Please Solve
James, an 18-year-old male visited the emergency room after being injured in a football game. James had fallen on his left wrist and was noted to have an open fracture of the wrist. He was admitted to the hospital for surgical repair of the fracture. The x-ray showed his wrist bone was in three parts and a small part was extending through the skin. His past medical history is negative.
1. What factors could impair bone healing in this patient?
2. Describe the four steps of fracture healing.
3. What are the risk factors that increase James chance for Osteomyelitis?
1. ANS: Factors affecting fracture healing:
A. Blood Supply: Soft tissue injury, Radiation, Chemical or thermal burns, Infection, Anaemia & hypoxia, Denervation, Excessive compression (more than 30lbs), and Age.
B. Excessive Movement: Inadequate immobilization and inadequate fixation or compliance
C. Gap: Interposed soft tissue, intact fellow bone, and distraction of bones.
D. Other: Nutrition (Vit C required for normal collagen) and Drugs (corticosteroids inhibit osteoblast differentiation.
2. ANS: Four steps of fracture healing:
Step 1: A hematoma (blood clot) forms from the periosteum and bone ruptured blood vessels. Bone cells deprived of nutrition die. The tissue becomes swollen, painful, and inflamed.
Step 2: In this, spongy bone forms close to developing blood vessels, and the fibrocartilage forms in more distant regions. The fibers and cartilage are deposited throughout the clot by fibroblasts forming a cartilage callus. Then the cartilage callus bulges over the bone side in the form of a splint to keep the ends together.
Step 3: The cartilage callus is converted to the woven bone and is now called a bony callus. In this, the bony callus replaces cartilage.
Step 4: The woven bone is remodeled to resemble the original bone, compact on the outside. The osteoclasts remove excess bony tissue restoring the new bone structure to its original form.
3. ANS: Osteomyelitis is a bone infection generally caused by bacteria. In most cases, it is caused by staphylococcus aureus bacteria, which are most predominantly found on our skin and nose.
Risk factors for osteomyelitis:
A. Long term skin infections.
B. Inadequately controlled diabetes.
C. Circulation disorders: When blood vessels are damaged or blocked Ex: arteriosclerosis.
D. Problems requiring intravenous lines or catheters. Ex: Dialysis machine tubing and Urinary catheters.
E. Conditions that impair the immune system. Ex: Chemotherapy and Poorly controlled diabetes
F. Illicit drugs
James, an 18-year-old male visited the emergency room after being injured in a football game. James had fallen on his left wrist and was noted to have an open fracture of the wrist. He was admitted to the hospital for surgical repair of the fracture. Th