General orthopaedics

Question 1

state the stages of fracture healing 4

Answer 1

hematoma formation- day 1-5

Fibrocartilaginous Callus Formation (Days 5 to 11)

Bony Callus Formation (Days 11 to 28)

Bone Remodelling (Day 18 onwards, lasting months to years)

Question 2

define direct and indirect fracture healing

Answer 2

direct-bone fragments fixed together by compression
-no callus formation
-bony ends joined and healed by osteoclasts and osteoblasts

indirect healing
-non-operative fracture healing
-small amountof motion and weightbearing at the fracture
-causes a soft calluse to form and secondary bone formation

Question 3

describe hematoma formation in bone healing

Answer 3

bld vsls supplying bone and periosteom are ruptured during fracture

hematoma forms

pro-inflam cytokines released tnf-alpha, IL,1,6,11,23

Question 4

describe the fibrocartilgationus callus formation part of bone healing

Answer 4

release of VEGF leads to angiogenesis at the site

fibrin rich granulation tissue develops

fibroblasts chondroblasts and osteoblasts are recruited and create firbocartilgtionous network

Question 5

describe the bony callus formation of bone healing

Answer 5

cartilgainous callus undergoes endochondral ossification

RANK-L is expressed causes further differentiation of chronoblasts/clasts and osteoblasts/clasts

cartilgationus callus is resorbeed and begins to calcigy

at end of phase hard calcified callus of immature bone forms

Question 6

describe the bone remoddeling part of bone healing

Answer 6

continued migration of osteoclasts/blasts hard callus undergoes repeated remodeling

-centre of callus is replaced by compact bone and ultimately results in regeneration of normal bone structure

Question 7

state the 3 types of nerve injuries 3

Answer 7

neuropraxia

axonotmesis

neutrotmesis

Question 8

define neuropraxia

Answer 8

mildest form of nerve injury

focal segmental demyelination at site of injury without axon disruption

Question 9

what does neuropraxia result in

Answer 9

blockage of nerve conduction and transient weakness or paresthesia

Question 10

define axonotmesis

Answer 10

injruy to axon but does not completely sever the surrounding endoneurial sheath so regeneration can take place

Question 11

define neurotmesis

Answer 11

complete anatomical disruption of both the axon and all of the surrounding CT

-no chance of spontaneous recovery
-early surgical treatment is necessary

Question 12

main differntials for patient preseing with a hot swollen acutely painful joint

Answer 12

septic arthtis

haemarthoris (traumatic injury/bleeding disordeR)

crystal arthopaties

rheumatologies
-RA
-spondylarhotpaties

Question 13

define the term seronegative conditions

Answer 13

are rheumatoid factor negative

Question 14

define osteocalsts and osteoblasts

Answer 14

Osteoclasts are responsible for aged bone resorption and osteoblasts are responsible for new bone formation

Question 15

common causes of abrnomal gait

Answer 15

Arthritis of the leg or foot joints
Conversion disorder (a mental disorder)
Foot problems (such as a callus, corn, ingrown toenail, wart, pain, skin sore, swelling, or spasms)
Broken bone
Injections into muscles that causes soreness in the leg or buttocks
Infection
Injury
Legs that are of different lengths
Inflammation or swelling of the muscles (myositis)
Shin splints
Shoe problems
Inflammation or swelling of the tendons (tendinitis)
Torsion of the testis
Brain, spinal cord, and peripheral nerves diseases
Vision problems

Question 16

x-ray films of fracture healing

Answer 16

[51]

Question 17

what needs to be assessed on an x-ray for a fracture 5

Answer 17

configuration of fracture
-spiral, transverse etc

part of the bone fractured
-proximal or distal tibia

whether it is displaced or not (ends of bones have come out of alignment)

type of displacement
-angulation(distal portion of bone points in different direction, can be varus or valgus)
-translation- degree of displacement

whether it is intra-articular or not