Wk.7 L3 - Bone Fractures

Question 1

LO

Answer 1

1. Outline the different causes for bone fractures
2. Describe the processes involved in healing of fractures
3. Compare and contrast healthy fracture healing to compromised healing
4. Recall the consequences and impact of fracture on the community and individual

Question 2

bone tissue

Answer 2

calcium + protein

Balance of collagen and hydroxyapetite

Question 3

Causes of Bone Fractures

Answer 3

178 million new fractures occur globally each year (burden)
Trauma is the number 1 cause of fracture

Underlying medical conditions increase risk:
- Osteoporosis
- Arthritis
- Sarcopenia
- Neurological conditions – Parkinson’s

Question 4

Endochondral (cartilage into bone) Fracture Repair

Answer 4

1) Blood clot formation
- Early stabilisation
- Immune cell infiltration (granulation tissue)

2) Soft callus formation
- Mesenchymal cells diff. into cartilage
- Cartilage callus replaces blood clot and granulation tissue
- Stabilise but allow some movement

3) Soft callus ossification
- Bridged/ union
- Endochondral ossification replaces cartilage cells
- Vascularisation

4) Hard callus remodelling
- Osteoclasts remodel woven bone into cortical bone
- Return to original shape

[heft]

Question 5

Causes of Impaired Healing

Answer 5

Local Tissue Level:
* Restricted Blood Flow
* Infection (open fracture)
* Stability

Systemic Level:
* Poor nutrition
- Smoking (impairs blood flow)
- Diabetes (Increases risk of union & blood flow)
- Medications
- Age and Comorbidities

Question 6

Impaired Bone Healing

Answer 6

Hypertrophic Non-union:
- Elephant and horse foot, oligotrophic
- Blood supply, but still not healing adequately
- Likely due to poor stability

Atrophic non-union:
- Atrophic, wedge, comminted, defect
- Poor vacularisation

Question 7

Surgical Correction of Impaired Healing

Answer 7

External fixator fascilitates union of fracture by moving it at a rate that can stimulate healing, while straightening the bone

Question 8

MSK Diseases Associated with Ageing

Answer 8

Sarcopenia
Osteoporosis
Osteoarthritis

Question 9

Increased Fractures with Age

Answer 9

Rapid rise in vertebral fractures

Burden is huge:
$3.4b AUS 2017

Question 10

Osteoporotic Fractures Impact QOL & reduce survival

Answer 10

Physical Health:
- Chronic pain and mobility/ disability

Emotional Wellbeing:
- Pain leads to emotional distress, including anxiety and depression and fear of fracture (social isolation)

Overall Health Status:
- Osteoporotic fractures are
associated with lower overall HR-QOL

Lifespan:
- Mortality in the first year following a hip
fracture is 20%

Question 11

LO recap

Answer 11

1) Outline the different causes for bone fractures
- Trauma is number 1 cause, but underlying factors/co-morbidities increase risk, MSK and Neuro logical diseases are key contributors

2) Describe the processes involved in healing of fractures
- hematoma/inflammation, soft (cartilage) callus, hard (bone) callus, remodelling to original shape

3) Compare and contrast healthy fracture healing to compromised healing
- Local (vascular, stability, infection) vs systemic (disease, nutrition) causes, delayed union/non -union, hypertrophic, atrophic

4) Recall the consequences and impact of fracture on the community and
the individual
- Severe disability, pain, loss of quality of life, increased mortality,
economic burden goes beyond primary care and is increasing with ageing population