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1B Musculoskeletal > Management of specific fractures > Flashcards

Management of specific fractures Flashcards

1
Q

what are the functions of bone?

A

support

protection

locomotion

hematopoiesis

lipid and mineral reservoir (particularly calcium)

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2
Q

what are the types of bones?

A

flat bone

long bones

irregular bones

short bones

sesamoid bones

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3
Q

what are the functions of flat bones and examples

A

protect internal organs

skull, thoracic cage, sternum, scapula

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4
Q

what are the functions of long bones and examples?

A

support and facilitate movement

humerus, radius, ulna, metacarpals

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5
Q

what is the function of irregular bones?

A

vary in shape and structure

e,g vertebrae, sacrum, pelvis, pubic, ilium or ischium

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6
Q

what are the features of short bones?

A

no diaphysis

as wide as they are long

provide stability and some movement

e.g carpals, tarsals

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7
Q

what are the functions of sesamoid bones?

A

embedded within tendons

potentially to protect tendons from stress or wear

e.g patella

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8
Q

what is the overall anatomy of bone?

A
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9
Q

what do bones have on the outside layer?

A

periosteum- provides blood and nutrition

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10
Q

what are the overall types of bones that can be formed?

A

woven (primary) bone

lamellar (secondary) bone

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11
Q

what is woven bone?

A

first type of bone to be formed- in embryonic development and fracture healing

consists of osteoid, randomly arranged collagen fibres

temporary structure replaced by mature lamellar bone

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12
Q

what is lamellar bone?

A

bone of adult skelton

highly organized sheets of mineralized osteoid, making it much stronger than woven bone

two types (compact and spongy)

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13
Q

what is the extracellular matrix bone function?

A

biomechanical and structural support

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14
Q

what does the extracellular matrix of bone contain?

A

collagen- type 1 (90%) abd type V

mineral salts- calcium hydroxyapatite

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15
Q

what is ECM initially called?

A

osteon

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16
Q

how does calcification occur?

A

mineral salts interpose between collagen fibres

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17
Q

what do osteoblasts do?

A

synthesise undifferentiated ECM

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18
Q

what are osteocytes?

A

osteoblasts entuned in bone

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19
Q

what are osteoclasts?

A

from monocytes

reabsorb bone

multinucleated cells

release H+ ions and lysosomal enzymes

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20
Q

what are osteoprogenitor cells?

A

undifferentiated stem cells

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21
Q

what is the difference between blood supply to bone and cartilage?

A

bone has a better blood supply

nutrient arteries supplying diaphysis and meta/epiphyseal vessels

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22
Q

how can bone grow?

A

endochondral

intramembranous

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23
Q

what is endochondral growth?

A

formation of bone onto a temporary cartilage scaffold

e.g hyaline cartilage replaced by osteoblasts secreting osteid in femur

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24
Q

what is intramembranous growth?

A

formation of bone directly onto fibrous connective tissue

e.g. temporal bone or scapula

provides width to bones

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25
what is bone removal undertaken by?
osteoclasts
26
why is osteoclast action necessary?
essential bone removal for body's metabolism as removal of bone increases calcium in blood
27
what is bone production done by?
osteoblasts
28
29
how do osteoblasts synthesis new bone?
have receptors from PTH, prostaglandins, vit D and cytokine activate and allow them to synthesise bone matrix
30
what does the coordinated action of osteoblasts and osteoclasts do?
take place as cutting cones that essentially drill through old bone
31
what do osteoblasts and osteocytes do in coordination?
lay down concentric lamellae and form osteons
32
what occurs in osteoporosis?
decrease in bone density, reducing structural integrity osteoclast \> osteoblast activity increased risk fragility fracture 3 types: postmenopausal, senile, seondary
33
what happens in rickets/osteomalacia?
vit D or calcium deficiency in children (rickets) or adults (osteomalacia) osteoid mineralizes poorly and remains pliable in rickets= epiphyseal growth plates can become distorted under weight of the body in osteomalacia= increased risk of fracture
34
what is osteogenesis imperfecta?
abnormal collagen synthesis increased fragility of bones, bone deformities and blue sclera rare, genetic autosomal dominant inheritence can be mistaken as NAD in children
35
what is a fracture?
discontinuity of bone
36
what can the orientation of fracture be?
transverse oblique spiral comminuted
37
what are the locations that a fracture can be on the bone?
38
what can the displacement be on a fracture?
displaced undisplaced
39
what can the skin penetration be on a fracture?
open or closed
40
what are the types of fracture healing?
primary/ direct secondary/ indirect
41
what is the process of primary bone healing?
cutter cone concept- line bone remodeling intramembranous healing, occurs via Haversian remodeling little or not gap (no movement) slow process
42
what is the process of secondary bone healing?
endochondral healing, involved responses in the periosteum and external soft tissues fast process resulting in callus formation (fibrocartilage) 1. Haematoma formation 2. soft callus formation 3. hard callus formaiton 4. remodelling
43
what happens in haematoma formation in bone healing?
damaged blood vessels bleed forming a hematoma neutrophils release cytokines signalling macrophage recruitment
44
what happens during soft callus formation?
collagen and fibrocartilage bridge the fracture site and new blood vessels form
45
what happens during hard callus formation?
osteoblasts brought in by new blood vessels mineralise the fibrocartilage to produce woven bone
46
what happens during remodelling in bone healing
months to years after injury osteoclasts remove woven bone and osteoblasts laid down as ordered lamellar bone
47
what are the pre-requisites for bone healing?
* minimal fracture gap * no movement if direct (primary) bone healing or some movement if indirect bone dealing * patient physiological state- nutrients, growth factors, age, diabetic, smoker
48
what is the time frame for bone healing?
about 6 months lower limb fractures twice as long as upper to heal paediatric heal twice as quickly
49
what law is bone remodelling determined by?
Wolff's law bone adapts to forces placed upon it by remodelling and growing in response to these external stimuli
50
what is done if the femur heals bent in a child?
axial loading should be direct with remodeling occurring through axial loading periosteum on the concave side will make more bone while on the convex side will be reabsorbed this causes it to straighten
51
what are the fracture healing complications?
non union and malunion
52
what is non-union?
failure of bone healing within an expected time frame
53
what are the types of non-union healing?
atrophic- healing completely stopped with no XR changes, often physiological oligotrophic hypertrophic (horse hoof and elephant foot)- too much movement, causing callus healing
54
what is malunion bone healing?
bone healing occurs but outside of normal parameters of alignment
55
what are the key principles of fracture management
1. resuscitate- save patient first 2. reduce- bring bones back together in acceptable alignment 3. rest- hold fracture in position 4. rehabilitate- bring back function and avoid stiffness
56
what are the conservative fracture management procedures?
rest, ice, elevate plaster fibreglass cast/splint traction-skin/bone
57
what are the surgical fracture management?
external fixation- monobiplanar, multiplanar ring internal fixation- ORIF, IM nail, MUA+ K wire arthroplasty- hemiarthroplasty, total joint replacement
58
what is the presentation of a shoulder dislocation?
variable history but often direct trauma pain restricted movement loss of normal shoulder contour
59
what assessment needs to be done in shoulder dislocation?
assess neurovascular status- Auxillary nerve
60
what investigations should be done in shoulder dislocation?
X-ray prior to any manipulation- identify fracture e.g humeral neck, greater tuberosity avulsion or glenoid scapular- Y view/modified axillary in addition to AP
61
what are the types of shoulder dislocation?
anterior- commonest, bimodal distribution, humeral head not overlying glenoid posterior - rare, associated with seizures/shocks, lightbulb sign on XR inferior- rare, arm held abducted above head, humeral head not articulating correctly
62
what is the management for shoulder dislocation?
vigorous manipulation or twisting manipulation should be avoided to avoid fractures safest method is traction-counter traction +/- gentle internal rotation to disimpact humeral head ensure adequate patient relaxation stimson method if alone same environment esp if elderly- e.g resus
63
what are the complications of a shoulder dislocation?
neurovascular damage to labrum and or glenoid damage to humeral head recurrent dislocations
64
when does a neurovascular complcation of shoulder disolcation present?
at time of presentation due to trauma sustained e.g axillary nerve iatrogenic as result of reduction maneuver delated onset due to evolving haematoma post injury/ manipulation
65
what is the sign of damage to the labrum and/or glenoid?
bankart lesion- soft or bony
66
what lesion is created from damage to humeral head?
Hi--Sachs lesion
67
what is the trend with recurrent dislocations and age?
the younger the patient the greater the risk of repeat dislocations
68
what is the typical presentation for proximal humerus fracture?
fall onto an outstretched hand typically in elderly or those with osteoporosis
69
what are the investigations for proximal humerus fracture?
plain XR CT if concern over articular involvement or high degrees of comminution
70
what are the classifications for proximal humerus fracture?
2 part- surgical neck fractures and greater tuberosity fracture 3 part fracture 4 part fracture
71
what is the management for proximal humerus fracture?
**collar and cuff** **ORIF**- plate and screws **arthroplasty**- humeral head fracture with large displacement (high risk non-union) **reverse arthroplasty**- unrepairable rotator cuff, previous unsuccessful shoulder replacement, complex fracture/ chronic shoulder dislocation
72
what is the presentation of distal radius fracture?
very common bimodal distribution often present with the mechanism of falling on the affected area swelling and visible deformity dorsal displacement due to fall on outstretched hand common
73
what are the classification types for distal radius fractures?
1. extra articular 1. dorsal angulation- colles fracture 2. volar angulation- smith fracture 2. intra-articular 1. dorsal angulation- dorsal barton 2. volar angulation- volar/reverse barton
74

1B Musculoskeletal (7 decks)

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