Week 6- Injury and Healing Flashcards by Aaska Banthiya

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)

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What are the different types of fractures?

Simple/closed
Open
Transverse
Spiral
Impacted
Greenstick and torus
Comminuted

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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

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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

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What groups of people are at risk of stress fractures?

Athletes, military personnel, female athlete triad

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

Weight baring bones eg tibia, metatarsals, navicular

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What is female athletes triad?

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

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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

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Who is typically likely to develop a vit D deficiency?

People with darker skin who dont get much sun

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What is the stage before osteoporosis?

Osteopenia (thinning of the bone)

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Why may someone develop osteoporosis?

Osteoclast activity> osteoblast activity

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Is osteoporosis more common in males or females?

Females

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

Fragility fractures (in hips, spine and wrist)

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What are the 5 main cancers that metastasise to bone?

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

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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

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What are the 4 primary bone cancers?

Osteosarcoma
Chondrosarcoma
Ewing sarcoma
Chordoma

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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

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How is osteogenesis imperfecta inherited?

Autosomal dominant or recessive

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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

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What are the 4 stages of Paget’s disease?

Osteoclastic activity
Mixed osteoclastic/osteoblastic activity
Osteoblastic activity
Malignant degeneration

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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