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BRS (RF) > Injury & healing > Flashcards

Injury & healing Flashcards

1
Q

What is a fracture?

A

A broken bone, it will heal whether or not a physician rests it in its anatomical position

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2
Q

What will happen to the bone during a fracture if it is not rest correctly?

A

The healing process will rebuild new bone but keep the bone in its deformed position

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3
Q

What is closed reduction?

A

Manipulation of broken bone, and set into natural position without surgical intervention

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4
Q

What is open reduction?

A

Requires surgery to expose the fracture and reset the bone

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5
Q

How are fractures classified?

A

Complexity
location
specific features

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6
Q

What are the 6 types of fracture?

A 
Transverse
Oblique
spiral
comminuted
impacted
greenstick
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7
Q

What is a transverse fracture?

A

Occurs straight across the long axis of the bone

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8
Q

What is an oblique fracture?

A

Occurs at an angle that is not perpendicular

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9
Q

What is a spiral fracture?

A

Bone segments are pulled apart as a result of twisting motion

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10
Q

What is a comminuted fracture?

A

Multiple breaks result in many small pieces between two large segments

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11
Q

What is classified as a simple comminuted fracture?

A

2 pieces

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12
Q

What is an impacted fracture?

A

One fragment is driven into the other, as a result of compression

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13
Q

What is a greenstick fracture?

A

Partial fracture in which one side of the bone is broken

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14
Q

What is an open fracture?

A

A fracture in which at least one end of the bone penetrates the skin, presenting potential risk of infection

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15
Q

What is a closed fracture?

A

A fracture in which the skin remains intact

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16
Q

What are displaced bone fractures?

A

Occurs when bony ends are not aligned

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17
Q

What is a stress fracture?

A

Repetitive application of forces on particular bone results in stress exertion on localised region -> Exceeds remodelling capacity causing bone weakening, stress fracture occurs

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18
Q

When does a bone experience stress?

A

Whenever a force is loaded upon it (Pull of a muscle or shock of a weight bearing extremity contacting the ground)

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19
Q

What does ADL mean?

A

Activities of daily living

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20
Q

What happens to bone when a force is removed?

A

The bone elastically rebounds to its original position. The force that a bone can endure and rebound back without damage is referred to as being within the elastic range

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21
Q

What are the weight baring bones?

A

Tibia, metatarsals, navicular

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22
Q

What is the female triad?

A

1) Amenorrhoea
2) Osteoporosis
3) Disordered eating

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23
Q

Why does osteoporosis increase risk of fractures?

A

Reduced bone mineral density, increasing porous structure

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24
Q

What are the pathological causes of fractures?

A 
Osteoporosis
Malignancy
Vitamin D deficiency 
Osteomyelitis 
Osteogenesis imperfecta
Paget's disease
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25
Q

What does vitamin D deficiency do to bone?

A

Osteomalacia + ricket’s

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26
Q

What are the 3 mechanisms of actions for fractures?

A

Pathological
Stress
Trauma

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27
Q

What is a trauma fracture?

A

Low energy and high energy transfer to bone

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28
Q

What is a stress fracture?

A

Abnormal stresses on normal bone

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29
Q

What is a pathological fracture?

A

Normal stresses on abnormal bone

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30
Q

What type of fracture is common for patients with osteoporosis?

A

Low energy trauma

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31
Q

How does osteoporosis and osteopenia occur?

A

Bone remodelling imbalance, bone resorption (osteoclast activity) > bone formation (osteoblast activity)

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32
Q

Which ligand is a mediator of osteoclast activity?

A

RANKL

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33
Q

What is the ratio for osteoporosis incidences between females: males?

A

4:1

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34
Q

When is the average age range for senile osteoporosis?

A

> 70

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35
Q

What is secondary osteoporosis typically associated with?

A

Hypogonadism
Glucocorticoid excess
alcoholism

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36
Q

What are the three most common fragility fractures?

A

Wrist, hip and spine

Low energy trauma

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37
Q

What T score is equivalent to osteoporosis?

A

-2.5

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38
Q

What T score range is diagnostic of osteopenia?

A

-1 –> -2.5

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39
Q

Why does menopause cause osteoporosis?

A

Oestrogen deficiency contributes towards excessive bone resorption. Osteoblasts, osteocytes, and osteoclasts express oestrogen receptors on their cell-surface membrane.
Function: Oestrogen prevents bone loss through the inhibition of osteoclastic bone resorption.
Oestrogen indirectly causes the increased production of transforming growth factor-beta that enhances osteoclast apoptosis. In the absence of oestrogen, T cells promote osteoclast recruitment ,and prolonged survival of interleukin-1, IL-6, and TNF-⍺. IL-6 contributes to the recruitment of osteoclasts.
Osteoblasts secrete IL-6 involved in osteoclast activation.
Post-menopausal women therefore exhibit an oestrogen deficiency, consequently stimulating osteoclastic activity due to a reduction in inhibitory effect, leading to osteoporosis.

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40
Q

What are the main examples of lytic cancers?

A

Breast, kidney, thyroid and lung

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41
Q

Which type of cancer has the ability to metastasis bone?

A

Lytic cancers (breast, kidney, thyroid and lung)

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42
Q

What are lytic cancers associated with?

A

Associated with reduction in size –> Referring to thinning and bone degradation

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43
Q

What are plastic cancers associated with?

A

Hyperplasia and hypertrophic mechanisms

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44
Q

What are the four main primary bone cancers?

A

Osteosarcoma
Chondrosarcoma
Ewing sarcoma
chroma

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45
Q

What pathology is associated with pre-epiphyseal closure vitamin D deficiency?

A

Rickets

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46
Q

What pathology is associated with post-epiphyseal closure vitamin D deficiency?

A

Osteomalacia

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47
Q

What are the consequences of a calcitriol deficiency?

A

reduced calcitriol activity  Hypocalcaemic conditions (Reduced Ca2+ absorption, renal reabsorption, & hyperparathyroidism)

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48
Q

What is the inheritance pattern of osteogenesis imperfecta?

A

hereditary - autosomal dominant/recessive

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49
Q

Which type of collagen is reduced in osteogenesis imperfecta?

A

Type 1 collagen

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50
Q

What is the function of collagen?

A

Collagen is an extracellular matrix protein secreted by fibroblasts & osteoblasts, and organised into insoluble fibres, comprising the extracellular matrix surrounding cells  Provides mechanical strength & rigidity to tissues and organs, especially to skeletal tissues: Bone, cartilage, tendons & ligaments.

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51
Q

What is the main feature of osteogenesis?

A

Reduced fracture of long bones

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52
Q

What is the aetiology of Paget’s disease?

A

Genetic and acquired factors

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53
Q

What is Paget’s disease?

A

Excessive bone degradation and disorganised bone remodelling -> Deformity, pain fracture, or arthritis. May transform into malignant disease

54
Q

What are the four stages of Paget’s disease?

A

1) Osteoclastic activity (increased bone resorption)
2) Mixed osteoclastic - osteoblastic activity (imbalance) results in disorganised bone remodelling, considering the osteoid scaffold is disrupted., and diverted through osteoclastic activity –> deformities arises
3) Osteoblastic activity
4) Malignancy degeneration

55
Q

What three main factors influence fracture healing?

A

Depends on type, severity, and distance between bone fragments

56
Q

What is direct bone healing?

A

Bones may heal directly by constructing new bone onto the fracture site -> Bone remodelling associated with osteoclast & osteoblast activity

57
Q

What is the first step of fracture healing?

A

Bleeding/haematoma

58
Q

What is a haemtoma, and the first stage of fracture healing associated with?

A

Prostaglandin/cytokine released; growth factors increase local blood flow –> Periosteal supply dominates

59
Q

Which blood supply dominates within step 1 fracture healing?

A

Periosteal supply

60
Q

When does step 1 fracture healing occur?

A

Week 1

61
Q

When does step 2 fracture healing occur?

A

Week 2-4

62
Q

What happens during step 2 fracture healing?

A

Granulation (connective/fibrotic) tissue deposited –> Soft callus (Type II collagen) -> cartilage; fibroblasts, woven bone (immature bone)

63
Q

What forms during step 2 fracture healing?

A

Soft callus

64
Q

Which type of collagen forms the soft callus?

A

Type 2 collagen

65
Q

What happens during step 3 fracture healing?

A

Fracture is bridged with soft callus –> Hard callus formation succeeds (laying down of osteoid –> type 1 collagen) facilitated by increased osteoblast activity

66
Q

When does step 3 fracture healing occur?

A

1-4 months

67
Q

When does stage 4 fracture healing occur?

A

4-12 months

68
Q

How is bone remodelled during stage 4 fracture healing?

A

Endochondral ossification

69
Q

What happens during stage 4 fracture healing?

A

Bone is remodelled through endochondral ossification lamellar bone in its place. Callus responds to activity, external forces, and the functional demands exerted onto bone; therefore this stimulates a balance of osteoblast & osteoclast activity to remodel bone (removal of excess).

70
Q

What re the four stages of fracture healing?

A

Haemtoma
Soft callus
hard callus
remodelling (endochondral ossification, osteoblast activity lamellar bone is integrated).

71
Q

What does Wolff’s Law state?

A

Wolff’s Law: States that bone grows and remodels in response to the forces that are exerted onto it. Placing specific stress in specific directions stimulates osteocyte activity.
Osteocyte apoptosis during disuse.

72
Q

What is primary bone healing associated with?

A

Intermembranous healing

73
Q

Which type of bone healing, primary or secondary is associated with absolute stability?

A

Primary bone healing

74
Q

What are the three main phases of primary bone healing?

A

Inflammatory phase
Reparative phase
remodelling phase

75
Q

Which cells are mainly involved in primary bone healing?

A

Osteoblasts

76
Q

Why is primary bone healing faster?

A

Osteoblasts move into fracture. In primary bone healing, the bone ends are in contact , osteoblasts can traverse across, and bone formation is accelerated, membrane forms. Membrane formation behaves as a conduit for osteoblasts to pass

77
Q

What is the inflammatory phase of pone healing?

A

Broken bones result in disrupted blood vessels, thus formation of a blood clot & haematoma. Inflammatory reaction results in cytokine release, growth factors & prostaglandins.
Fracture haematoma becomes organised and infiltrated by fibrovascular tissues, forming matrix for bone formation & primary callus

78
Q

What factors are released during the inflammatory phase of bone healing?

A

Cytokine ,prostaglandins, and growth factors

79
Q

What structure forms during the inflammatory phase of primary bone healing?

A

Primary callus

80
Q

What is the approximate duration of the inflammatory phase?

A

Duration: Hours - days

81
Q

Where does the thick mass callus form during the reparative phase of bone healing?

A

Around bone ends

82
Q

Which cells are recruited during the reparative phase of bone healing?

A

Osteoblasts are recruited to deposit type 1 collagen, derived from osteoid

83
Q

When is bone healing evident on radiographs?

A

7-10 days

84
Q

What happens during the reparative phase to the soft callus?

A

Soft callus transforms into hard callus

85
Q

What is a soft callus?

A

Plastic, easily performed or bend, if the fracture is not adequately supported

86
Q

What is a hard callus?

A

Weaker in comparison to normal bone

Better capability to withstand external forces to the stage of clinical union

87
Q

What is the stage of clinical union in terms of bone healing?

A

Fracture is not tender to palpation or with movement

88
Q

Which phase of bone healing is the longest?

A

Remodelling phase

89
Q

What is the average duration of the remodelling phase of bone healing?

A

Months-years

90
Q

During remodelling which law is obeyed?

A

Wolf’s Law

91
Q

How is the external callus removed during the remodelling phase of bone healing?

A

The external callus is no longer required, therefore is removed through osteoclast activity, and fracture site is smoothed & sculpted

92
Q

In which phase of bone healing is the epiphyses realigned and residual angulation corrected?

A

Remodelling

93
Q

What type of healing is associated with secondary bone healing?

A

Endochondral healing

94
Q

Which responses are involved in endochondral healing?

A

Involves responses in the periosteum and external soft tissue –> Relative stability

95
Q

Why is secondary bone healing less effective than primary bone healing?

A

Osteoblasts cannot jump across the gap. Cells derived from the periosteum causes osteoblasts to form osteoid, this bone formation joins the bone - cartilage precursor. Bone formation is unregulated, thus callus formation occurs

96
Q

What is the average healing time?

A

3-12 weeks depending on site

97
Q

What is the average length of time for phalange healing?

A

3 weeks

98
Q

What is the average length of time for metacarpal, healing?

A

4-6 weeks

99
Q

What is the average length of time for distal radius healing?

A

4-6 weeks

100
Q

What is the average length of time for forearm healing?

A

8-10 weeks

101
Q

What is the average length of time for femur healing?

A

12 weeks

102
Q

What is the average length of time for tibia healing?

A

10 weeks

103
Q

What is reduction in terms of fracture management?

A

Reduction involves restoring the anatomical alignment of a fracture or dislocation of the deformed limbs
Main principle: Correct the deforming forces that results in the injury

104
Q

What is the first stage of fracture management?

A

Reduction

105
Q

How is fracture reduction performed?

A

Performed closed,

106
Q

Why is reduced swelling an important concern during fracture management?

A

Reduction traction on the surrounded tissue causes reduced swelling, swollen soft tissue have high rates of wound complications

107
Q

What is the main aim of reducing traction on the traversing nerves?

A

Reduces neuropraxia

108
Q

What is the main aim of reducing pressure on blood vessels?

A

Restoration of affected vasculature

109
Q

What are the four main stages of fracture management?

A

Reduction
Hold
Fixation
Rehabilitation

110
Q

What is associated with hold during fracture management?

A

Describes fracture immobilisation, important to consider whether traction is required, whereby the muscle pull across the fracture site is strong, and the fracture is inherently unstable

111
Q

What clinical devices are usually implemented to immobilise fractures?

A

Plaster castes

Simple splints

112
Q

Why should an overlying dress be applied to the fracture site?

A

Enables fracture to swell

113
Q

What is the main risk if an overlying dress is not applied to the fracture site?

A

Patient may develop compartment syndrome

114
Q

What is axillary instability?

A

Fracture is able to rotate along its long axis

The plaster should cross both joint above and below

115
Q

What is the stabilisation stage of fracture management?

A

Fixation

116
Q

What are the two categories to fixate a fracture?

A

Internal (intramedullary nails, and screws)

External fixation

117
Q

What does the rehabilitation phase involve during fracture management?

A

Refers to the requirement for majority of patients to undergo an intensive period of physiotherapy following fracture management.
Advised that patients move from non immobilised unaffected joints from the outset

118
Q

What is tendinitis?

A

Inflammation of tendon associated from overuse (In addition to infection or rheumatic disease). Swelling, and pain results in reduced mobility of tendon & muscle.

119
Q

What is tedinosis?

A

Chronic conditions involving deterioration of collagen within tendons. Tendinosis is caused by overuse of a tendon –> Abnormal thickening

120
Q

What are the three main pathologies involved with tedinopathy?

A

Tendinitis
Tendinosis
Ruptured tendon

121
Q

What are the three grade classifications of ligament injury?

A

Grade 1, II, III

122
Q

What is a grade I ligament injury?

A

Slight incomplete tear

No notable joint instability

123
Q

What is a grade II ligament injury?

A

Moderate/severe incomplete tear –> Some joint instability. One ligament may be completely torn

124
Q

What is a grade III ligament injury?

A

Complete tear of 1 or more ligaments, there is an obvious indication of instability
Surgical intervention required

125
Q

What is the main pathology for the inflammatory phase of bone healing?

A

Fibrin clots formed in ligament tears

126
Q

What is the main pathology during the proliferation phase of bone healing?

A

Tendons & ligaments weakest, ensile strength builds

127
Q

Which bone healing phase is the most painful?

A

Inflammatory phase

128
Q

What is the main advantage of immobilisation?

A

Less ligament laxity (lengthening)

129
Q

In terms of strength which is better, mobilisation or immobilisation of ligamentous tissue?

A

Mobilisation results in grater overall strength

130
Q

What are the 5 main disadvantages for immobilisation of ligamentous tissue?

A 
Less overall strength
Protein degradation 
Production of inferior tissue Bly blast cells
Bone resorption 
Build tissue tensile strength
131
Q

What are the 2 main benefits of mobilising ligamentous tissue?

A

Ligament scars are wider, stronger & more elastic

Better alignment/quality of collagen

BRS (RF) (38 decks)

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