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(10-15% of patients with metastatic disease=CANCER PTS.
Cancer goes into bone and some other types of pathology “like cancer” makes you more susceptible to this fracture. |
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Stages of fracture healing.
HEMATOMA FORMATION |
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| Hematoma facilitates the formation of the fibrin meshwork that seals off fracture site and stops bleeding and serves as a framework for the influx of inflammatory cells, **fibroblasts***, and new capillary buds. |
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| What initiates the cellular events essential to bone healing? |
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| It is also the source of signaling molecules that initiates the cellular events that are critical to healing process. |
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T/F?
Hematoma Formation TISSUE HEALING. BONE IS A TISSUE! |
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Definition
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| FIBROCARTILAGINOUS CALLUS FORMATION |
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Definition
***NO WEIGHT BEARING YET***
Formation of granulation tissue called procallus. Fibroblasts from the periosteum, endosteum and red bone marrow proliferate and invade procallus. Fibroblasts produce a fibrocartilaginous soft callus bridge that connects bone fragments. |
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***USUALLY SAFE TO REMOVE CAST***
Fibrocartilaginous cartilage converted to bony callus. Newly formed ***osteoblasts*** first deposit bone on outer surface of bone and then move toward fracture site. Begins 3-4 weeks after injury. |
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| What stage of healing should a cast be removed? |
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Dead portions of bone are removed by osteoclasts and compact bone replaces spongy bone; reorganization of newly formed mineralized bone occurs along lines of mechanical stress. Resembles original unbroken bone but thickened area remains as evidence of healed fracture.
***Osteoclast responsible for the remodeling of the bone.*** |
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| REMODELING ____ responsible for the remodeling of the bone? |
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| ***NO WEIGHT BEARING YET*** |
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| FIBROCARTILAGINOUS CALLUS FORMATION |
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| ***SAFE TO REMOVE CAST*** |
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Definition
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| Fibroblastss are responsible for new capillary beds in? |
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Factors Affecting Bone Healing
What causes delayed bone healing? |
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Definition
Things that we can watch to make sure the healing process occurs.
•Increased cellularity and vascularity in child’s periosteum improves healing
•Fracture displacement, edema, arterial occlusion
•Type of bone, cancellous bone heals faster
•Degree of immobilization achieved
•Infection, malignancy, bone necrosis
•Amount of bone loss
•***Age, nutrition, meds, diseases=kidney disease, DM tissues don’t heal well. Make sure BS is controlled to impove healing.***
•Malunion, delayed union, nonunion |
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Factors Affecting Bone Healing
Fat embolism syndrome-***symptoms*** |
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Definition
• Respiratory failure, cerebral dysfunction and skin petechiae(does not blanch); symptoms within a few hours to 3-4 days. Initial findings subtle change in behavior and disorientation
•Stabilize fractures early to reduce risk of fat emboli. No meds to give, can’t dissolve these. |
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Factors Affecting Bone Healing
Fat embolism syndrome |
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Definition
| •FES refers to a constellation of clinical manifestations resulting from fat droplets in small blood vessels of lung or other organs after a long bone fracture or other major trauma. Released from bone marrow or adipose tissue at fracture site into venous system; rare Can kill or disable patient |
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Definition
| Death of bone segment caused by interruption of blood supply to marrow, medullary bone, or cortex; proximal femur, distal femur and proximal humerus |
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| What are the two of the most common causes of osteonecrosis? |
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Definition
***Untreated osteomyelitis, tissue ischemia***,
sickle cell disease(clump together), steroid therapy(long term, wound heal, weaken bone)(5-25%), and hip surgery
•Results from ischemia but mechanisms vary; steroids unclear may increase intraosseous pressure with vascular compression, sickle cell thrombosis |
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Musculoskeletal neoplasms
• Benign include |
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Definition
| osteoma, chrondroma, osteochrondroma, and giant cell |
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Musculoskeletal neoplasms
• Malignant Osteosarcoma |
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Definition
peak during teens, long bones with maximum growth velocity;localized pain and swelling. If you see a bump that is painful and just doesn’t go away. Will be removed surgical and have lost limbs to save life.
• Ewing’s sarcoma-small round cell tumors. Any age, early teen hears. Black or Asian kids. Found in femer in diaphysis. Pain, limit movement, tenderness over involved bone or tissue. |
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Musculoskeletal neoplasms
• Metastatic |
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Definition
skeletal metastases are most common ***malignancy of osseous tissue***: spine, femur, pelvis, ribs, sternum, humerus, skull. Invades bones
•***Breast, lung, prostate, kidney*** and thyroid are Most common, travel to bone .
***50% of bone must be destroyed before you see or are symptomatic***. lesion is visible on plain radiograph |
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Musculoskeletal neoplasms
•Multiple Myloma |
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Definition
•effects all bones in body. Bone cancer.
•***Increased CA levels, hyperkalemic. True in all bone cancers*** |
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Musculoskeletal neoplasms
Osteomylelitis |
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Definition
| Infection/inflammation of bone. |
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Osteomylelitis:
What are Two causes of osteopmyleltis? |
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Definition
-Infection/inflammation of bone.
-Open sore, surgery, or blood borne infection
-Acute or chronic infection |
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Osteomylelitis:
What is most common, over lying skin infection and goes to bone. |
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Definition
| •Direct contamination, seeding through ***bloodstream (hematogenous*** |
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| -vascular insufficiency not adequate bf to limb |
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Osteomylelitis:
Common organism |
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Definition
| •***Staphylococcus*** most common-produces a collagen binding adhesion molecule(sticks like glue) allowing it to adhere to connective tissue elements of bone and ability to internalize and survive in osteoblasts making the microorganism resistant to antibiotics.=long course of antibiotics 6-8 weeks. |
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Osteomylelitis:
• Sequestrum |
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Definition
-***infected dead bone separated from living bone***.
-Septic shock/Distributive Shock
•Decreased BP tank full, give vasopressor |
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Complications of fractures and other musculoskeletal injuries
Compartment syndrome causes? |
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Definition
Tissue compromise from pressure in the muscle compartment, BF and nerve & muscle death.
EX: from injury or cast on too tight. Increased pressure and compromises vessels and nerves.
•Hallmark symptom is pain out of proportion to the original injury |
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Complications of fractures and other musculoskeletal injuries
Most important symptom of the five Ps |
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Definition
paresthesia(numbness), pallor(pale), ***proprioception(can’t figure out where my arm is in space)***,
-pain, and pulse |
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