Bone Injuries Lecture Notes 2024 PDF

2024-09-23 Bone Injuries Dr. Kati Pasanen KNES 372/Lecture 7 1 Outline Previous Lecture Bone Structure and Function Bone Injuries Stress Fractures in Sport (examples) Young Athlete’s...

2024-09-23 Bone Injuries Dr. Kati Pasanen KNES 372/Lecture 7 1 Outline Previous Lecture Bone Structure and Function Bone Injuries Stress Fractures in Sport (examples) Young Athlete’s Spine & Tibial stress fracture Next Lecture/Instructions 2 1  2024-09-23 Previous Lecture Oscar Palma 3 Bone Structure and Function 4 2  2024-09-23 Two Types of Bone Tissue Trabecular (spongy) bone Cortical (compact) bone Cuboidal bones, flat bones, at Forms the outer shell of long the ends of long bones bones 75-95% porosity Low porosity 5-10% 5 Long Bone Anatomy "Bone cross-section" by Pbroks13 - Own work. Licensed under CC BY 3.0 via Wikimedia Commons 6 3  2024-09-23 Bone Marrow Red marrow – produces blood cells Children: in most bones Adults: flat bones, vertebrae, and long bones Yellow – stores fat Adults: long bones By OpenStax College [CC BY 3.0 (http://creativecommons.org/licenses/by/3.0)] 7 Function Bone serves a mechanical purpose Protects our internal organs Provides the body its basic shape Facilitates movement Provides a framework for support Mineral storage (calcium & phosphate) Blood cell production Fat storage Hormone regulation (osteocalcin) 8 4  2024-09-23 Adaptation to Training Physical training Training related increases bone mass Driven by dynamic, increases in bone rather than static, (bone mineral strength are site loading density) specific Peak strength and Only a short duration density typically of loading is between the ages of necessary 25 and 30 Turner CH, Bone 23, 399-407, 1998 9 Bone Tissue Remodels Osteoclasts – remove bone Osteoblasts – produce bone Continuously http://classconnection.s3.amazonaws.com/737/flashcards/1944737/png clast_blast_regulation-142BF299EE015B427A5.png 10 5  2024-09-23 Stress-Strain Curve Typical stress–strain curves of compact and spongy bones The last point of the stress–strain curve is the failure point Çehreli M. Biomechanics of Dental Implants: Handbook of Researchers. Nova Science; Hauppauge, NY, USA: 2012. 11 Bone Injuries 12 6  2024-09-23 Traumatic fracture (closed or open) Pathological fracture (e.g., osteoporosis and cancer) Bone Injury Stress fracture (fatigue fracture) Types Bone contusion (acute traumatic bone injury without fracture) Osteitis (inflammation of bone) Periostitis (inflammation of periosteum) 13 https://www.weissortho.com/blog/paul-georges-injury Open fracture (Compound fracture) – bone breaks Soft Tissue through skin Involvement Closed fracture – bone does not break through skin 14 7  2024-09-23 Fracture Patterns The pattern indicates the cause/mechanism http://www.intechopen.com/source/html/19650/media/image6.png 15 Diagnosis History Physical examination: Inspection, Palpation, ROM testing, Neurovascular assessment Imaging: X-Ray, CT scan, MRI 16 8  2024-09-23 Fracture Treatment Conservative treatment Splinting and bracing Plaster or fiberglass casting Bandages and orthoses Surgery When conservative treatment fails, or fracture is highly displaced or unstable Intramedullary rods Locking and stabilizing plates http://www.bonefixator.com/fracture_fixation/invasive_fracture_fixation.jpg 17 Stage 1: Blood clotting and inflammation (3-7 days) Stage 2: Soft callus formation (2 weeks) Stage 3: Hard callus formation (2 weeks) Stage 4: Bone remodelling (can last for many years) Fracture Healing 18 9  2024-09-23 Woven Bone vs. Lamellar Bone Woven Quickly formed, poorly bone organized (soft callus First bone formed during the stage) healing process Lamellar Slowly formed, highly bone organized (hard callus & Replaces woven bone during https://knyamed.com/blogs/difference-between/woven- remodeling the later stages of healing bone-vs-lamellar-bone stages) 19 Plates, Screws, and Rods 20 10  2024-09-23 Bone grafts Other Stem cell therapy Treatments Efficacy is questionable Ultrasound Electrical stimulation 21 Healing Time Clavicle Humerus Radius & Ulna Fingers 6-12 weeks 8-12 weeks 8-10 weeks 3-5 weeks Femoral neck Femur Tibia Fibula 3-6 months 3-6 months 3-6 months 6-8 weeks Vertebra Toes Ribs Pelvis 6 weeks – 4-6 weeks 4-6 weeks 8-12 weeks several months 22 11  2024-09-23 23 Complications Delayed union, Acute Infection malunion, compartment Osteonecrosis (open fractures) syndrome non-union Deep vein thrombosis & Nerve injury Vascular injury Osteoarthritis Pulmonary embolism 24 12  2024-09-23 Stress Fractures in Sport Young Athlete’s Spine & Tibial stress fracture 25 Young Athlete’s Spine 26 13  2024-09-23 Continuum: 1) Bone stress reaction (Posterior element overuse syndrome) 2) Fracture (Spondylolysis) 3) Slipping of vertebra (Spondylolisthesis) 27 Compression Mechanism 28 14  2024-09-23 https://orthoinfo.aaos.org/en/diseases--conditions/spondylolysis-and-spondylolisthesis/ 29 Excessive extension and rotation loads Risk Factors for Improper technique Spondylolysis & Spondylolisthesis Hyperlordosis Purcell & Micheli 2009 30 15  2024-09-23 Diagnosis and Treatment: Posterior Element Overuse Syndrome History, physical examination Imaging: e.g., X-ray, MRI Pain management: ice and NSAIDs Pain free activities: avoid extension! Physiotherapy: core strength, anti-lordotic exercises, stretching (hip flexors) Return to sport within 4-8 weeks 31 Diagnosis and Treatment: Spondylolysis and Spondylolisthesis UWSPORTSMEDICINE.ORG 32 16  2024-09-23 After surgery: - Week 1: short walks and stretching - Weeks 2-9: static stabilization exercises (core) - Weeks 6-12: dynamic strength exercises - Weeks 9-12: low impact aerobic training RTS between 6 months and 1 year https://orthoinfo.aaos.org/en/diseases--conditions/spondylolysis-and- spondylolisthesis/ 33 Medial Tibial Stress Syndrome (MTSS) Running and jumping Repetitive loading leads to periosteal inflammation along the tibia Pain and inflammation along middle- distal third of posteromedial aspect of tibia Diffuse pain Karlson et al. 2012 34 17  2024-09-23 MTSS: Diagnosis and Treatment History and physical examination (palpation) Alternative training Correction of malalignment & training problems Exercise therapy: strength and flexibility Prognosis is good if treated early! Karlson et al. 2012 35 Tibial Stress Fracture Running and jumping Significant pain during running, often disappears during rest, returns when athlete starts running again Focal pain Karlson et al. 2012 https://runningwritings.com/2012/05/injury-series-tibial-stress-fractures.html 36 18  2024-09-23 Tibial Stress Fracture: Diagnosis and Treatment History and physical examination (Palpation & hop test) X-ray; MRI Crutches & Brace & Alternative training When pain free → Progressive training Allen et al. 2004 37 Prevention of Stress Fractures 38 19  2024-09-23 Next Lecture Tendon Tendinopathy Injuries (Article) Cardoso TB, Pizzari T, Kinsella R, Hope D, Cook JL. Current trends in tendinopathy management. Best Pract Clin Res Rheum 2019; 33: 122-140. 39 Tendinopathy (Article) Management of tendinopathy 40 20  2024-09-23 Thank You! 41 21