Injury and Healing Flashcards
What are the trauma mechanism of action?
- Low energy
- High energy
What are the stress mechanism of action?
-Abnormal stresses on normal bone
What are the pathological mechanism of action?
-Normal stresses on abnormal bone
What are the different types of soft tissue integrity fracture patterns?
open
closed
What are the different types of bone fragments fracture patterns?
greenstick
simple
comminuted
What are the different types of displacement fracture patterns?
displaced
undisplaced
What are types of fracture?
- simple or closed
- open
- transverse
- spiral
- impacted
- greenstick and torus
- comminuted
What are some abnormal stresses of normal bone?
- Overuse so stress exerted on bone is greater than bone capacity to remodel
- Bone weakening
- Stress fracture
- Risk of complete fracture
What are causes of abnormal stress?
- Weight baring bones - tibia, metatarsals, navicular
- Activity related: athletes, occupational, military, female, athlete triad
- Disorded eating, amenorrhea, osteoporosis
What does vitamin D deficiency cause?
- Osteomalacia
- Rickets
What does malignancy cause?
- Primary
- Bone metastases
What does osteoporosis cause?
Soft bone
What are different types of osteroperosis?
More common in females [Female:Male = 4:1]
Postmenopausal Osteoporosis – Women 50-70
Senile Osteoporosis - > 70
Secondary osteoporosis
When does osteoporosis and osteopenia happen?
If osteoclast activity > osteoblast activity -> Disrupted microarchitecture
When does secondary osteoporosis happen?
•Hypogonadism •Glucocorticoid excess •Alcoholism Associated with ‘fragility fractures’ – hip, spine, wrist Low energy trauma -> fracture
What scores are associated with osteopenia and osteoporosis?
Normal bone: T-score greater than -1
Osteopenia T-score -1 to -2.5
Osteoporosis T-score of -2.5 or less
What are some primary bone cancers?
- Osteosarcoma
- Chondrosarcoma
- Ewing sarcoma
- Chordoma
What primary malignant tumours metastasise to bone?
- Prostate: blastic
- Breast: lytic and blastic
- Kidney: lytic
- Thyroid: lytic
- Lung: lytic
What does blastic mean?
Building
What does lytic mean?
Break down
What is paediatric vitamin D deficiency?
- Before physis closure
- Rickets
What is adult vitamin D deficiency?
- After physis closure
- Osteromalacia
What is osteogenesis imperfecta?
‘Brittle Bone Disease’
Hereditary – autosomal dominant or recessive
Why could there be a decrease in type 1 collagen in osteogenesis imperfecta?
- Decreased secretion
* Production of abnormal collagen
What are the effects of decrease in type 1 collagen in osteogenesis imperfecta?
- Bones
- Hearing
- Heart
- Sight
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
What are the four stages of Pages disease?
- Osteoclastic Activity
- Mixed osteoclastic-osteoblastic activity
- Osteoblastic activity
- Malignant degeneration
What is Wolff’s law?
Bone grows and remodels in response to the forces that are placed on it
What happens in week 1 of fracture healing?
- Haematoma formation
- Release of cytokines
- Granualtion tissue
- Inflammation
What happens in week 2-4/1-4 months of fracture healing?
- Soft callus formation
- Type II collagen - cartilage - Converted to hard callus
- Type I collagen - bone
What happens in 4-12 months if fracture healing?
- Callus repsonds to activity external forces, functional demands and growth
- Excess bone is removed
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)
What is involved in primary bone healing?
- Intermembranous healing
* Absolute stability
What is involved in secondary bone healing?
- Endochondral healing
- Involves responses in the periosteum and external soft tissues
- Relative stability
What are general fracture healing times?
- 3-12 Weeks depending on site
- Signs of healing visible on X-ray from 7-10 days
How long does it take for phalanges to heal?
3 weeks
How long does it take for metacarpals to heal?
4-6 weeks
How long does it take for distal radius to heal?
4-6 weeks
How long does it take for forearm to heal?
8-10 weeks
How long does it take for femur to heal?
12 weeks
How long does it take for tibia to heal?
10 weeks
What are the different types of reduction in fracture management?
- closed -> manipulation/traction -> skin/skeltal (pins in bones)
- open -> mini-incision/full exposure
What are the different types of hold in fracture management?
- no metal
- metal
- Closed-> plaster/traction -> skin/skeltal (pins in bones)
- Fixation
What are the different types of rehabilitation in fracture management?
- Move
- physiotherapy
- Use: painreleif / retrain
- Strengthen
- Weighbear
What are types of fixation?
- Internal -> intrameduillry (pins/nails) / extra medullary (plates/screws / pins)
- External -> monoplane / multiplaner
What are stages of fracture management?
reduce, hold, rehabilitate
What is a muscle?
force and motion
What is a ligament?
Connect bone to bone
What is a tendon?
Connect muscle to bone
Describe tendinopathy
- Tendinosis: abnormal thickening
- Tendinitis: inflammation
- Rupture
What is a grade I ligament injury?
Slight incomplete tear – no notable joint instability
What is a grade II ligament injury?
Moderate / Severe Incomplete Tear – Some joint instability. One ligament may be completely torn
What is a grade III ligament injury?
complete tearing of 1 or more ligaments – Obvious instability. Surgery usually required
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
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
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
Describe the maturation phase of ligament healing
- Days: weeks to years
- Pathology: max strength reached within a year
- Treatment implications: build strength
How does the mechanical environment affect healing?
- Movement
2. Forces
How does the biological environment affect healing?
- Blood supply
- Immune function
- Infection
- Nutrition
What is good about immobilisation on injured ligamentous tissue?
•Less ligament laxity (lengthening)
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)
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
