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Musculoskeletal and Rheumatology > Lecture 3: Injury and healing > Flashcards

Lecture 3: Injury and healing Flashcards

1
Q

What are the 3 mechanisms of bone fracture?

A
  • trauma (low energy, high energy)
  • stress (abnormal stresses on normal bone)
  • pathological (normal stresses on abnormal bone)
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2
Q

What are the different types of fracture patterns?

A

SOFT TISSUE INTEGRITY - open or closed
BONY FRAGMENTS - greenstick, simple or comminuted
DISPLACEMENT - displaced or undisplaced

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3
Q

What is an open fracture?

A

bone has broken through skin

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4
Q

What is a closed fracture?

A

skin is not broken

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5
Q

What is a displaced fracture?

A

bone breaks into 2 or more pieces and moves out of alignment

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6
Q

What is a non-displaced/undisplaced fracture?

A

bone breaks but doesn’t move out of alignment

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7
Q

What is a greenstick fracture?

A

an incomplete fracture in which the bone is bent, occurs most often in children

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8
Q

What is a simple fracture?

A

a fracture of the bone only, without damage to the surrounding tissues or breaking of the skin.

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9
Q

What is a comminuted fracture?

A

bone breaks into several pieces

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10
Q

What is an example of high energy trauma?

A

car crash

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11
Q

What is an example of low energy trauma?

A

falling down

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12
Q

How can stress lead to stress fractures?

A
  • stress exerted on bone is greater than bones capacity to remodel
  • bone weakening
  • stress fracture
  • risk of complete fracture
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13
Q

3 examples of weight-baring bones?

A
  • tibia
  • metatarsals
  • navicular
    related to athletes, occupation, military, female athlete triad
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14
Q

What are the 3 components of the female athlete triad?

A
  • disordered eating
  • amenorrhea
  • osteoporosis
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15
Q

What are some pathological disorders affecting bones?

A
  • osteoporosis
  • malignancy (cancer)
  • vitamin D deficiency
  • osteomyelitis
  • osteogenesis imperfecta
  • Paget’s disease
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16
Q

What is osteopenia?

A

a medical condition in which the protein and mineral content of bone tissue is reduced, but less severely than in osteoporosis.

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17
Q

What is osteoporosis?

A

a medical condition in which the bones become brittle and fragile from loss of tissue, typically as a result of hormonal changes, or deficiency of calcium or vitamin D.

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18
Q

What causes a disrupted microarchitecture in bone?

A

if osteoclast activity > osteoblast activity

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19
Q

Is osteoporosis more common in males or females?

A

females

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20
Q

Who can get postmenopausal osteoporosis?

A

women aged 50 - 70

21
Q

Who can get senile osteoporosis?

A

people aged over 70

22
Q

What is secondary osteoporosis and who can get it?

A

osteoporosis that is a result of hypogonadism, glucocorticoid excess, alcoholism etc. (due to secondary factors)
can happen to anyone at any age, 60% males

23
Q

What is osteopenia and osteoporosis associated with?

A

fragility fractures - hip, spine, wrist (where low energy trauma can lead to fractures)

24
Q

What primary malignant tumour metastasize to bone?

A
  • prostate (blastic - fill bone with extra cells)
  • breast (blastic or lytic)
  • kidney (lytic - destroy bone material)
  • thyroid (lytic)
  • lung (lytic)
25
Q

Name some primary bone cancers?

A
  • osteosarcoma
  • chondrosarcoma
  • Ewing sarcoma
  • chordoma
26
Q

5 causes of vit D deficiency?

A
  1. malabsorption or insufficient diet
  2. inadequate sun exposure
  3. liver disease
  4. renal disease
  5. receptor defects
27
Q

What does vit D deficiency cause in children?

A

Rickets (bowing of legs) - before physis closure

28
Q

What does vit D deficiency cause in adults?

A

osteomalacia - after physis closure, weaker bones

29
Q

What is osteogenesis imperfecta?

A

‘brittle bone disease’
hereditary - autosomal dominant or recessive
- decreased type 1 collagen due to –> decreased secretion, production of abnormal collagen
- results in insufficient osteoid production
- effects: bones, hearing, heart, sight

30
Q

What is Paget’s disease?

A
  • aetiology: genetic + acquired factors
  • excessive bone break down and disorganised remodelling –> deformity, pain, fracture or arthritis
  • may transform into malignant disease
  • 4 stages: (1) osteoclastic activity, (2) mixed osteoclastic-osteoblastic activity, (3) osteoblastic activity, (4) malignant degeneration
31
Q

What is Wolff’s law?

A

bone grows and remodels in response to forces that are placed on it

32
Q

What are the stages of fracture healing?

A

WEEK 1: haematoma formation, release of cytokines and granulation tissue
WEEKS 2-4/1-4 MONTHS: soft callus formation (type II collagen - cartilage), converted to hard callus (type I collagen - bone)
4-12 MONTHS: callus responds to activity, external forces, functional demands and growth, excess bone is removed

33
Q

What is primary bone healing?

A

intermembranous healing, absolute stability (involves a direct attempt by the cortex to re-establish itself after interruption without the formation of a fracture callus) might involve plate and screws

34
Q

What is secondary bone healing?

A
  • endochondral healing
  • involves responses in the periosteum and external soft tissues
  • relative stability
    (involves the classical stages of injury, haemorrhage inflammation, primary soft callus formation, callus mineralization, and callus remodelling)
35
Q

Outline fracture healing times?

A 
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
36
Q

What are the 3 stages of fracture management?

A
  • reduce
  • hold
  • rehabilitate
37
Q

What is reduction in fracture management?

A

realignment of the bone to prevent deformities
OPEN: surgical incision made to expose fragments and put them back in proper position (can be mini or full exposure)
CLOSED: displaced or fractured bone fragments are manipulated back into proper position or alignment w/o surgically exposing them (manipulation or traction which can be skin e.g. cast/bandaging or skeletal e.g. pins in bones)

38
Q

What is the hold phase of fracture management?

A

choosing how to hold the fracture - if it’s closed then use plaster or traction (skin or skeletal - pins in bones)
might need fixation

39
Q

What is fixation in fracture management?

A

stabilizing the fractured bone
can be:
- external: metal outside skin (can be monoplanar or multiplanar)
- internal: metal underneath skin
Internal can be:
- intramedullary: into canal of bone (pins and nails)
- extramedullary: into surface of bone (plates/screws and pins)

40
Q

What is the rehabilitate phase of fracture management?

A
  • use (pain relief, retrain)
  • move
  • strengthen
  • weight-bear
    to reverse effects of muscular atrophy
41
Q

What needs to be considered in fracture management?

A
  • is the fracture displaced?
  • is it stable? (soft tissues OK?, other illnesses?)
    or
  • is it at a joint surface? (what does the patient think)
42
Q

What is soft tissue injury?

A

INJURY TO:
muscle - force and motion
ligament - connect bone to bone
tendon - connect muscle to bone

43
Q

What is tendinopathy?

A

pathologies of the tendon

  • tendinosis (abnormal thickening)
  • tendinitis (inflammation)
  • rupture
44
Q

Ligament injury classifications?

A

Grade I - slight incomplete tear - no notable joint instability
Grade II - moderate/severe incomplete tear - some joint instability, one ligament may be completely torn
Grade III - complete tearing of 1 or more ligaments, obvious instability, surgery usually required

45
Q

What are the phases of ligament healing?

A
  • inflammatory phase, 1-7 days, fibrin clot formed in ligament tears
  • proliferation phase, 7-21 days, tendons and ligaments weakest, tensile strength builds
  • remodelling, >14 days, tendons and ligaments heal with scar tissue that reduces ultimate strength causes adhesions
  • maturation, weeks to years, max. strength reached within a year
46
Q

What factors affect tissue healing?

A
  • mechanical environment - movement, forces

- biological environment - blood supply, immune function (autoimmune conditions), infection, nutrition

47
Q

What are the effects of immobilisation on injured ligamentous tissue?

A

GOOD - less ligament laxity (lengthening)
BAD:
- less overall strength of ligament repair scar
- protein degradation exceeds protein synthesis (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)

48
Q

What are the benefits of mobilisation (movement) on injured ligamentous tissue?

A
  • ligament scars are wider, stronger and more elastic

- better alignment/quality of collagen

Musculoskeletal and Rheumatology (5 decks)

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