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BRS MUSCULOSKELETAL And RHEUM > Injury And Healing > Flashcards

Injury And Healing Flashcards

(105 cards)

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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 a 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?

A

POMOVO

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 measured?

A

By having a bone density that is more then 2.5x standard deviations away from the mean (T score below -2.5)

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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 collagen levels lower in osteogenesis imperfecta patients?

A

Decreased secretion
Production of abnormal collagen

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25
What does osteogenesis imperfecta impact?
Bones Hearing Heart Sight
26
Blue sclera is a symptom of what condition?
Osteogenesis imperfecta
27
What is Paget’s disease?
Excessive bone breakdown and disorganized remodeling which leads to deformity
28
What are the four stages of Paget’s disease?
1. Osteoclastic activity 2. Mixed osteoclastic-osteoblastic activity 3. Osteoblastic activity 4. Malignant degeneration
29
Which cancers are blastic (endures bone growth)?
Prostate cancer and breast cancer
30
Which cancer are lytic (bone eating)?
Kidney, thyroid, lung and breast
31
What are the four primary bone cancers?
Osteosarcoma Chondrocarcoma Ewing sarcoma Lymphoma
32
What are secondary bone cancers?
When cancers which originated in other tissues metastasize to the bone
33
What are the two types of fractures which affect the soft tissue integrity?
Open and close
34
What is a closed fracture?
Fractured under the skin
35
What is an open fracture?
One that pokes through the skin
36
What are the two types of fractures which involve the movement to the bone?
Displaced and undisplaced
37
What is an undisplaced fracture?
One that has hardly moves
38
What is a displaced fracture?
A fracture which has moved around alot
39
What are the three fractures associated with bony fragments?
Green stick, simple and comminuted
40
What is a green stick fracture?
When the bone fragments are bent
41
What is a multi fragmentary/ comminuted fracture?
When there are many fractures along the same bone resulting in many bone fragments
42
What are the 4 stages of general tissue healing?
Bleeding Inflammation New tissue formation Remodelling
43
What cells are involved with remodeling?
Macrophages, osteoclasts and blast cells
44
What is Wolff’s Law?
Bone grows and remodels in response to the forces that are placed on it
45
What three things happen in the inflammation stage of fracture healing?
Haematoma formation Cytokine release from the blood products Granulation tissue and blood vessel formation
46
What happens in the repair phase of fracture healing?
Soft callus formation (cartilage) which is then converted to hard callus (bone)
47
What happens during the remodelling phase of fracture repair?
The hard callus responds to external forces, functional demands and growth
48
What is the healing time of a phalange fracture?
3 weeks
49
What is the healing time of a metacarpal fracture?
4-6 weeks
50
What is the healing time of a distal radius fracture?
4-6 weeks
51
What is the healing time of a forearm fracture?
8-10 weeks
52
What is the healing time of a tibia fracture?
10 weeks
53
What is the healing time of a femur fracture?
12 weeks
54
From what point after a fracture can you see signs of visible healing?
7-10 days on the X Ray
55
What mechanism does primary bone healing occur by?
Intramembranous healing
56
When does primary bone healing occur?
When you have a stable fracture
57
What bone is formed through primary bone healing?
Woven bone is formed directly from mesenchymal cells
58
What is secondary bone healing?
When the mesenchymal cells form a chondral precursor which then produces bone cells
59
What are the four principles to fracture management?
Reduction Hold Fixation Rehabilitation
60
What is meant by open reduction?
This is where the surgeons open the skin and put the bones back together
61
What is meant by closed reduction?
Where the doctors physically push the bones together without surgical intervention
62
What are two methods of closed reduction?
Manipulation or traction
63
What are the two methods of traction?
-skin which is where a weight is used to align the bones -skeletal- pins are placed into bones
64
What are the methods of closed holding?
Plaster or traction (skin or skeletal)
65
What is the difference between the two types of fixation?
Internal = metal under the skin, can be in the medulla or out the medulla External = pins sticking out the skin
66
What are the two types of external fixation?
Monoplanar and multiplanar
67
What are the four concepts of rehabilitation?
Use Move Strengthen Weight bear
68
What do ligaments do?
Connects bone to bone
69
What do tendons do?
Connects bone to muscle
70
What are the three types of tendinopathy?
Tendinosis, tendinitis and rupture
71
What is tendinosis?
Degradation of the tendons collagen resulting in hardening, thickening or scarring of the tendons
72
What is tendinitis?
Inflammation of the tendons
73
How many grades of ligament tears are there?
3
74
What is a grade one ligament tear?
Slight incomplete tear, no notable joint instability
75
What is a grade two ligament tear?
Some joint instability, moderate to severe tear
76
What is a grade 3 tear?
Complete tearing of 1 or more ligaments with obvious instability, and surgery is required
77
What are the two methods on tendon repair?
Immobilize or surgery
78
What are the two ways of immobilizing a tendon / ligament tear?
Plaster or boot/brace
79
How are tendons surgically repaired?
Suturing
80
What are the positive and negatives of immobilizing injured ligamentous tissue?
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)
81
What are the benefits of mobilizing injured ligamentous tissue?
Ligament scars are wider, stronger and more elastic Better alignment and quantity of collagen
82
What are the 6 factors affecting tissue healing?
Nutrition Infection Immune function Blood supply Forces Movement
83
How long does the inflammatory phase of ligament healing last?
1-7 days
84
What does RICE stand for?
Rest, ice, compression, Elevation
85
When are range of motion exercise recommended to start following a ligament injury?
48hours
86
When does the remodelling phase start?
After more than 14 days
87
How long does it take to reach the maximum strength of a ligament following an injury?
A year at least
88
When performing an examination of a trauma patient, what information is essential to look for?
skin integrity, deformity, function, tenderness, neurovascular status
89
What are the two views of X rays which are commonly performed?
AP (Anterior Posterior) and lateral
90
What might you expect to see when examining a patient for a fracture
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
91
What are the three main principles of management?
Reduce Hold/ fixation Rehabilitate
92
What is a common twisting injury to the knee which results in the knee swelling up and a snap bing heard?
ACL Tear
93
What does PRICE mean in terms of short term management?
Protect Rest Ice Compress Elevate
94
In what cases does a torn ACL result in surgery?
When the patient is young, active, sporty and does movements which require the ACL
95
Why may surgery not be necessary for a torn ACL?
The muscles can compensate for the movement in some cases
96
What is tried before surgery in a torn ACL injury?
Physiotherapy
97
What condition is associated with a sharp, intense pain at the back of the ankle which occurs after hearing a loud snap?
Injured achilles tendon
98
What muscles do the achilles tendon associate with?
Soleus and gastrocnemius
99
What movements are associated with the achilles tendon?
Plantarflexion and dorsiflexion of the foot
100
What are the examination findings from a ruptured achilles tendon?
Difficulty walking, unable to perform heel raises, thickening, tenderness and swelling on the affected side,
101
What is tendonosis?
Thickening of the tendon that makes it prone to tear
102
What happens when you have an injured achilles tendon and dangle your feet off the end of the bed?
The affected foot remains in dorsiflexion
103
What are the four stages of tendon repair?
Inflammatory, reparative, remodelling (consolidation) and remodelling (maturation)
104
What are some general complications with tendon surgery?
DVT (Deep vein thrombosis), infection and prolonged immobility
105
What are some specific surgery complications of tendon repair?
Neurovascular injury, ankle infection, pressure sores from plaster or boot

BRS MUSCULOSKELETAL And RHEUM (17 decks)

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