Musculoskeletal Growth/Injury and Repair Flashcards

Question

what factors could alter the first stage in bone healing?

Answer 1

NSAIDs loss of haematoma (open fractures, surgery) extensive tissue damage resulting in poor blood supply

Answer 2

platelet derived growth factor PDGF transforming growth factor beta TGF-b insulin like growth factor IGF vascular endothelial growth factor VEGF

Answer 3

``` begins when pain and swelling subside lasts undil bony fragments are united by cartilage or fibrous tissue some stability of the fracture angulation can still occur increased vascularity ```

Answer 4

replacing cartilage with demineralised bone matrix | placement of bone grafts

Answer 5

osteoconductive osteoinductive best choice

Answer 6

``` cortical cancellous fresh prepared structural osteoconductive not osteoinductive creeping substitution ```

Answer 7

disease transmission

Answer 8

conversion of cartilage to woven bone in typical long bones there is endochondral and membranous bone formation increasing rigidity and secondary bone remodelling can be seen on xray

Answer 9

woven bone converted to lamellar bone medullary canal reconstituted Wolff's law applies

Answer 10

when a fracture fails to heal in the expected time

Answer 11

1. High energy injury 2. Distraction results in increased osteogenic jumping 3. Instability 4. Infection 5. Steroids 6. Immune suppressants 7. Smoking 8. Warfarin 9. NSAID 10. Ciprofloxacin 11. Failure of calcification fibrocartilage 12. Instability – excessive osteoclasis 13. Abundant callus formation 14. Pain and tenderness 15. Persistent fracture line sclerosis

Answer 12

different fixation dynamisation bone grafting

Answer 13

``` muscle origin from bone muscle belly musculotendinous juntion tendon (? sesamoid bone, ? tendon sheath) tendinous insertion into bone ```

Answer 14

longitudinal arragement of cells (tenocytes) and fibres (type 1 collagen) long narrow spiralling of collagen bundles known as fasicles

Answer 15

Tendons are connected to the sheath by vincula and there is a synovial lining with fluid giving lubrication and nutrition. Thickenings of the tendon sheath form strong annular pulleys. Tendons are flexible structures that are very strong when tensed.

Answer 16

reduces water content and glycosaminoglycan concentration and strength

Answer 17

``` degeneration inflammation enthesiopathy traction apophysitis avulsion +/- bone fragment tear - intrasubstance/musculotendinous junction laceration crush ischaemia attrition nodules ```

Answer 18

intrasubstance mucoid degeneration may be swollen, painful, tender, may be asymptomatic ?precursors to rupture

Answer 19

de Quervain's stenosing tenovaginitis tendons of EPB and APL passing through common tendon sheath at radial aspect of wrist swollen, tender, hot, red positive Finklestein's test

Answer 20

inflammation at insertion to bone muscle/tendon | usually at muscle origin rather than tendon insertion e.g. lateral humeral epicondylitis (Tennis elbow)

Answer 21

plantar fasciitis

Answer 22

``` Osgood Schlatter's disease insertion of patellar tendon into anterior tibial tuberosity adolescent active boys recurrent load inflammation ```

Answer 23

conservative - limited application, retraction tendon | operative - reattchment tendon through bone, fixation bone fragment

Answer 24

``` achilles load exceeds failure strength mechanism of rupture: Pushing off with weight bearing forefoot whilst extending knee joint (53%) e.g. sprint starts or jumping movements ▪ Unexpected dorsiflexion of ankle (17%) e.g. slipping into hole ▪ Violent dorsiflexion of plantar flexed foot (10%) e.g. fall from height o Treatment ▪ Conservative • Where ends can be opposed o Mobilise (partial rupture) e.g. medial ligament of knee o Splint Figure 5 Pulley System in Digits • Where healing will occur o Not intraarticular ▪ Operative • High risk rerupture • High activity • Ends cannot be opposed ```

Answer 25

medial head of gastrocnemius at musculotendinous junction with achilles mis called plantaris syndrome often partial

Answer 26

``` E.g. finger flexors (FDS and FDP) ▪ Common ▪ Males > females ▪ Young adults ▪ Repair surgically and early but beware old injuries ▪ Technically challenging ```

Answer 27

This is the part of a spinal nerve distal to the roots. They are bundles of nerve fibres that range in diameter from 0.3-22𝜇m. Schwann cells form a thin cytoplasmic tube around the nerves. Larger fibres are found in multi-layered insulating membranes known as myelin sheaths. There are multiple layers of connective tissue surrounding axons. A peripheral nerve is a highly organised structure comprised of nerve fibres, blood vessels and connective tissue. Axons are coated with endoneurium and grouped into fasicles covered with perineurium and grouped into nerves covered with epineurium.

Answer 28

large motor axons muscle stretch tension sensory axons

Answer 29

``` touch pressure vibration joint proprioception sensory axons ```

Answer 30

efferent motor axons

Answer 31

sharp pain very light touch temperature

Answer 32

sympathetic preganglionic motor axons

Answer 33

dull, aching,burning pain | temperature

Answer 34

compression | trauma

Answer 35

o Entrapment o Carpal tunnel syndrome – median nerve at wrist o Sciatica – spinal root by IV disc o Morton’s neuroma – digital neuroma in 2nd or 3rd web space of forefoot

Answer 36

blow | laceration

Answer 37

avulsion | traction

Answer 38

neurpraxia axonotmesis neurotmesis

Answer 39

▪ Nerve in continuity ▪ Stretched (8% will damage microcirculation) or bruised ▪ Revisable conduction block – local ischaemia and demyelination ▪ Prognosis good (weeks or months)

Answer 40

▪ Endoneurium intact (tube in continuity) but disruption of axons; more severe injury ▪ Stretched ++ (15% elongation disrupts axons) or crushed or direct blow ▪ Wallerian degeneration follows ▪ Prognosis fair • Sensory recovery better than motor • Often not normal but enough to recognise pain, hot, cold, sharp, blunt

Answer 41

Complete nerve division ▪ Laceration or avulsion ▪ No recovery unless repaired by direct suturing or grafting ▪ Endoneural tubes disrupted so high chance of miswiring during regeneration ▪ Prognosis poor

Answer 42

``` • Sensory features o Dysaethesiae (disordered sensation) ▪ Anaesthetic ▪ Hypo + hyper aesthetic ▪ Paraesthetic • Motor Figure 6 Peripheral Nerve Regeneration Figure 7 Sunderland Grading of Nerve Injury o Paresis (weakness) o Paralysis ± wasting o Dry skin – loss of tactile adherence since sudomotor nerve fibres not stimulating sweat glands in skin • Reflexes o Diminished or absent ```

Answer 43

Healing of nerve injuries is very slow. It starts with initial death of axons distal to the site of injury, Wallerian degeneration and then degradation myelin sheath. Proximal axonal budding occurs after about 4 days. Regeneration proceeds at a rate of about 1mm/day (or 1 inch/month), but in children 3-5mm/day is possible. Pain is the first modality to return. Prognosis for recovery depends on whether the nerve is “pure” (only sensory or motor) or “mixed” and how distal the lesion is (proximal is worse).

Answer 44

Tinel’s sign can monitor recovery. Tap over the site of nerve and paraesthesia will be felt as far distally as regeneration has progressed. Injury can be assessed, and recovery monitored by electrophysiological nerve conduction studies.

Answer 45

1. Immediate surgery within 3 days for clean and sharp injuries 2. Early surgery within 3 weeks for blunt/contusion injuries 3. Delayed surgery, performed 3 months after, for closed injuries

Musculoskeletal Growth/Injury and Repair Flashcards

(85 cards)