Injury And Healing Flashcards
(116 cards)
1
Q
What are the three mechanisms of a fracture?
A
Stress, trauma and pathological
2
Q
What are the two types of trauma fractures?
A
High energy and low energy
3
Q
What is meant by a stress fracture?
A
When there is abnormal stress placed on normal bone
4
Q
Which bones do stress fractures normally occur on?
A
Weight bearing bones
5
Q
What activities are stress fractures related to.
A
Athletes, occupational, military
6
Q
What is an insufficiency fracture?
A
When the bone may have been thinned or weakened, so is insufficiently strong
7
Q
Describe the sequence of events that can result in s 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
8
Q
What factors can cause bone weakening?
A
Disordered eating, osteoporosis, amenorrhea
9
Q
What is meant by a pathological fracture?
A
Where NORMAL stresses are exerted in ABNORMAL bone
10
Q
What are some causes of abnormal bone seen in pathological fractures? POMOVO
A
Pagets Osteogenesis Imperfecta Malignancy Osteomyelitis Vitamin D deficiency Osteoporosis
11
Q
What is osteomyelitis?
A
Inflammation or swelling that occurs in the bone
12
Q
What happens when osteoclast activity > osteoblast activity?
A
Bone micro architecture is disrupted
13
Q
How is osteoporosis measure?
A
By having a bone density that is more then 2.5x standard deviations away from the mean
14
Q
Is osteoporosis more common in males or females?
A
Females
15
Q
What is senile osteoporosis?
A
Primary osteoporosis that is linked to age
16
Q
What is secondary osteoporosis?
A
Osteoporosis that occurs in any age,
17
Q
What are three causes of secondary osteoporosis?
A
Hypogonadism
Glucocorticoid excess
Alcoholism
18
Q
What type of fractures is secondary osteoporosis associated with?
A
Hip, spine and wrist fractures = fragility fractures
19
Q
What minerals does vitamin D help absorb?
A
Calcium, magnesium and phosphate
20
Q
How is vitamin D made?
A
Synthesized from the sun
21
Q
What happens if you have inadequate calcium or phosphate?
A
Results in a defect in Osteoid matrix mineralization
22
Q
What condition does vitamin D deficiency result in for children and adults?
A
Rickets for children’s
Osteomalacia for adults
23
Q
What is reduced in osteogenesis imperfecta?
A
Type 1 collagen
24
Q
Why are type I collagen levels lower in osteogenesis imperfecta patients?
A
Production of abnormal collagen
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
Chondrosarcoma
Ewing sarcoma
Lymphoma
32
What are secondary bone cancers?
When cancers which originated in other tissues metastasize to the bone
33
What can secondary bone cancers be classified as?
Blastic or lytic metastases
34
What are the two types of fractures which affect the soft tissue integrity?
Open and closed
35
What is a closed fracture?
Fractured under the skin
36
What is an open fracture?
One where the bone penetrates the skin, presenting a risk of infection
37
What are the two types of fractures which involve the movement to the bone?
Displaced and undisplaced
38
What is an undisplaced fracture?
One that has hardly moved apart
39
What is a displaced fracture?
When bones have move apart a lot
40
What are the three fractures associated with bony fragments?
Green stick, simple and multi fragmentary
41
What is a green stick fracture?
When the bone fragments are bent
42
What fracture is this?
Green stick
43
What is a multi fragmentary fracture?
When there are many fractures along the same bone resulting in many bone fragments
44
What fracture is this?
Multi fragmentary
45
What are the 4 stages of general tissue healing?
Bleeding
Inflammation
New tissue formation
Remodelling
46
What cells are involved with remodeling?
Macrophages, osteoclasts and blast cells
47
What is Wolff’s Law?
Bone grows and remodels in response to the forces that are placed on it
48
What four things happen in the inflammation stage (step 1) of fracture healing?
Haematoma formation
Cytokine release from the blood products
Granulation tissue
Blood vessel formation
49
What happens in the repair phase (step 2) of fracture healing?
Soft callus formation (cartilage) which is then converted to hard callus (bone)
50
What happens during the remodeling phase (step 3) of fracture repair?
The hard callus responds to external forces, functional demands and growth
51
What is the healing time of a phalange fracture?
3 weeks
52
What is the healing time of a metacarpal fracture?
4-6 weeks
53
What is the healing time of a distal radius fracture?
4-6 weeks
54
What is the healing time of a forearm fracture?
8-10 weeks
55
What is the healing time of a tibia fracture?
10 weeks
56
What is the healing time of a femur fracture?
12 weeks
57
From what point after a fracture can you see signs of visible healing?
7-10 days on the X Ray
58
What mechanism does primary bone healing occur by?
Intramembranous healing
59
When does primary bone healing occur?
When you have a stable fracture
60
What bone is formed through primary bone healing?
Woven bone is formed directly from mesenchymal cells
61
What is secondary bone healing?
When the mesenchymal cells form a chondral precursor which then produces bone cekls
62
What are the four principles to fracture management?
Reduction
Hold
Fixation
Rehabilitation
63
What is meant by open reduction?
This is where the surgeons open the skin and put the bones back together
64
What is meant by closed reduction?
Where the doctors physically push the bones together without surgical intervention
65
What are two methods of closed reduction?
Manipulation or traction
66
What are the two methods of traction?
Skin traction – bandage and weight used to align bones
Skeletal traction – pins and weight used to align bones
67
What are the methods of closed holding?
Plaster or traction (skin or skeletal)
68
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
69
What are the two types of external fixation?
Monoplanar and multiplanar
70
What are the four concepts of rehabilitation?
Use
Move
Strengthen
Weight bear
71
What do ligaments do?
Connects bone to bone
72
What do tendons do?
Connects bone to muscle
73
What are the three types of tendinopathy?
Tendinosis, tendinitis and rupture
74
What is tendinosis?
Degradation of the tendons collagen resulting in hardening, thickening or scarring of the tendons
75
What is tendinitis?
Inflammation of the tendons
76
How many grades of ligament tears are there?
3
77
What is a grade one ligament tear?
Slight incomplete tear, no notable joint instability
78
What is a grade two ligament tear?
Some joint instability, moderate to severe tear
79
What is a grade 3 tear?
Complete tearing of 1 or more ligaments with obvious instability, and surgery is required
80
What are the two methods on tendon repair?
Immobilize or surgery
81
What are the two ways of immobilizing a tendon / ligament tear?
Plaster or boot/brace
82
How are tendons surgically repaired?
Suturing
83
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)
84
What are the benefits of mobilizing injured ligamentous tissue?
Ligament scars are wider, stronger and more elastic
Better alignment snd quantity of collagen
85
What are the 6 factors affecting tissue healing?
```
Nutrition
Infection
Immune function
Blood supply
Forces
Movement
```
86
How long does the inflammatory phase of ligament healing last?
1-7 days
87
What does RICE stand for?
Rest, ice, compression, Elevation
88
When are range of motion exercise recommended to start following a ligament injury?
48hours
89
When does the remodeling phase start?
After more than 14 days
90
How does does it take to reach the maximum strength of a ligament following an injury?
A year at least
91
When performing an examination of a trauma patient, what information is essential to look for?
skin integrity, deformity, function, tenderness, neurovascular status
92
What are the two views of X rays which are commonly performed?
AP and lateral
93
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
```
94
What are the three main principles of management?
Reduce
Hold
Rehabilitate
95
What is a common twisting injury to the knee which results in the knee swelling up and a snap bing heard?
ACL Tear
96
What does PRICE mean in terms of short term management?
```
Protect
Rest
Ice
Compress
Elevate
```
97
In what cases does a torn ACL result in surgery?
When the patient is young, active, sporty and does movements which require the ACL
98
Why may surgery not be necessary for a torn ACL?
The muscles can compensate for the movement in some cases
99
What is tried before surgery in a torn ACL injury?
Physiotherapy
100
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
101
What muscles do the achilles tendon associate with?
Soleus and gastrocnemius
102
What movements are associated with the achilles dendon?
Plantarflexion and dorsiflexion of the foot
103
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,
104
What is tendinosis?
Thickening of the tendon that makes it prone to tear
105
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
106
What are the four stages of tendon repair?
Inflammatory, reparative, remodelling (consolidation) and remodelling (maturation)
107
What are some general complications with tendon surgery?
Deep vein thrombosis, infection and prolonged immobility
108
What are some specific surgery complications of tendon repair?
Neurovascular injury, ankle infection, pressure sores from plaster or boot
109
What is classified as osteopenia or osteoporosis in a T-test?
Osteopenia is up to 2.5 SD from normal (T score between -1 and -2.5)
Osteoporosis is more than 2.5 SD from normal (T score -2.5 or less)
110
What fracture is this?
Simple/closed
111
What fracture is this?
Open
112
What fracture is this?
Transverse
113
What fracture is this?
Spiral
114
What fracture is this?
Impacted
115
What fracture is this?
Greenstick
116
What fracture is this?
Multifragmentary
