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1B Musculoskeletal > Management of specific fractures > Flashcards

Management of specific fractures Flashcards

1
Q

what are the functions of bone?

A

support

protection

locomotion

hematopoiesis

lipid and mineral reservoir (particularly calcium)

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2
Q

what are the types of bones?

A

flat bone

long bones

irregular bones

short bones

sesamoid bones

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3
Q

what are the functions of flat bones and examples

A

protect internal organs

skull, thoracic cage, sternum, scapula

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4
Q

what are the functions of long bones and examples?

A

support and facilitate movement

humerus, radius, ulna, metacarpals

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5
Q

what is the function of irregular bones?

A

vary in shape and structure

e,g vertebrae, sacrum, pelvis, pubic, ilium or ischium

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6
Q

what are the features of short bones?

A

no diaphysis

as wide as they are long

provide stability and some movement

e.g carpals, tarsals

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7
Q

what are the functions of sesamoid bones?

A

embedded within tendons

potentially to protect tendons from stress or wear

e.g patella

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8
Q

what is the overall anatomy of bone?

A
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9
Q

what do bones have on the outside layer?

A

periosteum- provides blood and nutrition

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10
Q

what are the overall types of bones that can be formed?

A

woven (primary) bone

lamellar (secondary) bone

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11
Q

what is woven bone?

A

first type of bone to be formed- in embryonic development and fracture healing

consists of osteoid, randomly arranged collagen fibres

temporary structure replaced by mature lamellar bone

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12
Q

what is lamellar bone?

A

bone of adult skelton

highly organized sheets of mineralized osteoid, making it much stronger than woven bone

two types (compact and spongy)

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13
Q

what is the extracellular matrix bone function?

A

biomechanical and structural support

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14
Q

what does the extracellular matrix of bone contain?

A

collagen- type 1 (90%) abd type V

mineral salts- calcium hydroxyapatite

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15
Q

what is ECM initially called?

A

osteon

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16
Q

how does calcification occur?

A

mineral salts interpose between collagen fibres

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17
Q

what do osteoblasts do?

A

synthesise undifferentiated ECM

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18
Q

what are osteocytes?

A

osteoblasts entuned in bone

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19
Q

what are osteoclasts?

A

from monocytes

reabsorb bone

multinucleated cells

release H+ ions and lysosomal enzymes

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20
Q

what are osteoprogenitor cells?

A

undifferentiated stem cells

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21
Q

what is the difference between blood supply to bone and cartilage?

A

bone has a better blood supply

nutrient arteries supplying diaphysis and meta/epiphyseal vessels

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22
Q

how can bone grow?

A

endochondral

intramembranous

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23
Q

what is endochondral growth?

A

formation of bone onto a temporary cartilage scaffold

e.g hyaline cartilage replaced by osteoblasts secreting osteid in femur

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24
Q

what is intramembranous growth?

A

formation of bone directly onto fibrous connective tissue

e.g. temporal bone or scapula

provides width to bones

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25
Q

what is bone removal undertaken by?

A

osteoclasts

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26
Q

why is osteoclast action necessary?

A

essential bone removal for body’s metabolism as removal of bone increases calcium in blood

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27
Q

what is bone production done by?

A

osteoblasts

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28
Q
A
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29
Q

how do osteoblasts synthesis new bone?

A

have receptors from PTH, prostaglandins, vit D and cytokine

activate and allow them to synthesise bone matrix

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30
Q

what does the coordinated action of osteoblasts and osteoclasts do?

A

take place as cutting cones that essentially drill through old bone

31
Q

what do osteoblasts and osteocytes do in coordination?

A

lay down concentric lamellae and form osteons

32
Q

what occurs in osteoporosis?

A

decrease in bone density, reducing structural integrity

osteoclast > osteoblast activity

increased risk fragility fracture

3 types: postmenopausal, senile, seondary

33
Q

what happens in rickets/osteomalacia?

A

vit D or calcium deficiency in children (rickets) or adults (osteomalacia)

osteoid mineralizes poorly and remains pliable

in rickets= epiphyseal growth plates can become distorted under weight of the body

in osteomalacia= increased risk of fracture

34
Q

what is osteogenesis imperfecta?

A

abnormal collagen synthesis

increased fragility of bones, bone deformities and blue sclera

rare, genetic autosomal dominant inheritence

can be mistaken as NAD in children

35
Q

what is a fracture?

A

discontinuity of bone

36
Q

what can the orientation of fracture be?

A

transverse

oblique

spiral

comminuted

37
Q

what are the locations that a fracture can be on the bone?

A
38
Q

what can the displacement be on a fracture?

A

displaced

undisplaced

39
Q

what can the skin penetration be on a fracture?

A

open or closed

40
Q

what are the types of fracture healing?

A

primary/ direct

secondary/ indirect

41
Q

what is the process of primary bone healing?

A

cutter cone concept- line bone remodeling

intramembranous healing, occurs via Haversian remodeling

little or not gap (no movement)

slow process

42
Q

what is the process of secondary bone healing?

A

endochondral healing, involved responses in the periosteum and external soft tissues

fast process resulting in callus formation (fibrocartilage)

  1. Haematoma formation
  2. soft callus formation
  3. hard callus formaiton
  4. remodelling
43
Q

what happens in haematoma formation in bone healing?

A

damaged blood vessels bleed forming a hematoma

neutrophils release cytokines signalling macrophage recruitment

44
Q

what happens during soft callus formation?

A

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

45
Q

what happens during hard callus formation?

A

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

46
Q

what happens during remodelling in bone healing

A

months to years after injury

osteoclasts remove woven bone and osteoblasts laid down as ordered lamellar bone

47
Q

what are the pre-requisites for bone healing?

A
  • minimal fracture gap
  • no movement if direct (primary) bone healing or some movement if indirect bone dealing
  • patient physiological state- nutrients, growth factors, age, diabetic, smoker
48
Q

what is the time frame for bone healing?

A

about 6 months

lower limb fractures twice as long as upper to heal

paediatric heal twice as quickly

49
Q

what law is bone remodelling determined by?

A

Wolff’s law

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

50
Q

what is done if the femur heals bent in a child?

A

axial loading should be direct

with remodeling occurring through axial loading

periosteum on the concave side will make more bone while on the convex side will be reabsorbed

this causes it to straighten

51
Q

what are the fracture healing complications?

A

non union and malunion

52
Q

what is non-union?

A

failure of bone healing within an expected time frame

53
Q

what are the types of non-union healing?

A

atrophic- healing completely stopped with no XR changes, often physiological

oligotrophic

hypertrophic (horse hoof and elephant foot)- too much movement, causing callus healing

54
Q

what is malunion bone healing?

A

bone healing occurs but outside of normal parameters of alignment

55
Q

what are the key principles of fracture management

A
  1. resuscitate- save patient first
  2. reduce- bring bones back together in acceptable alignment
  3. rest- hold fracture in position
  4. rehabilitate- bring back function and avoid stiffness
56
Q

what are the conservative fracture management procedures?

A

rest, ice, elevate

plaster fibreglass cast/splint

traction-skin/bone

57
Q

what are the surgical fracture management?

A

external fixation- monobiplanar, multiplanar ring

internal fixation- ORIF, IM nail, MUA+ K wire

arthroplasty- hemiarthroplasty, total joint replacement

58
Q

what is the presentation of a shoulder dislocation?

A

variable history but often direct trauma

pain

restricted movement

loss of normal shoulder contour

59
Q

what assessment needs to be done in shoulder dislocation?

A

assess neurovascular status- Auxillary nerve

60
Q

what investigations should be done in shoulder dislocation?

A

X-ray prior to any manipulation- identify fracture e.g humeral neck, greater tuberosity avulsion or glenoid

scapular- Y view/modified axillary in addition to AP

61
Q

what are the types of shoulder dislocation?

A

anterior- commonest, bimodal distribution, humeral head not overlying glenoid

posterior - rare, associated with seizures/shocks, lightbulb sign on XR

inferior- rare, arm held abducted above head, humeral head not articulating correctly

62
Q

what is the management for shoulder dislocation?

A

vigorous manipulation or twisting manipulation should be avoided to avoid fractures

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

ensure adequate patient relaxation

stimson method if alone

same environment esp if elderly- e.g resus

63
Q

what are the complications of a shoulder dislocation?

A

neurovascular

damage to labrum and or glenoid

damage to humeral head

recurrent dislocations

64
Q

when does a neurovascular complcation of shoulder disolcation present?

A

at time of presentation due to trauma sustained e.g axillary nerve

iatrogenic as result of reduction maneuver

delated onset due to evolving haematoma post injury/ manipulation

65
Q

what is the sign of damage to the labrum and/or glenoid?

A

bankart lesion- soft or bony

66
Q

what lesion is created from damage to humeral head?

A

Hi–Sachs lesion

67
Q

what is the trend with recurrent dislocations and age?

A

the younger the patient the greater the risk of repeat dislocations

68
Q

what is the typical presentation for proximal humerus fracture?

A

fall onto an outstretched hand

typically in elderly or those with osteoporosis

69
Q

what are the investigations for proximal humerus fracture?

A

plain XR

CT if concern over articular involvement or high degrees of comminution

70
Q

what are the classifications for proximal humerus fracture?

A

2 part- surgical neck fractures and greater tuberosity fracture

3 part fracture

4 part fracture

71
Q

what is the management for proximal humerus fracture?

A

collar and cuff

ORIF- plate and screws

arthroplasty- humeral head fracture with large displacement (high risk non-union)

reverse arthroplasty- unrepairable rotator cuff, previous unsuccessful shoulder replacement, complex fracture/ chronic shoulder dislocation

72
Q

what is the presentation of distal radius fracture?

A

very common

bimodal distribution

often present with the mechanism of falling on the affected area

swelling and visible deformity

dorsal displacement due to fall on outstretched hand common

73
Q

what are the classification types for distal radius fractures?

A
  1. extra articular
    1. dorsal angulation- colles fracture
    2. volar angulation- smith fracture
  2. intra-articular
    1. dorsal angulation- dorsal barton
    2. volar angulation- volar/reverse barton
74
Q
A

1B Musculoskeletal (7 decks)

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