Week7musculoskeletallecture
- 1. HN Unscheduled and Emergency Care Topic: Musculoskeletal Topic Number:7
- 2. Learning Outcomes By the end of this lecture you should be able to discuss: • the healing process in bone. • classifications of fracture. • the normal timescales for the stages of healing. • factors that affect healing. • In-hospital principles of management of fractures.
- 3. Fractures
- 4. Functions and Composition of Bone Tissue components • 25% water • 25% protein fibres (notably collagen) • 50% mineral salts (Primarily Calcium Phosphate) • Strong yet lightweight Functions • Support and Protection • Assist movement • Mineral "bank" (Ca & Phosphate) • Blood cell production - haemopoesis (red marrow) • Energy storage - adipose tissue (yellow marrow)
- 5. Fracture healing: Stage 1 Blood vessels and nerves are ruptured Haematoma formation Macrophages remove dead cell tissue
- 6. Fracture healing: Stages 2 and 3 • Chondrocytes and fibroblasts form ‘soft callus’ • Fracture unites – stage 3
- 7. Fracture healing: Stage 4 • Hard callus formation and consolidation • Callus becomes mineralized into woven bone • Osteoblasts lay down bone
- 8. Fracture healing: Stage 5 • Remodeling • Osteoclasts erode surface to allow osteoblasts to lay down further bone • Callus is reshaped along lines of stress
- 9. Fracture healing timescales Stage Features Time Inflammation Site protection & clearance Healing process begins 0 – 2 weeks Callus formation Scaffold for new bone Soft hard Fluffy opacity on x-ray 2 – 3 weeks Union Bridging by cartilage / immature bone Fracture stable but weak 4 – 6 weeks Consolidation All callus replaced by bone Immature bone lamellar bone Bone secure 6 – 8 weeks Remodelling Continued osteoblast / osteoclast activity Reshaping to best density and shape 1 – 2 years
- 10. Remodelling
- 11. Classification of Fractures: Aetiology 1. Direct violence 2. Indirect violence Spontaneously e.g following a muscle contraction – avulsion 3. Pathological Abnormally weak bone: tumours, cysts, osteoporosis 4. Fatigue/stress Commonest in 2nd metatarsal in young adults (march #), also tibia in runners and vertebrae in fast bowlers
- 12. Fracture types
- 13. Classification of Fractures: Open or closed • Also known as compound and simple • Closed fractures – no open wound
- 14. Clinical Examination • History • Pain over # site • Loss of function • Deformity • Crepitus • Swelling • Radiographically – at least two different views • Stress films, CT, MRI, bone scans
- 15. Principles of Management 1. Reduction 2. Immobilisation 3. Rehabilitation
- 16. Stabilisation – simple external Collar & cuff splint Cast/ POP
- 17. Stabilisation – external pneumatic cast Functional brace
- 19. External fixation Halo brace Ilizarov frame
- 20. Internal fixation Dynamic hip screw
- 21. Immediate Complications Following a Fracture • Injury to major blood vessels haemorrhage • Damage and injury to surrounding soft tissues i.e. nerves, viscera, ligaments, tendons, joints • Compartment syndrome
- 22. Early Complications • Infection-– open fracture • Pulmonary embolism – fatal !
- 23. Late complications Delayed union (3-4/12)/ Mal union/ non union: Smokers, Alcoholics, DM Fear of WB • Avascular necrosis – # NOF • Shortening – especially in children when epiphyseal plate disruption has occurred • CRPS (complex regional pain syndrome)– on removal of POP • Secondary osteoarthritis
- 24. Mal-union Healing with faulty shape Non-union Healing process stops Avascular necrosis Ischaemia bone death
- 25. End of presentation © Pearson College 2013