MSK 3: Injury and Healing

Question 1

What are the 3 mechanisms of bone fracture?

Answer 1

Stress
Trauma
Pathological

Question 2

What is the difference between pathological and stress fractures?

Answer 2

Pathological is normal stresses on abnormal bone, stress is abnormal stress on normal bone.

Question 3

What terms are used to describe soft tissue integrity in fractures?

Answer 3

Open

Closed

Question 4

What is a greenstick fracture?

Answer 4

The fracture is not complete in the bone.

Question 5

What is a comminuted fracture?

Answer 5

The bone is broken into many bone fragments

Question 6

What is the name given to a bone with one complete break, with no fragments?

Answer 6

Simple fracture

Question 7

In what ways can a fracture be displaced?

Answer 7

Transverse
Spiral
Impacted

Question 8

What is the process of a stress fracture developing?

Answer 8

• Overuse
• Stress exerted on bone is greater than bone’s capacity to remodel.
• Bone weakening
• Stress fracture
• Risk of complete fracture

Question 9

What are the factors of of female athlete triad?

Answer 9

Disordered eating
Amenorrhea
Osteoporosis

Question 10

Give examples of causes of pathological fractures?

Answer 10

Osteoporosis
Malignancy
Vit D deficiency
Osteomyelitis
Osteogenesis imperfecta
Paget's disease

Question 11

What is osteoporosis?

Answer 11

Disrupted bone microarchitecture due to increased osteoclast activity over osteoblast.

Question 12

Is osteoporosis more common in males or females?

Answer 12

Females (4:1)

Question 13

What are three causes of secondary osteoporosis?

Answer 13

Hypogonadism
Glucocorticoid excess
Alcoholism

Question 14

What kind of bone fractures are associated with osteoporosis?

Answer 14

Fragility fractures from low energy trauma

Question 15

What are some examples of primary bone cancers?

Answer 15

Osteosarcoma
Chondrosarcoma
Ewing sarcoma
Chordoma

Question 16

How can cancers that are not primarily in the bone affect bones?

Answer 16

Metastases from breast, prostate, kidney, thyroid or lung cancer.

Question 17

What condition does vitamin D deficiency cause in adult and children’s bones?

Answer 17

Osteomalacia and rickets

Question 18

What are causes of vitamin D deficiency and related bone conditions?

Answer 18

Inadequate sun exposure
Malabsorption 
Liver disease
Renal disease
Receptor defects

Question 19

What is ‘brittle bone disease’?

Answer 19

Osteogenesis imperfecta
Am autosomal dominant or recessive conditon of reduced type 1 collagen due to decreased secretion and production of abnormal collagen, resulting in insufficient osteoid production.

Question 20

What is pagets disease?

Answer 20

Ecessive bone breaking with disorganised remodelling, causing deformities, pain, fractures and athritis.

Question 21

What are the four stages of pagets disease?

Answer 21

• Osteoclast activity
• Mixed osteoclastic-osteoblastic activity
• Osteoblastic activity
• Malignant degeneration

Question 22

In week 1 post-fracture what happens in the healing process?

Answer 22

Heamatoma formation
Cytokine release
Granulation tissue forms

Question 23

Between week 2-4 what happens in the healing process?

Answer 23

Soft callus (fibrocartilage) formation 
New blood vessels are formed

Question 24

Within 1-4 months of a bone fracture what occurs in the healing process?

Answer 24

The soft callus is converted to bone.

Question 25

Within 4-12 months of a fracture what happens in the healing process?

Answer 25

The callus responds to activity, external forces, functional demands and growth. Excess bone is removed.

Question 26

What is primary bone healing?

Answer 26

Intramembranous healing providing absolute stability. | e.g with plates and screws (no movement)

Question 27

What is secondary bone healing?

Answer 27

Endochondral healing involving responses in the periosteum and external soft tissues, providing relative stability.

Question 28

When are signs of healing visible of x-rays?

Answer 28

7-10 days

Question 29

What are the three main stages of fracture management?

Answer 29

Reduce Hold Rehabilitate

Question 30

What are the two types of reduction, and examples of each?

Answer 30

Open: mini-incision or full exposure Closed: manipulation or traction (skin or skeletal)

Question 31

What are the options for hold?

Answer 31

Closed: plaster or traction | Fixation

Question 32

What are some examples of fixation?

Answer 32

Internal: intermedullary (pins/nails) or extramedullary (plates/pins) External: Monoplanar or multiplanar

Question 33

What are the stages of rehabilitation?

Answer 33

Use (pain-relief and retrain) Move Strengthen Weight-bear

Question 34

What considerations should there be when deciding treatment?

Answer 34

``` Displaced? Stable? At the joint surface? Soft tissue integrity? Other illnesses? Patients wishes? ```

Question 35

What is tendinosis?

Answer 35

Abnormal thickening of tendons

Question 36

What is tendinitis?

Answer 36

Inflammation of tendons

Question 37

In addition to abnormal thickening and inflammation, what could also happen to tendons if a fracture is displaced?

Answer 37

Rupture

Question 38

What does a 'Grade I' ligament injury suggest?

Answer 38

Slight incomplete tear with no notable joint instability.

Question 39

What does a 'Grade II' ligament injury suggest?

Answer 39

Moderate/severe incomplete tear with some instability.

Question 40

What does a 'Grade II' ligament injury suggest?

Answer 40

Complete tearing of 1 or more ligaments with obvious instability.

Question 41

What are the stages of ligament healing and their time frame?

Answer 41

``` Inflammatory phase (1-7 days) Proliferation phase (7-21 days) Remodelling (>14 days) Maturation (weeks to years) ```

Question 42

What is the pathology of inflammatory phase?

Answer 42

Fibrin clot formed in ligament tears.

Question 43

What is the pathology of proliferation phase?

Answer 43

Tendons and ligaments are weakest, tensile strength builds

Question 44

What is the pathology of remodelling?

Answer 44

Tendons and ligaments heal with scar tissue that reduces ultimate strength and causes adhesions.

Question 45

What factors affect tissue healing?

Answer 45

Mechanical environment: movement and forces | Biological environment: Blood supply, immune function, infection, nutrition.

Question 46

What are the benefits of mobilisation on injured ligamentous tissue?

Answer 46

Scars are wider, stronger and more elastic | Better alignment/quality of collagen

Question 47

What are the bad effects of immobilisation of injured ligamentous tissue?

Answer 47

Less strength of scar Protein degradation exceeds synthesis in collagen Production of inferior tissue by blast cells Resorption of bone at site of ligament insertion Build tissue tensile strength