MUSCULOSKELETAL

DISORDERS

JDMA CREATIVES
Table of Contents
01 Fracture

Stages of Bone
02 Healing

03 Compartment
Syndrome

04 Gout

05 Osteoporosis
 FRACTURE

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 Fracture
A bone fracture is a break in the continuity of a bone. A significant
percentage of bone fractures occur because of high force impact or stress.
However, a fracture may also be the result of some medical conditions
that weaken the bones. These include osteoporosis and some types of
cancer. The medical term for these is a pathological fracture.
In this article, we detail the different types of bone fractures, their various
causes, and the treatments available. A bone fracture is a full or partial
break in the continuity of bone tissue. Fractures can occur in any bone in
the body.

There are several different ways in which a bone can fracture. For
example, a closed fracture is a break to the bone that does not damage
surrounding tissue or tear through the skin.
By contrast, a compound fracture is one that damages surrounding tissue
and penetrates the skin. Compound fractures are generally more serious
than simple fractures due to the risk of infection.

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 TYPES
There are a number of other fracture types, including:
Avulsion fracture:
A muscle or ligament pulls on the bone, fracturing it.
Comminuted fracture:
An impact shatters the bone into many pieces.
Compression, or crush, fracture:
This generally occurs in the spongy bone in the spine. For example, the
front portion of a vertebra in the spine may collapse due to osteoporosis.
Fracture dislocation:
This occurs when a joint dislocates, and one of the bones of the joint
fractures.
Greenstick fracture:
The bone partly fractures on one side but does not break completely,
because the rest of the bone can bend.
Hairline fracture:
This is a thin, partial fracture of the bone.
Impacted fracture:
When a bone fractures, a piece of the bone may impact another bone.
Intra-articular fracture:
This occurs when a fracture extends into the surface of a joint.
Longitudinal fracture:
This is when the fracture extends along the length of the bone.
Oblique fracture:
An oblique fracture is one that occurs opposite to a bone’s long axis.
Pathological fracture:
This occurs when an underlying condition weakens the bone and causes a
fracture.
Spiral fracture:
Here, at least one part of the bone twists during a break.
Stress fracture:
Repeated stress and strain can fracture a bone. This is commonTrusted
Source among athletes.
Transverse fracture:
This is a straight break across the bone.
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 SYMPTOMS
Symptoms of a fracture vary depending on its location, a person’s age
and general health, and the severity of the injury.
However, people with a bone fracture will typically experience some of
the following:

pain
swelling
bruising
discolored skin around the affected area
protrusion of the affected area at an unusual angle
inability to put weight on the injured area
inability to move the affected area
a grating sensation in the affected bone or joint
bleeding if it is an open fracture
In more severe cases, a person may experience:

dizziness
faintness or lightheadedness
nausea

CAUSES
Healthy bones are extremely resilient and can withstand surprisingly
powerful impacts. However, under enough force, they may crack or
break.
Physical trauma, overuse, and health conditions that weaken the bones,
such as osteoporosis, are the leading causes of bone fractures. Other
factors can also increase an individual’s risk of sustaining fractures.
A person’s bones will typicallyTrusted Source weaken with age, which
increases the risk of them breaking. As a person ages, the likelihood of
their developing a condition that weakens the bones is also greater.

COMPLICATIONS

While bone fractures typically heal well with appropriate treatment,

there can be complications, such as:
Bone heals in the wrong position:
A fracture may heal in the wrong position, or the bones may shift during
the healing process.
Disruption of bone growth:
If a childhood bone fracture becomes disrupted during healing, this may
affect the typical development of that bone. This can raise the risk of
future deformity in the bone.
Bone or bone marrow infection:
In a compound fracture, bacteria can enter through a break in the skin
and infect the bone or bone marrow. This can become a persistent
infection.
Bone death (avascular necrosis):
If the bone loses its essential supply of blood, it may die.

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 STAGES OF
BONE HEALING

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 Stages of Bone Healing
The bone healing process is the same in all broken bones. This is true
whether a bone has been cut as part of a surgical procedure or fractured
through an injury.
The bone healing process has three overlapping stages: inflammation,
bone production and bone remodeling.

INFLAMMATION

Inflammation starts immediately after the bone is fractured and lasts for
several days. When the bone is fractured, there is bleeding into the area,
leading to inflammation and clotting of blood at the fracture site. This
provides the initial structural stability and framework for producing new
bone.

BONE PRODUCTION

Bone production begins when the clotted blood formed by inflammation is

replaced with fibrous tissue and cartilage (known as soft callus). As healing
progresses, the soft callus is replaced with hard bone (known as hard
callus), which is visible on x-rays several weeks after the fracture.
 BONE REMODELING
Bone remodeling, the final phase of bone healing, goes on for several
months. In remodeling, bone continues to form and becomes compact,
returning to its original shape. In addition, blood circulation in the area
improves. Once adequate bone healing has occurred, weightbearing (such
as standing or walking) encourages bone remodeling.​

HOW LONG DOES BONE HEALING TAKE?

Bone generally takes six to 12 weeks to heal to a significant degree. In
general, children's bones heal faster than those of adults. The foot and ankle
surgeon will determine when the patient is ready to bear weight on the area.
This will depend on the location and severity of the fracture, the type of
surgical procedure performed and other considerations.

WHAT HELPS PROMOTE BONE HEALING?

If a bone will be cut during a planned surgical procedure, some steps can
be taken pre- and postoperatively to help optimize healing. The surgeon
may offer advice on diet and nutritional supplements that are essential
to bone growth. Smoking cessation and adequate control of blood sugar
levels in people living with diabetes are important. Smoking and high
glucose levels interfere with bone healing.
For all patients with fractured bones, immobilization is a critical part of
treatment because any movement of bone fragments slows down the
initial healing process. Depending on the type of fracture or surgical
procedure, the surgeon may use some form of fixation (such as screws,
plates or wires) on the fractured bone and/or a cast to keep the bone from
moving. During the immobilization period, weightbearing is restricted as
instructed by the surgeon.
Once the bone is adequately healed, physical therapy often plays a key
role in rehabilitation. An exercise program designed for the patient can
help in regaining strength and balance and can assist in returning to
normal activities.

WHAT CAN HINDER BONE HEALING?

A wide variety of factors can slow down the healing process. These include:
Movement of the bone fragments; weightbearing too soon
Smoking, which constricts the blood vessels and decreases circulation
Medical conditions, such as diabetes, hormone-related problems or
vascular disease
Some medications, such as corticosteroids and other
immunosuppressants
Fractures that are severe, complicated or become infected
Advanced age
Poor nutrition or impaired metabolism
Low levels of calcium and vitamin D

HOW CAN SLOW HEALING BE TREATED?

If the bone is not healing

as well as expected or fails
to heal, the foot and ankle
surgeon can choose from
a variety of treatment
options to enhance bone
growth, such as continued
immobilization for a
longer period, bone
stimulation or surgery
with bone grafting or use
of bone growth proteins.
 COMPARTMENT
SYNDROME

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 Compartment Syndrome
Compartment syndrome is a painful and sometimes serious medical
condition in which excessive pressure builds up within a muscle
compartment, impeding the blood flow to the tissues in the affected area
thus depriving them of necessary oxygen (ischemia). Compartment
syndrome occurs most commonly in the front muscle compartment of the
calf, but can also present in the arms, hands, feet, and buttocks.
Compartment syndrome often occurs after an injury and can be classified
as acute or chronic, depending on the cause.
Acute compartment syndrome is
considered a medical emergency
and usually presents shortly after
an accident or fracture, while
chronic (also called exertional)
compartment syndrome may take
days or weeks to develop and is
generally associated with physical
exertion or exercise. If left
untreated, compartment
syndrome can result in severe
tissue damage, loss of body
function, cellular death (necrosis),
or amputation.

HOW COMPARTMENT SYNDROME OCCURS

Muscles, blood vessels, and nerves are organized into groupings called
compartments that are covered by walls of tough connective tissues
(fascia). The fascia’s job is to keep the tissues in place within each
compartment, therefore, the membrane does not easily stretch or
expand.When an injury occurs, fluid from inflammation (edema) or blood
can accumulate inside a compartment which creates increased pressure on
the tissues in that compartment, as well as decreased blood flow. Without
adequate blood flow, these affected tissues can be damaged quickly.
 TYPES OF COMPARTMENT SYNDROME
There are 2 main types of compartment syndrome: acute compartment
syndrome and chronic (also called exertional) compartment syndrome.

ACUTE COMPARTMENT SYNDROME

Acute compartment syndrome, which is the most common type, is usually
caused by a fractured arm or leg, and the pressure almost always develops
rapidly. Acute compartment syndrome can, however, also appear later,
after the fracture is treated with casting or surgery.
Other injuries or factors that can contribute to acute compartment
syndrome include:
Constrictive or overly tight bandaging or casting
Burns
Crush injuries
Compression of a limb for a prolonged period
Severely bruised muscle, such as from a vehicular accident or contact
sports injury
Blood clot in the arm or leg
Surgery involving blocking a blood vessel in an extremity
Anabolic steroid use
Heavy alcohol or drug use

SYMPTOMS OF ACUTE COMPARTMENT SYNDROME

Symptoms of acute compartment syndrome can include:
Sudden, persistent aching in a leg or arm (often worsening when the
limb is stretched)
Pain that seems more severe than the injury warrants
Tightness, swelling, and bruising of the affected area
Tingling and/or burning (paresthesia) in the limb
Numbness or paralysis in the limb (may indicate permanent damage)
 TREATING ACUTE COMPARTMENT SYNDROME
Most patients experiencing acute compartment syndrome require
immediate surgery to alleviate the compartment pressure. Relieving
pressure from acute compartment syndrome involves the surgeon cutting
through the fascia of the affected compartment in a procedure called a
fasciotomy. In some cases, the surgical site must be left open until the
swelling reduces. Skin grafting may also be utilized.
After a fasciotomy, recovery may include:
Elevation of the affected limb
Cold therapy
Pain and anti-coagulation medication
Wound management
Physical therapy to regain muscle strength and range of motion
Temporary limitations on physical activities

CHRONIC COMPARTMENT SYNDROME

Chronic, also called exertional, compartment syndrome is typically not an
emergency, as in acute compartment syndrome. The pressure within the
compartment usually develops over a period of days or weeks, often due to
overexertion during rigorous exercise. Chronic compartment syndrome
most commonly affects the lower leg, thigh, or buttock and presents within
approximately 30 minutes after beginning strenuous activity.

SYMPTOMS OF CHRONIC COMPARTMENT SYNDROME

Chronic compartment syndrome symptoms include pain and/or cramping
during exercise (especially activity involving repetitive motion) and is
often mistaken for shin splints due to symptom similarity. The pain
typically subsides upon stopping the activity.

Other possible symptoms of chronic compartment symptoms include:

Numbness, tightness, tingling, or weakness in the affected limb
Difficulty moving the limb
Bulge in the muscle (muscle hernia)
 COMMON ACTIVITIES
Common activities that may contribute to chronic or exertional
compartment syndrome are:
Tennis
Running
Swimming
Intense and/or frequent workouts

POSSIBLE FACTORS
Other possible factors thought to be involved in developing chronic
compartment syndrome include:
Enlarged muscles
Overly inflexible or thick fascia around the compartment
Venous hypertension (pressure in the veins)
If you are experiencing symptoms of chronic compartment syndrome,
you should discontinue the activity causing the pain. Continuing to
exercise through the pain can cause permanent damage to the tissue
within the compartment.

TREATING CHRONIC (EXERTIONAL) COMPARTMENT SYNDROME

The pain and swelling from chronic compartment syndrome usually

resolves with rest and avoidance of the activity causing the pressure.
Other non-surgical treatments include:
Anti-inflammatory medications
Physical therapy
Elevation of the affected limb
Modification of the contributing activity
Changing exercise surface
Orthotic inserts in the shoes
Inclusion of low-impact activities in your exercise routine
Icing the affected extremity after exercising
 CAUSES OF COMPARTMENT SYNDROME
ACUTE COMPARTMENT CHRONIC COMPARTMENT
SYNDROME SYNDROME
Acute compartment syndrome can Chronic compartment syndrome
be caused by: usually occurs in young people who
do regular repetitive exercise, such
a broken bone or a crush injury – as running or cycling.
this is the most common cause
a plaster cast or tight bandage being The exact cause is unknown.
applied to a limb before it has A leading theory is that it's caused
stopped swelling by temporary swelling of the
burns, which can cause the skin to muscles during exercise affecting
become scarred and tight the blood supply to a whole group
surgery to repair a damaged or of muscles.
blocked blood vessel (once blood is
able to flow back into a muscle, it
can lead to swelling)
In rare cases, it can occur without
any obvious injury.

WHEN TO GET MEDICAL ADVICE

It's important to get medical advice if you think you have compartment
syndrome:

go to your nearest accident and emergency (A&E) department as soon

as possible if you think you have acute compartment syndrome
speak to your GP for advice if you think you have chronic
compartment syndrome
Acute compartment syndrome is a medical emergency and ideally needs
to be treated in hospital within a few hours to avoid permanent damage to
the muscles or nerves.
Chronic compartment syndrome is much less serious, but it's a good idea
to get your symptoms checked out and have the cause diagnosed.
 GOUT

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 Gout
Gout is a painful form of arthritis. When your body has extra uric acid,
sharp crystals may form in the big toe or other joints, causing episodes of
swelling and pain called gout attacks. Gout is treatable with medications
and changes in diet and lifestyle.
Doctors place gout under the umbrella
term “arthritis” — a broad range of joint
diseases and joint pain. Some forms of
arthritis inflame joints, while others
don’t. Gout is a common form of
inflammatory arthritis. It’s due to a
crystal called uric acid.
Gout causes pain and swelling in one or
more joints. It typically affects the big
toe. But it’s also found in other
joints, including the knee, ankle, foot, hand, wrist and elbow.

WHO IS AFFECTED BY GOUT?

Gout can affect anyone. It usually occurs earlier in men than women. It
generally occurs after menopause in women. Men can be three times more
likely than women to get it because they have higher levels of uric acid
most of their lives. Women reach these uric acid levels after menopause.
People are more likely to get gout if they have:
Overweight/obesity.
Congestive heart failure.
Diabetes.
Family history of gout.
Hypertension (high blood pressure).
Kidney disease.
You are also more likely to develop gout if you:
Consume a diet high in animal proteins.
Consume a significant amount of alcohol.
Are on water pills (diuretics).
 SYMPTOMS OF GOUT
An episode of gout is called a gout
attack. Gout attacks are very
painful and can happen quite
suddenly, often overnight. During a
gout attack, symptoms in the
affected joint(s) may include:
Intense pain.
Redness.
Stiffness.
Swelling.
Tenderness, even to light touch,
such as from a bedsheet.
Warmth, or a feeling like the
joint is “on fire.”
How long does a gout attack last?
A gout attack can last a week or two. Between gout attacks, you may have no
symptoms at all.

CAUSES OF GOUT
The human body makes uric acid
during the breakdown of chemicals
called purines found in certain food
and drinks. This normal byproduct
goes through the kidneys and exits
the body when you pee.
Sometimes the body produces too
much uric acid. Or the kidneys
can’t do a good job handling it.

When the body has high levels of uric acid, or hyperuricemia, uric acid
crystals can concentrate in the joints. The sharp, needle-like crystals cause
gout. However, many people with higher uric acid levels never get gout.
 OSTEOPOROSIS

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 Osteoporosis
Osteoporosis means "porous bone," or bone that has become more open due
to a loss of bone cells. As such, it's often described as a disorder characterized
by "holey" bones. This might be confusing because if you viewed a healthy
bone under a microscope, it would appear to have gaps similar to what you
would see in a honeycomb but a bone affected by osteoporosis will contain
much bigger spaces than healthy bones.
Though post-menopausal women are most commonly associated with
osteoporosis, men also experience it. In fact, it's estimated that 20% of the 10
million Americans with osteoporosis are men.

SYMPTOMS OF OSTEOPOROSIS
Many times people learn they have osteoporosis because a bone fractures
when doing something that should not break a bone, like standing up or
lightly bumping an object. A bone fracture is one of the top symptoms of
low bone density.
However, there are early signs of osteoporosis that may appear before a
bone breaks.

Following is an osteoporosis symptoms list:

Loss of height over a period of time due to bone degeneration in the
spine.
Back pain due to a collapsed vertebra in the spine.
Back pain due to a spinal fracture.
Developing a curvature of the spine near the shoulders (widow’s
hump).
Developing a curvature anywhere along the spine.
Stooped or poor posture.
Difficulty doing simple activities, like getting out of a chair, without
using the arms.
One or more markers for osteoporosis are indicated in blood test
results, like low vitamin D levels (vitamin D from diet or supplements
is needed for calcium absorption).

STAGES OF OSTEOPOROSIS
In many cases, the pain associated with osteoporosis is mostly due to a
bone fracture. Back pain is common when a spinal compression fracture
occurs. Pain in the neck or hips is another one of the common signs of
osteoporosis. However, osteoporosis and pain also go hand-in-hand when
a bone weakens and causes other problems, such as a skeletal
misalignment or difficulties with bending and twisting the body.

Osteoporosis develops so slowly that the signs the disease is developing

are often overlooked. It is important to never ignore the warning signs of
osteoporosis.

RISK FACTORS FOR DEVELOPING OSTEOPOROSIS

In many cases, the pain associated with osteoporosis is mostly due to a
bone fracture. Back pain is common when a spinal compression fracture
occurs. Pain in the neck or hips is another one of the common signs of
osteoporosis. However, osteoporosis and pain also go hand-in-hand when
a bone weakens and causes other problems, such as a skeletal
misalignment or difficulties with bending and twisting the body.
Osteoporosis develops so slowly that the signs the disease is developing
are often overlooked. It is important to never ignore the warning signs of
osteoporosis.
Some of the controllable risks that can lead to bone loss include:
Hormones – lowered sex hormones or excessive thyroid hormones.
Medications – corticosteroids and drugs used for seizures, cancer,
gastric reflux, and transplant rejection.
Diet – a diet with low calcium intake.
Vitamin D level – low vitamin D level impedes the absorption of
calcium.
Eating disorders – not getting enough nutrients due to a highly
restricted food intake, leading to being underweight.
Exercise – lack of weight-bearing exercise or a sedentary lifestyle.
Alcohol – consuming more than two drinks a day.

RISK FACTORS FOR DEVELOPING OSTEOPOROSIS

If you have osteoporosis, your bones are weak and prone to fracture.
Fractured bones caused by osteoporosis are most commonly located in the
hip, spine, and wrist. These fractures result in a variety of complications:
Severe, chronic pain
Loss of height
Stooped posture
Restricted mobility
Depression