overview of MSK disease

Question 1

4 factors affecting healing in connective tissue

Answer 1

1. proximity of viable tissue (apposition of damaged ends and removal of dead tissue)
2. vascular supply (oxygen, nutrients, removing toxic byproducts)
3. presence of infection
4. physical/mechanical stress (including hormonal and metabolic macro and microenvironment)

Question 2

degenerative joint disease is also called

Answer 2

osteoarthritis

Question 3

2 crystal deposition diseases

Answer 3

gout and CPPD

Question 4

sprain

Answer 4

stretch and/or tear of ligament

Question 5

strain

Answer 5

stretch and/or tear of muscle or tendon

Question 6

strain

Answer 6

stretch and/or tear of muscle or tendon

Question 7

pathophysiology of soft tissue injury

Answer 7

disruption of collagen fibres and/or skeletal muscle cell

tendons and ligaments have poor blood supply and take sgnificant time to heal if torn

Question 8

major gaps in soft tissue injury

Answer 8

healing cannot bridge major gaps
requires surgery and rehab
eg. achilles tendon tear, anterior cruciate ligament of knee

similar issues with incised wounds or lacerations involving tendons/muscle

Question 9

fracture

Answer 9

a disruption in the cortex, trabecular bone or both

may lead to discontinuity in the bone

Question 10

fracture occurs when

Answer 10

the stress or load on the bone exceeds the mechanical strength of the bone

Question 11

avulsion

Answer 11

part of the bone is pulled off, for examplle by a tendon

Question 12

classification for paediatric fractures involving the growth plate

Answer 12

salter-harris classification

Question 13

classifcation for facial fractures

Answer 13

Le Fort

Question 14

importance of fractures in paetiadric growth pllate

Answer 14

may impair normal future growth of the bone

Question 15

integrated AO/JOT classification

Answer 15

1. anatomical location
2. fracture morphology - simple/wedge/multi-fragmentary/complex
3. modifiers/qualfers (displacement/impaction/dislocation/articular/spiral)

Question 16

most common types of fractures

Answer 16

• transverse
• linear (usually stress)
• oblique non-displaced
• oblique displaced
• spiral
• greenstick - on the side of the cortex
• comminuted

Question 17

linear fracture is usually due to

Answer 17

stress

Question 18

comminuted

Answer 18

multifragmentary

Question 19

open fracture

Answer 19

commonly due to high energy trauma
tibia and phalanx of finger most common site
high risk of infection and necrotic bone and soft tissue or vascular compromise

Question 20

fracture dislocation

Answer 20

high energy
often in hyperextended or hyperflexed position
risk of vascular compromise
often may have avulsion or intra-articular components or secondary injury

Question 21

crush fracture

Answer 21

type of impaction fracture
particularly involving vertebral body of spine, can be very severe pain and neural/functional issues
often insufficiency fracture

Question 22

pathological and insufficiency fractures

Answer 22

low trauma
fracture due to normal stress on abnormal bone that occur in the setting of either no history of trauma, or a low energy injury that ordinarily would not cause a fracture

Question 23

pathological fracture

Answer 23

fracture through a pre existing lesion in the bone

Question 24

insufficiency fracture

Answer 24

type of pathological fracture where the entire bone is weakened.abnormal (osteoporosis, paget’s)

Question 25

repetitive injury/stress fracture

Answer 25

accumulation of micro-fractures leading to a true fracture of the cortex
abnormal stress on normal bone

Question 26

compression fracture

Answer 26

due to abnormal end on load

Question 27

non-accidental injury

Answer 27

suspected physical abuse.inflicted injury
multiple fractures, different angles
different ages of fractures
fractures in sites not normally injured
history is inconsistent with the severity or pattern of injury

Question 28

model of fracture healing

Answer 28

• bleeding followed by haematoma (blood clot)
• inflammatory stage - leading to granulation tissue (new vessel formation) and organisation of the haematoma over several days
• soft calllus - fibrin meshwork, fibroblast ingrowth
• activated mesenchymal cells differentiate into chrondrocytes that produce firbocartilage and hyaline cartilage
• undergo enchondral ossification
• leads to bony callus
• over weeks to months the bony callus undergoes remodelling and progressively returns to pre-fracture strength
• signs of old fracture can persist for years and remodelling continues

Question 29

four main factors affecting healing

Answer 29

1. immobilization - aposition of damaged ends
2. vascular supply - oxygen, nutrients, removing toxic byproducts)
3. presence of infection
4. physical/mechanical stress (including hormonal and metabolic macro and microenvironment

Question 30

early fracture complications

Answer 30

1. bleeding and complications of major haemorrhage
2. infection and sepsis
3. hypoxia/ischaemia and other tissues in vascular territory
4. inability to bear weight/mobilise
5. disproportionate strain

Question 31

intermediate - late complications

Answer 31

1. pulmonary embolism (thrombus, fat/marrow embolus)
2. compartment syndrome - can cause vascular or nerve compromise
3. joint problems (intra-articular), spontaneous arthrodesis, early OA
4. chronic osteomyelitis

Question 32

non-union

Answer 32

fracture site does not heal

Question 33

causes of non-union

Answer 33

interposition of soft tissue 
excessuce gap or step 
infection 
poor blood supply 
malignancy - local or systemc 
malnutrition/metabolic disease (diabetes, cushing's, vit C definiency)

Question 34

pseudoarthritis

Answer 34

false joint

deformity oof bone, secndary mechanical effects due to altered force on the joint, refracture