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BRS > Muskoskeletal disorders > Flashcards

Muskoskeletal disorders Flashcards

1
Q

What are causes of fractures?

A

Trauma: high or low energy
Stress: abnormal stresses on normal bone
Pathological: normal stresses on abnormal bone

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2
Q

How is soft tissue integrity affected by fractures?

A

Open- bone has broken through skin

Closed- skin not broken

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3
Q

What are different ways bones can break?

A

Greenstick- incomplete fracture where bone is bent, occurs most often in children
Simple- fracture of the bone only without damage to surrounding tissues or breaking of skin
Comminuted- bone breaks in several places

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4
Q

How can the displacement of a bone be classified?

A

Displaced- bone breaks in 2 or more pieces and moves out of alignment
Undisplaced- bone breaks but doesn’t move out of alignment

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5
Q

What causes a stress fracture?

A

Stress exerted on bone is greater than bone capacity to remodel
Bone weakening leads to stress fracture which can lead to a risk of incomplete fracture
Occurs on weight bearing bone

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6
Q

In what specific type of individual may a stress fracture be common in?

A

Young female athlete

Females athlete triad: interrelationship between amenorrhea, disordered eating and osteoporosis

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7
Q

What does Wolff’s law tell us about fracture healing?

A

Bone grows and remodels in response to forces placed upon it

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8
Q

How long does a fracture take to heal?

A

takes 3-12 weeks depending on site

Signs of visible healing on x-ray from 7-10 days

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9
Q

What are the steps to a fracture healing?

A
  1. Inflammation (week 1): haematoma formation, release of cytokines, granulation tissue
  2. Repair (week 2-4): soft callous formation (type II collagen) converted to hard callous (type I collagen) (1-4 months)
  3. Remodelling (4-12 months): callous responds to activity, external forces, functional demands and growth. Excess bone is removed
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10
Q

What are pathological disorders that affect bone?

A
  1. Osteopenia
  2. Osteoporosis
  3. Malignancy
  4. Vitamin D deficiency (osteomalacia/ rickets)
  5. Osteomyelitis (bone infection)
  6. Osteogenesis imperfecta
  7. Padgets disease
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11
Q

What is osteopenia?

A

Protein and mineral contents of bone tissue is reduced but less severely than osteoporosis

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12
Q

What is osteoporosis?

A

Disease characterised by low bone mass and structural deterioration of bone tissue with consequent increase in bone fragility and susceptibility to fracture
Caused by osteoclast activity > osteoblast structure
Most common in females
Secondary osteoporosis can occur at any age. Can be due to hypogonadism, glucocorticoid excess, alcoholism

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13
Q

How do we diagnose osteoporosis and osteopenia?

A

A t score is used to diagnose- this is standard deviations from the mean using bone mass as unit
T>-1 = normal bone
T -1 - 2.5 = osteopenia
T

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14
Q

how does malignancy cause fractures?

A

Primary bone cancers inc. : osteosarcoma, chondrosarcoma, Ewing sarcoma, chondroma
Can also get primary tumours in other parts of the body that metastasise to bone inc. prostate, kidney, breast, thyroid and lung

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15
Q

How does vitamin D deficiency cause fractures?

A 
Rickets = paediatric consequence of vitamin D deficiency. Occurs before physis closure. Can cause bowing of tibia/legs
Osteomalacia= adult consequence of vit. D deficiency. Occurs after physis closure. Symptoms inc. weaker bones, pain and tenderness
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16
Q

What is osteogenesis imperfecta?

A

Brittle bone disease
Its autosomal dominant or recessive
Decreased type I collagen due to: decreased secretion or production of abnormal collagen
Results in insufficient osteoid production

17
Q

What is padgets disease?

A

Can be caused by genetic or acquired factors
Excessive bone breakdown and disorganised modelling- deformity, pain, fracture or arthritis
May transform into a malignant disease
4 stages:
1. Osteoclastic activity
2. Mixed osteoclastic- osteoblastic activity
3. Osteoblastic activity
4. Malignant degeneration
Rushed bone building leads to woven rather than lamellar patterns

18
Q

What are the different types of bone healing?

A 
Primary bone healing:
- intramembranous healing
- absolute stability 
- direct to woven bone
Secondary bone healing:
- endochondral healing
- involves responses in periosteum and external soft tissues
- relative stability
- classical stages of healing: inflammation, repair, remodelling
19
Q

What are the 4 ways of managing fractures?

A

Reduction
Hold
Fixation
Rehabilitate

20
Q

What is reduction?

A

Realignment of bone to prevent deformities
Open: surgical incision made to expose fragments and put them back into proper position - can be done by mini- incision or full exposure
Closed: displaced or fractured bone fragments manipulated back into proper position or alignment without surgery - can be done by manipulation or traction (hang weight of injury)

21
Q

What is holding?

A

Choosing how to hold the fracture
Can be done by fixation or Closed
Closed includes plaster or traction

22
Q

What is fixation?

A

Stabilising the fractured bone
External- metal outside bone. Includes monoplane or multiplane
Internal: metal underneath skin. Includes intramedullary (pins and needles) or extramedullary (plates/screws and pins)

23
Q

What does rehabilitation include?

A

Use
Move
Strengthen
Weight-bear

24
Q

What is a soft tissue injury?

A

Injury to muscles, ligament or tendons

25
Q

What is tendinopathy?

A

Injury of tendon. Includes:

  • Tendinosis (abnormal thickening)
  • Tendinitis (inflammation)
  • Rupture
26
Q

How are ligament injuries classified?

A

Grade I: slight incomplete tear- no notable joint instability
Grade II: moderate/severe incomplete tear- some joint instability, one ligament might be completely torn
Grade III: complete tearing of 1 or more ligaments, obvious instability, surgery usually required

27
Q

What are common ligament injuries?

A

ACL tears and Achilles tendon tears

28
Q

How do soft tissue injuries heal?

A

Inflammation: fibrin clot formed in ligament tears
- treatment implications: RICE (rest, ice, compression, elevate), ROM exercises
Proliferation: tendons and ligaments weakest, tensile strength builds
- TIs: full ROM and WB exercises
Remodelling: tendons and ligaments heal with scar tissue that reduces ultimate tensile strength
-TIs: build strength
Maturation: Max strength reached within a year

29
Q

What are the effects of immobilisation?

A

Pros:
-Less ligament laxity
Cons:
-Less overall strength of ligament repair scar
-Protein degradation exceeds protein synthesis
-Production of inferior tissue by blast cells
-Resorption of bone at site of ligament insertion

30
Q

What are effects of mobilisation?

A

Pros:

  • Ligament scars are wider, stronger and more elastic
  • Better alignment/quality of collagen

BRS (60 decks)

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