Injury + Healing Flashcards
What are the 3 mechanisms of bone fracture?
- Trauma
- Stress
- Pathological
What are the 2 main types of trauma fractures?
- Low energy
* High energy
How does a stress fracture occur?
overuse ➡ stress exerted on bone is greater than bones capacity to remodel ➡ bone weakening ➡ stress fracture ➡ risk of complete fracture
What is a stress fracture?
fracture caused by abnormal stresses on normal bone
What is a pathological or insufficiency fracture?
fracture caused by normal stresses on abnormal bone
What are 6 causes of pathological fractures?
- osteoporosis
- paget’s disease
- osteogenesis imperfecta
- vitamin D deficiency
- osteomyelitis
- malignancy
What is the difference between osteopenia + osteoporosis?
- penia = not so severe bone loss, T-score of -1 to -2.5
* porosis = more severe bone loss, T-score of -2.5 or less
What is osteopenia + osteoporosis?
- OC activity > OB activity
- bone microarchitecture is disrupted
- more common in females (F : M , 4 : 1)
What is primary osteoporosis? What is it caused by?
- caused by natural age-related changes to bone
* e.g. postmenopausal or senile
What is secondary osteoporosis? What is it caused by?
- caused by other clinical disorders or conditions
- e.g. hypogonadism, glucocorticoid excess, alcoholism
- more common in males
What is congenital osteogenesis imperfecta?
- hereditary autosomal dominant or recessive disorder
- causes a reduction in Type I Collagen due to:
- Decreased secretion
- Production of abnormal collagen
- results in insufficient osteoid production
What is Paget’s disease?
• excessive bone break down + disorganised remodelling
• leading to deformity,
pain, fracture or arthritis
What are 4 examples of primary bone cancers?
- Osteosarcoma
- Chondrosarcoma
- Ewing sarcoma
- Chordoma
What is secondary bone cancer?
when tumours from other tissue metastasise to bone
What 5 most common tissues to cause secondary bone cancer?
- prostate (blastic)
- breast (blastic + lytic)
- kidney (lytic)
- thyroid (lytic)
- lung (lytic)
What 3 ways in which fractures are patterned or classified?
- soft tissue integrity
- bony fragments
- movement
What are the 2 types of soft tissue integrity fractures?
- open
* closed
What are the 3 types of bony fragment fractures?
- greenstick
- simple
- multifragmentary
What are the 2 types of movement fractures?
- displaced
* undisplaced
What are the general principles of tissue healing? What cells do they involve?
- bleeding (blood)
- inflammation (neutrophils + macrophages)
- new tissue formation (blasts)
- remodelling (macrophages, OCs + OBs)
What does the inflammation phase of fracture healing involve?
- haematoma formation
- release of cytokines
- granulation tissue + blood vessel formation
What does the repair phase of fracture healing involve?
- soft callus formation (Type II collagen - cartilage)
* converts to hard callus (Type I collagen - bone)
What does the remodelling phase of fracture healing involve?
- callus responds to activity, external forces, functional demands + growth
- excess bone is removed
What is Wolff’s Law?
bone grows and remodels in response to the forces that are placed on it
What is primary bone healing?
- Intermembranous healing
* Absolute stability
What is secondary bone healing?
- Endochondral healing
- Involves responses in the periosteum + external soft tissues
- Relative stability
What is the range of fracture healing times?
3-12 weeks
What are the general principles of fracture management?
- Reduce
- Hold
- Rehabilitate
What are the 4 ways in which a fracture can be reduced?
- manipulation (closed)
- traction (closed)
- mini-incision (open)
- full exposure (open)
What is reduction by closed manipulation?
n
What is reduction by closed traction (skin or skeletal)?
m
What are the different types of fracture fixation?
m
What are 4 components of rehabilitation?
o
What are 3 forms of tendinopathy?
Or
How are ligament injuries classified?
See
How are tenden / ligament tears treated?
@a
What are the benefits of immobilization of injured ligamentous tissue?
m
What are the disadvantages of immobilization of injured ligamentous tissue?
g
What are the benefits of mobilization of injured ligamentous tissue?
Woo
What factors of the mechanical environment that affect fracture healing?
Lec
What factors of the biological environment that affect fracture healing?
E
How does Vitamin D deficiency result in fractures?
- vitamin D facilitates calcium, magnesium + phosphate absorption
- inadequate Ca or PO4 = defect in osteoid matrix mineralisation
What does severe Vitamin D deficiency cause in children?
rickets
What does severe Vitamin D deficiency cause in adult?
osteomalacia
