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BRS Musculoskeletal System > Injury and Healing > Flashcards

Injury and Healing Flashcards

1
Q

3 mechanisms of bone fracture + definitions?

A

Trauma - Low energy transfer and high energy transfer

Pathological - normal stresses on abnormal bone.

Stress - abnormal stresses on normal bone.

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2
Q

What are ADLs?

A

Activities of daily living.

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3
Q

When does a bone experience stress?

A

Bone experiences a stress whenever a force is loaded upon it. Low levels of these forces cause bone to deform → Strain.

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4
Q

2 types of trauma?

A

High energy

Low energy

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5
Q

Briefly explain a stress fracture?

A

Repetitive applications of forces on a particular bone results in stress exertion on localised region → Excess remodelling capacity → Bone weakening persists → Stress fractures (potentiates risk of complete fracture).

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6
Q

List pathological causes of fracture.

A 
Osteoporosis - Soft bone, reduced BMD
Malignancy - Primary, bone metastases 
VD deficiency - Insufficient exposure to sunlight, reduced vitamin-D source → Osteomalacia + Ricket's 
Osteomyelitis - Infection of the bone
OI - Collagen deficiency
Paget's disease
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7
Q

What are the weight bearing bones?

A

Femur, tibia, metatarsals, navicular

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8
Q

What is the female triad?

A

Amenorrhoea - Absence of periods; low oestrogen levels.

Osteoporosis - Reduction in bone mineral density, thus increasing porous structure; susceptible to fracture.

Disordered eating - Ca2+ deficiency.

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9
Q

What type of trauma is more common in people with osteoporosis?

A

Low energy trauma

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10
Q

Outline the basic pathophysiology behind osteopenia and osteoporosis.

A

Bone resorption (Osteoclast activity) > Bone formation (Osteoblast activity) → Disrupted microarchitecture.

(RANK ligand and RANK → mediators of osteoclast activity. Production of RANKL by osteoblastic cells bind to cognate RANK receptor; activates intracellular pathways (NF kappa beta), results in induction of osteoclastogenic genes.)

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11
Q

In what age range can women experience post-menopausal osteoporosis?

A

50-70

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12
Q

What is secondary osteoporosis associated with?

A

Hypogonadism
Alcoholism
Glucorticoid excess

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13
Q

What type of fracture and where are associated with osteoporosis?

A

Fragility fracture

Hip, spine, wrist associated with low energy trauma.

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14
Q

Senile osteoporosis age?

A

> 70

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15
Q

Outline the diagnosis system for osteoporosis and osteopenia.

A

Based on measurement of bone mineral density (BMD), using dual energy X-ray absorptiometry.

The parameters of the DEXA baseline comparisons are sex-attached and age matched in comparison to health population presenting a Z-score. Alternatively the BMD results are reported as a comparison to a sex-matched young healthy adult (T-score). These scores are expressed in standard deviations.

Osteoporosis: T score of -2.5 or less.
Osteopenia: T score between -1 and -2.5.

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16
Q

What does Vitamin D facilitate?

A

Calcium, magnesium and phosphate absorption.

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17
Q

What is the clinical significance of Vitamin D deficiency in adults and children?

A

Pre-epiphyseal closure → Rickets

Post-epiphyseal closure → Osteomalacia

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18
Q

What does Vitamin D deficiency do to the body as a whole?

A

Vitamin-D deficiency (Calcitriol) attributed to dysfunctional renal 1-alpha-hydroxylase and hepatic 25-hydroxylase results in reduced calcitriol activity. → Hypocalcaemia conditions (Reduced Ca2+ absorption, renal absorption and hyperparathyroidism.

19
Q

What is often seen in people who had or have rickets?

A

Bowing of bones

20
Q

Inheritance pattern of OI?

A

Can be autosomal dominant or recessive

21
Q

Outline the pathogenesis of OI.

A

Reduction in type I collagen secretion. Collagen is an ECM protein secreted by fibroblasts and osteoblasts and organised into insoluble fibres, comprising the ECM surrounding cells → Provides mechanical strength and rigidity to tissues and organs, especially to skeletal tissues: Bone cartilage, tendons and ligaments.
Insufficient osteoid production.

22
Q

What things does OI effect?

A

Bones
Hearing
Heart
Sight (Blue sclerae, lens dislocation)

23
Q

Aetiology of Paget’s disease?

A

Genetic and acquired factors.

24
Q

Explain the pathogenesis of Paget’s.

A

Excessive bone degradation and disorganised bone remodelling → Deformity, pain, fracture or arthritis. May transform into malignant disease.

25
Q

What are the 4 stages of Paget’s disease?

A
  1. Osteoclastic activity.
  2. Mixed osteoclastic-osteoblastic activity.
  3. Osteoblastic activity.
  4. Malignant degeneration.
26
Q

Examples of lytic (bone eating) cancers.

A

Kidney, breast, thyroid and lung

27
Q

Examples of blastic (bone forming) cancers.

A

Prostate and breast.

28
Q

On an X-ray, what would you see if patient had a purely lytic cancer?

A

Increased bone resorption > Black spaces where bone (white) should be.

29
Q

List of primary bone cancers.

A

Osteosarcoma, Ewing sarcoma, chondrosarcoma and lymphoma

30
Q

What is the difference between closed and open reduction?

A

Closed - Manipulation of broken bond and set into natural position without surgical intervention.

Open - Requires surgery to expose the fracture and reset the bone.

31
Q

What are fractures classified by?

A

Soft tissue integrity (closed/open), bony fragments (greenstick, simple multifragmentory), movement (displaced/undisplaced)

32
Q

What is the difference between undisplaced and displaced?

A

Undisplaced - Hardly moved.

Displaced - Move a lot.

33
Q

Outline the whole process of fracture healing (complex) with weeks involved.

A

Step 1:
Week 1: Bleeding/ Haematoma → prostaglandin/cytokine released; growth factors increase local blood flow → Periosteal supply dominates.

Step 2:
Week 2-4: Granulation (Connective/fibrotic) tissue deposited → Soft callus (Type 2 collagen → Cartilage; fibroblasts, woven blood (immature bone)

Step 3:
1-4 months: Fracture is bridged with soft callus → Hard callus formation succeeds (laying down of osteoid → Type 1 collagen) facilitated by increased osteoblast activity.

Step 4:
4-12 months: Bone remodelled through endochondral ossification lamellar bone in its place. Callus responds to activity, external forces, and the functional demands exerted onto bone; therefore this stimulates a balance of osteoblast and osteoclast activity to remodel bone (removal of excess).

34
Q

Outline the basic order of fracture of healing.

A

Inflammation > Haematoma formation > Soft callus (Type II collagen) > Hard callus (Type I collagen) > Remodelling (callus responds to activity, external forces, functional demands + growth affect the way the bone then regrows out. Excess bone removed).

35
Q

State Wolff’s Law.

A

Bone grows and remodels in response to the forces that are placed on it.

36
Q

Outline the differences between primary and secondary bone healing.

A

Primary - Intramembranous healing, absolute stability, direct to woven bone.

Secondary - Endochondral healing, involves responses in the periosteum and external soft tissues, relative stability, endochondral ossification: more callus.

37
Q

What is the average fracture healing time?

A

3-12 Weeks depending on site

38
Q

When are the signs of healing first visible on XR?

A

From 7-10 days

39
Q

What are the average healing times for the following bones: phalanges, metacarpals, distal radius, forearm, tibia and femur?

A 
Phalanges - 3 weeks 
Metacarpals - 4-6 weeks 
Distal radius - 4-6 weeks 
Forearm - 8-10 weeks 
Tibia - 10 weeks 
Femur - 12 weeks
40
Q

What are the general principles of fracture management?

A

Reduction - Restoring anatomical alignment of a fracture or dislocation of deformed limbs - Closed or open.

Hold - Fracture immobilisation. Hold ends in right position. No metal or metal.

Fixation - results in stabilisation to assist with bone healing through mechanical devices. This is divided into internal (intramedullary nails and screws) and external fixation.

Rehabilitate - Move, physiotherapy, use > Stiff limb that may be painful or weak and you then need to rehabilitate that limb.

41
Q

List the types of closed and open reduction.

A

Closed - Manipulation or traction > skin or skeletal (pins in bones)

Open - Mini-incision and full exposure.

42
Q

List the types of hold.

A

Hold > Fixation OR Closed > Plaster OR Traction > Skin or skeletal

43
Q

List the types of fixation

A

Internal > Intramedullary > Pins and nails OR extramedullary > Plate/screws and pins

External > Monoplanar or multiplanar

44
Q

List the different methods of rehabilitation.

A

Use > Pain relief or restrain
Move
Strengthen
Weight bear

BRS Musculoskeletal System (6 decks)

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