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Z YEAR 1 BRS Bones > Injury and Healing > Flashcards

Injury and Healing Flashcards

1
Q

What are the trauma mechanism of action?

A
  • Low energy

- High energy

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2
Q

What are the stress mechanism of action?

A

-Abnormal stresses on normal bone

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3
Q

What are the pathological mechanism of action?

A

-Normal stresses on abnormal bone

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4
Q

What are the different types of soft tissue integrity fracture patterns?

A

open

closed

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5
Q

What are the different types of bone fragments fracture patterns?

A

greenstick
simple
comminuted

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6
Q

What are the different types of displacement fracture patterns?

A

displaced

undisplaced

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7
Q

What are types of fracture?

A
  • simple or closed
  • open
  • transverse
  • spiral
  • impacted
  • greenstick and torus
  • comminuted
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8
Q

What are some abnormal stresses of normal bone?

A
  1. Overuse so stress exerted on bone is greater than bone capacity to remodel
  2. Bone weakening
  3. Stress fracture
  4. Risk of complete fracture
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9
Q

What are causes of abnormal stress?

A
  • Weight baring bones - tibia, metatarsals, navicular
  • Activity related: athletes, occupational, military, female, athlete triad
  • Disorded eating, amenorrhea, osteoporosis
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10
Q

What does vitamin D deficiency cause?

A
  • Osteomalacia

- Rickets

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11
Q

What does malignancy cause?

A
  • Primary

- Bone metastases

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12
Q

What does osteoporosis cause?

A

Soft bone

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13
Q

What are different types of osteroperosis?

A

More common in females [Female:Male = 4:1]
Postmenopausal Osteoporosis – Women 50-70
Senile Osteoporosis - > 70
Secondary osteoporosis

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14
Q

When does osteoporosis and osteopenia happen?

A

If osteoclast activity > osteoblast activity -> Disrupted microarchitecture

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15
Q

When does secondary osteoporosis happen?

A 
•Hypogonadism
•Glucocorticoid excess
•Alcoholism
Associated with ‘fragility fractures’ – hip, spine, wrist
Low energy trauma -> fracture
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16
Q

What scores are associated with osteopenia and osteoporosis?

A

Normal bone: T-score greater than -1
Osteopenia T-score -1 to -2.5
Osteoporosis T-score of -2.5 or less

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17
Q

What are some primary bone cancers?

A
  • Osteosarcoma
  • Chondrosarcoma
  • Ewing sarcoma
  • Chordoma
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18
Q

What primary malignant tumours metastasise to bone?

A
  • Prostate: blastic
  • Breast: lytic and blastic
  • Kidney: lytic
  • Thyroid: lytic
  • Lung: lytic
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19
Q

What does blastic mean?

A

Building

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20
Q

What does lytic mean?

A

Break down

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21
Q

What is paediatric vitamin D deficiency?

A
  • Before physis closure

- Rickets

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22
Q

What is adult vitamin D deficiency?

A
  • After physis closure

- Osteromalacia

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23
Q

What is osteogenesis imperfecta?

A

‘Brittle Bone Disease’

Hereditary – autosomal dominant or recessive

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24
Q

Why could there be a decrease in type 1 collagen in osteogenesis imperfecta?

A
  • Decreased secretion

* Production of abnormal collagen

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25
What are the effects of decrease in type 1 collagen in osteogenesis imperfecta?
* Bones * Hearing * Heart * Sight
26
What is Paget's disease and what is it caused by?
-Aetiology: Genetic & acquired factors Excessive bone break down and disorganised remodeling -> deformity, pain, fracture or arthritis -May transform into a malignant disease -Bone doesn't remodel
27
What are the four stages of Pages disease?
1. Osteoclastic Activity 2. Mixed osteoclastic-osteoblastic activity 3. Osteoblastic activity 4. Malignant degeneration
28
What is Wolff's law?
Bone grows and remodels in response to the forces that are placed on it
29
What happens in week 1 of fracture healing?
1. Haematoma formation 2. Release of cytokines 3. Granualtion tissue - Inflammation
30
What happens in week 2-4/1-4 months of fracture healing?
1. Soft callus formation - Type II collagen - cartilage 2. Converted to hard callus - Type I collagen - bone
31
What happens in 4-12 months if fracture healing?
- Callus repsonds to activity external forces, functional demands and growth - Excess bone is removed
32
What are the steps of fracture healing?
Step 1: Bleeding/Haematoma – prostaglandins/cytokines released; growth factors  increase local blood flow – Periosteal supply takes over Step 2: Granulation Tissue/connective tissue/Fibrous tissue laid down / Soft Callus Step3: Once fracture is bridged with soft callus- hard callus is formed ( laying down of Osteoid/ bone) Step4 : Bone is remodelled via endochondral ossification lamellar bone in its place. (look at notes)
33
What is involved in primary bone healing?
* Intermembranous healing | * Absolute stability
34
What is involved in secondary bone healing?
* Endochondral healing * Involves responses in the periosteum and external soft tissues * Relative stability
35
What are general fracture healing times?
- 3-12 Weeks depending on site | - Signs of healing visible on X-ray from 7-10 days
36
How long does it take for phalanges to heal?
3 weeks
37
How long does it take for metacarpals to heal?
4-6 weeks
38
How long does it take for distal radius to heal?
4-6 weeks
39
How long does it take for forearm to heal?
8-10 weeks
40
How long does it take for femur to heal?
12 weeks
41
How long does it take for tibia to heal?
10 weeks
42
What are the different types of reduction in fracture management?
- closed -> manipulation/traction -> skin/skeltal (pins in bones) - open -> mini-incision/full exposure
43
What are the different types of hold in fracture management?
- no metal - metal - Closed-> plaster/traction -> skin/skeltal (pins in bones) - Fixation
44
What are the different types of rehabilitation in fracture management?
- Move - physiotherapy - Use: painreleif / retrain - Strengthen - Weighbear
45
What are types of fixation?
- Internal -> intrameduillry (pins/nails) / extra medullary (plates/screws / pins) - External -> monoplane / multiplaner
46
What are stages of fracture management?
reduce, hold, rehabilitate
47
What is a muscle?
force and motion
48
What is a ligament?
Connect bone to bone
49
What is a tendon?
Connect muscle to bone
50
Describe tendinopathy
1. Tendinosis: abnormal thickening 2. Tendinitis: inflammation 3. Rupture
51
What is a grade I ligament injury?
Slight incomplete tear – no notable joint instability
52
What is a grade II ligament injury?
Moderate / Severe Incomplete Tear – Some joint instability. One ligament may be completely torn
53
What is a grade III ligament injury?
complete tearing of 1 or more ligaments – Obvious instability. Surgery usually required
54
Describe the inflammatory phase of ligament healing
- Days: 1-7 - Pathology: fibrin clots formed in ligament tears - Treatment implications: RICE / NSAIDS no longer recommended / Strat ROM exercises after 48 hours
55
Describe the proliferation phase of ligament healing
- Days: 7-21 - Pathology: tendons and ligaments weakest, tensile strength builds - Treatment implications: full ROM and WB exercises
56
Describe the remodelling phase of ligament healing
- Days: >14 days - Pathology: tendons and ligaments heal with scar tissue that reduces ultimate strength causes adhesions - Treatment implications: build strength
57
Describe the maturation phase of ligament healing
- Days: weeks to years - Pathology: max strength reached within a year - Treatment implications: build strength
58
How does the mechanical environment affect healing?
1. Movement | 2. Forces
59
How does the biological environment affect healing?
1. Blood supply 2. Immune function 3. Infection 4. Nutrition
60
What is good about immobilisation on injured ligamentous tissue?
•Less ligament laxity (lengthening)
61
What is bad about immobilisation on injured ligamentous tissue?
* Less overall strength of 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 - 9 weeks)
62
What are the benefits of mobilisation (movement) on injured ligamentous tissue?
* Ligament scars are wider, stronger, and are more elastic | * Better alignment / quality of collagen

Z YEAR 1 BRS Bones (5 decks)

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