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BRS 5 Musculoskeletal > Injury And Healing > Flashcards

Injury And Healing Flashcards

1
Q

What are the three mechanisms of a fracture?

A

Stress, trauma and pathological

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2
Q

What are the two types of trauma fractures?

A

High energy and low energy

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3
Q

What is meant by a stress fracture?

A

When there is abnormal stress placed on normal bone

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4
Q

Which bones do stress fractures normally occur on?

A

Weight bearing bones

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5
Q

What activities are stress fractures related to.

A

Athletes, occupational, military

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6
Q

What is an insufficiency fracture?

A

When the bone may have been thinned or weakened, so is insufficiently strong

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7
Q

Describe the sequence of events that can result in s stress fracture becoming a complete fracture?

A

Overuse of the bone
Stress on bone > bones capacity to remodel
Bone weakens
Stress fracture
Many stress fractures leads to the risk of a complete fracture

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8
Q

What factors can cause bone weakening?

A

Disordered eating, osteoporosis, amenorrhea

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9
Q

What is meant by a pathological fracture?

A

Where NORMAL stresses are exerted in ABNORMAL bone

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10
Q

What are some causes of abnormal bone seen in pathological fractures? POMOVO

A 
Pagets
Osteogenesis Imperfecta
Malignancy
Osteomyelitis
Vitamin D deficiency 
Osteoporosis
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11
Q

What is osteomyelitis?

A

Inflammation or swelling that occurs in the bone

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12
Q

What happens when osteoclast activity > osteoblast activity?

A

Bone micro architecture is disrupted

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13
Q

How is osteoporosis measure?

A

By having a bone density that is more then 2.5x standard deviations away from the mean

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14
Q

Is osteoporosis more common in males or females?

A

Females

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15
Q

What is senile osteoporosis?

A

Primary osteoporosis that is linked to age

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16
Q

What is secondary osteoporosis?

A

Osteoporosis that occurs in any age,

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17
Q

What are three causes of secondary osteoporosis?

A

Hypogonadism
Glucocorticoid excess
Alcoholism

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18
Q

What type of fractures is secondary osteoporosis associated with?

A

Hip, spine and wrist fractures = fragility fractures

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19
Q

What minerals does vitamin D help absorb?

A

Calcium, magnesium and phosphate

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20
Q

How is vitamin D made?

A

Synthesized from the sun

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21
Q

What happens if you have inadequate calcium or phosphate?

A

Results in a defect in Osteoid matrix mineralization

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22
Q

What condition does vitamin D deficiency result in for children and adults?

A

Rickets for children’s

Osteomalacia for adults

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23
Q

What is reduced in osteogenesis imperfecta?

A

Type 1 collagen

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24
Q

Why are type I collagen levels lower in osteogenesis imperfecta patients?

A

Production of abnormal collagen

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25
Q

What does osteogenesis imperfecta impact?

A

Bones
Hearing
Heart
Sight

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26
Q

Blue sclera is a symptom of what condition?

A

Osteogenesis imperfecta

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27
Q

What is Paget’s disease?

A

Excessive bone breakdown and disorganized remodeling which leads to deformity

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28
Q

What are the four stages of Paget’s disease?

A
  1. Osteoclastic activity
  2. Mixed osteoclastic-osteoblastic activity
  3. Osteoblastic activity
  4. Malignant degeneration
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29
Q

Which cancers are blastic (endures bone growth)?

A

Prostate cancer and breast cancer

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30
Q

Which cancer are lytic (bone eating)?

A

Kidney, thyroid, lung and breast

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31
Q

What are the four primary bone cancers?

A

Osteosarcoma
Chondrosarcoma
Ewing sarcoma
Lymphoma

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32
Q

What are secondary bone cancers?

A

When cancers which originated in other tissues metastasize to the bone

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33
Q

What can secondary bone cancers be classified as?

A

Blastic or lytic metastases

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34
Q

What are the two types of fractures which affect the soft tissue integrity?

A

Open and closed

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35
Q

What is a closed fracture?

A

Fractured under the skin

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36
Q

What is an open fracture?

A

One where the bone penetrates the skin, presenting a risk of infection

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37
Q

What are the two types of fractures which involve the movement to the bone?

A

Displaced and undisplaced

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38
Q

What is an undisplaced fracture?

A

One that has hardly moved apart

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39
Q

What is a displaced fracture?

A

When bones have move apart a lot

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40
Q

What are the three fractures associated with bony fragments?

A

Green stick, simple and multi fragmentary

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41
Q

What is a green stick fracture?

A

When the bone fragments are bent

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42
Q

What fracture is this?

A

Green stick

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43
Q

What is a multi fragmentary fracture?

A

When there are many fractures along the same bone resulting in many bone fragments

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44
Q

What fracture is this?

A

Multi fragmentary

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45
Q

What are the 4 stages of general tissue healing?

A

Bleeding
Inflammation
New tissue formation
Remodelling

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46
Q

What cells are involved with remodeling?

A

Macrophages, osteoclasts and blast cells

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47
Q

What is Wolff’s Law?

A

Bone grows and remodels in response to the forces that are placed on it

48
Q

What four things happen in the inflammation stage (step 1) of fracture healing?

A

Haematoma formation
Cytokine release from the blood products
Granulation tissue
Blood vessel formation

49
Q

What happens in the repair phase (step 2) of fracture healing?

A

Soft callus formation (cartilage) which is then converted to hard callus (bone)

50
Q

What happens during the remodeling phase (step 3) of fracture repair?

A

The hard callus responds to external forces, functional demands and growth

51
Q

What is the healing time of a phalange fracture?

A

3 weeks

52
Q

What is the healing time of a metacarpal fracture?

A

4-6 weeks

53
Q

What is the healing time of a distal radius fracture?

A

4-6 weeks

54
Q

What is the healing time of a forearm fracture?

A

8-10 weeks

55
Q

What is the healing time of a tibia fracture?

A

10 weeks

56
Q

What is the healing time of a femur fracture?

A

12 weeks

57
Q

From what point after a fracture can you see signs of visible healing?

A

7-10 days on the X Ray

58
Q

What mechanism does primary bone healing occur by?

A

Intramembranous healing

59
Q

When does primary bone healing occur?

A

When you have a stable fracture

60
Q

What bone is formed through primary bone healing?

A

Woven bone is formed directly from mesenchymal cells

61
Q

What is secondary bone healing?

A

When the mesenchymal cells form a chondral precursor which then produces bone cekls

62
Q

What are the four principles to fracture management?

A

Reduction
Hold
Fixation
Rehabilitation

63
Q

What is meant by open reduction?

A

This is where the surgeons open the skin and put the bones back together

64
Q

What is meant by closed reduction?

A

Where the doctors physically push the bones together without surgical intervention

65
Q

What are two methods of closed reduction?

A

Manipulation or traction

66
Q

What are the two methods of traction?

A

Skin traction – bandage and weight used to align bones
Skeletal traction – pins and weight used to align bones

67
Q

What are the methods of closed holding?

A

Plaster or traction (skin or skeletal)

68
Q

What is the difference between the two types of fixation?

A

Internal = metal under the skin, can be in the medulla or out the medulla

External = pins sticking out the skin

69
Q

What are the two types of external fixation?

A

Monoplanar and multiplanar

70
Q

What are the four concepts of rehabilitation?

A

Use
Move
Strengthen
Weight bear

71
Q

What do ligaments do?

A

Connects bone to bone

72
Q

What do tendons do?

A

Connects bone to muscle

73
Q

What are the three types of tendinopathy?

A

Tendinosis, tendinitis and rupture

74
Q

What is tendinosis?

A

Degradation of the tendons collagen resulting in hardening, thickening or scarring of the tendons

75
Q

What is tendinitis?

A

Inflammation of the tendons

76
Q

How many grades of ligament tears are there?

A

3

77
Q

What is a grade one ligament tear?

A

Slight incomplete tear, no notable joint instability

78
Q

What is a grade two ligament tear?

A

Some joint instability, moderate to severe tear

79
Q

What is a grade 3 tear?

A

Complete tearing of 1 or more ligaments with obvious instability, and surgery is required

80
Q

What are the two methods on tendon repair?

A

Immobilize or surgery

81
Q

What are the two ways of immobilizing a tendon / ligament tear?

A

Plaster or boot/brace

82
Q

How are tendons surgically repaired?

A

Suturing

83
Q

What are the positive and negatives of immobilizing injured ligamentous tissue?

A

Good = less ligament lengthening

Bad =
Less overall length of ligament repair scar

Protein degradation exceeds protein synthesis

Production of inferior tissue by blast cells

Resorption of bone at site of ligament insertion

Decreased tissue tensile strength (50% in 6-9 weeks)

84
Q

What are the benefits of mobilizing injured ligamentous tissue?

A

Ligament scars are wider, stronger and more elastic
Better alignment snd quantity of collagen

85
Q

What are the 6 factors affecting tissue healing?

A 
Nutrition
Infection
Immune function
Blood supply
Forces
Movement
86
Q

How long does the inflammatory phase of ligament healing last?

A

1-7 days

87
Q

What does RICE stand for?

A

Rest, ice, compression, Elevation

88
Q

When are range of motion exercise recommended to start following a ligament injury?

A

48hours

89
Q

When does the remodeling phase start?

A

After more than 14 days

90
Q

How does does it take to reach the maximum strength of a ligament following an injury?

A

A year at least

91
Q

When performing an examination of a trauma patient, what information is essential to look for?

A

skin integrity, deformity, function, tenderness, neurovascular status

92
Q

What are the two views of X rays which are commonly performed?

A

AP and lateral

93
Q

What might you expect to see when examining a patient for a fracture

A 
Inability to weight bear
Severe pain 
Swelling and point tenderness 
Deformity 
Scrapes / abrasions 
Wound if open fracture 
Loss of movement 
Loss of sensation if nerve injury
94
Q

What are the three main principles of management?

A

Reduce
Hold
Rehabilitate

95
Q

What is a common twisting injury to the knee which results in the knee swelling up and a snap bing heard?

A

ACL Tear

96
Q

What does PRICE mean in terms of short term management?

A 
Protect
Rest
Ice
Compress
Elevate
97
Q

In what cases does a torn ACL result in surgery?

A

When the patient is young, active, sporty and does movements which require the ACL

98
Q

Why may surgery not be necessary for a torn ACL?

A

The muscles can compensate for the movement in some cases

99
Q

What is tried before surgery in a torn ACL injury?

A

Physiotherapy

100
Q

What condition is associated with a sharp, intense pain at the back of the ankle which occurs after hearing a loud snap?

A

Injured achilles tendon

101
Q

What muscles do the achilles tendon associate with?

A

Soleus and gastrocnemius

102
Q

What movements are associated with the achilles dendon?

A

Plantarflexion and dorsiflexion of the foot

103
Q

What are the examination findings from a ruptured achilles tendon?

A

Difficulty walking, unable to perform heel raises, thickening, tenderness and swelling on the affected side,

104
Q

What is tendinosis?

A

Thickening of the tendon that makes it prone to tear

105
Q

What happens when you have an injured achilles tendon and dangle your feet off the end of the bed?

A

The affected foot remains in dorsiflexion

106
Q

What are the four stages of tendon repair?

A

Inflammatory, reparative, remodelling (consolidation) and remodelling (maturation)

107
Q

What are some general complications with tendon surgery?

A

Deep vein thrombosis, infection and prolonged immobility

108
Q

What are some specific surgery complications of tendon repair?

A

Neurovascular injury, ankle infection, pressure sores from plaster or boot

109
Q

What is classified as osteopenia or osteoporosis in a T-test?

A

Osteopenia is up to 2.5 SD from normal (T score between -1 and -2.5)
Osteoporosis is more than 2.5 SD from normal (T score -2.5 or less)

110
Q

What fracture is this?

A

Simple/closed

111
Q

What fracture is this?

A

Open

112
Q

What fracture is this?

A

Transverse

113
Q

What fracture is this?

A

Spiral

114
Q

What fracture is this?

A

Impacted

115
Q

What fracture is this?

A

Greenstick

116
Q

What fracture is this?

A

Multifragmentary

BRS 5 Musculoskeletal (13 decks)

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