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Year 2 MSK > Injury and Healing > Flashcards

Injury and Healing Flashcards

1
Q

What occurs when the ACL is injured?

A

Wobbly knee

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2
Q

What are the three mechanisms of bone fracture?

A

Trauma- low/high energy
Stress- abnormal stresses on normal bone
Pathological- normal stresses on abnormal bone

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3
Q

How can you describe fracture patterns?

A

Soft tissue: Open or closed

Bony fragments: Greenstick/ Simple/ Comminuted

Displacement: Displaced/ Undisplaced

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4
Q

What is an example of high energy trauma?

A

Car crash

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5
Q

Give an example of low energy trauma?

A

Fall

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6
Q

How can a stress fracture occur?

A 
Overuse
Stress exerted on bone is greater than bones capacity to remodel
Bone weakening 
Stress fracture
Risk of complete fracture
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7
Q

Who is at risk of developing stress fractures?

A

Athletes

Military personnel

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8
Q

What is the female athlete triad?

A 
Regular strenuous exercise 
Insufficient calorie intake
Weight loss
Amenorrhoea 
Osteoporosis
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9
Q

Which bones a prone to stress fractures?

A

Weight baring bones

e.g. tibia, metatarsals, navicular

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10
Q

Give examples of pathological stresses?

A 
Osteoporosis
Malignancy 
Vit D deficiency
Osteomyelitis
Osteogenesis Imperfecta
Paget's disease
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11
Q

What conditions are caused by Vitamin D deficiency?

A

Osteomalacia

Ricket’s

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12
Q

What occurs when osteoclast activity > osteoblast activity?

A

Disrupted microarchitecture

More common in females 4:1

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13
Q

What are the different types of osteoporosis?

A

Postmenopausal Osteoporosis – Women 50-70
Senile Osteoporosis - > 70
Secondary osteoporosis: Any age, 60% Male
Hypogonadism
Glucocorticoid excess
Alcoholism

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14
Q

What are osteopenia and osteoporosis associated with?

A

Associated with ‘fragility fractures’ – hip, spine, wrist

Low energy trauma  fracture

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15
Q

What cancers are blastic?

A

Prostate

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16
Q

What cancers are lytic?

A

Kidney
Thyroid
Lung

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17
Q

What does Vit D deficiency cause in paeds?

A

Before physis closure

Rickets

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18
Q

What does Vit D deficiency cause in adults?

A

After physis closure

Osteomalacia

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19
Q

What are the main features of osteogenesis imperfecta?

A

‘Brittle Bone Disease’
Hereditary – autosomal dominant or recessive
↓ Type I Collagen due to:
Decreased secretion
Production of abnormal collagen
Results in insufficient osteoid production

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20
Q

What does OI effect?

A 
Bones
Hearing
Heart
Sight
Blue sclera
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21
Q

What are the main features of Paget’s disease?

A

Aetiology: Genetic & acquired factors
Excessive bone break down and disorganised remodeling  deformity, pain, fracture or arthritis
May transform into a malignant disease

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22
Q

What are the 4 stages of Paget’s?

A

Osteoclastic Activity
Mixed osteoclastic-osteoblastic activity
Osteoblastic activity
Malignant degeneration

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23
Q

What happens during week 1 of fracture healing?

A

Haematoma formation
Release of Cytokines
Granulation tissue

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24
Q

What happens during week 2- 4 months?

A

Soft Callus formation
(Type II Collagen - Cartilage)
Converted to hard callus
(Type I Collagen - Bone)

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25
What happens during months 4-12?
Callus responds to activity, external forces, functional demands and growth Excess bone is removed
26
What are the signs of fracture?
Oedema Inflammation Bleeding
27
What is primary bone healing?
Intermembranous healing | Absolute stability
28
What is the secondary bone healing?
Endochondral healing Involves responses in the periosteum and external soft tissues Relative stability
29
What are the different fracture healing times?
3-12 Weeks depending on site Signs of healing visible on X-ray from 7-10 days ``` Phalanges: 3 weeks Metacarpals: 4-6 weeks Distal radius: 4-6 weeks Forearm: 8-10 weeks Femur: 12 weeks Tibia: 10 weeks ```
30
What does healing time depend on?
Proximity to the heart | Depends on blood supply and soft tissue coverage
31
What is the secondary bone healing?
Endochondral healing Involves responses in the periosteum and external soft tissues Relative stability greater Callous formation
32
What are three steps of fracture management?
Reduce Hold Rehabilitate
33
What is reducing?
Bring the two structures together Closed: Manipulation or Traction Open: Mini incision or Full exposure
34
How can you hold?
Without metal: Plaster or Traction | With metal: Fixation
35
What are the two types of fixation?
``` Internal: Intramedullary- Pins/Nails Extramedullary- Plates and screws/Pins External Monoplanar Multiplayer ```
36
How can you rehabilitate?
``` Move Physiotherapy Use Strengthen Weigh-bear Retrain Pain relief ```
37
What do ligaments do?
Connect bone to bone
38
What do tendons do?
Connect muscle to bone
39
What can happen to tendons?
Thickening Inflammation Rupture
40
What do you call abnormal thickening of the tendon?
Tendinosis
41
What do you call inflammation of the tendons?
Tendinitis
42
How do you classify ligament injury?
Grade I Grade II Grade III
43
What are the features of grade I?
Grade I – Slight incomplete tear – no notable joint instability
44
What are the features of grade II?
Grade II – Moderate / Severe Incomplete Tear – Some joint instability. One ligament may be completely torn
45
What are the features of grade III?
Grade III – complete tearing of 1 or more ligaments – Obvious instability. Surgery usually required
46
What are the phases of ligament healing?
Inflammatory phase Proliferation phase Remodeling Maturation
47
What happens in the inflammatory phase?
1-7 days | Fibrin clot formed in ligament tears
48
What happens in the proliferation phase?
7-21 days | Tendons and ligaments weakest, tensile strength builds
49
What happens during remodelling phase?
> 14 days Tendons and ligaments heal with scar tissue that reduces ultimate strength  causes adhesions 
50
What happens during maturation?
Weeks to years | Max strength reached within a year.
51
What factors affecting tissue healing?
Mechanical environment - movement - forces Biological environment - blood supply - immune function - infection - nutrition
52
What are the effects of immobilisation on injures ligamentous tissue?
GOOD Less ligament laxity (lengthening) BAD 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)
53
What are the benefits of mobilisation on injured ligamentous tissue?
Ligament scars are wider, stronger, and are more elastic | Better alignment / quality of collagen
54
What is manipulation?
Movement in to place
55
What is traction?
Put pin through the bone and pull with a weight/ sticky tape with weight
56
What does intramedullary mean?
Within the medullary cavity
57
What does extra-medullary mean?
Alongside the bone
58
What is multiplanar fixation?
External hardware on all sides (cage-like) | Partly internal
59
What is monoplanar fixation?
External hardware on one side of the limb | Partly internal
60
What are the functions of the achilles tendon?
Connects the gastrocnemius and soleus to the calcaneus Plantar flexes the foot Tendon pulls the foot down
61
What complications can result from surgery?
Damage to Nerves Vasculature Surrounding tissues Shortening of tendon: Stiffness/ restricted movement Insufficient tightening: Persistent symptoms Repair might fail: rerupture Infection
62
What is the ACL?
Anterior cruciate ligament
63
What does the ACL do?
Stablises knee joint Prevents forward movement of the tibia Connects the femur to the tibia
64
What should a patient do in the first 6 weeks of healing?
``` Protect Rest Ice Compression Elevation ```
65
What should a patient do from 6-9 months post-injury?
Physio: movement strengthen muscles start walking normally
66
What should the patient do post 9 months?
Training Jumping Improve balance and proprioception
67
What are the different types of displacement (translation)?
Proximal/distal Anterior/posterior Medial /lateral
68
What are the different types of displacement (angulation)?
Internal/external rotation Dorsal/volar Varus/valgus
69
What are the general complications of fractures?
Fat embolus (hours - from bone marrow release) DVT (days-weeks) PE Infection/sepsis Prolonged immobility (UTI, chest infections, sores)
70
What are urgent local complications of fractures?
``` Local visceral Vascular injury Nerve injury Compartment syndrome Haemarthrosis Infection Gangrene ```
71
What are less urgent local complications of fractures?
``` Fracture blisters Plaster sores Pressure sores Nerve entrapment Myositis ossificans ligament injury Tendon lesions Joint stiffness Algodystrophy ```
72
What are the late local complications of fractures?
``` Delayed union Mal-union Non-union Avascular necrosis Muscle contracture Joint instability Osteoarthritis ```
73
What are the different NoF fractures?
``` Subcapital Transcervical Intertrochanteric Subtrochanteric 3 part intertrochanteric ```
74
What are the features of extra-capsular NoF fracture?
minimal risk to blood supply and AVN: fix with plate and screws (Dynamic hip screw)
75
What are the features of intra-capsular NoF fracture?
if undisplaced: less risk to blood supply: fix with screws If displaced: 25-30% risk AVN: replace in older patients; fix if young
76
How are synovial joint stabilised
Muscles/tendons Ligament Bone surface congruity
77
What are the components of a synovial joint?
Synovium Synovial fluid Articular cartilage
78
What is cartilage composed of?
1) specialized cells (chondrocytes) | 2) extracellular matrix: water, collagen and proteoglycans mainly aggrecan
79
What is aggrecan?
- a proteoglycan that possesses many chondroitin sulfate and keratin sulfate chains - characterized by its ability to interact with hyaluronan (HA) to form large proteoglycan aggregates
80
What is osteoarthritis?
Degenerative arthritis
81
What is inflammatory arthritis?
Main type is rheumatoid
82
What is the same in osteoarthritis and rheumatoid arthritis?
Joint space narrowing Indicates articular cartilage loss This can occur in osteoarthritis (primary abnormality) and in Rheumatoid Arthritis (secondary damage due to synovitis)
83
What are features in osteoarthritis not present in rheumatoid arthritis?
Subchondral sclerosis | Osteophytes
84
What are features of rheumatoid arthritis not present in osteoarthritis?
Osteopenia | Bony erosions
85
What is the WHO definition of OA?
is a long-term chronic disease characterized by the deterioration of cartilage in joints which results in bones rubbing together and creating stiffness, pain, and impaired movement.
86
What are the main OA risk factors?
``` Age Weight Metabolic syndrome Mechanical constraints (high levels of activity) Hereditary Female Post-menopause ```
87
What are the radiographic changes of OA?
Joint space narrowing Osteophytes Subchondral cysts Sclerosis
88
What are the symptoms of OA?
Pain (exertional/rest/night) Disability: walking distance/stairs/giving way Deformity
89
What comprises a limb assessment?
Look Feel Move Special tests
90
What is the conservative management of OA?
``` Analgesics Physiotherapy Walking aids Avoidance of exacerbating activity Injections (steroid/viscosupplementation) ```
91
What are the interventions for OA?
``` Replace (knee/hip) Realign (knee/big toe) Excise (toe) Fuse (big toe) Synovectomy (Rheumatoid) Denervate (wrist) ```
92
What are the main features of osteomyelitis?
``` Acute or chronic Primary or secondary Pain/swelling/discharge Systemic signs: Fevers, sweats wt loss ```
93
What are the main features of septic arthritis?
Pain Joint swelling/stiffness Fevers, sweats, wt loss
94
What causes septic arthritis?
Bacterial infection of a joint (usually caused by spread from the blood)
95
What are the risk factors of septic arthritis?
Immunosuppressed, pre-existing joint damage, intravenous drug use (IVDU)
96
Why is septic arthritis a medical emergency?
Untreated, septic arthritis can rapidly destroy a joint
97
In who should you consider septic arthritis?
Consider septic arthritis in any patient with an acute painful, red, hot, swelling of a joint, especially if there is fever
98
How is septic arthritis diagnosed?
Diagnosis is by joint aspiration. Send sample for urgent Gram stain and culture
99
What commonly is responsible for septic arthritis?
Staphylococcus aureus, Streptococci, Gonococcus
100
What is the treatment for septic arthritis?
Treatment is with surgical wash-out (‘lavage’) and intravenous antibiotics Immobilise joint in acute phase Physiotherapy once over acute phase
101
What investigations are done with bone infection?
``` Plain films MRI scans: bony architecture/collections CT if MRI not available Bone scans: multifocal disease Labelled White cell scans ``` CRP: acute marker ESR slower response WCC TB culture/PCR
102
What are the treatments for osteomyelitis?
Immobilise joint in acute phase | Physiotherapy once over acute phase

Year 2 MSK (9 decks)

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