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BRS Y1 > Week 6- Injury and Healing > Flashcards

Week 6- Injury and Healing Flashcards

1
Q

What are the 3 mechanisms of bone fracture?

A

Trauma (low energy or high energy)
Stress (abnormal stress on normal bone)
Pathological (normal stress on abnormal bone)

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2
Q

What are the different types of fractures?

A 
Simple/closed
Open
Transverse
Spiral
Impacted
Greenstick and torus
Comminuted
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3
Q

What needs to be described when diagnosing a fracture?

A

Soft tissue integrity: is it open or closed
Bony fragments: is it greenstick, simple or comminuted
Displacement: is the bone displaced or undisplaced

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4
Q

How do stress fractures arise?

A

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

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5
Q

What groups of people are at risk of stress fractures?

A

Athletes, military personnel, female athlete triad

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6
Q

What bones are at risk of being affected by stress fractures?

A

Weight baring bones eg tibia, metatarsals, navicular

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7
Q

What is female athletes triad?

A

Disordered eating (calorie deficit)
Amenorrhea (due to high weight loss)
Osteoporosis (bigger holes make them prone to fracture)

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8
Q

What may be pathological causes of fracture?

A 
Osteoporosis (soft bone)
Malignancy (primary or bone metastases)
Vit D deficiency (osteomalacia or rickets)
Osteomyelitis (infection of the bone)
Osteogenesis imperfecta
Paget’s disease
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9
Q

Who is typically likely to develop a vit D deficiency?

A

People with darker skin who dont get much sun

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10
Q

What is the stage before osteoporosis?

A

Osteopenia (thinning of the bone)

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11
Q

Why may someone develop osteoporosis?

A

Osteoclast activity> osteoblast activity

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12
Q

Is osteoporosis more common in males or females?

A

Females

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13
Q

What are fractures associated with osteoporosis called? Where do they most commonly occour?

A

Fragility fractures (in hips, spine and wrist)

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14
Q

What are the 5 main cancers that metastasise to bone?

A 
Prostate (blastic)
Breast (blastic or lytic)
Lytic:
Kidney
Thyroid
Lung
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15
Q

What is the difference between a blastic and a lytic cancer?

A

Blastic: cancer cells fill the organ
Lytic: cancer cells cause destruction of cells in organ

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16
Q

What are the 4 primary bone cancers?

A

Osteosarcoma
Chondrosarcoma
Ewing sarcoma
Chordoma

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17
Q

What is osteogenesis imperfecta?

A

Brittle bone disease, type 1 collagen decreases due to decreased secretion and production of abnormal collagen resulting in insufficient osteoid production

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18
Q

How is osteogenesis imperfecta inherited?

A

Autosomal dominant or recessive

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19
Q

What is Paget’s disease?

A

Excessive bone break down and disorganised remodelling leading to deformity, pain, fracture and arthritis, can transform into a malignant disease

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20
Q

What are the 4 stages of Paget’s disease?

A

Osteoclastic activity
Mixed osteoclastic/osteoblastic activity
Osteoblastic activity
Malignant degeneration

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21
Q

What test should you order if a young child presents with stunted growth and aches/pains?

A

Vit D level

22
Q

Describe the process of fracture healing

A

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]

23
Q

What is Wolff’s law?

A

Bone growth and remodelling in response to the forces that are placed on it

24
Q

What does primary bone healing involve?

A

Intermembranous healing

25
Q

What does secondary bone healing involve?

A

Endochondral healing (involves periosteum and external soft tissue)

26
Q

What is the typical fracture healing time?

A

3-12 weeks

27
Q

Why may there be a lump in the bone after fracture on an x ray?

A

The lump is the formation of a callus

28
Q

Generally what bones heal faster?

A

Bones closer to the heart (mainly due to blood supply)

29
Q

What type of bone healing gives absolute stability?

A

Primary

30
Q

What are the 3 main stages of fracture management?

A

Reduction- get the bone ends toughly together
Hold- the bones together so healing can take place
Rehabilitation

31
Q

What is malunion?

A

When the bone heals in the wrong place and a limb is shorter that the other one

32
Q

Describe the different methods of bone reduction

A

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

33
Q

Describe how bone can be held during fracture management

A

Closed- in a plaster or via traction (w traction being skin or skeletal pins and bones)

Open

34
Q

Describe how bones can be fixated

A

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)

35
Q

What is bone fixation?

A

Putting bones in place using metal

36
Q

Describe what bone rehabilitation entails during fracture management

A

Use of the bone
Moving the bone/limb
Strengthening the bone
Weight bearing

37
Q

What are the 3 soft tissues that can be injured?

A

Muscle
Ligament
Tendons

38
Q

What is tendinosis?

A

Abnormal thickening of the tendon

39
Q

What is tendinitis?

A

Inflammation of the tendons

40
Q

What are the 3 ways tendon injuries manifest?

A

Tendinosis
Tendinitis
Rupture of the tendon

41
Q

What are the ligament injury classifications? Describe tearing and joint stability in all of them

A

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)

42
Q

What are the 4 phases of ligament healing? What are the days associated with each phase

A 
Inflammatory phase (day 1-7)
Proliferation phase (day 7-21)
Remodeling ( > 14 days)
Maturation (weeks to years)
43
Q

What are the 2 main things that facilitate healing?

A 
Mechanical environment (movement and forces)
Biological environment (blood supply, immune function, infection, nutrition)
44
Q

Describe some advantages and disadvantages of immobilizing injured ligament tissue?

A

Adv: less ligament lengthening
Disadv: less overall strength, protein degradation exceeds protein synthesis, production of inferior tissue

45
Q

What are some benefits of mobilizing injured ligamentous tissue?

A

Ligament scars are stronger and more elastic, there is better alignment/quality of collagen

46
Q

Which bone to which muscle does the Achilles tendon connect?

A

Connects the calf muscles (gastrocnemius and soleus) to the calcaneus

47
Q

What is the role of the Achilles tendon?

A

To transmit power from the calf muscles to the foot and allow plantar flexion of the ankle

48
Q

What may be post op complications of an Achilles tendon repair surgery?

A

Immediate: nerve damage (sural nerve runs close to Achilles tendon)

Early: clot or infection

Late: rerupture

49
Q

What are the 2 ways of examining the function of the ACL?

A

Anterior drawer test

Lachmans test

50
Q

What is the function of the ACL?

A

Stops the tibia moving anteriorly

51
Q

How are ACL injuries treated?

A

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

52
Q

How can surgical complications be classed?

A

Either local or general

Both local and general can have immediate, early and late manifestations

BRS Y1 (52 decks)

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