Conditions Of Bone

Front 1

What are the 4 stages of bone healing?

Back 1

Hematoma (immediate)
Soft Callus Formation (1-2wks)
Bony Callus Formation (2-4wks)
Remodeling bone (6-10wks)

Front 2

Hematoma

Back 2

(Occurs immediately)
Blood forms in the break
Hematoma=collection of blood

Front 3

Bony Callus Formation

Back 3

(2-4 wks)
Granulation tissue, fibrous scar tissue, mixture of woven bone and fibrocartilage appear in hematoma
These are replaced by a bony callus
Mixture of spongy cancellous bone and cartilage
This mixture can withstand partial weightbearing--wtb is thought to improve healing

Front 4

Remodeling Bone

Back 4

(6-10wks)
Granulation tissue and fibrocartilage are gone
Unstressed cartilage and excess bone are replaced by dense bone
Normal stress remodels the union into the normal contour

Front 5

Healed Bone

Back 5

Normal contour is complete and unstressed bone dissappears

Front 6

Pathologic fx

Back 6

Caused by disease
(Osteoporosis)

Front 7

Stress fx

Back 7

Caused by repeated microfxs from high stress over an extended period of time

Front 8

Trauma related fx

Back 8

Require a force create enough to break bone

Front 9

If the bhone is not anatomically aligned...

Back 9

Deformity will occur as it heals

Front 10

Diseased bone heals __________

Back 10

poorly

Front 11

General management of fx healing

Back 11

Management includes alignment of bone and immobilization
Healing requires calories-so if there's poor diet there will be poor healing
Impaired vascular supply will impair healing

Front 12

What nutrients are necessary for healing?

Back 12

Vitamin D
Phosphate
Calcium

Front 13

Nonunions can occur because of:

Back 13

Lack of immobilization
Poor blood supply
Infection
Poor diet

Front 14

Consequences of non-unions?

Back 14

Psuedoarthritis of false joint
Mal-alignment (non-anatomic alignment)

Front 15

Greenstick fx

Back 15

Incomplete break

Front 16

An open fx is called _________

Back 16

compound fx
(these are more prone to infection

Front 17

Multiple fxs are called ________

Back 17

comminuted

Front 18

Spiral fxs are caused by a?

Back 18

Twisting force

Front 19

Impacted fxs are caused by?

Back 19

A sudden end to end force
(Compression fx in the vertebra

Front 20

Avulsion fx

Back 20

is where the tendon pulls off a piece of bone

Front 21

How are fxs diagnosed?

Back 21

Primarily x-ray (sometimes CT/MRI)
Pain, swelling, limited ROM

Front 22

Medical complications of fx?

Back 22

Fat emboli can travel to the lungs
Infection (esp w/ open fx)
Compartment syndrome (involving nerves and vessels)
Later osteoarthritis
Aseptic necrosis (blood supply gets cut off and tissue dies)

Front 23

Closed reduction vs Open reduction

Back 23

Closed-doesn't break skin
Open-surgery

Front 24

ORIF

Back 24

Open reduction internal fixation
(internal=hardwear inside)
(external=hardwear outside)

Front 25

UE Fx positioning?

Back 25

Typical immobilization position is wrist extension with MP flexion and IP extension

Front 26

How long does immobilization of UE fx last?

Back 26

3-5wks (but varies)

Front 27

What is an important OT consideration of UE fxs?

Back 27

To keep the non-involved jts moving

Front 28

How can edema be controlled during immobilization?

Back 28

Through positioning or TEDS

Front 29

What do you do when you're recently out of a cast?

Back 29

Measure ROM to establish a baseline
Edema management
Can initiate resistive activities when bony healing is sufficient as per MD
Address jt stiffness

Front 30

How do you address jt stiffness?

Back 30

If joints are stiff and painful and there's no intra jt damage, you can use thermal modalities to reduce pain and stiffness

Front 31

Colles fx

Back 31

The most common wrist fx
Distal radius fx w/ distal radial/ulnar joint impacted
Wrist ext, flex, pro/supination limited
Often treated with an external fixator

Front 32

Scaphoid bone fx

Back 32

2nd most common wrist fx
Wrist is usually in dorsal flex at time of injury
These fxs take a long time to heal due to poor blood supply
Can be casted up to several months
The degree of stiffness and pain when someone comes out of the cast after such a prolonged period is a real concern

Front 33

Osteomyelitis

Back 33

Bacterial infection of the bone
Can result in bone necrosis and inflammation

Front 34

Aseptic necrosis/bone infarct/avascular necrosis

Back 34

Impaired blood flow to the bone
OT's treat many hip fxs that are the result of the head of the femur losing blood supply

Front 35

Osteoporosis

Back 35

Is decreased bone mass-more bone is being reabsorbed than formed
Increased bone porousness
Normal bone structure-just not enough of it

Front 36

How is osteoporosis diagnosed?

Back 36

Bone density test

Front 37

Where is osteoporosis more common?

Back 37

Verterae
Femur
Pelvis

Front 38

Osteoposis can be a secondary condition to?

Back 38

Dietary deficiency
Immobilization following illness or paralysis
Consequence of medication (heparin)
Cancer that has metastasized

Front 39

Osteoporosis can result in

Back 39

Spinal kyphosis or an abnormal forward curvature of the spine

Front 40

Osteomalacia

Back 40

Soft bones caused by lack of mineralizations
(Known as Ricketts in developing kids)
Assosciated with poor diet
Bow legged and abnormal rib development
Associated with chronic renal failure as calcium levels fall

Front 41

Metastatic cancer

Back 41

Cancer that has travelled into the bone from another primary site (prostate, breast and lung)

Front 42

Primary bone cancer

Back 42

Is rare
-Can have bone forming tumors
-Cartilage forming tumors
-Fibrous tumors

Front 43

Achondroplagia

Back 43

Dwarfism caused by the epiphyseal cartilage not forming normally
Normal trunk with short arms and legs

Front 44

Osteogenesis imperfecta

Back 44

Brittle bone disease caused by a problem with collagen formation
(fxs occur easily, kids can't play outside, fatigue easily, etc)

Front 45

Paget disease of bone

Back 45

Unknown etiology
The pace of bone production/break down increases
The result is very thick bone that may be deformed