Case Study 1 (fractured left ankle)

Question 1

Give 5 functions of bones

Answer 1

Support
Protection
Movement
Mineral storage (calcium)
Blood cell production

Question 2

Describe the bone components and what they provide

Answer 2

• 30% organic matrix
  provides flexibility and tensile strength
• 70% inorganic salts
  provides hardness

Question 3

Describe the anatomy of a bone

Answer 3

Epiphysis (ends); compact and spongy bone

Diaphysis (shafts); compact bone collar

Question 4

Describe how bones grow

Answer 4

Epiphysial growth plates allow long bones to lengthen
Cartilage cells in the growth plate divide
Cartilage replaced by bone
Growth plates fuse at 20

Question 5

Name the 4 stages of fracture healing

Answer 5

1. Hematoma formation and inflammation
2. Callus formation
3. Consolidation
4. Remodelling

Question 6

What is a hematoma?

Answer 6

Abnormal collection of blood outside of a blood vessel

Question 7

When does the hematoma formation and inflammation phase of fracture healing begin and end?

Answer 7

Occurs immediately after the injury

Ends approx one week after the injury

Question 8

What happens in the callus formation phase of fracture healing?

Answer 8

Clotted blood from the inflammation is replaced with fibrous tissue and cartilage (known as soft callus)
Capillaries grow into the tissue

Question 9

What happens in the consolidation phase of fracture healing and when does it occur?

Answer 9

Soft callus is replaced by hard bone (known as hard callus)

Occurs 3-4 weeks after injury

Question 10

What happens in the remodelling phase of fracture healing?

Answer 10

Bone continues to form and becomes compact, returning to its original shape

Question 11

Why is immobilisation of a fractured ankle important?

Answer 11

Immobilisation is critical to stop movement of bone fragments in the fracture.

Question 12

Name some exercises to help with the rehabilitation of the fractured ankle

Answer 12

Resisted ankle plantar and dorsiflexion
Ankle alphabet
Heel raises

Question 13

What factors can hinder bone healing?

Answer 13

• smoking
  constricts blood vessels and decreases circulation
• low levels of calcium

Question 14

How can smoking hinder bone healing?

Answer 14

Reduces circulation
Smoking causes arteriosclerosis (a build-up of fatty deposits) in the vessels, reducing blood flow and reduces the elasticity of the vessel walls

Question 15

How does inflammation occur?

Answer 15

White blood cells help fight infection by attacking invaders and consuming infected or dead cells. They are produced in the bone marrow.
Acute inflammation reaction

Question 16

What is the role of a hematoma after a fracture

Answer 16

The fracture hematoma acts to both resolve bleeding at the fracture site and to contain and eliminate potential sources of infection

Question 17

What happens during the hematoma formation and inflammation stage of healing.

Answer 17

Hemostasis has three major steps:

1) vasoconstriction (caused by smooth muscle cells)
2) temporary blockage of a break by a platelet plug (platelets adhere to damaged endothelium to form a platelet plug )
3) blood coagulation or formation of a fibrin clot

Question 18

What is the most common type of ankle fracture and why?

Answer 18

The most common type is a lateral malleolus fracture, at the bottom of the fibula. More common to break the fibula as it is the thinner bone

Question 19

What tips can you give to help with swelling

Answer 19

• sit with the leg elevated when resting

- apply ice to manage pain

Question 20

What tips can you give to help with stiffness

Answer 20

• move ankle regularly to regain full ROM

- gradually increase walking on the ankle

Question 21

What initial exercises would you prescribe, when would these be completed and what do they help with?

Answer 21

Help improve movement and function
Start as soon as the plaster is removed
Repeat 3 or 4 times a day
- move the ankle in circles (OR ankle alphabet)
- sit on a chair, alternately raise heels and toes

Question 22

What do intermediate exercises focus on and what would you prescribe?

Answer 22

Focus on strength at the ankle

• resisted plantar and dorsiflexion
• stand on one leg
• heel raises

Question 23

What bones form the ankle joint?

Answer 23

• Fibula
• Tibia
• Talus

Question 24

What muscles perform plantar flexion and give their origins and insertions

Answer 24

- Gastrocnemius (2 heads)
medial and lateral condyles of femur
posterior calcaneus via calcaneal tendon
- Soleus
posterior surface of tibia
posterior calcaneus via calcaneal tendon
- Plantaris
lateral supracondylar ridge of femur
posterior calcaneus via calcaneal tendon

Question 25

What muscles perform dorsiflexion and give their origins and insertions

Answer 25

-Tibialis Anterior lateral condyle of tibia medial cuneiform

Question 26

What plane of movement do plantar and dorsiflexion occur in?

Answer 26

Sagittal plane

Question 27

Name the ligaments found in the ankle and foot

Answer 27

``` Medial ligaments (DELTOID LIGAMENTS) - anterior and posterio tibiotalar - tibiocalcaneal - tibionavicular Lateral ligaments - anterior and posterior talofibular - calcaneofibular ``` ``` Spring ligament (calcaneonavicular ligament) Achilles tendon/ Calcaneal tendon in the back of the foot ```

Question 28

What is the prime mover of foot inversion, state the origin and insertion

Answer 28

Tibialis posterior Origin: superior tibia and fibula Insertion: tuberosity of the navicular, base of 2nd, 3rd and 4th metatarsals

Question 29

How many degrees of freedom does the foot have?

Answer 29

two degrees flexion/extension = sagittal plane inversion/eversion = frontal plane

Question 30

What type of joint is the ankle joint?

Answer 30

Synovial hinge joint joining the distal ends of the tibia and fibula to the proximal end of the talus.

Question 31

Name the main muscles working in foot eversion and give their origin and insertion

Answer 31

Peroneus longus - proximal end of lateral side of fibula - medial cuneiform and 1st metatarsal Peroneus brevis - distal two thirds of lateral side of fibula - base of 5th metatarsal