Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 2 > Management Of Fractures And Soft Tissue Injuries > Flashcards

Management Of Fractures And Soft Tissue Injuries Flashcards

1
Q

What is a fracture?

A

A break in the bone or cartilage continuity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the clinical presentation of a fracture?

A

Pain, loss of function, swelling, abnormal motion, deformity and tenderness.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How are fractures diagnosed?

A

X-Rays are the first point of imaging however they have low resolution so can lack enough detail for confirmation of fractures.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What can be used for high specificity bone imaging?

A

Radioactive tracers
MRI scan
CT scan
Special views

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How can MRI be used in bone imaging?

A

Provided high resolution of the physical appearance of bones and soft tissue such as cartilage and tendons. This would be ideal for oedema, inflammation, degenerative bone disease and bone marrow tumours. It is expensive and time consuming so it is reserved for important procedures.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How can radioactive tracers be used in bone imaging?

A

Ingestion of a radioactive isotope collects in bone tissue at sites of abnormalities called hot spots, emitting gamma radiation.. This is a useful indicator for tumours or arthritis, bone infection or fracture.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How can CT scans be used in bone imaging?

A

3D X-Ray imaging for providing higher resolution of the bones and soft tissues and joints for fractures or other abnormalities such as misalignment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the types of bone fractures?

A

Classified based on being
Open/closed
Angle of fracture: transverse, oblique, longitudinal and commisure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is an open fracture?

A

Pierces through the skin and poses an infection risk.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is a closed fracture?

A

Fracture to bone does not cause the bone to pierce skin however, there is still a soft tissue injury risk.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How does a spiral fracture occur?

A

Due to a torsional/rotational force on the bone.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is a comminuted fracture?

A

Causes a singular bone to break into 2 or more fragments.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is angularation of bone?

A

Deviation of the normal alignment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is an avulsion fracture?

A

Part of the bone breaks off from the main mass because
1) forceful contraction of muscle occurs
2) ligament is stretched in the opposite direction of the force

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is a partial vs complete fracture?

A

Partial break in the bone
Complete separates the bone into two fragments and is a transverse break.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is a displaced fracture?

A

Gap between broken ends of bone which requires surgery to correct and move into place.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is a stable fracture?

A

Fracture of the 2 bone fragments line up.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is a compression fracture?

A

Compressive forces from trauma or gravity causes bones (especially osteoporotic) to collapse and jam together in the vertebrae of elderly people, typically exacerbated by bone degenerative diseases.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is osteomalacia?

A

Deficiency in Vitamin D due to inadequate sun exposure or malnutrition results in breakdown of bone, typically treated with Vitamin D supplementation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is osteogenesis imperfecta?

A

Congenital condition where bones are prone to fracture, and have difficulty building mass caused by mutation in collagen genes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is scurvy?

A

Severe malnutrition of Vitamin C; this is important for building collagen matrix of bones by osteoblasts.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is osteomalacia?

A

Vitamin D deficiency results in a low bone mass that increases fracture incidence, known as Ricket’s in children. There is high PTH and ALP to compensate for low Ca2+ and Phosphate. It causes build up of non-mineralised osteoid.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is Paget’s disease?

A

Structural disorganisation of bone where they are LARGE and WEAK with UNKNOWN CAUSE, and causes bowing of the legs. Typically affects the skull, lumbar vertebrae and the pelvis and femur. This typically occurs after measles infection or genetic mutation. There is high level of ALP but normal calcium, phosphate and PTH

->Includes an initial lytic phase, mixed phase of lysis and building bone and the sclerotic phase where new bone formation occurs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are stress fractures?

A

Minuscule breaks in the same bone by low intensity forced accumulate over time, commonly in athletes which are difficult to view on X-Rays.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is an impaction fracture?

A

Bones are compressed by forces and crumble under the weight of compression. Children are more prone to this injury because of their growth plate remaining present.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How is bone formation regulated?

A

Osteoblasts secrete the signalling factor RANKL which binds to the receptor on osteoclasts for initiating bone resorption. Eventually, osteoblasts will release OPG that binds to RANKL and blocks binding of APG. Osteoclasts secrete an osteoid seam formed mainly of collagen which enables calcium and phosphate binding for formation of bone matrix.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How does fracture healing occur?

A

Inflammatory phase

Haemotoma formation

Reparative phase: Fibrocartilagenous callus of granular tissue forms between the fracture space. This converts into a bony callus - which eventually becomes remodelled by osteoblasts into compact bone.

Remodelling phase: occurs over several years with angularation being correctly realigned when epiphyses realign.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is an important distinction between a soft and hard callus?

A

Soft callus cannot withstand external forces therefore, support of the bone using splints or a cast is essential for the transition to the hard callus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Where does callus formation occur typically on bone?

A

Endosteum and periosteum.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is osseous metaplasia?

A

Conversion of soft tissue into osseous bone in remodelling.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Which bones does callus formation not occur?

A

Areas of periosteum deficiency in the Skull and femur neck because callus typically form in those bone zones.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

When do fractures become easier to visualise radiographically?

A

After 10 days.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

When does a callus form in remodelling?

A

After 3 weeks, the soft tissue swelling regresses and the callus forms initially.

34
Q

How long does it take for bone to consolidate after injury?

A

For short bones: 2 months
For long bones: 4 months

35
Q

Which factors increase rate of bone healing?

A

Oblique fracture
Exercise
Childhood due to growth hormone
Metaphyseal fracture: recruits more mesenchymal stem cells than the diaphysis

36
Q

Why does delayed union occur?

A

Inadequate blood supply reduced the time for the fractured regions to rejoin.

37
Q

Why does malunion occur?

A

Malunion is when the bones heal in an abnormal position because of a residual deformity. This can be healing process begins before bones can be set or osteomyelitis and when this occurs near joints, result in pseudoarthritis. This can typically occur when complex fractures points or at an angle

38
Q

What are the risk factors for malunion?

A

Obesity, diabetes and smoking.

39
Q

Which fracture type is common in children?

A

Greenstick fractures- angulated fractures of the long bone which creates a bowing appearance because children have more softer and fragile bones.

40
Q

What is a Torus fracture?

A

Most common fracture in children by FOOSH
-> Incomplete compression fracture in the long bones of children which creates bowing appearance.

41
Q

Why is it difficult to image fractures in children?

A

Epiphyseal growth plates present in children are difficult to distinguish fractures.

42
Q

What factors decrease rate of bone healing?

A

Hyperthyroidism, corticosteroids, inadequate blood supply, chronic hypoxia and transverse fracture.

43
Q

What is a type 1 fracture in children?

A

Fracture in the epiphyseal growth plate.

44
Q

What is a type 2 fracture in children?

A

Fracture in the epiphyseal growth plate extending into the metaphysis.

45
Q

What is a type 3 fracture in children?

A

Fracture in the epiphyseal growth plate affecting the epiphysis articular surface.

46
Q

What is a type 4 fracture in children?

A

Fracture in the epiphyseal growth plate which causes metaphysis fracture.

47
Q

What is a type 5 fracture in children?

A

Fracture of the epiphyseal growth plate due to a crushing compressive force.

48
Q

What is the most common fracture type in children?

A

Type 2 fracture: epiphyseal fracture extending into the metaphysis in Torus

49
Q

How can fracture lines be visible in an X-Ray?

A

After 7-10 days when the fracture is parallel to the x-ray beam. It is delayed because it takes time for the margins of the fractures to absorb.

50
Q

How is an X-Ray of long bone performed?

A

Along the entire length of the bone, two images perpendicular to each other with an oblique view.

51
Q

What is the risk with open fractures?

A

Osteomyelitis which canbe reduced with debridement and irrigation.

52
Q

When do vascular injuries occur in bone fractures?

A

Popliteal artery is at risk in a tibia/femur fracture or knee dislocation.

This can lead to haemorrhage and severe blood loss. The limb should be examined for ischaemia using the 5 P’s.

53
Q

What nerve injury is caused by bone injury?

A

Blunt or penetrating trauma which can affect sensation and movement control. Two-point discrimination is useful for determining the nerve abnormalities.

54
Q

What is neuropraxia?

A

Mild nerve injury where there is compression of the myelin sheath, producing a tingling sensation and normal function returns in weeks to months.

55
Q

What is axonotmesis?

A

Nerve injury where compression of the myelin sheath occurs and axon degeneration, disrupting the transmission of action potentials. There may be slow spontaneous healing.

56
Q

What is neurotmesis?

A

Severe nerve injury where the degeneration of axon and synaptic terminals occur along with disintegration of the myelin sheath. This results in complete loss of peripheral sensation and motor function and requires surgical repair.

57
Q

What is compartment syndrome?

A

Typically occurs in the legs or forearm where acute muscle pain occurs after fracture.

Trauma from a bone fracture causes inflammation during repair which increases pressure of the muscular compartment. This results in reduced blood supply to the muscle tissue and results in reduced venous return, resulting in oedema. Ischaemia to the region results in rhabdomylosis, increasing creatine kinase levels in the blood. Increasing urinary output to relieve pressure is an important management.

58
Q

What is avascular necrosis?

A

Death of bone tissue due to lack of blood supply. Femoral head, scaphoid, talus, capitate and lunate bone are vulnerable.

59
Q

What is complex regional pain syndrome?

A

Following a fracture, excessive pain in an area extending beyond the peripheral nerve sensation. This can occur due to pro-inflammatory cytokines such as TNF- alpha, IL-2 and IL-6, bradykinin and substance P which increase central sensitisation. Associated with allodynia and hyperalgesia.

60
Q

What is fat embolism?

A

Commonly occurs after an injury in the pelvis or long bone of femur which releases adipose tissue stored in the yellow marrow. These occlude the lung parenchyma and peripheral circulation.

61
Q

What is a fracture blister?

A

Blisters due to fractures in areas of the bod with little skin, such as elbow, ankle, foot and knee.

Immobilisation of the limb increases DVT and pulmonary embolism. Reduced exercise weakens muscles, causing atrophy and the muscles of respiration, causing more mucus and pathogen build up and resulting in pneumonia. Decreased bladder emptying increases UTI risk.

62
Q

What is subluxation?

A

Partial loss of continuity/dislocation in the joint articulation.

63
Q

What is dislocation?

A

Complete loss of continuity in the joint articular surfaces.

64
Q

What is associated with dislocation?

A

Severe pain, deformity, recurrent dislocations, neuromuscular injury and soft tissue injury.

65
Q

How is dislocation managed?

A

Analgesia and relocating the joint as soon as possible to avoid the difficulties with muscle swelling and spasming.

66
Q

What are sprains?

A

Injury to the supporting fibres of the ligament.

67
Q

How are sprains managed?

A

Ice to reduce pain and swelling
Elevation to reduce swelling
Immobilisation to prevent further injury using a splint
NSAIDS

-> Sprains are typically viewed using an ultrasound.

68
Q

What is tendinitis?

A

Inflammation of the tendon due to the overuse of the muscles, typically the rotator cuff, Achilles tendon, elbow point and radial side of wrist. Rest, iceing and NSAID use is recommended and rehabilitation exercise.

69
Q

What is bursitis?

A

Inflammation of the bursa due to infection or fractural injury, typically in the subacromial region, greater trochanter of femur, olecranon and prepatellar bursa.

70
Q

How are orthopaedic injuries managed ?

A

ABCDE: airways, breathing, circulation, disability, exposure.
Wound management, immobilisation with a cast, surgery
Assessing neuromuscular status and range of movements.

71
Q

What are the 5 P’s?

A

Pain, pallor, paraesthesia, paralysis, pulselessness.

72
Q

What is Osteomyelitis?

A

Inflammation of the bone due to inflammation by staphylococcus aureus via bone fracture site or the bloodstream. It results in pus formation, necrosis of bone cells primarily in the long bones at the epiphysis.

73
Q

What is a Colles fracture?

A

Fall on an outstretched hand which causes fracture to the distal radius and posterior displacement.

74
Q

What are the risk factors for osteoporosis?

A

Underweight
Over 50/post menopausal
Endocrine disorders such as diabetes, hyperthyroidism and growth hormone deficiency

75
Q

Which medications worsen osteoporosis?

A

Anti-epileptics
Long-term unfractionated heparin therapy
SSRIs for depression
Proton pump inhibitors

76
Q

Which medications worsen osteoporosis?

A

Anti-epileptics
Long-term unfractionated heparin therapy
SSRIs for depression
Proton pump inhibitors

77
Q

How are osteoclasts activated?

A

Osteoclasts precursors contain RANKL ligand on their surface and require T cell coactivation to free the NAFKb gene transcriptor for pre-osteoblast -> osteoclast. This process is stimulated by IL-6.

78
Q

How does primary hyperparathyroidism present?

A

Asymptomatic but may have symptoms of hypercalcaemia such as twitching, renal stones and fatigue.

Caused by Excess secretion of PTH with high ALP, low phosphate and high calcium.

79
Q

How does secondary hyperparathyoridism present?

A
80
Q

What is the bone profile of osteoporosis?

A

Normal calcium, phosphate, ALP and pTH

81
Q

How does a neck of the femur fracture present?

A

Leg is shortened and externally rotated.

Year 2 (247 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions