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MSK Systems > 9: MSK Growth Injury and Repair - Ligament, Tendon and Bone > Flashcards

9: MSK Growth Injury and Repair - Ligament, Tendon and Bone Flashcards

1
Q

what are ligaments composed of?

A
  • collagen fibres (type 1)
  • fibroblasts (communicate)
  • sensory fibres; proprioception, stretch, sensory
  • vessels (surface)
  • crimping (allow stretch)
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2
Q

compared to tendons, ligaments have…

A
  • lower % of collagen
  • higher % of proteoglycans and water
  • less organised collagen fibres
  • rounder fibroblasts
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3
Q

what is the treatment for a ligament rupture/tear?

A

conservative:
- partial
- no instability
- poor candidate for surgery

operative:
- instability
- expectation (sportsmen)
- compulsory (multiple)

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4
Q

describe the structural anatomy of a tendon

A
  • longiudinal arrangement of cells (mostly tenoxytes) and fibres (collagen type 1 - triple helix)
  • fascicles of long narrow spiralling collagen bundles
  • collagen bundles covered by endotenon
  • fascicles covered by paratenon
  • tendon covered by epitenon
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5
Q

what layer of a tendon is the blood supply found?

A

fine network of blood vessels in paratenon

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6
Q

give an example of where a tendon sheath is found?

A

flexor tendons in distal palm and fingers

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7
Q

tendons are connected to tendon sheath by what?

A

vincula

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8
Q

what is the function of a tendon?

A
  • to be flexible and very strong when under tension
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9
Q

list some causes of tendon injury

A
  • degeneration
  • inflammation
  • enthesiopathy
  • traction apophysitis
    **- avulsion +/- bone fragment
  • tear - intrasubstance (rupture)**
  • tear musculotendinous junction
  • laceration/incision
  • crush/ischaemia/attrition
  • nodules
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10
Q

what is de Quervain’s stenosing tenovaginitis?

A
  • inflammation of extensor pollicus brevis EPB + adductor pollicus longus APL passing through common tendon sheath at radial aspect of wrist.
  • presents with swollen, tender, hot, red wrist
  • positive Finkelstein’s test
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11
Q

what is enthesiopathy?

give examples

A
  • inflammation at insertion of muscle/tendon or ligament to bone.
  • muscle/tendon: usually at muscle origin rather than tendon insertion e.g. lateral humeral epicondylitis (tennis elvow) - common extensor origin
  • ligament: plantar fasciitis
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12
Q

describe traction apophysitis, e.g. Osgood-Schlatter disease

A
  • Osgood-Schlatter disease is a self-limited condition characterized by inflammation and stress-induced injury of the tibial tuberosity at the insertion point of the patellar tendon.
  • It typically affects adolescents and is associated with high levels of physical activity, particularly in sports that involve running, jumping, or rapid changes in direction.
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13
Q

what is the treatment of tendon avulsion +/- bone fragment?

A
  • conservative: limited application, retraction tendon
  • operative: reattachment tendon > through bone, fixation bone fragment
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14
Q

common mechanisms of tendon intrasubstance rupture

A
  • pushing off with weight bearing forefoot whilst extending knee joint e.g. sprint starts or jumping movements
  • unexpected dorsiflexion of ankle e.g. slipping into hole
  • violent dorsiflexion of plantar flexed foot e.g. fall from height
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15
Q

clinical features of achilles tendon rupture

A
  • positive Simmond’s (squeeze) test
  • palpable tender gap
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16
Q

tendon rupture treatment

A

conservative:
- mobilise (partial rupture) e.g. med lig knee
- splint/cast

operative:
- if high risk rerupture
- if high activity
- if ends cannot be opposed

17
Q

list the differences between cortical and cancellous bone

A

cortical:
- diaphysis
- resist bending and torsion
- laid down circumferentially
- less biologically active

cancellous:
- metaphysis
- resists/absorbs compression
- site of longitudinal growth (physis)
- very biologically active

18
Q

what is a fracture?

A
  • break in structural continuity of bone
  • may be a crack, break, split, crumpling, buckle
19
Q

why do bones fail?

A
  • high energy transfer in normal bones, takes a lot of energy
  • repetitive stress in normal bones > stress fracture
  • low energy transfer in abnormal bones e.g. osteoporosis, osteomalacia, metastatic tumour, other bone disorders
20
Q

what are the four stages of fracture repair?

A
  • inflammation
  • soft callus
  • hard callus
  • bone remodelling
21
Q

what is the gold-standard for the majority of bone graft needs?

A
  • autogenous cancellous bone graft
  • is both osteoconductive and osteoinductive
22
Q

why is a bone allograft not as effective as a autogenous cancellous bone graft?

A
  • not osteoinductive
  • risk of disease transmission
23
Q

when does the soft callus (second stage) stage of fracture repair begin and end?

A
  • begins when pain and swelling subside
  • lasts until bony fragments are united by cartilage or fibrous tissue
24
Q

what happens during stage 3 (hard callus) of fracture repair?

A
  • conversion of cartilage to woven bone
  • in a typical long bone fracture: endochondral bone formation and membranous bone formation.
25
Q

what happens during stage 4 (bone remodelling) of fracture repair?

A
  • conversion of woven bone to lamellar bone
  • medullary canal is reconstituted
  • bone responds to loading characteristics Wolff’s law
26
Q

describe the importance of strain in fracture repair

A
  • degree of instability is best expressed as magnitude of strain (% change of initial dimension)
  • if strain is too low mechanical induction of tissue differentiation fails
  • too high and healing process does not progress to bone formation
27
Q

what is a delayed union fracture?

A

failure to heal in expected time

28
Q

list some causes of a delayed union fracture

A
  • high energy injury
  • distraction (increased osteogenic jumping)
  • instability
  • infection
  • steroids
  • immune suppressants
  • smoking
  • warfarin
  • NSAID
  • ciprofloxacin
29
Q

causes of a non-union/failure to heal fracture

A
  • failure calcification fibrocartliage
  • instability - excessive osteoclasts
  • abundant callus formation
  • pain + tenderness
  • persistent fracture line
  • sclerosis

MSK Systems (38 decks)

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