Bone injury and healing

Question 1

what are the different mechanisms of action that can lead to bone fracture?

Answer 1

Trauma- Low or HIgh energy

Stress- abnormal stress on normal bone

Pathological- normal stress on abnormal bone

Question 2

what are the different types of fracture?

Answer 2

Question 3

what type of fracture is it if the bony ends arent aligned?

Answer 3

displaced

Question 4

what are the questions you ask yourself when trying to figure out what type of fracture it is?

Answer 4

• are the soft tissues intact?
• is the break complete? if so how many pieces
• are the bony ends aligned?

Question 5

Whats the difference between high energy and low energy trauma?

Answer 5

High energy- car crash

Low energy- simple fall

Question 6

Describe how abnormal stress on bone can lead to fracture

Answer 6

• Overuse
• stress exerted is GREATER than bone capacity to remodel
• Bone weakens
• Stress fracture
• Risk of complete fracture increases

Question 7

what are the types of bone typically affected by abnormal stresses?

Answer 7

Weight bearing bones like:

Tibia, Metatarsals, navicular

Question 8

what are the related activities that can lead to abnormal stresses on bone

Answer 8

Athletes, military, femal athlete triad

Question 9

In pathological mechanisms, what are the common pathologies and what can they lead to?

Answer 9

• Osteoporosis- soft bone
• Malignancy- caused by bone metastases or primary
• Vit D deficiency- rickets or osteomalacia
• Osteomylitis
• Osteogenesis imperfecta
• Paget’s disease

Question 10

what are the 2 different types of bone metastases malignancy; give examples

Answer 10

BLASTIC- Prostrate and breast; increase in size

LYTIC; decrease in size by breaking down- Breast, kidney, thyroid, lung

Question 11

what are the examples of primary bone cancers?

Answer 11

Osteosarcoma

Chondrosarcoma

Ewing sarcoma

Chordoma

Question 12

Contrastthe effects of Vit D def on kids and adults, explain why

Answer 12

kiDS: cause RICKETS- bowing of legs. this is due to deficeny before epiphyseal plate closes

ADULTS: Osteomalacia; physis has already closed. No deformity seen but bone is soft and can EASILY fracture

Question 13

Describe the pathophysiology of Osteogenesis imperfecta

Answer 13

decreased Type 1 collagen secretion OR abnormal collagen secretion

insuffucient osteiod production

effects:

• Blue sclera
• heart, and hearing problems.Bone problem

Question 14

How does Paget’s disease develop?

Answer 14

caused by GENETIC AND ACQUIRED factors

XS bone breakdown and disorganised remodelling. Lead to deformity, pain, fracture or arthritis

May develop into a malignant disease

Question 15

what are the four stages of Pagets disease

Answer 15

1. Osteoclastic activity
2. Mixed osteo-osteoblast activity
3. osteoblastic activity
4. malognant degeneration

Question 16

what are the different stages of fracture healing?

Answer 16

1. Heamatoma, release of cytokines and granulation tissue
2. Week2-4 soft callus (type 2 collagen) and then gets turned to hard callus (type1)
3. 4-12 months; bone remodels to external activityand forces. excess bone is removed

Question 17

What is Wolff’s law

Answer 17

bone remodels and grows in responseto forces placed on it

Question 18

what is primary bone healing?

Answer 18

Intermembranous healing; osteocytes easily jump across gaps

absolute stability

Question 19

What is secondary bone healing?

Answer 19

Endochondral healing

involves responses in periosteum and external soft tissues

Relative stabiltiy

Question 20

what is normal fracture helaing time

Answer 20

3-12 weeks depending on site.

it takes longer the further it is from the heart.

healing signs seen on X rays from 7-10 days

Question 21

what are the 3 steps in effective fracture mangement?

Answer 21

Reduce

Hold or fix

Rehabilitate

Question 22

what are the different ways of reduction?

Answer 22

Question 23

what are the different ways of holding

Answer 23

Question 24

what are the different ways of fixation

Answer 24

Question 25

what is an advantage of external fixation over internal

Answer 25

can easily tell if there's infection

Question 26

what are the methods of rehab?

Answer 26

Question 27

what are the different forms of tedinopathy

Answer 27

1. Tendinosis- abnormal; thickening 2. Tendinitis- inflammation 3. rupture

Question 28

what are the ligament injury classification?

Answer 28

Grade 1- sloght tear; no notable joint instabiltiy Grade 2- moderate tear; maybe 1 ligament completely torn. some notable joint instabilty Grade 3- complete tearing of more that 1 ligament. obvious instabiltiy. surgery required

Question 29

what are the factors affecting tissue healing?

Answer 29

Mechanical environ- movement and forces Bio environ- blood supply, infection, nutrition, immune function

Question 30

describe the features of osteoporosis

Answer 30

Firstly there's ostepenia which leads to osteporosis more dominant in female (4:1) ratio occurs when osteoclast activity is gretaer than osteoblast activity which leads to a disrupted microarchitecture associated with fragility fractures of hip, spine and wrist due to low trauma

Question 31

what are the different stages of life that osteporosis can occur?

Answer 31

Senile osteoporosis- over 70 yr post menopausal- 50-70 women secondary; any age; cuased by: alcoholism, XS cortisol or hypogonadism

Question 32

what are the T scores for normal, osteopenia and osteoporosis?

Answer 32

Normal: greater than -1 Osteopenia- -1 to -2.5 osteoporosis; less than -2.5

Question 33

what are the merits and problems of immobilisation and mobilisation for healing ligamentous tissue

Answer 33

Question 34

What are the stages of Ligament & tendon healing?

Answer 34

Inflam phase- fibrin clot forms in tear. (within a week) proliferation- tendons and ligaments weakest. builds stremgth. 7-21 days remodelling- heal with scar tissue that reduce ultimate strength Maturation- max strength reached within a year

Question 35

What are the complications of surgically reparing tendons

Answer 35

tendon made too tight nerve damage, infection, blood vessels, muscle damge anaesthetic risk pulmonary embolism bleeidng blood clots