Injury And Healing Flashcards
What are the three mechanisms of a fracture?
Stress, trauma and pathological
What are the two types of trauma fractures?
High energy and low energy
What is meant by a stress fracture?
When there is abnormal stress placed on normal bone
Which bones do stress fractures normally occur on?
Weight bearing bones
What activities are stress fractures related to.
Athletes, occupational, military
What is an insufficiency fracture?
When the bone may have been thinned or weakened, so is insufficiently strong
link between stress fractures and complete fractures
Many stress fractures leads to the risk of a complete fracture
Describe the sequence of events that can result in a stress fracture?
Overuse of the bone
Stress on bone > bones capacity to remodel
Bone weakens
Stress fracture
What factors can cause bone weakening?
Disordered eating, osteoporosis, amenorrhea
What is meant by a pathological fracture?
Where NORMAL stresses are exerted in ABNORMAL bone
What are some causes of abnormal bone seen in pathological fractures? POMOVO - 6
Pagets
Osteogenesis Imperfecta
Malignancy
Osteomyelitis
Vitamin D deficiency
Osteoporosis
What is osteomyelitis?
Inflammation or swelling that occurs in the bone
What happens when osteoclast activity > osteoblast activity?
Bone micro architecture is disrupted
what happens in osteomalacia?
reduction in bone mineralisation - softening of bones
what happens in osteoporosis
weakening of bones - brittle bone
Why are women more prone to osteoporosis
oestrogen slows down bone loss and improves retention of calcium
How is osteoporosis measure?
By having a bone density that is more then 2.5x standard deviations away from the mean
Is osteoporosis more common in males or females?
Females
What is senile osteoporosis?
Primary osteoporosis that is linked to age
what is osteopenia?
when the protein and mineral content in bone tissue is reduced, before development into osteoperosis
What is secondary osteoporosis?
Osteoporosis that occurs in any age
what type of trauma fractures are found in osteopenia and osteoporosis
low energy trauma
What are three causes of secondary osteoporosis?
Hypogonadism
Glucocorticoid excess
Alcoholism
What type of fractures is secondary osteoporosis associated with?
Hip, spine and wrist fractures = fragility fractures
What minerals does vitamin D help absorb?
Calcium, magnesium and phosphate
How is vitamin D made?
Synthesized from the sun
What happens if you have inadequate calcium or phosphate?
Results in a defect in Osteoid matrix mineralization
What condition does vitamin D deficiency result in for children?
Rickets
What condition does vitamin D deficiency result in for adults?
Osteomalacia
What is reduced in osteogenesis imperfecta?
Type 1 collagen
Why are collagen levels lower in osteogenesis perfecto patients? - 2
1 - Decreased secretion
2 - Production of abnormal collagen
What does osteogenesis imperfecta impact? - 4
Bones
Hearing
Heart
Sight
Blue sclera is a symptom of what condition?
Osteogenesis imperfecta
What is Paget’s disease?
Excessive bone breakdown and disorganized remodeling which leads to deformity
What are the four stages of Paget’s disease?
- Osteoclastic activity
- Mixed osteoclastic-osteoblastic activity
- Osteoblastic activity
- Malignant degeneration
what are lytic cancers in bones
bone eating/breakdown cancers
what are blastic cancers in bones?
endures bone growth
Which cancers are blastic? - 2
Prostate cancer and breast cancer
Which cancer are lytic (bone eating)? - 3
Kidney, thyroid, lung and breast
What are the four primary bone cancers? - 4
Osteosarcoma
Chondrocarcoma
Ewing sarcoma
Lymphoma
What are secondary bone cancers?
When cancers which originated in other tissues metastasize to the bone
What are the two types of fractures which affect the soft tissue integrity?
Open and close
What is a closed fracture?
Fractured under the skin
What is an open fracture?
One that pokes through the skin
What are the two types of fractures which involve the movement to the bone?
Displaced and undisplaced
What is an undisplaced fracture?
fracture where bones are not out of alignment
What is a displaced fracture?
A fracture where bones are no longer in their correct alignment positions
What are the three fractures associated with bony fragments?
Green stick, simple and multi fragmentary
What is a green stick fracture?
When the bone fragments are bent
What is a multi fragmentary fracture?
When there are many fractures along the same bone resu,ting in many bone fragments
What are the 4 stages of general tissue healing?
Bleeding
Inflammation
New tissue formation
Remodelling
What cells are involved with remodeling? - 3
Macrophages, osteoclasts and blast cells
What is Wolff’s Law?
Bone grows and remodels in response to the forces that are placed on it
What three things happen in the inflammation stage of fracture healing?
Haematoma formation
Cytokine release from the blood products
Granulation tissue and blood vessel formation
What happens in the repair phase of fracture healing?
Soft callus formation (cartilage) which is then converted to hard callus (bone)
What happens during the remodeling phase of fracture repair?
The hard callus responds to external forces, functional demands and growth and any excess bone is removed
What is the healing time of a phalange fracture?
3 weeks
What is the healing time of a metacarpal fracture?
4-6 weeks
What is the healing time of a distal radius fracture?
4-6 weeks
What is the healing time of a forearm fracture?
8-10 weeks
What is the healing time of a tibia fracture?
10 weeks
What is the healing time of a femur fracture?
12 weeks
From what point after a fracture can you see signs of visible healing?
7-10 days on the X Ray
What mechanism does primary bone healing occur by?
Intramembranous healing
When does primary bone healing occur?
When you have a stable fracture
What bone is formed through primary bone healing?
Woven bone is formed directly from mesenchymal cells
What is secondary bone healing?
When the mesenchymal cells form a chondral precursor which then produces bone cells
What are the four principles to fracture management?
Reduction
Hold
Fixation
Rehabilitation
What is meant by open reduction?
This is where the surgeons open the skin and put the bones back together
What is meant by closed reduction?
Where the doctors physically push the bones together without surgical intervention
What are two methods of closed reduction?
Manipulation or traction
What are the two methods of traction?
Through skin which is where a weight is used to align the bones or pins are placed into bones
What are the methods of closed holding?
Plaster or traction (skin or skeletal)
What is the difference between the two types of fixation?
Internal = metal under the skin, can be in the medulla or out the medulla
External = pins sticking out the skin
What are the two types of external fixation?
Monoplanar and multiplanar
What are the four concepts of rehabilitation?
Use
Move
Strengthen
Weight bear
What collagen type is both ligaments and tendons made from?
Type I Collagen
what 3 things can cause ligament or tendon injury
sports, trauma and laceration
What do ligaments do?
Connects bone to bone
what is an avulsion fracture?
when a small chunk of bone attached to a tendon or ligament gets pulled away from the main part of the bone.
What type of muscle contraction usually causes ligament and tendon injuries
eccentric contraction
What do tendons do?
Connects bone to muscle
What are the three types of tendinopathy?
Tendinosis, tendinitis and rupture
What is tendinosis?
Degradation of the tendons collagen resulting in hardening, thickening or scarring of the tendons
What is tendinitis?
Inflammation of the tendons
How many grades of ligament tears are there?
3
What is a grade one ligament tear?
Slight incomplete tear, no notable joint instability
What is a grade two ligament tear?
Some joint instability, moderate to severe incomplete tear
How long does it take for ligaments and tendons to undergo maximum strength recovery
> 6 months
What is a grade 3 tear?
Complete tearing of 1 or more ligaments with obvious instability, and surgery is required
What are the two methods on tendon repair?
Immobilize or surgery
What are the two ways of immobilizing a tendon / ligament tear?
Plaster or boot/brace
How are tendons surgically repaired?
Suturing
What are the negatives of immobilising injured ligamentous tissue? - 5
Less overall length of ligament repair scar
Protein degradation > protein synthesis
Production of inferior tissue by blast cells
Resorption (loss) of bone at site of ligament insertion
Decreased tissue tensile strength (50% in 6-9 weeks)
What are the positive of immobilizing injured ligamentous tissue? - 1
less ligament lengthening
What are the benefits of mobilizing injured ligamentous tissue? - 3
Ligament scars are wider, stronger and more elastic
Better alignment snd quantity of collagen
What are the 5 factors affecting tissue healing?
Nutrition Infection Immune function Blood supply Forces Movement
How long does the inflammatory phase of ligament healing last?
1-7 days
What does RICE stand for?
Rest, ice, compression, Elevation
When are range of motion exercise recommended to start following a ligament injury?
48hours
When does the remodeling phase start?
After more than 14 days
When performing an examination of a trauma patient, what information is essential to look for?
skin integrity, deformity, function, tenderness, neurovascular status
What are the two views of X rays which are commonly performed?
AP and lateral
What might you expect to see when examining a patient for a fracture - 8
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
What does ACL stand for
anterior cruciate ligament
What are the three main principles of management?
Reduce
Hold
Rehabilitate
What is the role of the ACL in the knee?
help stabilize the knee joint and allows proprioception and pivoting
What is a common twisting injury to the knee which results in the knee swelling up and a snap bing heard?
ACL Tear
What does PRICE mean in terms of short term management?
Protect Rest Ice Compress Elevate
In what cases does a torn ACL result in surgery?
When the patient is young, active, sporty and does movements which require the ACL
Why may surgery not be necessary for a torn ACL?
The muscles can compensate for the movement in some cases
What is tried before surgery in a torn ACL injury?
Physiotherapy
What condition is associated with a sharp, intense pain at the back of the ankle which occurs after hearing a loud snap?
Injured achilles tendon
What does tendon achilles connect?
muscle to bone
What muscles do the achilles tendon associate with?
Soleus and gastrocnemius
what is plantarflexion?
a movement in which the top of your foot points away from your leg
what is dorsiflexion?
backward bending and contracting of your hand or foot
What movements are associated with the achilles tendon?
Plantarflexion and dorsiflexion of the foot
What are the examination findings from a ruptured achilles tendon?
Difficulty walking, unable to perform heel raises, thickening, tenderness and swelling on the affected side,
What is tendonosis?
Thickening of the tendon that makes it prone to tear
What happens when you have an injured achilles tendon and dangle your feet off the end of the bed?
The affected foot remains in dorsiflexion
What are the four stages of tendon repair? - 4
Inflammatory, reparative, remodelling (consolidation) and remodelling (maturation)
What are some general complications with tendon surgery? - 3
DVT, infection and prolonged immobility
What are some specific surgery complications of tendon repair? - 3
Neurovascular injury, ankle infection, pressure sores from plaster or boot
Lachmann’s Test and Anterior Drawer - what do you do and what do you expect to see in a damaged ACL?
pulling the tibia forward - with no restriction given from knee
Pivot Shift
rotational test on knee to see if there is a knee injury
what does the ACL connect?
connects tibia to femur
what test is used to diagnose tendon achilles
Simmonds Calf squeeze test
