Week 6- Injury and Healing Flashcards
What are the 3 mechanisms of bone fracture?
Trauma (low energy or high energy)
Stress (abnormal stress on normal bone)
Pathological (normal stress on abnormal bone)
What are the different types of fractures?
Simple/closed Open Transverse Spiral Impacted Greenstick and torus Comminuted
What needs to be described when diagnosing a fracture?
Soft tissue integrity: is it open or closed
Bony fragments: is it greenstick, simple or comminuted
Displacement: is the bone displaced or undisplaced
How do stress fractures arise?
Overuse leads to stress exerted on bone greater than the bones capacity to remodel, this causes the bone to weaken and can lead to a stress fracture
What groups of people are at risk of stress fractures?
Athletes, military personnel, female athlete triad
What bones are at risk of being affected by stress fractures?
Weight baring bones eg tibia, metatarsals, navicular
What is female athletes triad?
Disordered eating (calorie deficit)
Amenorrhea (due to high weight loss)
Osteoporosis (bigger holes make them prone to fracture)
What may be pathological causes of fracture?
Osteoporosis (soft bone) Malignancy (primary or bone metastases) Vit D deficiency (osteomalacia or rickets) Osteomyelitis (infection of the bone) Osteogenesis imperfecta Paget’s disease
Who is typically likely to develop a vit D deficiency?
People with darker skin who dont get much sun
What is the stage before osteoporosis?
Osteopenia (thinning of the bone)
Why may someone develop osteoporosis?
Osteoclast activity> osteoblast activity
Is osteoporosis more common in males or females?
Females
What are fractures associated with osteoporosis called? Where do they most commonly occour?
Fragility fractures (in hips, spine and wrist)
What are the 5 main cancers that metastasise to bone?
Prostate (blastic) Breast (blastic or lytic) Lytic: Kidney Thyroid Lung
What is the difference between a blastic and a lytic cancer?
Blastic: cancer cells fill the organ
Lytic: cancer cells cause destruction of cells in organ
What are the 4 primary bone cancers?
Osteosarcoma
Chondrosarcoma
Ewing sarcoma
Chordoma
What is osteogenesis imperfecta?
Brittle bone disease, type 1 collagen decreases due to decreased secretion and production of abnormal collagen resulting in insufficient osteoid production
How is osteogenesis imperfecta inherited?
Autosomal dominant or recessive
What is Paget’s disease?
Excessive bone break down and disorganised remodelling leading to deformity, pain, fracture and arthritis, can transform into a malignant disease
What are the 4 stages of Paget’s disease?
Osteoclastic activity
Mixed osteoclastic/osteoblastic activity
Osteoblastic activity
Malignant degeneration
What test should you order if a young child presents with stunted growth and aches/pains?
Vit D level
Describe the process of fracture healing
Heamotoma formed
Release of cytokines
Granulation tissue [week 1]
Soft callus formation (type II collagen- cartilage)
Converted to hard callus (type I collagen- bone)[1-4 months]
Callus responds to activity and excess bone is removed [4-12 months]
What is Wolff’s law?
Bone growth and remodelling in response to the forces that are placed on it
What does primary bone healing involve?
Intermembranous healing
What does secondary bone healing involve?
Endochondral healing (involves periosteum and external soft tissue)
What is the typical fracture healing time?
3-12 weeks
Why may there be a lump in the bone after fracture on an x ray?
The lump is the formation of a callus
Generally what bones heal faster?
Bones closer to the heart (mainly due to blood supply)
What type of bone healing gives absolute stability?
Primary
What are the 3 main stages of fracture management?
Reduction- get the bone ends toughly together
Hold- the bones together so healing can take place
Rehabilitation
What is malunion?
When the bone heals in the wrong place and a limb is shorter that the other one
Describe the different methods of bone reduction
Closed- via manipulation or traction (w traction meaning either skin or skeletal [pins and bones])
Open- have to cut skin open to realign bones via mini incision or full exposure
Describe how bone can be held during fracture management
Closed- in a plaster or via traction (w traction being skin or skeletal pins and bones)
Open
Describe how bones can be fixated
Externally- monoplanar or multiplanar
Internally- extramedullary (on the surface of the bone via plate/screws and pins) or intramedullary (in the bone via pins/nails)
What is bone fixation?
Putting bones in place using metal
Describe what bone rehabilitation entails during fracture management
Use of the bone
Moving the bone/limb
Strengthening the bone
Weight bearing
What are the 3 soft tissues that can be injured?
Muscle
Ligament
Tendons
What is tendinosis?
Abnormal thickening of the tendon
What is tendinitis?
Inflammation of the tendons
What are the 3 ways tendon injuries manifest?
Tendinosis
Tendinitis
Rupture of the tendon
What are the ligament injury classifications? Describe tearing and joint stability in all of them
Grade I- slight and incomplete tear (no notable joint instability)
Grade II- moderate/severe incomplete tear (some joint instability, one ligament may be completely torn)
Grade III- complete tearing of one or more ligaments (obvious joint instability with surgery required)
What are the 4 phases of ligament healing? What are the days associated with each phase
Inflammatory phase (day 1-7) Proliferation phase (day 7-21) Remodeling ( > 14 days) Maturation (weeks to years)
What are the 2 main things that facilitate healing?
Mechanical environment (movement and forces) Biological environment (blood supply, immune function, infection, nutrition)
Describe some advantages and disadvantages of immobilizing injured ligament tissue?
Adv: less ligament lengthening
Disadv: less overall strength, protein degradation exceeds protein synthesis, production of inferior tissue
What are some benefits of mobilizing injured ligamentous tissue?
Ligament scars are stronger and more elastic, there is better alignment/quality of collagen
Which bone to which muscle does the Achilles tendon connect?
Connects the calf muscles (gastrocnemius and soleus) to the calcaneus
What is the role of the Achilles tendon?
To transmit power from the calf muscles to the foot and allow plantar flexion of the ankle
What may be post op complications of an Achilles tendon repair surgery?
Immediate: nerve damage (sural nerve runs close to Achilles tendon)
Early: clot or infection
Late: rerupture
What are the 2 ways of examining the function of the ACL?
Anterior drawer test
Lachmans test
What is the function of the ACL?
Stops the tibia moving anteriorly
How are ACL injuries treated?
Patient can choose to have surgery or not (where the ACL would be reconstructed)
They will then be put in a brace, once this comes off they do strengthening exercises, cycling etc and can return to sports after 9-12 months
How can surgical complications be classed?
Either local or general
Both local and general can have immediate, early and late manifestations
