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BRS Y2 > Management of Specific Fractures > Flashcards

Management of Specific Fractures Flashcards

1
Q

What type of tissue is bone?

A

A specialised form of connective tissue

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2
Q

What are some of the main functions of bone?

A

Support
Protection
Locomotion
Haematopoiesis- reservoir of stem cells for RBC formation
Lipid and mineral storage- particularly calcium

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3
Q

What are the 3 regions of bone and where are they found?

A

Epiphysis (next to the metaphysis at the top and bottom of the bone)
Metaphysis (next to the diaphysis)
Diaphysis (in the middle of the bone)

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4
Q

What type of bone is found in the epiphysis?

A

Cancellous (spongy) bone

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5
Q

What type of bone is found in the cortex?

A

Cortical (compact) bone

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6
Q

What layer surround the bone?

A

Periosteum

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7
Q

What is the periosteum and why is it important?

A

It is the outermost layer that surrounds the bone, it is important as its involved with the blood supply to cancellous bone

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8
Q

What is the role of flat bones?

A

To protect organs

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9
Q

What is the role of long bones?

A

Facilitate movement

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10
Q

What is the role of short bones?

A

Provide stability and movement by articulation

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11
Q

What is special about short bones?

A

They don’t have a diaphysis

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12
Q

Where are sesamoid bones found?

A

Embedded in tendon

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13
Q

What are the types of bone?

A 
Flat
Long
Short
Sesamoid
Irregular
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14
Q

What are the 2 forms of bone?

A

Woven

Lamellar

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15
Q

What type of bone is formed first?

A

Woven

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16
Q

Describe woven bone

A

A temporary structure with random arrangements of collagen

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17
Q

Describe lamellar bone

A

Has a stronger and more regular structure than woven bone

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18
Q

What is the role of ECM in bone?

A

Provides biochemical and mechanical support

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19
Q

What does ECM in bone contain?

A

Collagen type 1 and 5 (90% type 1)

Mineral salts

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20
Q

What are the cellular components of bone?

A

Osteoblasts
Osteocytes
Osteoclasts
Osteoprogenitor stem cells

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21
Q

What is the role of osteoblasts in bone?

A

Synthesis of uncalcified ECM

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22
Q

What is the role of osteoclasts in bone?

A

Resorb bone

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23
Q

What is special about osteoclasts?

A

One of the few multinucleated cells in the body

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24
Q

What are bone stem cells called?

A

Osteoprogenitor cells

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25
Q

What are the 2 methods of bone formation?

A

Endochondral

Intramembranous

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26
Q

Compare the blood supply of bone to cartilage

A

Blood supply to bone is a lot richer

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27
Q

Describe endochondral ossification briefly

A

Bone development from hyaline cartilage

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28
Q

Describe intramembranous ossification briefly

A

Formation of bone directly onto fibrous tissue (bone development from fibrous membrane)

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29
Q

What state are bones constantly in?

A

A state of remodelling

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30
Q

What is the role of osteoclasts? Why are they needed?

A

Bone removal, this is needed as it increases calcium levels in the body

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31
Q

What is the role of osteoblasts?

A

Bone synthesis

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32
Q

How are osteoblasts activated?

A

They have receptors for PTH, prostaglandins, vitamin D and cytokines that activate the process of bone sythesis

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33
Q

What is Wolff’s law?

A

Bone adapts to forces placed upon it by remodelling and growing in response to these external stimuli

34
Q

What is osteoporosis?

A

Reduced bone density

35
Q

What is rickets/osteomalacia? What is the difference between them?

A

Low vitamin D
Rickets is what its called in children
Osteomalacia is what its called in adults

36
Q

Define fracture

A

A discontinuity in the bone

37
Q

What are the 4 ways fractures are desribed?

A

Orientation
Location
Displacement
Skin penetration

38
Q

What are the possible orientations of fractures?

A

Transverse
Oblique
Spiral
Comminuted

39
Q

What are the possible locations of fractures?

A

Epi/meta/diaphysis

ie position on the bone

40
Q

What are the possible displacement categories of fractures?

A

Displaced

Undisplaced

41
Q

What are the possible skin penetration categories of fractures?

A

Open

Closed

42
Q

What does AO/OTA classification of fractures involve?

A

It considers the bone, where the fracture is, the type and the subgroup

43
Q

Describe primary bone healing

A

Intramembranous healing that occurs via Haversian remodelling, which is when osteoblasts and osteoclasts co ordinate to heal via a cutter cone model

44
Q

What gap size allows primary bone healing?

A

Little (<500 mm) or no gap

45
Q

Describe secondary bone healing

A

Involves responses in periosteum and external soft tissue
A fast process resulting in callous formation made of fibrocartilage
The 4 steps are:
Haematoma formation
Soft callous formation
Hard callous formation
Remodelling

46
Q

How is a haematoma formed in secondary bone healing?

A

Damaged blood vessels bleed

Neutrophils release cytokines signaling macrophage recruitment

47
Q

How does a soft callous form in secondary bone healing?

A

Collagen and fibrocartilage bridge the fracture site and new blood vessels form

48
Q

How does a hard callous form in secondary bone healing?

A

Osteoblasts, brought in by new blood vessels, mineralise the fibrocartilage to produce woven bone

49
Q

What does remodelling involve in secondary bone healing?

A

Osteoclasts are removed and woven bone deposited then months to years after injury osteoclasts remove woven bone and osteoblasts laid down as ordered lamellar bone

50
Q

What are the 3 main things fracture healing requires?

A

A very small fracture gap
Almost no movement if primary healing, some movement if secondary
Patients physiological state to be optimised

51
Q

What is the difference in healing time for upper vs lower limb fractures?

A

Lower limb fractures take twice as long to heal as upper limb fractures

52
Q

What is the difference in healing time for children vs adults?

A

Paediatric fractures heal twice as fast as adults

53
Q

What is non union?

A

Failure of bone healing within an expected time frame

54
Q

What are the 2 types of non union and how are they different?

A 
Atrophic= healing completely stopped with no x ray changes, often physiological (smokers, diabetics, delayed presentation)
Hypertrophic= too much movement causing callus healing
55
Q

What is malunion?

A

Bone healing occurs but outside the normal parameters of alignment

56
Q

What is the main difference between malunion and non union

A

In non union the bone doesnt heal and the 2 parts are not touching
In maunion the 2 parts touch but they are misalinged and they have healed

57
Q

What are the 4 steps in management of a fracture?

A

Resuscitate
Reduce
Rest
Rehabilitation

58
Q

What are the 2 main methods by which fractures can be managed?

A

Conservative

Surgical

59
Q

What does conservative management of fractures involve?

A

First= rest, ice, elevation
Second=plaster/fibreglass cast or splint
Third= traction via skin or bone

60
Q

What does surgical management of fractures involve?

A

MUA and K-wire- extra cortical
ORIF= open reduction internal fixation- extra cortical
IM nail= intermedullary nail intra cortical
External fixation- mono or bi planar (can’t close the defect at the time of the procedure)

61
Q

When is MUA and K wire useful in fracture management?

A

Good in kids as they have very thick periosteum and later the wires can be pulled out

62
Q

When is IM nail useful in fracture management?

A

Good for long fractures

63
Q

When is external fixation useful in fracture management?

A

If you can’t close the defect at the time of the procedure

64
Q

What most commonly causes shoulder dislocation?

A

Trauma

65
Q

What is important to consider when there is a shoulder dislocation?

A

Check if there is axillary nerve damage as the brachial plexus near the shoulder

66
Q

What are the 3 types of shoulder joint dislocation? Which is most common?

A 
Anterior= most common, when the humeral head is not overlying the glenoid fossa
Posterior= associated with seizures or shocks, lightbulb sign is seen
Inferior= arm is held above the head and the humeral head is not articulating
67
Q

What is the main method for treating shoulder dislocation?

A

Safest method is to use traction-counter traction +/- gentle internal rotation to disimpact humeral head

68
Q

In shoulder dislocation what is Hill Sach’s defect?

A

Top of humeral head is hit on the glenoid as its dislocated

69
Q

In shoulder dislocation what is Bankart lesion?

A

Damage to the labrum and/or glenoid, can be soft or bony

70
Q

Typically who gets fracture of the proximal humerus?

A

Those with osteoporosis or the elderly

71
Q

How is proximal humerus fracture managed?

A

Collar and cuff if the fracture is 2 parts

If more can do an ORIF

72
Q

What physical action commonly causes a fracture of the proximal humerus?

A

Falling onto an outstretched hand

73
Q

What are the 2 types of distal radius fracture?

A

Extra and intra articular

74
Q

What are the 2 angulations possible in distal radius fractures?

A

Dorsal

Volar

75
Q

Why is it important to look out for carpal fractures?

A

Missing them can result in loss of wrist function as blood supply may become compromised

76
Q

What results in fractures when blood supply is lost?

A

Avascular necrosis

77
Q

What is the commonest carpal bone fracture?

A

Fracture of the scaphoid bone

78
Q

When should scaphoid bone fracture be considered?

A

In any distal radial injury but it commonly occurs because of a fall backwards onto the hand

79
Q

How are fractures of the scaphoid managed?

A

If undisplaced conservative management in a cast is sufficient
If displaced ORIF is usually undertaken

80
Q

How does dislocation of the lunate bone usually arise?

A

Progressive disruption to the ligament

BRS Y2 (85 decks)

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