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Musculoskeletal System > Musculoskeletal Growth/Injury and Repair > Flashcards

Musculoskeletal Growth/Injury and Repair Flashcards

1
Q

Why do bones fail?

A

High energy transfer in normal bones
Repetitive stress in normal bones (stress fracture)
Low energy transfer in abnormal bones (Osteoporosis, osteomalacia, metastatic tumour, other bone disorders)

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2
Q

What are the four stages of fracture repair?

A

Inflammation
Soft callus
Hard callus
Bone remodelling

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3
Q

Does bone scar?

A

No

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4
Q

Stage 1 of bone repair: inflammation

A

Begins immediately after fracture
Hematoma and fibrin clot
Platelets, PMN’s, Neutrophils, Monocytes, Macrophages
By products of cell death – lysosomal enzymes
Fibroblasts
Mesenchymal & Osteoprogenitor cells
Angiogenesis

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5
Q

When does soft callus begin?

A

When pain and swelling subside

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6
Q

How long does soft callus formation last?

A

Until bony fragments are united by cartilage or fibrous tissue

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7
Q

Hard callus

A

Conversion of cartilage to woven bone

“Secondary” bone healing - natural

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8
Q

Bone remodelling

A

Converson of woven bone to lamellar bone

Medullary canal is reconstituted

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9
Q

What is delayed union?

A

Failure to heal in expected time

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10
Q

Delayed union causes

A 
High energy injury
Instability
Infection
Steroids
Immune suppressants
Smoking
Warfarin
NSAID
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11
Q

What is non union?

A

Failure to heal

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12
Q

What is a peripheral nerve

A

The part of a spinal nerve distal to the nerve roots.
Bundles of nerve fibres.
Range in diameter from 0.3-22 μm

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13
Q

What surrounds a peripheral nerve?

A

Schwann cells

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14
Q

Structure of a nerve

A

AXONS coated with ENDONEURIUM grouped into FASCICLES (nerve bundles) covered with PERINEURIUM; grouped to form the NERVE which is covered in EPINEURIUM

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15
Q

Types of nerve injury

A 
Compression
Trauma - direct (blow, laceration)
Indirect (avulsion, traction)
Neurapraxia
Axonotmesis
Neurotmesis
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16
Q

Causes of nerve compression

A

Entrapment
Classical conditions =>
Carpal tunnel syndrome (median nerve at wrist)
Sciatica (spinal root by intervertebral disc)
Morton’s neuroma (digital nerve in 2nd or 3rd web space of forefoot)

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17
Q

What is neurapraxia?

A

Nerve in continuity
Stretched or bruised
Reversible conduction block - local ischaemia and demyelination
Prognosis good

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18
Q

Axonotmesis

A 
Endoneurium intact - tube in continuity, but disruption of axons; more severe injury
Stretched ++ or crushed or direct blow
Prognosis fair (sensory recovery often better than motor)
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19
Q

Can peripheral nerves regenerate?

A

Yes

20
Q

What is neurotmesis?

A

Complete nerve division
Laceration or avulsion
No recovery unless repaired (by direct suturing or grafting)
Endoneural tubes disrupted so high chance of “miswiring” during regeneration
Prognosis poor

21
Q

What are closed nerve injuries?

A

Associated with nerve injuries in continuity

22
Q

Nerve injuries in continuity

A

Neuropraxis

Axonotmesis

23
Q

Closed nerve injuries management

A

Spontaneous recovery possible

Surgery indicated after 3 months

24
Q

What are open nerve injuries?

A

Frequently related to nerve division

Neurotmetic injuries

25
Q

Management of open nerve injuries

A

Early surgery

Distal portion of the nerve undergoes Wallerian degeneration

26
Q

What is Wallerian degeneration?

A

The axonal skeleton disintegrates, and the axonal membrane breaks apart. Axonal degeneration is followed by degradation of the myelin sheath and infiltration by macrophages. The macrophages, accompanied by Schwann cells, serve to clear the debris from the degeneration

27
Q

What are the main clinical features of nerve injury?

A

Sensory
Motor
Reflexes

28
Q

What are the clinical features of nerve injury?

Sensory

A

Dysaethesiae (disordered sensation)

  • anaesthetic (numb)
  • hypo- & hyper-aesthetic
  • paraesthetic (pins & needles)
29
Q

What are the clinical features of nerve injury?

Motor

A 
Paresis (weakness) or paralysis ± wasting
Dry skin  (loss of tactile adherence since sudomotor nerve fibres not stimulating sweat glands in skin)
30
Q

What are the clinical features of nerve injury?

reflexes

A

Diminished or absent

31
Q

How does healing of injured nerves begin?

A

Initial death of axons distal to the site of injury
Wallerian degeneration
Then degradation of myelin sheath
Proximal axonal budding occurs after about 4 days

32
Q

What is the rate of regeneration?

A

About 1 mm/day

33
Q

What is the first modality to return after nerve injury

A

Pain

34
Q

Is prognosis better for a distal or proximal lesion? (nerve injury)

A

Distal

35
Q

What is Tinel’s sign?

A

Tap over site of nerve and paraesthesia will be felt as far distally as regeneration has progressed

36
Q

Direct nerve repair

A 
Laceration
No loss nerve tissue
Microscope/Loupes
Bundle repair
Growth factors
37
Q

What is the rule of three (nerve injury)

A

Immediate surgery within 3 days for clean and sharp injuries

Early surgery within 3 weeks for blunt/contusion injuries

Delayed surgery, performed 3 months after injury, for closed injuries

38
Q

Tendon injury

A 
Degeneration
Inflammation
Enthesiopathy
Avulsion ± bone fragment  
Tear - rupture
Tear - musculotendinous junction
Laceration
Crush
Nodules
39
Q

Degeneration of tendon

A

eg Achilles tendon

  • Intrasubstance mucoid degeneration
  • May be swollen, painful, tender; may be asymptomatic
  • Precursor to rupture
40
Q

Inflammation of tendon

A

eg de Quervain’s stenosing tenovaginitis

  • Tendons of EPB + APL passing through common tendon sheath at radial aspect of wrist
  • Swollen, tender, hot, red
  • Positive Finklestein’s test
41
Q

Enthesiopathy

A

Inflammation at insertion to bone

42
Q

Avulsion ± bone fragment

A

Failure at insertion
Load exceeding failure strength while muscle contracting
Mallet finger

43
Q

What is mallet finger?

A

Insertion of extensor tendon into dorsum of base of distal phalanx of finger
Forced flexion of extended finger

44
Q

Avulsion treatment

A 
Conservative
   -Retraction tendon
Operative
   -Reattachment tendon
   -Fixation bone fragment
45
Q

Tendon rupture treatment

A 
Conservative
   -Mobilise (partial rupture)     
   -Splint/cast
Operative
   -High risk rerupture
   -High Activity
   -Ends cannot be opposed
46
Q

Acute knee pain small child differential diagnosis

A 
Acute septic arthritis
Trauma
Acute inflammatory arthritis
Transient synovitis
Rheumatic fever
Haemophilia
Soft tissue infection

Musculoskeletal System (19 decks)

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