Injury and Healing Flashcards by Anouk Wijeratne

What occurs when the ACL is injured?

Wobbly knee

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What are the three mechanisms of bone fracture?

Trauma- low/high energy
Stress- abnormal stresses on normal bone
Pathological- normal stresses on abnormal bone

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How can you describe fracture patterns?

Soft tissue: Open or closed

Bony fragments: Greenstick/ Simple/ Comminuted

Displacement: Displaced/ Undisplaced

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What is an example of high energy trauma?

Car crash

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Give an example of low energy trauma?

Fall

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How can a stress fracture occur?

Overuse
Stress exerted on bone is greater than bones capacity to remodel
Bone weakening 
Stress fracture
Risk of complete fracture

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Who is at risk of developing stress fractures?

Athletes

Military personnel

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What is the female athlete triad?

Regular strenuous exercise 
Insufficient calorie intake
Weight loss
Amenorrhoea 
Osteoporosis

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Which bones a prone to stress fractures?

Weight baring bones

e.g. tibia, metatarsals, navicular

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Give examples of pathological stresses?

Osteoporosis
Malignancy 
Vit D deficiency
Osteomyelitis
Osteogenesis Imperfecta
Paget's disease

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What conditions are caused by Vitamin D deficiency?

Osteomalacia

Ricket’s

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What occurs when osteoclast activity > osteoblast activity?

Disrupted microarchitecture

More common in females 4:1

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What are the different types of osteoporosis?

Postmenopausal Osteoporosis – Women 50-70
Senile Osteoporosis - > 70
Secondary osteoporosis: Any age, 60% Male
Hypogonadism
Glucocorticoid excess
Alcoholism

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What are osteopenia and osteoporosis associated with?

Associated with ‘fragility fractures’ – hip, spine, wrist

Low energy trauma  fracture

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What cancers are blastic?

Prostate

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What cancers are lytic?

Kidney
Thyroid
Lung

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What does Vit D deficiency cause in paeds?

Before physis closure

Rickets

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What does Vit D deficiency cause in adults?

After physis closure

Osteomalacia

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What are the main features of osteogenesis imperfecta?

‘Brittle Bone Disease’
Hereditary – autosomal dominant or recessive
↓ Type I Collagen due to:
Decreased secretion
Production of abnormal collagen
Results in insufficient osteoid production

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What does OI effect?

Bones
Hearing
Heart
Sight
Blue sclera

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What are the main features of Paget’s disease?

Aetiology: Genetic & acquired factors
Excessive bone break down and disorganised remodeling  deformity, pain, fracture or arthritis
May transform into a malignant disease

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What are the 4 stages of Paget’s?

Osteoclastic Activity
Mixed osteoclastic-osteoblastic activity
Osteoblastic activity
Malignant degeneration

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What happens during week 1 of fracture healing?

Haematoma formation
Release of Cytokines
Granulation tissue

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What happens during week 2- 4 months?

Soft Callus formation
(Type II Collagen - Cartilage)
Converted to hard callus
(Type I Collagen - Bone)

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What happens during months 4-12?

Callus responds to activity, external forces, functional demands and growth Excess bone is removed

What are the signs of fracture?

Oedema Inflammation Bleeding

What is primary bone healing?

Intermembranous healing | Absolute stability

What is the secondary bone healing?

Endochondral healing Involves responses in the periosteum and external soft tissues Relative stability

What are the different fracture healing times?

3-12 Weeks depending on site Signs of healing visible on X-ray from 7-10 days ``` Phalanges: 3 weeks Metacarpals: 4-6 weeks Distal radius: 4-6 weeks Forearm: 8-10 weeks Femur: 12 weeks Tibia: 10 weeks ```

What does healing time depend on?

Proximity to the heart | Depends on blood supply and soft tissue coverage

What is the secondary bone healing?

Endochondral healing Involves responses in the periosteum and external soft tissues Relative stability greater Callous formation

What are three steps of fracture management?

Reduce Hold Rehabilitate

What is reducing?

Bring the two structures together Closed: Manipulation or Traction Open: Mini incision or Full exposure

How can you hold?

Without metal: Plaster or Traction | With metal: Fixation

What are the two types of fixation?

``` Internal: Intramedullary- Pins/Nails Extramedullary- Plates and screws/Pins External Monoplanar Multiplayer ```

How can you rehabilitate?

``` Move Physiotherapy Use Strengthen Weigh-bear Retrain Pain relief ```

What do ligaments do?

Connect bone to bone

What do tendons do?

Connect muscle to bone

What can happen to tendons?

Thickening Inflammation Rupture

What do you call abnormal thickening of the tendon?

Tendinosis

What do you call inflammation of the tendons?

Tendinitis

How do you classify ligament injury?

Grade I Grade II Grade III

What are the features of grade I?

Grade I – Slight incomplete tear – no notable joint instability

What are the features of grade II?

Grade II – Moderate / Severe Incomplete Tear – Some joint instability. One ligament may be completely torn

What are the features of grade III?

Grade III – complete tearing of 1 or more ligaments – Obvious instability. Surgery usually required

What are the phases of ligament healing?

Inflammatory phase Proliferation phase Remodeling Maturation

What happens in the inflammatory phase?

1-7 days | Fibrin clot formed in ligament tears

What happens in the proliferation phase?

7-21 days | Tendons and ligaments weakest, tensile strength builds

What happens during remodelling phase?

> 14 days Tendons and ligaments heal with scar tissue that reduces ultimate strength causes adhesions

What happens during maturation?

Weeks to years | Max strength reached within a year.

What factors affecting tissue healing?

Mechanical environment - movement - forces Biological environment - blood supply - immune function - infection - nutrition

What are the effects of immobilisation on injures ligamentous tissue?

GOOD Less ligament laxity (lengthening) BAD Less overall strength of ligament repair scar Protein degradation exceeds protein synthesis r net d in collagen quantity Production of inferior tissue by blast cells Resorption of bone at site of ligament insertion Build tissue tensile strength (50% in 6 - 9 weeks)

What are the benefits of mobilisation on injured ligamentous tissue?

Ligament scars are wider, stronger, and are more elastic | Better alignment / quality of collagen

What is manipulation?

Movement in to place

What is traction?

Put pin through the bone and pull with a weight/ sticky tape with weight

What does intramedullary mean?

Within the medullary cavity

What does extra-medullary mean?

Alongside the bone

What is multiplanar fixation?

External hardware on all sides (cage-like) | Partly internal

What is monoplanar fixation?

External hardware on one side of the limb | Partly internal

What are the functions of the achilles tendon?

Connects the gastrocnemius and soleus to the calcaneus Plantar flexes the foot Tendon pulls the foot down

What complications can result from surgery?

Damage to Nerves Vasculature Surrounding tissues Shortening of tendon: Stiffness/ restricted movement Insufficient tightening: Persistent symptoms Repair might fail: rerupture Infection

What is the ACL?

Anterior cruciate ligament

What does the ACL do?

Stablises knee joint Prevents forward movement of the tibia Connects the femur to the tibia

What should a patient do in the first 6 weeks of healing?

``` Protect Rest Ice Compression Elevation ```

What should a patient do from 6-9 months post-injury?

Physio: movement strengthen muscles start walking normally

What should the patient do post 9 months?

Training Jumping Improve balance and proprioception

Injury and Healing Flashcards

(66 cards)