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MUSCULOSKELETAL - BRS > 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

link between stress fractures and complete fractures

A

Many stress fractures leads to the risk of a complete fracture

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8
Q

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

A

Overuse of the bone
Stress on bone > bones capacity to remodel
Bone weakens
Stress fracture

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9
Q

What factors can cause bone weakening?

A

Disordered eating, osteoporosis, amenorrhea

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10
Q

What is meant by a pathological fracture?

A

Where NORMAL stresses are exerted in ABNORMAL bone

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11
Q

What are some causes of abnormal bone seen in pathological fractures? POMOVO - 6

A

Pagets
Osteogenesis Imperfecta
Malignancy
Osteomyelitis
Vitamin D deficiency
Osteoporosis

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12
Q

What is osteomyelitis?

A

Inflammation or swelling that occurs in the bone

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13
Q

What happens when osteoclast activity > osteoblast activity?

A

Bone micro architecture is disrupted

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14
Q

what happens in osteomalacia?

A

reduction in bone mineralisation - softening of bones

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15
Q

what happens in osteoporosis

A

weakening of bones - brittle bone

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16
Q

Why are women more prone to osteoporosis

A

oestrogen slows down bone loss and improves retention of calcium

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17
Q

How is osteoporosis measure?

A

By having a bone density that is more then 2.5x standard deviations away from the mean

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18
Q

Is osteoporosis more common in males or females?

A

Females

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19
Q

What is senile osteoporosis?

A

Primary osteoporosis that is linked to age

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20
Q

what is osteopenia?

A

when the protein and mineral content in bone tissue is reduced, before development into osteoperosis

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21
Q

What is secondary osteoporosis?

A

Osteoporosis that occurs in any age

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22
Q

what type of trauma fractures are found in osteopenia and osteoporosis

A

low energy trauma

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23
Q

What are three causes of secondary osteoporosis?

A

Hypogonadism
Glucocorticoid excess
Alcoholism

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24
Q

What type of fractures is secondary osteoporosis associated with?

A

Hip, spine and wrist fractures = fragility fractures

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25
Q

What minerals does vitamin D help absorb?

A

Calcium, magnesium and phosphate

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26
Q

How is vitamin D made?

A

Synthesized from the sun

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27
Q

What happens if you have inadequate calcium or phosphate?

A

Results in a defect in Osteoid matrix mineralization

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28
Q

What condition does vitamin D deficiency result in for children?

A

Rickets

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29
Q

What condition does vitamin D deficiency result in for adults?

A

Osteomalacia

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30
Q

What is reduced in osteogenesis imperfecta?

A

Type 1 collagen

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31
Q

Why are collagen levels lower in osteogenesis perfecto patients? - 2

A

1 - Decreased secretion
2 - Production of abnormal collagen

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32
Q

What does osteogenesis imperfecta impact? - 4

A

Bones
Hearing
Heart
Sight

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33
Q

Blue sclera is a symptom of what condition?

A

Osteogenesis imperfecta

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34
Q

What is Paget’s disease?

A

Excessive bone breakdown and disorganized remodeling which leads to deformity

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35
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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36
Q

what are lytic cancers in bones

A

bone eating/breakdown cancers

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37
Q

what are blastic cancers in bones?

A

endures bone growth

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38
Q

Which cancers are blastic? - 2

A

Prostate cancer and breast cancer

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39
Q

Which cancer are lytic (bone eating)? - 3

A

Kidney, thyroid, lung and breast

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40
Q

What are the four primary bone cancers? - 4

A

Osteosarcoma
Chondrocarcoma
Ewing sarcoma
Lymphoma

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41
Q

What are secondary bone cancers?

A

When cancers which originated in other tissues metastasize to the bone

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42
Q

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

A

Open and close

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43
Q

What is a closed fracture?

A

Fractured under the skin

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44
Q

What is an open fracture?

A

One that pokes through the skin

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45
Q

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

A

Displaced and undisplaced

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46
Q

What is an undisplaced fracture?

A

fracture where bones are not out of alignment

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47
Q

What is a displaced fracture?

A

A fracture where bones are no longer in their correct alignment positions

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48
Q

What are the three fractures associated with bony fragments?

A

Green stick, simple and multi fragmentary

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49
Q

What is a green stick fracture?

A

When the bone fragments are bent

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50
Q

What is a multi fragmentary fracture?

A

When there are many fractures along the same bone resu,ting in many bone fragments

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51
Q

What are the 4 stages of general tissue healing?

A

Bleeding
Inflammation
New tissue formation
Remodelling

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52
Q

What cells are involved with remodeling? - 3

A

Macrophages, osteoclasts and blast cells

53
Q

What is Wolff’s Law?

A

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

54
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

55
Q

What happens in the repair phase of fracture healing?

A

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

56
Q

What happens during the remodeling phase of fracture repair?

A

The hard callus responds to external forces, functional demands and growth and any excess bone is removed

57
Q

What is the healing time of a phalange fracture?

A

3 weeks

58
Q

What is the healing time of a metacarpal fracture?

A

4-6 weeks

59
Q

What is the healing time of a distal radius fracture?

A

4-6 weeks

60
Q

What is the healing time of a forearm fracture?

A

8-10 weeks

61
Q

What is the healing time of a tibia fracture?

A

10 weeks

62
Q

What is the healing time of a femur fracture?

A

12 weeks

63
Q

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

A

7-10 days on the X Ray

64
Q

What mechanism does primary bone healing occur by?

A

Intramembranous healing

65
Q

When does primary bone healing occur?

A

When you have a stable fracture

66
Q

What bone is formed through primary bone healing?

A

Woven bone is formed directly from mesenchymal cells

67
Q

What is secondary bone healing?

A

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

68
Q

What are the four principles to fracture management?

A

Reduction
Hold
Fixation
Rehabilitation

69
Q

What is meant by open reduction?

A

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

70
Q

What is meant by closed reduction?

A

Where the doctors physically push the bones together without surgical intervention

71
Q

What are two methods of closed reduction?

A

Manipulation or traction

72
Q

What are the two methods of traction?

A

Through skin which is where a weight is used to align the bones or pins are placed into bones

73
Q

What are the methods of closed holding?

A

Plaster or traction (skin or skeletal)

74
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

75
Q

What are the two types of external fixation?

A

Monoplanar and multiplanar

76
Q

What are the four concepts of rehabilitation?

A

Use
Move
Strengthen
Weight bear

77
Q

What collagen type is both ligaments and tendons made from?

A

Type I Collagen

78
Q

what 3 things can cause ligament or tendon injury

A

sports, trauma and laceration

79
Q

What do ligaments do?

A

Connects bone to bone

80
Q

what is an avulsion fracture?

A

when a small chunk of bone attached to a tendon or ligament gets pulled away from the main part of the bone.

81
Q

What type of muscle contraction usually causes ligament and tendon injuries

A

eccentric contraction

82
Q

What do tendons do?

A

Connects bone to muscle

83
Q

What are the three types of tendinopathy?

A

Tendinosis, tendinitis and rupture

84
Q

What is tendinosis?

A

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

85
Q

What is tendinitis?

A

Inflammation of the tendons

86
Q

How many grades of ligament tears are there?

A

3

87
Q

What is a grade one ligament tear?

A

Slight incomplete tear, no notable joint instability

88
Q

What is a grade two ligament tear?

A

Some joint instability, moderate to severe incomplete tear

89
Q

How long does it take for ligaments and tendons to undergo maximum strength recovery

A

> 6 months

90
Q

What is a grade 3 tear?

A

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

91
Q

What are the two methods on tendon repair?

A

Immobilize or surgery

92
Q

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

A

Plaster or boot/brace

93
Q

How are tendons surgically repaired?

A

Suturing

94
Q

What are the negatives of immobilising injured ligamentous tissue? - 5

A

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)

95
Q

What are the positive of immobilizing injured ligamentous tissue? - 1

A

less ligament lengthening

96
Q

What are the benefits of mobilizing injured ligamentous tissue? - 3

A

Ligament scars are wider, stronger and more elastic

Better alignment snd quantity of collagen

97
Q

What are the 5 factors affecting tissue healing?

A 
Nutrition
Infection
Immune function
Blood supply
Forces
Movement
98
Q

How long does the inflammatory phase of ligament healing last?

A

1-7 days

99
Q

What does RICE stand for?

A

Rest, ice, compression, Elevation

100
Q

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

A

48hours

101
Q

When does the remodeling phase start?

A

After more than 14 days

102
Q

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

A

skin integrity, deformity, function, tenderness, neurovascular status

103
Q

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

A

AP and lateral

104
Q

What might you expect to see when examining a patient for a fracture - 8

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
105
Q

What does ACL stand for

A

anterior cruciate ligament

106
Q

What are the three main principles of management?

A

Reduce
Hold
Rehabilitate

107
Q

What is the role of the ACL in the knee?

A

help stabilize the knee joint and allows proprioception and pivoting

108
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

109
Q

What does PRICE mean in terms of short term management?

A 
Protect
Rest
Ice
Compress
Elevate
110
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

111
Q

Why may surgery not be necessary for a torn ACL?

A

The muscles can compensate for the movement in some cases

112
Q

What is tried before surgery in a torn ACL injury?

A

Physiotherapy

113
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

114
Q

What does tendon achilles connect?

A

muscle to bone

115
Q

What muscles do the achilles tendon associate with?

A

Soleus and gastrocnemius

116
Q

what is plantarflexion?

A

a movement in which the top of your foot points away from your leg

117
Q

what is dorsiflexion?

A

backward bending and contracting of your hand or foot

118
Q

What movements are associated with the achilles tendon?

A

Plantarflexion and dorsiflexion of the foot

119
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,

120
Q

What is tendonosis?

A

Thickening of the tendon that makes it prone to tear

121
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

122
Q

What are the four stages of tendon repair? - 4

A

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

123
Q

What are some general complications with tendon surgery? - 3

A

DVT, infection and prolonged immobility

124
Q

What are some specific surgery complications of tendon repair? - 3

A

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

125
Q

Lachmann’s Test and Anterior Drawer - what do you do and what do you expect to see in a damaged ACL?

A

pulling the tibia forward - with no restriction given from knee

126
Q

Pivot Shift

A

rotational test on knee to see if there is a knee injury

127
Q

what does the ACL connect?

A

connects tibia to femur

128
Q

what test is used to diagnose tendon achilles

A

Simmonds Calf squeeze test

MUSCULOSKELETAL - BRS (13 decks)

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