Injury and Healing Flashcards
What are the 3 mechanisms of bone fracture?
- Trauma - high energy or low energy impacts have different consequences but both can lead to bone fractures
- Stress - Abnormal stresses placed on normal bone
- Pathological - Normal stresses placed on abnormal bone structures
What are the 3 different fracture patterns of bone?
How are these 3 different fracture patterns used to describe a fracture?
What else is there to consider and why?
Soft tissue integrity, bony fragments, displacement
- Soft tissue integrity (i.e. bone sticking out through the skin or not) - open or closed
- Bony fragments - greenstick (young children), simple or multifragmentary / comminuted
- Displacement - displaced (bones moved apart) or undisplaced
Age and energy transfer - high or low energy transfer affects different ages differently, and energy transfer can also help determine other issues e.g. collapsed lung, internal bleeding, etc. if high energy impact
If asked to describe a fracture, what are the key points to remember to mention?
Spiral or oblique, site of fracture, shape - single or multifragmentary, displacement (translated laterally or medially)
What are stress fractures?
In which group do stress fractures commonly occur in?
What is the female athlete triad?
Fractures that occur when the stress placed upon the bone is greater than the bone’s capacity to remodel (usually occurs on weight-bearing bones) - often occurs when people who train push themselves too far, especially if it is a dramatic change. Normally the fractures are stable, but further exertion increases risk of complete fracture / unstable fracture
Occurs commonly in millitary personnel and athletes - often a cause of female athlete triad
FAT - female who is train extensively, their calorie intake sometimes is insufficient in comparison to how much they are burning / exerting = deficit in their intake = can result in amenorrhea and osteoporosis
What are some pathological causes of bone fractures?
What is osteoporosis?
Who is more at risk for developing osteoporosis?
Normal stresses are placed on abnormal bone. Abnormal bone can arise from: osteoporosis (soft bone), malignancy (primary or metastases), vitamin D deficiency, osteomyelitis (infection of the bone), osteogenesis imperfecta, Paget’s disease
Osteoporosis = low bone density = results in bone weakening + fragility
Women - after menopause, decrease in oestrogen production = reduction in bone density
What is osteopenia? Why does osteopenia occur?
What are the 3 types of osteoporosis?
What is osteopenia associated with?
Stage before osteoporosis (thinning of the bone) - if osteoclast activity is greater than the osteoblast activity
Senile osteoporosis = in over 70s; postmenopausal osteoporosis = women aged between 50-70; secondary osteoporosis = any age, secondary due to hypogonadism, glucocorticoid excess, steroid use, alcoholism etc.
Fragility of bones - can result in hip fractures, wrist fractures, fractures to the spine, etc.
Bone cancers can affect the bone, but cancers that metastasise can have secondary affects on bone as well
What are 5 examples of cancers that metastasise to have blastic or lytic effects on bone?
What is the difference between -blastic and -lytic?
Fill in the venn diagram to whether these cancers have blastic or lytic effects:
What are the names of some primary bone cancers?
Cancers including prostate, breast, kidney, thyroid, lung that metastasise can have:
- blastic effects = bone building
- lytic effects = bone thinning / break down
osteosarcoma, chondrosarcoma, ewing sarcoma, chordoma
What issues in the different areas of this diagram that can lead to Vitamin D deficiency?
How can Vitamin D deficiency weaken bones?
What are the effects of Vitamin D deficiency in children VS adults?
Lack of Vitamin D results in less Ca2+ absorbed in the gut from the diet, so more osteoclast activity (breakdown of bone) to maintain Ca2+ levels in the blood
As the bone does not mineralise, causes Rickets in children before the growth plates have fused (bowing of bones) and osteomalacia in adults after the growth plates have fused (soft, thin bones that can cause pain and fracture easily)
What is osteogenesis Imperfecta? What is it caused by?
‘Brittle bone disease’ - hereditary (autosomal dominant or recessive)
Decreased Type I collagen production due to decreased secretion or production of abnormal collagen
Results in insufficient osteoid (unmineralised, organic component of bone) production
Collagen is found in many parts of our body - therefore osteogenesis imperfecta affects the eyes (sight), heart, bones and soft tissue
What is Paget’s Disease?
Function of osteoclasts and osteoblasts is disturbed - so the breakdown and remodelling process of the bone is non-functional resulting in deformities of the bone
Often results in bone cancers as the cells are abnormal
How can you tell if a finger is fractured?
Look to see if there is any swelling, perhaps test movement of the fingers
Swelling is due to haematoma - i.e. blood vessels burst so there is bleeding, the inflammatory factors cause inflammation, blood clots to try seal off the blood vessel
How do fractures heal? From Week 1 to Week 52:
Hematoma - blood vessels burst, bleeding
Inflammation - as white blood cells come in
Blot clots - as platelets seal off bleeding from blood vessel
Inflammation stimulates fibroblasts - lay down collagen for soft callus formation, ‘woven’ = immature bone
The osteoclasts and osteoblasts start remodelling this bone - formation of hard callus
How can bone healing be facilitated clinically?
What is the difference between primary and secondary bone healing?
What is a callus? In which type of healing are calluses more likely to be formed?
Using e.g. plasters, plates and screws etc. that can stabilise the fracture so the bones are aligned when healing
Primary = absolute stability (often contains metal work e.g. screws placed by surgeon to help healing), intermembraneous healing, generally heals almost perfectly as the ends are aligned so bone cells can jump across so they heal quickly
Secondary = relative stability, endochondral healing (slightly more disordered), as the ends of the fractures aren’t aligned, bone cells cannot jump across so are layed around randomly (forming a callus)
Like a lump of bone where the fracture has healed = more prominently formed from secondary bone healing as the bone healing is more disordered
How long does it take for bone to heal?
Depends on how far away it is from the heart - depending on blood supply and soft tissue support
e.g. sternum / clavicle = 2-3 months, but feet = can take 6 months
What are the aims of fracture management?
What are the 3 steps to manage a fracture depending on the type of fracture it is?
Allow healing to take place, to return the limb to function (so patient can go back to their life), make sure function is optimal (rehabilitate)
- Reduce the fracture by getting the bones ends roughly together: generally for closed fractures, the bones are realigned by manipulation
- Hold the fracture to allow for either primary or secondary bone healing to take place
- Fix (not always necessary): put in plates and screws
- Rehabilitate that area - due to musular atrophy (muscle wastage from lack of use / movement), stiffness, pain
How is the fracture reduced? Fill in this flowchart:
Bones are pushed back together generally using manipulation for closed fractures, otherwise the area needs to be cut open and the bones are put back
Manipulation = move around and pull on the skin / limb from the outside
Traction = pull on pin attached through the skin to the bone
How is the fracture held to allow healing? Fill in this flowchart:
Can be held in place using a plaster, or by placing a pin in the bone and pulling on the pin using a weight (traction)
If the fracture cannot be held using closed methods, how is the fracture fixed into position? Fill in this flowchart:
Why is the main advantage of an external fixation?
Metal can be put underneath the skin (internal) or on the surface of the skin (external)
For internal fixation, the metal can be placed inside the canal of the bone = intramedullary; or the metal can be placed on the surface of the bone = extramedullary
For external fixation, rods and screws are inserted into the bone, but also exit out of the skin
Adv = easy to assess for infection
How can the area affected by the fracture be rehabilitated? Fill in this flowchart:
Person needs to slowly start using that area, moving, strengthening, weightbearing etc.
Where is the achilles tendon?
Label the basic anatomy around the achilles:
What is the function of the achilles?
At the back of the lower limb, connecting the calf muscles to the heel bone
Connects the gastrocnemius and soleus muscles (calf muscles) to the calcaneus (heel bone)
Supports body weight - especially when standing, walking, running, jumping etc.
When the calf contracts, the achilles tendon pulls the foot down (pointed down) - this is plantar flexion
Plantar flexion is important when walking / running / climbing - pushes you off the ground
Where is the ACL (anterior cruciate ligament)?
Label the basic anatomy around the ACL:
What is the function of the ACL?
In the knee - ACL inserts the front of the tibia to the back of the femur
ACL prevents forward movement of the tibia
Controls rotational stability
Muscles prevent knee from falling out of the front
Synovial joint = contains articular cartilage
