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B > Injury and Healing > Flashcards

Injury and Healing Flashcards

1
Q

Mechanisms of bone fracture

A

Trauma (low/high energy)
Stress(repetitive)- abnormal stresses on bone
Pathological - normal stresses on bone but indicated underlying problem with bone structure

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2
Q

How does a stress fracture occur

A 
Overuse
Stress exerted on bone > bone's capacity to remodel
Bone weakening
Stress fracture
Risk of complete fracture
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3
Q

Weight bearing bones

A

Femur
Tibia
Metatarsals
Navicular

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4
Q

Activity related stress fracture

A 
Atheletes
Occupational 
Military
Female 
Stress fracture
Risk of complete fracture
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5
Q

Female athlete triad

A

Disordered eating
amenorrhea
osteoporosis

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6
Q

Pathological causes

A 
Osteoporosis- soft bone
Malignancy - primary/bone mets
Vitamin D deficiency ( calcitriol) - osteomalacia/rickets
Osteomylitis
Osteogenesis Imperfecta
Pagets
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7
Q

What infection can particularly predispose people to fractures

A

TB

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8
Q

Osteoporosis

A

Loss of bone density

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9
Q

Osteoporosis cause

A

Osteoclast activity is greater than osteoblast activity and so there is disrupted microarchitecture.

associated with ‘fragility fractures’- hip, spine , wrist
Low energy trauma- leads to fracture

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10
Q

Primary vs secondary osteoporosis

A

Primary osteoporosis is due to the normal ageing process while secondary osteoporosis is due to specific clinical disorders

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11
Q

Primary osteoporosis

A

senile osteoporosis->70

Post menopausal osteoporosis - 50-70

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12
Q

Secondary osteoporosis

A

Hypogonadism
Glucocorticoid excess
alcoholism

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13
Q

Vitamin d deficiency

A

inadequate calcium or phosphate - defect in osteoid matrix mineralisaton

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14
Q

OI

A

Brittle bone disease

Heriditary - autosomal dom or rec

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15
Q

OI pathogenesis

A

Decreased Type 1 collagen due to decreased secretion or production of abnormal collage

This leads to insufficient osteoid production ( due to lack of normal collagen`)

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16
Q

Effects of OI

A

Bones
Hearing
Heart
Sight

Patients can present with blue sclera, lens dislocation and short stature

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17
Q

Pagets Disease

A

Metabolic disturbance of bone turnover so you have increased/decreased osteoblast and osteoclast activity

Genetic/acquired

excessive bone breakdown and disorgansed remodelling leads to deformity, pain , fracture and arthritis

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18
Q

Pathogenesis of pagets disease

A

osteoclastic activity
Mixed osteoclastic-osteoblastic activity
Osteoblastic activity
Malignant degeneration- develop into osteosarcoma of bone or osteomalacia

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19
Q

Primary bone cancer

A

Osteosarcoma (osteoblastic tissues)
Chondrosarcoma (chondral tissue)
Ewing sarcoma
Lymphoma

20
Q

Secondary bone cancer

A

Blastic- prostate
Lytic- kidney, thyroid, lung
Both - breast

21
Q

Fracture patterns stages

A

1) Soft tissue integrity (pierced skin or not)- open /closed

2) Bony fragments:
- greenstick( bent only really happens in children)
- Simple (one break)
- Multifragmentary ( comminuted)

3) Movement: displaced/undisplaced

22
Q

Tissue healing general stages

A

Bleeding - blood
Inflammation - neutrophils, macrophages
New tissue formation- BLASTS ( chondro for bones, osteo for bones, fibro for collagen tissue such as tendons or ligaments)
Remodelling - ma

23
Q

Fracture healing

A

1) Bleeding - haematoma formation
2) inflammation : release of cytokines. granulation of tissue and blood vessel formation
3) Repair - soft callus formation ( type 2 collagen - cartilage)
Converted to hard callus - Type 1 collagen : bone
4) remodelling : callus responds to activity, external forces, functional demands and growth. Excess bone is removed ( wolffs law)

24
Q

Primary bone healing

A

Intramembranous healing
Absolute stability
Direct to woven bone

25
Q

secondary bone healing

A

Endochondral healing
Involves responses in the periosteum and external soft tissues
Relative stability
Endochondral ossification : more callus (in comparison to primary bone healing)

26
Q

Bone healing times

A

Upper limbs generally heal quicker than lower limbs
hands heal quicker than feet
Babies are very good

But healing times vary according to age, biology and comorbidity of patient

27
Q

Principles of fracture management

A

Reduce : closed/open
Hold: no metal/metal
Rehabilitate: move, physiotherapy , use

28
Q

Reduction of closed fracture manipulation example

A

Collis fracture where the radium is dorsally tilted/angulated - like a dinner fork

29
Q

Reduction traction

A

Skin ( bandage and the hand to weight)
Skeletal ( pins in bones) - put a bin and then out a weight to the metal as you can apply more force to pin and the actual bone then you can to skin

30
Q

Look at fixation flow chart

A

Look at fixation flow chart

31
Q

Rehabilitation

A

Use- pain relief/ retrain
Move
Strengthen
Weight bear

32
Q

Why do tendons tear

A

Tendinopathy

  • tendinosis ( abnormal thickening )
  • tendinitis - inflammation
  • rupture

Sportsmen may already have thickening/inflammation of the tendons

33
Q

treatment of tendon or ligament tears

A

1) immobolise - rely on the haematoma formation process and place in a plaster or boot or brace
2) Surgical repair - suture

34
Q

immobilisation vs surgical repair on ligament inury

A

Immobilisation means there is less lengthening/laxity. But there s less overall strength of the ligament repair scar and there is protein degradation.

Surgical repair means that the ligament scars are wider, stronger and more elastic and that there is better alignment and quality of collagen

35
Q

Factors afecting tissue healing

A

Mechanical environment: movement /force

biological environment: blood supply, immune function , infection, nutrition ( diabetes increases healing time)

36
Q

What might you see when examining a patient for a fracture

A 
Inability to weight bear
severe pain
Swelling and point tenderness
deformity
scrapes/abrasions
wound if open fracture
loss of movement
Loss of sensation of nerve injury
37
Q

STAR

A

Site
Which side and where is it (position by thirds)
TAR (all about displacement)
Translation
Movement of fracture bony ends away from eachother
Angulation
Displacement from the normal axis
Rotation
Rotation of the distal fragment in relation to the proximal portion - may be more obvious clinically than on XR

38
Q

Role of ACL

A

Connect bone to bone
Stabilise joint
Made of type I/III collagen
ACL prevents anterior shift of tibia on femur

Also stops tibia moving forward and sliding in from of fibula

39
Q

presentation of ACL tear

A

pain, knee giving way, can’t push or twist knee

40
Q

test for ACL tear

A

lachmanns
anterior drawer
pivot shift

41
Q

Short term management for ACL injury

A

PRICE and then maybe splinting/bracing

42
Q

long term management for ACL injury

A

Operative vs Non operative

Operative : repair and replace ( graft from hamstring)
Non operative : brace

ACL does not heal well once torn and you will have an unstable knee and cant stick back onto ligament. Knee may stick onto PCL.

but some muscles can compensate - go onto quads

43
Q

Things to think about when operating on ACL injury

A 
age
symptoms- pain or giving way
activity level
has physio been tried
other structures involved
indications for ACL reconstruction
patellar tendon/ hamstring
44
Q

which muscles insert into the achilles tendon

A

soleus and gastrocnemius

45
Q

function of achiles

A

plantar flexion - point foot away from you

46
Q

signs of achilles tendon injury

A

difficulty walking/limp - says that it feels like a shot to the back of the leg
unable to perform heel raises - standing on tip toes (even after a couple of months)
thickening, tenderness and swelling on affected side
when prone with feet off the end of couch, the affected side is held in dorsiflexion

47
Q

achilles tendon/ any surgery operation complications

A

General :
DVT, infection, prolonged immobility leading to chest, UTI, infections and sores

Specific:
Neurovascular injury
tendon rupture
local infection 
ankle stiffness
pressure sores from plaster or boot

B (24 decks)

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