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Bone Injuries

Bone Injuries. Traumatic - single event or low frequency 1. Very High load (low frequency) 2. Unusual type of loads – One which the skeletal structure isn’t designed to handle 3. Combination loads – shear + bending + torsion + compression, etc. Bone Injuries.

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Bone Injuries

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  1. Bone Injuries Traumatic - single event or low frequency 1. Very Highload (low frequency) 2. Unusual type of loads – One which the skeletal structure isn’t designed to handle 3. Combination loads – shear + bending + torsion + compression, etc

  2. Bone Injuries • Materials Fatigue - repeated loads • • don’t give bone chance to recover • 1. Materials fatigue or overuse or "stress fracture" • 2. Very High frequency (moderate to high loads) • 3. Nutritional and hormonal factors increase risk • ex. low Ca2+ intake, low estrogen levels

  3. Bone Injuries • Fractures • avulsion (tensile) – Often accompanies tendon and ligament injuries.

  4. Bone Injuries • Fractures • spiral (torsion)

  5. Bone Injuries • Fractures > impacted, comminuted (compression)

  6. Bone Injuries • Fractures > greenstick fracture – Usually seen in children whose bones are not fully mineralized.

  7. Bone Injuries • Fractures • Material fatigue or stress fracture x-ray nuclear bone scan

  8. Minimizing Risk of Suffering a Stress Fracture (s = F/area) • 1. Use proper protective equipment (i.e., helmets, footwear, etc.) loads area • 2. Be careful exercising when fatigued • 3. Avoid coming back too soon after an injury • 4. Proper off-season or pre-season training (pre-hab) • 5. Avoid switching sports or events without proper training • 6. Take occasional days off • 7. Start slowly when initiating training

  9. Stages of Rehabilitation after Bone Fracture • When bone fractures, soft tissue must absorb released energy exacerbating damage • Immediate Treatment (RICE) • Rest • Ice • Compression • Elevation

  10. Stages of Rehabilitation after Bone Fracture • NSAIDS (non-steroidal anti-inflammatory drugs) • Inhibitors of Cyclooxygenase (COX) • COX ------> prostaglandins • aspirin, ibuprofen, naproxen sodium, ketoprofen • Each drug has a different structure

  11. Therapeutics after Fracture • goal: quick restoration of normal function • set fracture, limited immobilization • reconditioning • A. Passive, ROM exercises (CPM) • B. Active exercises(involves muscle contractions) • Mod-> high reps; low --> mod intensity

  12. Rehabilitation after Connective Tissue Injuries • reconditioning • Purpose: • A. Increase blood flow • B. increase “mechanical action” • Protection of joint cartilage from atrophy, loss of cushioning • C. decrease scar tissue • D. Some mechanical stress needed to promote healing

  13. Fracture Healing Sequence • Inflammatory phase (1-5 days) • ALARM • >prostaglandins, histamine, free radicals (nitric oxide, hydrogen peroxide, etc.) released • *swelling, inflammation, increase blood flow, signals repair process to start

  14. Fracture Healing Sequence • Inflammatory phase (1-5 days) • >WBC's, platelets • >growth factors • *Insulin-like growth factor (IGF-1) • *Transforming growth factor (TGF) • * Vascular endothelial growth factor (VEGF) • * Fibroblast growth factor (FGF) • >fibroblasts, chondrocytes, osteoblasts

  15. Fracture Healing Sequence • Reparative phase (10-30 days) • Callus forms • cross-sectional area • fibrous --> cartilage --> bone-like

  16. Fracture Healing Sequence • Remodeling phase (2 months or more) • callus shrinks • increased strength and stiffness • Total: at least 3 months

  17. Immobilization • reduces mechanical stress around area of bone which has suffered fracture • • However, plaster and fiberglass casts (non-removable) weaken bone overall

  18. Immobilization - 8 wks normal stress immobilization strain

  19. Immobilization - alternatives • Aircast • Sling • Support

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