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MOD 7: Lecture 1
Fractures and Dislocations:Etiology and Healing.
| Question | Answer |
|---|---|
| Who said this "we see so far b/c we stand on the shld of giants"? | Sir Isaac Newton |
| What does the "we see so far b/c we stand on the shld of giants" quote mean? | we know what we know b/c of previous ppl or something like that |
| "ANATOMY IS TO PHYS AS GEOGRAPHY IS TO HISTORY; IT DESCRIBES THE THEATRE OF EVENTS" who said that? | jean Ferme (1497-1558) the natural part of medicine |
| What are the 2 major types of bone? | corticol and cancellous or trabecular |
| What does colagen do? | helps resist tensile forces and makes it strong |
| What is groung substance or bone salts? | help with rigitity |
| How strong is bone? | 2/3 strength of steel |
| ex of long bone is (tubular)? | femur |
| ex of short bone (cuboidal)? | carpals |
| ex of flat bones? | skull bones, scapula |
| What is cortical bone (compact bone)? | harder, found in long bones...Cortical bone is dense and forms the surface of bones, contributing 80% of the weight of a human skeleton. It is extremely hard, formed of multiple stacked layers with few gaps |
| What is cancellous bone (trabeccular, spongy)? | Spongy, web like, low density and strength but very high surface area, that fills the inner cavity of long bones. The external layer of cancellous bone contains red bone marrow |
| Normal bone cell growth: describe it | 1. ossification center 2. the ossification center calcifies 3.trabecular formation 4. if trabecular it will go into a more woven design 5. it is layed down as hard bone tissue |
| What are the 3 types of cells found in bone? | osteoblasts (newly developing), osteocyte (mature bone cells), osteoclasts (packman... helps to remove dead tissue and debris and allows for a space for new cells to be formed) |
| What is the more elastic type of bone with some bending quality? | organic includes collagen |
| What is the more rigid bone type. | inorganic, include Ca++, P, Mg, Na, Fl, hydroxyl carbonate |
| "He who loves practice w/out theory is like a seafarer who boards a ship w/out wheel or compass and knows whether not to travel" Who said this and what does it mean? | davinci... basically you gotta know the anatomy |
| What are fractures? | a structural break, bone breaks b/c of physical force probably causing soft tissue injury...look at the associated tissue damage |
| What are the functions of bone? | – Protect organs, Support attachment for ms, Basis for movement (origin & insertion), Formation for cells in bone marrow, Storage for salts (Ca, P, Mg) |
| If a fx is suspected, what should be donw with radiographs? | its important to take different views of fractures |
| Describe a medial malleolar fracture | Medial malleolus injuries to the ankle result from eversion forces. Depending on the direction and strength, forces may result in sprain or rupture of the deltoid ligament or fracture of the medial malleolus. |
| What is a tension force | like a snap... it starts to bend and can tolerate so much force until it eventually snaps |
| what types of forces can cortical bone withstand | compression and shearing |
| What type of fx causes the most fx in cortical bone | tension forces (bending forces) |
| what types of fx does bending forces cause | transvers, oblique, greenstick all in cortical bones |
| what types of fx does a twisting force cause | spiral fx of cortical bone |
| what type of fx does a traction force cause | avulsion fx of cortical bone |
| with what type of fx does the tendon pull off a part of the bone | avulsion fx |
| comminuted fractures are more common in | cancellous but can also happen in corticol bone |
| what causes a comminuted fx | compression forces |
| when does a callous formation occur? | 2 weeks post injury |
| when is there a huge fracture callous and fx line is fading? | 8 weeks |
| when can you still see a litttle of the fx callous but the bone healing is more in alignment | 6 mos post injury |
| when is the bone remodeled by wolffs law? | 18 months |
| What type of bone is more susceptible to crushing forces | cancellous bones |
| what types of fx occur as a result of crushing forces | crush fx (impacted) and buckle fx (in kids) both more common in cancellous bone |
| what structure of the bone are rich in new bone cells so the fx will hang on and not break off completely | metaphysis and periosteum |
| Bone formation and absorption of callous are quicker in | cancellous bone |
| How can you describing fx by site? | where is bone broken, proximal or distal ect. |
| What are the different ways that you can describe fractures? | by site, extent, configuration, relationship of fx to eachother, relationship of fx to external environment(simple or compound...open or closed), other complications (AVN) |
| if the osteogenic sleeve (part of periosteum)has been damaged... | it is thicker in kids and has the ability to repair |
| Where is bone is usually thicker? | under the ms |
| What are sx of fx | localized pain with movement, ms guarding, weakness, tenderness, loss of function, swelling, person may have heard a crack or other noise, may have to do c med hx like OP |
| when do you get a stress fx | when you are repeatedly causing trauma to a bone (aka March fx), may be seen in runners, ballet dancers, ppl with not good shoe wear, once the stress fx is dx it already starts healing |
| What type of fx is seen in runners, dancers | stress fx |
| Symptoms of a stress fx | localized pain aggregated c activity and relieved c rest, insidious onset |
| Pathological Fx | when you fx b/c bones are brittle like in OP or OI |
| Why are stress fractures tough to diagnose? | b/c it starts to heal, seen callous on x-ray |
| The initial stages of healing occurs in what time frame? | first 48-72 hrs |
| The early stages of healing occur in what time frame? | 2-3 days - 6 weeks |
| The stage of clinical union occurs in what time frame? | 6-8 weeks |
| At what stage of healing are tiny blood vessels torn and internal bleeding occurs? | the initial stage of healing |
| At what stage of healing does the normal clotting process occur? | the initial stage of healing |
| At what stage of healing does "ring” of avascular bone appear? | the initial stage of healing |
| At what stage of healing does At what stage of healing does fx hematoma appear? | the initial stage of healing |
| What happens during a fx hematoma? | when large arteries in the surrounding the mm and fat are also torn, they result in a massive hematoma that spreads throughout the surrounding soft tissues |
| The internal and external callus occurs during what phase of healing. | the early stage |
| What is Wolff's law when specific to remodeling of bone | bone returns to normal diameter and sharp corners round off secondary to stresses on the bone |
| This type of callus grow from the osteogenic prolific cells | external callus and internal callus haha trick ? |
| This type of callus grows from cells that grow from the periosteum | external callus |
| Where is cancellous bone found? | in spine, pelvis |
| What are the steps involved in the initial effect stages of healing? | Tiny blood vessles are torn, Localized internal bleeding, Normal clotting, “ring” of avascular bone, Fx hematoma |
| What type of fracture is broken straight across the bone, is the result of a sharp, direct blow? | Transverse fracture |
| What fracture is broken at an angle across the bone and is usually the result of a sharp angled blow to the bone. | Oblique fracture |
| What usually occurs in children, whose still soft bones splinter without breaking in two. Sudden force causes only the outer side of the bent bone to break. | Greenstick fracture |
| What type of fracture is caused by a twisting force that creates an oblique fracture around and through the bone. | Spiral fracture |
| What type of fracture is caused by a traction force. | Avulsion fracture |
| What type of fracture involves the articular cartilage of a joint | articular fracture |
| What type of fracture, which splinters and contains small bone particles, can shatter into more than two pieces? This fracture is usually caused by severe force, such as in a car accident. | communited fracture |
| How can you describe fractures by extent? | incomplete(crack, harline, buckle, greenstick) or complete |
| How can you describe fractures by configuration? | transvere, oblique, spiral, or communited |
| How can you describe fractures by relationship of the fracture fragments to each other? | undisplaced or displaced(translated, angulated, rotated, distracted, overriding, or impacted) |
| How can you describe fractures by relationship of the fracture to the external environment? | closed (skin is intact) or open (breaks through the skin) |
| How can you describe fractures by other complications? | uncomplicated or complicated (AVN) |
| What type of callus forms from the osteogenic cells of the endosteum? | internal callus |
| What is the purpose of internal & external callus? | to heal the fracture through rapid growth of the osteogenic tissue. |
| At what stage of healing is the internal and external callus formed? | early stage of healing |
| What occurs during the early stages of healing? | Int. and ext. callous is formed, rapid growth of osteogenic tissue, Fx callus is radiolucent and then Fx callus becomes firm, Osteogenic cells (first Osteoblast and then the osteoblasts change to primary woven bone) |
| At what stage of healing do you see rapid growth of the osteogenic tissue? | early stage of healing |
| At what stage of healing do you see osteoblasts changing to primary woven bone? | the early stage of healing |
| At what stage of healing is the person usually in a cast? | early stage of healing |
| What happens during the stage of clinical union after a fracture? | Internal & external callus come together to form the primary callus, Callus is firm enough to resist clinical tests for mvt , Fx line is visible on x-ray(clinical union occurred), cast is removed |
| At what stage of healing do you see internal & external callus come together to form the primary callus? | stage of clinincal union |
| At what stage of healing is the callus firm enough to resist clinical tests for mvt? | stage of clinical union |
| A what stage of healing can you see Fx line on x-ray(clinical union occurred)? | stage of clinical union |
| At what stage of healing is the cast removed? | stage of clinical union |
| What occurs at the stage of consolidation? | Replacement of primary callus w/mature lamellar bone, Resorption of callus, Immature cells are replaced by mature bone, Radiographic healing is seen |
| What does Wolff's law state as it applies to bone healing? | – Bone returns to normal diameter & sharp corners round off 2° to stresses on the bone |
| At what stage of healing do you see the replacement of primary callus w/ mature lamellar bone? | stage of consolidation |
| At what stage of healing do you see resorption of callus? | stage of consolidation |
| At what stage of healing do you see Immature cells are replaced by mature bone? | stage of consolidation |
| At what stage of healing do you see complete radiographic healing? | stage of consolidation |
| Name 2 advantages of an ORIF. | you can get function faster & b/c this stabilizes the alignment, and Fx site is stress protected |
| Name 2 disadvantages of ORIF. | • No stimulus for production of callus (Normal physiology is decreased, hardware impedes formation of callus therefore longer healing time) |
| Where does healing occur in an ORIF. | Healing occurs between Fx fragments |
| Give examples of cases where you could use an ORIF? | fx of radius & subluxation of the int RU jt, fx of ulna & ant dislocation, olecranon fx, displace fx of lat humerus, fx sublux of ankle w/ avulsion of med malleolus w/ fx of fib, comminuted intertrochanteric fx |
| In which type of bone does healing occur more quickly and why? (cancellous or cortical) | Cancellous b/c rich blood supply, Increased surface area, Primary woven bone formation |
| When looking at a radiograph, how do you know when clinical union is established? | when you can see fx site & contact b/n 2 surfaces on x-ray |
| Whe do you reach consolidation after a cancellous bone fracture? | when trabecular pattern is re-established |
| What are the determinants of rate of healing in different types of ppl? | age (the younger the faster), site (cancellous if faster), configuration (simple faster than complicated), displacement, blood supply (better in cancellous) |
| Name and describe 3 types of abnormal types of healing of a fx. | malunion, delayed union, nonunion |
| What is it called when a fracture has healed in normal time but in a less than an optimal position? | fracture malunion |
| What is it called when a fracture does not heal? | fracture nonunion, may have resultant formation of a fibrous nonunion or a false joint(pseudoarthrosis) |
| What is it called when a fracture heals but takes longer than usual b/c there is a disease process going on that impeding the healing process or a person is doing something that aren’t supposed to do? | delayed union |
| What occurs during fracture healing in cortical bone with rigid internal fixation? | Metallic devices ,“Stress-relief OP”, Removal of fixation device, idk see pg 428 in salter |
| Cancellous and cortical bone occur in a similar process except ... | cancellous heals in 3 weeks while cortical heals in 6-8 weeks |
| What is the treatment for a non-union | Rx: usually fixation is done, sometimes bone stimulator |
| Joint problems occur when a person has been immobilized because | Transient Stiffness, Persistent Stiffness: contracture , issues, Adhesions b/n muscles & muscle/bone(PROM, jt mobs to break up adhesions), Person can develop DJD |
| What are the early local complications of fracture? | loss of skeletal integrity (necrosis, gangrene, venous thrombosis), bone fragments, hemorrhaging, AVN of bone, infection (Osteomyelitis, septic arthritis) |
| What are the early remote complications of fracture? | fat embolus (could lead to PE and kill you), seen more in long bones, pneumonia, tetanus, delirium tremens, Sx of fat embolus: Δin behavior, disoriented, êrespiration, chest pain, trouble breathing, sweaty, blue, color Δs |
| What are the late local complications of a fracture? | related to jt stiffness, bony & ms complications, DJD, persistent infection, posttraumatic OP, growth disturbances |
| What are the late remote complications of a fracture? | kidney stones (renal calci) from bed rest, necrosis, post traumatic stress syndrome, accident neurosis |
| What are the effects of immobilization? | Muscle atrophy, CT weakening, ↓ ROM, Cartilage degeneration, Contractures, ↓ proprioception, ↓ endurance, ↓ function, Hypersensitivity |
| What are some Rx during immobilization? | Stretching for decrease ROM & contracture, Isometrics for decrease strength, Standing on one leg on different surfaces for proprioception, Grip exercises to improve fn, Bike/treadmill for CV, Rub w/ different materials for hypersensitivity |
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