Upper limb pt1: shoulder, upper arm, elbow and fracture healing

Question 1

What movements occur at shoulder girdle?

Answer 1

• Elevation
• Depression
• Protraction
• Retraction

Question 2

What is in the pectoral girdle?

Answer 2

Scapula and clavicle

Question 3

What are the pectoral girdle main joints?

Answer 3

• Sternoclavicular joint
• Acriomioclavicular joint
• Gelnohumeral joint

Question 4

What is a fracture?

Answer 4

Break in the continuity of a bone, including:
- Periosteal tearing
- soft tissue damage

Question 5

Pathological fractures=

Answer 5

Is a fracture caused by trivial trauma if the bone is abnormal:
- Osteoporosis
- Paget’s disease
- Tumours

Question 6

Healing of fractures=

Answer 6

Usually takes 3-4 months, begins as soon as the bone is broken, the bone is capable of regeneration. Different stages of healing is:
1. Haematoma
- Blood vessels in the fractured area are damaged, causing bleeding and the formation of a hematoma (blood clot).
The hematoma provides a scaffold for cells to migrate to the fracture site
2. Granulation tissue
- Haematoma is invaded by capillaries and fibroblasts, and there is an influx of macrophages and bone cells
3. Callus formation
- involves stabilising the fracture with cartilage (soft callus) and then replacing it with immature bone (hard callus) where osteoblasts produce a bony collar to join ends, this is complete at 4-6 weeks
4. Remodelling
-refines and strengthens the bone, returning it to its pre-fracture state, so medullary canal is restored.

Question 7

What factors are detrimental to fracture healing?

Answer 7

poor blood supply
- scaphoid, neck of femur
poor nutrition
- lack of protein & vitamins
Age

Question 8

Complications during fracture healing:

Answer 8

• infection, causes necrosis of bone
• delayed union, caused by inadequate blood supply
• non union
• avascular necrosis
• mal union
• shortening