Injury and healing (22)

Question 1

What are the causes of bone fracture?

Answer 1

• trauma: low energy and high energy
• stress: abnormal stress on normal bone
• pathological: normal stresses on abnormal bone

Question 2

What are the options for soft tissue integrity when diagnosing a fracture?

Answer 2

open or closed

is the skin breached?

Question 3

What are the options for bony fragments when diagnosing a fracture?

Answer 3

• simple
• greenstick (not fully fragmented)
• comminuted/multifragmentory

Question 4

What are the options for displacement when diagnosing a fracture?

Answer 4

displaced/undisplaced

Question 5

How does a stress fracture occur?

Answer 5

stress- abnormal stresses on normal bone
overuse–> stress exerted on bone>bone’s capacity to remodel
–> bone weakening–> stress fracture–> risk of complete fracture

Question 6

What is the female athlete triad?

Answer 6

• disordered eating
• amenorrhea
• osteoporosis

Question 7

What are the causes of pathological fractures?

Answer 7

• osteoporosis
• malignancy: primary or bone metastases
• vitamin D deficiency: osteomalacia or Ricket’s
• osteomyelitis
• osteogenesis imperfecta
• Paget’s disease

Question 8

What is osteopenia?

Answer 8

stage before osteoporosis

- thinning of the bone

Question 9

When do osteopenia/ osteoporosis occur and what are the different types?

Answer 9

• if osteoclast activity>osteoblast activity
• more common in females
• postmenopausal osteoporosis, senile osteoporosis, 2y osteoporosis (any age, due to hormones)

Question 10

What are the most common ‘fragility fractures’?

Answer 10

hip, spine, wrist

low energy trauma–> fracture

Question 11

What are the 5 main cancers that metastasise to bone?

Answer 11

prostate (blastic)
breast (blastic and lytic)
kidney (lytic)
thyroid (lytic)
lung (lytic)

Question 12

What are some of the primary bone cancers?

Answer 12

osteosarcoma
chondrosarcoma
Ewing sarcoma
chordoma

Question 13

What is osteogenesis imperfecta?

Answer 13

• ‘brittle bone disease’
• hereditary mutation- changed AA
• dec. type 1 collagen bc dec. secretion and production of abnormal collagen–> results in insufficient osteoid production

Question 14

What is Paget’s disease?

Answer 14

• genetic and acquired factors
• osteoclast and osteoblast activity muddled–> excessive bone breakdown and disorganised remodelling
• deformity, pain, fracture or arthritis
• may transform into cancer bc abnormal cells

Question 15

What are the stages of fracture healing?

Answer 15

1. haematoma stage: blood accumulates, swelling, release of cytokines, granulation tissue
2. soft callus formation: new blood vessels, spongy bone trabeculae, cartilage and fibrous tissue
3. hard callus formation: bony callus of spongy bone
4. bone remodelling: becomes strong bone, compact bone laid down, excess bone removed by osteoclasts

Question 16

What is Wolff’s law?

Answer 16

bone grows and remodels in response to the forces that are placed upon it

Question 17

What is primary bone healing?

Answer 17

• needs absolute stability, e.g. using a compression plate

- intramembrous ossification

Question 18

What is secondary bone healing?

Answer 18

• occurs when fixation is not rigid (relative stability), e.g. using a cast
• echondral ossification
• involves responses in the periosteum and external soft tissues

Question 19

How long do fractures tend to take to heal?

Answer 19

3-12 weeks

Question 20

What are the 3 general stages of fracture management?

Answer 20

• reduce: get bone ends roughly together
• hold: metal/no metal
• rehabilitate: move and use

Question 21

How can we get bones back together if there is a closed fracture?

Answer 21

• manipulation

- traction (pulling): skin or skeletal/pins in bones

Question 22

How can we get bones back together if there is an open fracture?

Answer 22

• mini-incision

- full exposure (big incision)

Question 23

What are the methods of holding a fracture?

Answer 23

• closed: plaster
  or traction (skin or skeletal/pins)
• fixation (metal)

Question 24

What is external fixation?

Answer 24

surgical treatment used to set bone fractures in which a cast would not allow proper alignment of the fracture

Question 25

What is internal fixation?

Answer 25

involves the surgical implementation of implants for the purpose of repairing a bone

Question 26

What are the aspects of rehabilitation?

Answer 26

• use
• move
• strengthen
• weightbear

Question 27

What can happen to tendons?

Answer 27

• tendinitis: abnormal thickening
• tendinitis: inflammation
• rupture

Question 28

What are the ligament and tendon graded classifications for injury?

Answer 28

• grade 1: slight/incomplete tear, no noticeable joint instability
• grade 2: moderate or severe incomplete tear, some joint instability
• grade 3: complete tearing of 1 or more ligaments, obvious instability–> surgery usually required

Question 29

What are the stages of ligament healing?

Answer 29

• inflammatory phase
• proliferation phase
• remodelling
• maturation

Question 30

What factors affect tissue healing?

Answer 30

• mechanical environment: movement, forces

- biological environment: blood supply, immune function, infection, nutrition

Question 31

What are the benefits of mobilisation (movement) on injured ligamentous tissue?

Answer 31

• ligament scars are wider, stronger and more elastic

- better alignment/quality of collagen

Question 32

What are the disadvantages of immobilisation (surgery) on injured ligamentous tissue?

Answer 32

• scar
• production of inferior tissue by blast cells
• less overall strength of ligament

Question 33

What are the advantages of immobilisation (surgery) on injured ligamentous tissue?

Answer 33

less ligament laxity (lengthening)