

A

Reduction
Hold
Fixation
Rehabilitation

60
Q

What is meant by open reduction?

A

This is where the surgeons open the skin and put the bones back together

61
Q

What is meant by closed reduction?

A

Where the doctors physically push the bones together without surgical intervention

62
Q

What are two methods of closed reduction?

A

Manipulation or traction

63
Q

What are the two methods of traction?

A

-skin which is where a weight is used to align the bones
-skeletal- pins are placed into bones

64
Q

What are the methods of closed holding?

A

Plaster or traction (skin or skeletal)

65
Q

What is the difference between the two types of fixation?

A

Internal = metal under the skin, can be in the medulla or out the medulla

External = pins sticking out the skin

66
Q

What are the two types of external fixation?

A

Monoplanar and multiplanar

67
Q

What are the four concepts of rehabilitation?

A

Use
Move
Strengthen
Weight bear

68
Q

What do ligaments do?

A

Connects bone to bone

69
Q

What do tendons do?

A

Connects bone to muscle

70
Q

What are the three types of tendinopathy?

A

Tendinosis, tendinitis and rupture

71
Q

What is tendinosis?

A

Degradation of the tendons collagen resulting in hardening, thickening or scarring of the tendons

72
Q

What is tendinitis?

A

Inflammation of the tendons

73
Q

How many grades of ligament tears are there?

A

3

74
Q

What is a grade one ligament tear?

A

Slight incomplete tear, no notable joint instability

75
Q

What is a grade two ligament tear?

A

Some joint instability, moderate to severe tear

76
Q

What is a grade 3 tear?

A

Complete tearing of 1 or more ligaments with obvious instability, and surgery is required

77
Q

What are the two methods on tendon repair?

A

Immobilize or surgery

78
Q

What are the two ways of immobilizing a tendon / ligament tear?

A

Plaster or boot/brace

79
Q

How are tendons surgically repaired?

A

Suturing

80
Q

What are the positive and negatives of immobilizing injured ligamentous tissue?

A

Good = less ligament lengthening

Bad =
Less 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)

81
Q

What are the benefits of mobilizing injured ligamentous tissue?

A

Ligament scars are wider, stronger and more elastic
Better alignment and quantity of collagen

82
Q

What are the 6 factors affecting tissue healing?

A

Nutrition
Infection
Immune function
Blood supply
Forces
Movement

83
Q

How long does the inflammatory phase of ligament healing last?

A

1-7 days

84
Q

What does RICE stand for?

A

Rest, ice, compression, Elevation

85
Q

When are range of motion exercise recommended to start following a ligament injury?

A

48hours

86
Q

When does the remodelling phase start?

A

After more than 14 days

87
Q

How long does it take to reach the maximum strength of a ligament following an injury?

A

A year at least

88
Q

When performing an examination of a trauma patient, what information is essential to look for?

A

skin integrity, deformity, function, tenderness, neurovascular status

89
Q

What are the two views of X rays which are commonly performed?

A

AP (Anterior Posterior) and lateral

90
Q

What might you expect to see when examining a patient for a fracture

A

Inability to weight bear
Severe pain
Swelling and point tenderness
Deformity
Scrapes / abrasions
Wound if open fracture
Loss of movement
Loss of sensation if nerve injury

91
Q

What are the three main principles of management?

A

Reduce
Hold/ fixation
Rehabilitate

92
Q

What is a common twisting injury to the knee which results in the knee swelling up and a snap bing heard?

A

ACL Tear

93
Q

What does PRICE mean in terms of short term management?

A

Protect
Rest
Ice
Compress
Elevate

94
Q

In what cases does a torn ACL result in surgery?

A

When the patient is young, active, sporty and does movements which require the ACL

95
Q

Why may surgery not be necessary for a torn ACL?

A

The muscles can compensate for the movement in some cases

96
Q

What is tried before surgery in a torn ACL injury?

A

Physiotherapy

97
Q

What condition is associated with a sharp, intense pain at the back of the ankle which occurs after hearing a loud snap?

A

Injured achilles tendon

98
Q

What muscles do the achilles tendon associate with?

A

Soleus and gastrocnemius

99
Q

What movements are associated with the achilles tendon?

A

Plantarflexion and dorsiflexion of the foot

100
Q

What are the examination findings from a ruptured achilles tendon?

A

Difficulty walking, unable to perform heel raises, thickening, tenderness and swelling on the affected side,

101
Q

What is tendonosis?

A

Thickening of the tendon that makes it prone to tear

102
Q

What happens when you have an injured achilles tendon and dangle your feet off the end of the bed?

A

The affected foot remains in dorsiflexion

103
Q

What are the four stages of tendon repair?

A

Inflammatory, reparative, remodelling (consolidation) and remodelling (maturation)

104
Q

What are some general complications with tendon surgery?

A

DVT (Deep vein thrombosis), infection and prolonged immobility

105
Q

What are some specific surgery complications of tendon repair?

A

Neurovascular injury, ankle infection, pressure sores from plaster or boot

BRS MUSCULOSKELETAL And RHEUM (17 decks)

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