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Bone Injury, image …
Bone Injury
Pathological Calcification/Mineralisation
List the types of Calcification
Dystrophic Calcification
Metastatic Calcification
Dystrophic Calcification
What is Dystrophic Calcification ?
Dystrophic Calcification is the deposition of calcium into dead or degenerate tissue.
The Serum Calcium and Phosphate levels are NORMAL.
Deposition is usually localised
List the examples of sites where Dystrophic Calcification occurs
Caseous Necrosis
Fat Necrosis
Infarcts
Dead Parasite
Metastatic Calcification
What is Metastatic calcification ?
Metastatic Calcification is the deposition of Calcium into normal, living tissue.
Serum Hypercalcemia and Hypophosphatemia are present.
Deposition is often wide spread: Parenchymal organs, Vessels, Soft Tissue.
What are the causes of Metastatic Calcification ?
Sarcoidosis
Vitamin D intoxication
Primary, Secondary, and Tertiary Hyperthyroidism
What are the Aetiological Classifications of Fractures ?
Traumatic
Stress
Pathological
What are the causes of Pathological Fractures ?
Cause of Pathological fractures are divided according to whether they affect a single bone or many bones in the body simultaneously.
The causes are:
Local Bone Disease
General Skeletal Disease
List the Causes of Pathological Fractures Local Bone Disease
- Infections
- Benign Neoplasms
- Malignant Neoplasms
- Mechanical: Bone atrophy in paralysis.
Skeletal Bone Disease
- Congenital
- Metabolic
- Disseminated (distributed) Neoplasia
- Mechanical
Differentiate Between Closed and Open FracturesClosed fractures are called Simple Fractures. meaning that the skin overlying the fracture is intact. Open Fractures are called Compound Fractures. Meaning that there is a wound communicating from the fractured bone to a defect in the overlying skin. The bone is protruding through the skin wound.
List the Different Types Fracture Patterns
Transverse Fracture
Oblique Fracture
Butterfly Fracture
Spiral Fracture
Comminuted Fracture
Segmental Fracture
What are the Fracture Patterns in Children?
Green Stick Fractures (not a full fracture)
Growth Plate Fractures
List The Stages of Fracture Healing or Bone Healing
Week 0: Haematoma and Bone Necrosis
Immediately after a bone breaks, there is bleeding at the fracture site to form a Haematoma.
Weak 1: Inflammation
During the first week after the fracture takes place, macrophages start to digest the Haemotoma and necrotic bone ends at the fracture site.
New blood vessels start to grow into the blood clot to form Granulation tissue.
Osteoblasts proliferate along the inside of the periosteum and the edges of the broken bone.
Week 2-4: Provisional Callus Formation
Towards the end of the first month after the fracture, cartilage and woven bone are laid down around the fracture to form a soft or provisional callus.
The fracture site is not strong enough top bear forces at this stage.
Week 5-12: Definitive Callus Formation
In the second month after the fracture, the cartilage and woven bone are replaced by permanent lamella bone to form a hard or definitive Callus.
The fracture has now united and the plaster can be removed.
Months: Remodeling and Stress
Many months afterwards the bone remodels according to the daily stress applied to it.
NOTE: This is an approximate timeframe for a lower limb fracture in an adult.
An upper limb and a fracture in a child would take about half the amount of time to heal.
List the Complications of Fractures The Complications of Fractures can be divided into:
- Those related to the fracture itself
- Those associated with the injury, meaning those which affect soft tissues adjacent to the bone.
What are some of the adjacent tissue that can be injured when a fracture takes place ?Major Blood VesselsNervesVisceraTendonsJointsFat Embolism
List The Complicated Fractures That are Related to The Fracture Itself
Related to the Fracture Itself:
Infection
Delayed Union
Non-Union
Avascular Necrosis
Mal-Union
Shortening
- Infection
List the number of ways an Infection can occur during a fractureInfections can occur during a fracture through: Compound Fractures
Surgical Interventions
Chronic Osteomyelitis
Sinus Discharging Pus
Retards Union
- Delayed Union
What is Delayed Union ?Delayed union is when definitive callus has not formed adequately by the expected time.It is when bone fragments are still freely mobile 3 months after the injury.Mention some of the Causes of Delayed UnionPoor blood supply
Infection
Ma-alignment
Site devoid of periosteum
Pathological Fracture
- Non-Union
What is Non-Union ?Non-union is when it becomes clear that the fractured ends of a bone will never unite after any length of time. Non-Union is when radiological changes of aborted healing process result in a Fibrous Union with a False Joint. What are the causes of Non-Union ?Delayed Union
Failure of Immobilization
Interposition of Soft TissueNOTE: Non-Union can ONLY be corrected by Surgical Intervention
- Avascular Necrosis
What is Avascular Necrosis ?Avascular necrosis is when a fracture interrupts the blood supply to the articular end of a bone devoid of vascular soft tissue attachment. Eg: Head of Femur, Scaphoid Bone, TalusResulting in the Bone Death or OsteoArthrits.
- Mal-Union
What does Mal-Union mean ?Mal-union means union at an abnormal position.
- Shortening
Shortening means that a bone has lost some of it's length after a fracture heals. List the causes of ShorteningMal-union with overlap or angulation
Crushing or Loss of bone
Interference with growth plate in children
The x-ray on the left shows a fractured metatarsal bone. The x-ray on the right shows the healing of that fracture with a had callus formation.
These are X-rays of a pathological fractures. How ? The already diseased bones around the site of fracture would have looked abnormal even before a small amount of force which resulted in the bones breaking was applied.
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The X-rays show how overlapping ends of the fracture on the left have remodeled after a month over many months to form a straight bone shaft on the right.
A discharging sinus through the skin overlying the tibial fracture which may have been complicated by osteomyelitis.
Left: Delayed Union.
Right: Non-Union
Necrotic wrist bone on left becomes densely calcified and later disintegrates (right).
Hip fracture on the left is united at an abnormal position. Compared to the hip fracture on the right that is held in the correct position by plate and screw.