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Musculoskeletal Rheumatology > Injury and Healing > Flashcards

Injury and Healing Flashcards

1
Q

What are the causes/mechanisms of actin for bone fractures?

A
  1. Trauma -low energy, high energy
  2. Stress- abnormal stress on normal bone
  3. Pathological- normal stresses on abnormal bone
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2
Q

What are the fracture patterns?

A

Soft tissue integrity:
open or closed

Bony fragments:
greenstick or simple or comminuted/multi-fragmentary

Displacement:
displaced (bone moved) or undisplaced

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3
Q

What does an open fracture mean?

A

-the skin has been breached

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4
Q

An amateur runner is training for his first marathon. He is trying to make a positive change from his otherwise sedentary lifestyle and has really been pushing himself. What type of fracture might he be at risk of developing?

A

-stress

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5
Q

What is ‘stress’ on a bone causing fractures?

A
  • stress exerted on bone is greater than bones capacity to remodel
  • causes bone weakening
  • stress fracture
  • risk of complete fracture
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6
Q

What are the weight bearing bones?

A
  • tibia
  • metatarsals
  • navicular
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7
Q

What are the risk factors for bone fractures due to stress?

A
  • disordered eating
  • amenorrhea
  • osteoporosis

(-army personnel)

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8
Q

What are pathological bone fractures?

A

-normal stress on abnormal bone

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9
Q

What are the causes of pathological bone fractures?

A
  • Osteoporosis- soft bone
  • Malignancy- primary & bone metastases
  • Vit D deficiency- osteomalacia (in adults) & Ricket’s (in children)
  • Osteomyelitis (bone infection)
  • Osteogenesis imperfecta
  • Paget’s disease
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10
Q

When does osteopenia & osteoporosis occur?

A
  • when osteoclast activity>osteoblast activity

- causes disrupted microarchitecture

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11
Q

What are the risk factors for osteopenia & osteoporosis?

A
  • more common in females
  • postmenopausal osteoporosis women 50-70
  • senile osteoporosis >70
  • secondary osteoporosis: any age:
  • hypogonadism
  • glucocorticoid excess
  • alcoholism
  • associated with ‘fragility fractures’ - hip, spine, wrist
  • low energy trauma - fracture
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12
Q

What are -blastic malignancies?

A
  • prostate

- breasts

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13
Q

What are the -lytic malignancies?

A
  • breasts
  • kidney
  • thyroid
  • lung
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14
Q

What are the primary bone cancer?

A
  • osteosarcoma
  • chondrosarcoma
  • ewing sarcoma
  • chordoma
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15
Q

What primary malignant tumours metastasise to bone?

A

-prostate, breast, kidney, thyroid, lung

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16
Q

What are the conditions associated with vitamin D deficiency?

A

Rickets:

  • paediatrics
  • before physis closure

Osteomalacia:

  • adults
  • after physis closure
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17
Q

What are physes?

A

-growth plates founding bones

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18
Q

What is osteogenesis imperfect?

A
  • ‘Brittle Bone Disease’
  • hereditary - autosomal dominant or recessive

Decrease in type 1 collagen due to:

  • decreased secretion
  • production of abnormal collagen

Results in insufficient osteoid production

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19
Q

What areas are affected by osteogenesis imperfect?

A
  • bones
  • hearing
  • heart
  • sight (collagen in sclera of eyes- blue sclera)
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20
Q

What is Paget’s disease?

A
  • genetic and acquired factors
  • excessive bone break down and disorganised remodelling
  • may transform into a malignant disease

Four stages:

  • Osteoclastic activity
  • Mixed osteoclastic-osteoblastic activity
  • Osteoblastic activity
  • Malignant degeneration
21
Q

What are the effects of Paget’s disease?

A
  • deformity
  • pain
  • fracture
  • arthiritis
22
Q

A 6-year old South Asian boy moves to Glasgow with his family. His mother is concerned that he is complaining of aches and pains and his growth seems to have plateaued. What test would you order? What’s the diagnosis?

A
  • low vitamin D level

- rickets

23
Q

What is Wolff’s Law?

A

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

24
Q

What is the process of fracture healing?

A

Week 1:

  • haematoma formation (due to ruptured blood vessels)
  • release of cytokines
  • granulation tissue

Week 2-4 & 1-4 months:

  • soft callus formation: Type II Collagen- cartilage
  • converted to hard callus: Type I collagen -bone

4-12 months:

  • callus responds to activity, external forces, functional demands and growth
  • excess bone is removed.
25
Q

What are the two types of bone healing?

A

Primary bone healing:

  • intermembranous healing
  • absolute stability

Secondary bone healing:

  • endochondral healing
  • involves responses in the periosteum and external soft tissues
  • relative stability
26
Q

What is the general fracture healing time?

A

-3-12 weeks depending on site

depends on blood supply and soft tissue coverage

27
Q

When are signs of healing visible on x-ray from?

A

-7-10 days

28
Q

How long do the phalanges take to heal?

A

-3 weeks

29
Q

How long do the metacarpals take to heal?

A

4-6 weeks

30
Q

How long does the distal radius take to heal?

A

4-6 weeks

31
Q

How long does the forearm take to heal?

A

8-10 weeks

32
Q

How long does the femur take to heal?

A

-12 weeks

33
Q

How long does the tibia take to heal?

A

-10 weeks

34
Q

After sustaining an unstable fracture to his fibula bone, a medical student has an operation with a plate and screws to fix it. 10 weeks later his x-ray shows the fracture has healed nicely. This is an example of what type of bone healing?

A

-primary

35
Q

What are the three stages of fracture management?

A
  • reduction- open or closed
  • hold- metal or no metal
  • rehabilitate- move, physiotherapy, use
36
Q

What is traction?

A

-held by skin or skeletal (pins in bones)

37
Q

What is fixation?

A

Internal:

  • intramedullary- pins or nails
  • extramedullary- plate/screw or pins

External:

  • monoplanar
  • multiplanar
38
Q

What is reduction?

A

Open:

  • multi-incision
  • full exposure

Closed:

  • manipulation
  • traction- skin or skeletal (pins in bones)
39
Q

What are the considerations if the fracture is displaced?

A

Is it stable?

  • Are soft tissues ok?
  • What other illnesses?

Is it a joint surface?
-What does the patient think?

40
Q

What are the stages of fracture management?

A
  • Reduce
  • Hold
  • Fix
  • Rehabilitate
41
Q

What is a ligament?

A

-connect bone to bone

42
Q

What is a tendon?

A

-connects muscle to bone

43
Q

What can happen to tendons?

A

Tendinosis
-abnormal thickening

Tendinitis
-inflammation

Rupture

44
Q

What are the classifications of ligament injury?

A

Grade I- slight incomplete tear- no notable joint stability

Grade II- moderate/sever incomplete tear

  • some joint instability
  • one ligament may be torn

Grade III

  • complete tearing of 1 or more ligaments
  • obvious instability
  • surgery usually required
45
Q

What are the phases of ligament healing?

A
  1. Inflammatory phase (1-7 days):
    - fibrin clot forms in ligament tears
  2. Proliferation phase (7-21 days):
    - tendons and ligaments weakest, tensile strength builds
  3. Remodelling (>14 days):
    - tendons and ligaments heal with scar tissue that reduces ultimate strength
    - causes adhesions
  4. Maturation (weeks to years):
    - max strength reached within year
46
Q

What are the factors affecting tissue healing?

A

Mechanical environment:

  • movement
  • forces

Biological environment:

  • blood supply
  • immune function
  • infection
  • nutrition
47
Q

What are the good and bad effects of immobilisation (brace or plaster) on injured ligamentous tissue?

A

Good:
-less ligament laxity (lengthening)

Bad:

  • less overall strength go ligament repair scar
  • protein degradation exceeds protein synthesis r net d in collagen quantity
  • production of inferior tissue by blast cells
  • resorption of bone at site of ligament insertion
  • build tissue tensile strength (50% in 6-9weeks)
48
Q

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

A
  • ligament scars are wider, stronger, and more elastic

- better alignment/quality of collagen

Musculoskeletal Rheumatology (6 decks)

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