Injury and healing (22) Flashcards
What are the causes of bone fracture?
- trauma: low energy and high energy
- stress: abnormal stress on normal bone
- pathological: normal stresses on abnormal bone
What are the options for soft tissue integrity when diagnosing a fracture?
open or closed
is the skin breached?
What are the options for bony fragments when diagnosing a fracture?
- simple
- greenstick (not fully fragmented)
- comminuted/multifragmentory
What are the options for displacement when diagnosing a fracture?
displaced/undisplaced
How does a stress fracture occur?
stress- abnormal stresses on normal bone
overuse–> stress exerted on bone>bone’s capacity to remodel
–> bone weakening–> stress fracture–> risk of complete fracture
What is the female athlete triad?
- disordered eating
- amenorrhea
- osteoporosis
What are the causes of pathological fractures?
- osteoporosis
- malignancy: primary or bone metastases
- vitamin D deficiency: osteomalacia or Ricket’s
- osteomyelitis
- osteogenesis imperfecta
- Paget’s disease
What is osteopenia?
stage before osteoporosis
- thinning of the bone
When do osteopenia/ osteoporosis occur and what are the different types?
- if osteoclast activity>osteoblast activity
- more common in females
- postmenopausal osteoporosis, senile osteoporosis, 2y osteoporosis (any age, due to hormones)
What are the most common ‘fragility fractures’?
hip, spine, wrist
low energy trauma–> fracture
What are the 5 main cancers that metastasise to bone?
prostate (blastic) breast (blastic and lytic) kidney (lytic) thyroid (lytic) lung (lytic)
What are some of the primary bone cancers?
osteosarcoma
chondrosarcoma
Ewing sarcoma
chordoma
What is osteogenesis imperfecta?
- ‘brittle bone disease’
- hereditary mutation- changed AA
- dec. type 1 collagen bc dec. secretion and production of abnormal collagen–> results in insufficient osteoid production
What is Paget’s disease?
- 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
What are the stages of fracture healing?
- haematoma stage: blood accumulates, swelling, release of cytokines, granulation tissue
- soft callus formation: new blood vessels, spongy bone trabeculae, cartilage and fibrous tissue
- hard callus formation: bony callus of spongy bone
- bone remodelling: becomes strong bone, compact bone laid down, excess bone removed by osteoclasts
What is Wolff’s law?
bone grows and remodels in response to the forces that are placed upon it
What is primary bone healing?
- needs absolute stability, e.g. using a compression plate
- intramembrous ossification
What is secondary bone healing?
- occurs when fixation is not rigid (relative stability), e.g. using a cast
- echondral ossification
- involves responses in the periosteum and external soft tissues
How long do fractures tend to take to heal?
3-12 weeks
What are the 3 general stages of fracture management?
- reduce: get bone ends roughly together
- hold: metal/no metal
- rehabilitate: move and use
How can we get bones back together if there is a closed fracture?
- manipulation
- traction (pulling): skin or skeletal/pins in bones
How can we get bones back together if there is an open fracture?
- mini-incision
- full exposure (big incision)
What are the methods of holding a fracture?
- closed: plaster
or traction (skin or skeletal/pins) - fixation (metal)
What is external fixation?
surgical treatment used to set bone fractures in which a cast would not allow proper alignment of the fracture
What is internal fixation?
involves the surgical implementation of implants for the purpose of repairing a bone
What are the aspects of rehabilitation?
- use
- move
- strengthen
- weightbear
What can happen to tendons?
- tendinitis: abnormal thickening
- tendinitis: inflammation
- rupture
What are the ligament and tendon graded classifications for injury?
- 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
What are the stages of ligament healing?
- inflammatory phase
- proliferation phase
- remodelling
- maturation
What factors affect tissue healing?
- mechanical environment: movement, forces
- biological environment: blood supply, immune function, infection, nutrition
What are the benefits of mobilisation (movement) on injured ligamentous tissue?
- ligament scars are wider, stronger and more elastic
- better alignment/quality of collagen
What are the disadvantages of immobilisation (surgery) on injured ligamentous tissue?
- scar
- production of inferior tissue by blast cells
- less overall strength of ligament
What are the advantages of immobilisation (surgery) on injured ligamentous tissue?
less ligament laxity (lengthening)
