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Phase Two > MSK > Flashcards

MSK Flashcards

1
Q

What Cells make up bones

A

osteoblasts, osteoclasts, osteocytes and Oligodendrocyte progenitor cells (OPCs)

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2
Q

What makes up the Matrix of bones

A

Organic = osteoid (40%)
Collagen Type I - Resists tension, twisting and bending

Inorganic (60%)
Calcium hydroxyapatite - Resists compressive forces

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3
Q

What is Woven Bone

A

Disorganised bone that forms the embryonic skeleton and fracture callus.

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4
Q

What is Lamellar Bone

A

Mature bone that can be one of two types:

Cortical/compact: dense outer layer
Cancellous/trabecular: porous central laye

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5
Q

How can bones form

A

Intramembranous Ossification or Endochondral Ossification

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6
Q

What is Intramembranous Ossification

A

Direct ossification of mesenchymal bone models formed during embryonic development.

e.g. Skull bones, mandible and clavicle

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7
Q

What is Endochondral Ossification

A

Mesenchyme goes to cartilage goes to bone

e.g. Most bones ossify this way

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8
Q

What are the main stages of Fracture Healing

A

Reactive Phase
o Bleeding
Reparative Phase
Inflammation

Remodelling Phase
o Proliferation
o Consolidation

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9
Q

What is the Reactive Phase of fracture repair and how long does it last?

A

Bleeding into fracture site fgrms haematoma

Inflammation - cytokine, GF and vasoactive mediator release leads to recruitment of leukocytes and fibroblasts forming granulation tissue

From injury to 48hrs

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10
Q

What is the Reparative Phase of fracture repair and how long does it last?

A

Proliferation of osteoblasts and fibroblasts forms cartilage and woven bone production leading to callus formation.

Consolidation (endochondral ossification) of woven bone forms lamellar bone

2 days to 2 weeks

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11
Q

What is the Remodelling Phase of fracture repair and how long does it last?

A

Remodelling of lamellar bone to cope with the mechanical forces applied to it (Wolff’s Law: “form follows function”)

1wk – 7yrs

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12
Q

What is the healing time of a Closed Fracture

A

3wks

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13
Q

What is the healing time of a paediatric Fracture

A

3wks

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14
Q

What is the healing time of a metaphyseal Fracture

A

3wks

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15
Q

What is the healing time of an upper limb Fracture

A

3wks

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16
Q

What is the healing time of an Adult Fracture

A

6wks

17
Q

What is the healing time of a Lower limb Fracture

A

6wks

18
Q

What is the healing time of a Diaphyseal Fracture

A

6wks

19
Q

What is the healing time of an Open Fracture

A

6wks

20
Q

What is the rule for healing time of wounds

A

Normal fractures take 3 weeks to heal. Any complicating factor, e.g. Adult bone, open wound etc doubles healing time

21
Q

What are the main classifications of fractures

A

Traumatic
Stress
Pathological

22
Q

What are the types of Traumatic fracture

A

Direct: e.g. assault with metal bar
Indirect: e.g. Fall on outstretched hand (FOOSH) leads to clavicle fracture
Avulsion

23
Q

What is a Stress Fracture

A

Bone fatigue due to repetitive strain causes fracture E.g. foot fractures in marathon runners

24
Q

What is a Pathological Fracture

A

Normal forces applied but bone is diseased

Local causes: tumours
General causes: osteoporosis, Cushing’s, Paget’s

25
Q

What is the system of describing a fracture

A

PAID

o Demographics
o Pt. details
o Date radiograph taken
o Orientation and content of image

o Pattern
o Transverse
o Oblique
o Spiral
o Multifragmentary
o Crush
o Greenstick
o Avulsion

Anatomical Location

Intra- / extra-articular
o Dislocation or subluxation

Deformity (distal relative to proximal)
o Translation
o Angulation or tilt
o Rotation
o Impaction (→shortening)

Soft Tissues
o Open or closed
o Neurovascular status
o Compartment syndrome

Specific Fractyre Details
o Salter-Harris
o Garden
o Colles’, Smith’s, Galeazzi, Monteggia

26
Q

What features must a radio-graph of a fracture have?

A

Radiographs must be orthogonal (at right angles): request AP and lat. films.

Need images of joint above and joint below

27
Q

What are the stages of Fracture Management

A 
4Rs
Resuscitation 
Reduction 
Restriction 
Rehabilitation
28
Q

What are the steps of Resuscitation in fracture management

A

Follow Advanced Trauma Life Support guidelines
Assess C-spine, chest then pelvis
Fractures usually assessed in second assessment
Assess neurovascular status and look for dislocations
Consider reduction and splinting before imaging - leads to reduced pain, bleeding and risk of neurovascular injury
X-ray once stable

29
Q

What is the treatment of open fractures

A

6 A’s

Analgesia: Morphine + Midazolam
Assess: NV status, soft tissues, photograph
Antisepsis: wound swab, copious irrigation, cover with betadine-soaked dressing.
Alignment: align fracture and splint
Anti-tetanus: check status (booster lasts 10yrs)
Abx - Fluclox 500mg IV/IM + benpen 600mg IV/IM (Or, augmentin 1.2g IV)

Treat with debriment in theatre

30
Q

What is the classification of Open fractures

A

Gustillo Classification

  1. Wound <1cm in length
  2. Wound ≥1cm with minimal soft tissue damage
  3. Extensive soft tissue damage
31
Q

What is the most dangerous complication of open fractures and how is it treated

A

Clostridium perfringes

Wound infections and gas gangrene
± shock and renal failure

Rx: debride, benzylpeniclin + clindamycin

32
Q

What are the principles and methods of Reduction in fracture management

A

Displaced fractures should be reduced -
Unless no effect on outcome, e.g. ribs Aim for anatomical reduction (esp. if articular surfaces involved)
Alignment is more important than opposition

Methods
Manipulation / Closed reduction
o Under local, regional or general anaesthetic
o Traction to dis-impact
o Manipulation to align

Traction
o Not typically used now.
o Employed to overcome contraction of large muscles: e.g. femoral fractures
o Skeletal traction vs. skin traction

Open reduction (and internal fixation) 
o Accurate reduction vs. risks of surgery 
o Intra-articular fractures
o Open fractures
o 2 fractures in 1 limb
o Failed conservative Management
o Bilat identical fractures
33
Q

What are the principles and methods of Restriction in fracture management

A

Principles
Inter-fragmentary strain hypothesis dictates that tissue formed at fracture site depends on strain it experiences.
Fixation leads to reduced strain and better bone formation
Fixation also reduces pain while increasing stability and ability to function.

Methods

Non-rigid
o Slings
o Elastic supports

Plaster
o POP
o In first 24-48h use back-slab or split cast due to risk of compartment syndrome

Functional bracing
o Joints free to move but bone shafts supported in cast segments.

Continuous traction
e.g. collar-and-cuff

Ex-Fix
o Fragments held in position by pins/wires which are then connected to an external frame.
o Intervention is away from field of injury.
o Useful in open fractures, burns, tissue loss to allow wound access and reduced infection risk.
o Risk of pin-site infections

Internal fixation
o Pins, plates, screws, IM nails
o Usually perfect anatomical alignment
o Increased stability which Aid early mobilisation

34
Q

What are the principles and methods of Rehabilitation in fracture management

A

Principles
Immobility leads to reduced muscle and bone mass and joint stiffness
Need to maximise mobility of uninjured limbs
Quick return to function reduces later morbidity

Methods
o Physiotherapy: exercises to improve mobility
o OT: splints, mobility aids, home modification
o Social services: meals on wheels, home help

35
Q

General Complications of Fractures

A

Tissue Damage
o Haemorrhage and shock
o Infection
o Muscle damage leading to rhabdomyolysis

Anaesthesia
o Anaphylaxis
o Damage to teeth
o Aspiration

Prolonged Bed Rest
o Chest infection
o UTI
o Pressure sores and muscle wasting
o DVT, PE
o Reduced bone mineral density (BMD)
36
Q

Specific Complications of Fractures

A

Immediate
Neurovascular damage
Visceral damage

Early
Compartment syn.
Infection (worse if assoc with metalwork)
Fat embolism →Acute respiratory distress syndrome

Late
Problems with union
Avascualr Necrosis
Growth disturbance
Post-traumatic osteoarthritis
Complex regional pain syndromes
Myositis ossificans
37
Q

What are the 3 main types of Neurological Complication of a fracture

A

Neuropraxia - Temporary interruption of conduction w/o loss of axonal continuity.

Axonotmesis
o Disruption of nerve axon leads to distal Wallerian degeneration
o Connective tissue framework of nerve preserved
o Regeneration occurs and recovery is possible.

Neurotmesis
o Disruption of entire nerve fibre
o Surgery required and recovery not usually complete

38
Q

What is the common palsy associated with Ant. shoulder dislocation/Humeral surgical neck frcture

A

Axillary Nerve Palsy

Numb chevron Weak abduction

Phase Two (3 decks)

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