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UM - MSK > Bone > Flashcards

Bone Flashcards

Bone fx and Bone Histology

1
Q

Define fracture

A

A break in the structural continuity of bone or cartilage

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2
Q

List the causes of a fracture

A

External Forces - Trauma
Internal Forces
Pathologies

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3
Q

List the signs of fractures

A 
Deformity of the bone
Edema
Ecchymosis
Loss of general function
WB pain
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4
Q

Risk factors for a fracture

A

Bone demineralization

Trauma

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5
Q

List the forces that can cause fractures

A

Tension
Compression
Bending
Torsional

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6
Q

List the symptoms of fractures

A

pain
point tenderness
increased w/vibration or tapping

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7
Q

What are Greenspan’s 7 elements for complete description of fractures

A
  1. site and extent
  2. type (complete or incomplete)
  3. alignment
  4. direction of lines
  5. special features
  6. associated abnormalities
  7. special types
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8
Q

What is a comminuted fracture

A

More than two pieces of bone caused by higher load or trauma

segmental (across) or butterfly (down and across)

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9
Q

How do you describe fracture alignment

A

Distal segment relative to proximal

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10
Q

What is a displaced fracture

A

loss of contact b/t the two fragments

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11
Q

What is angulation?

A

Displacement of the distal fracture fragment, named by the direction of the apex formed

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12
Q

Describe Displacement:

Shifted

A

Fx surfaces not in contact w/one another & apposition is present

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13
Q

Describe Displacement:

Distracted

A

Ends are separated and pull apart from each other

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14
Q

Describe Displacement:

Overriding

A

Mm spasms w/injury causing bones to be pulled past each other and shortening it

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15
Q

Describe Displacement:

Distracted and rotated

A

Looks straight but is actually rotated about its longitudinal axis

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16
Q

Transverse Fracture

A

Perp to long axis of bone, caused by a bending force and usually retains its alignment

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17
Q

Longitudinal fracture

A

Parallel to long axis of bone, caused by a repetitive stress or extension of oblique fx
Risk: tibial in runners jumpers and old women

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18
Q

Oblique fx

A

across the bone, caused by combined forces of axial compression, bending and torsion, requiring moderate energy

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19
Q

Spiral fx

A

jagged points across bone, caused by a low energy torsion force and heals better due to pieces fitting together, but edges can damage soft tissue

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20
Q

Avulsion fx

A

at end of tendon or ligament caused by tensile loading of the bone from a forceful mm contraction

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21
Q

Butterfly fx

A

A comminuted fx from compression and bending forces, w/fx on side of concavity

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22
Q

impaction fx

A

Bone is driven into itself, shortening the bone from a axial compression force

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23
Q

What are the two types of impaction fractures

A

Depression: stronger bone into weaker bone
Compression: axial loading which compresses one side and puts traction on the other

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24
Q

List the special types of fractures

A

stress
pathological
periprosthetic
bone graft

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25
Q

What is a stress fracture

A

High frequency, low level loading fx from repetitive fatigue

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26
Q

what is a pathological fracture

A

systemic or local fx from a disease process

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27
Q

what is a periprosthetic fx

A

occur in association w/prosthetic joint replacement, years after operation

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28
Q

what is a bone graft fracture

A

2-3 years after a reconstruction surgery from defects in the screw holes

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29
Q

What are some fx in children

A 
Greenstick - fx on tension side but cortex and periosteum still intact on compression side
Plastic bowing
Torus fracture (buckle) - of cortex
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30
Q

What is the SALTER-harris classification for

A

epiphyseal fractures in children

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31
Q

What does SALTER stand for?

A 
S - straight across
A - above
L - lower / beLow
T - through
ER - Erase growth plate
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32
Q

What is the Tscherne Classification for?

A

Soft tissue injury in closed fx

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33
Q

BONUS CARD!

A

YOU’RE DOING GREAT!!! KEEP GOING :)

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34
Q

What is the Gustilo Classification for

A

Open fractures, and is based on the size of the wound

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35
Q

What are the fracture complicatoins

A

Nonunion - failure to unite
malunion - healing, but a deformity results angular or rotary
delayed union - slow
posttraumatic OA
pseudoarthrosis - false joint associated w/non-union ends

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36
Q

What are the 5 Ps of compartment syndrome?

A 
Pain
Pallor
Paresthesia
Paralysis
Pulselessness
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37
Q

What are open fx complications

A 
Nerve injury
arterial injury
infection
complex regional pain syndrome
limb length discrepancy
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38
Q

T or F: Fx can cause life threatening complications

A

True - fat embolisms, pulmonary embolism, gas gangrene, and hemorrhages can occur 2nd to fx

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39
Q

What are some of the fx healing considerations

A

Aging (adults slow, kids 2x)
Nutritional challenges (Vit D and Ca+ def)
Co-morbidities (bowel diseases)
Blood supply (poor circulation, smoking, vascular disease)
site and type of fx

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40
Q

What heals faster, cancellous or cortical bone

A

Cancellous (trabecular/spongy) bone since it has an abundant blood supply

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41
Q

What heals faster, spiral or transverse fx

A

spiral

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42
Q

What heals faster, UE or LE fx

A

UE

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43
Q

Cortical Bone Healing: Inflammatory stage

A

0-3 days after fx, w/mesenchymal cells to envelop fx w/a fibrin clot formed b/t the two ends

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44
Q

What happens if fx gap is….
< 10 micrometers
> 10 micrometers

A

< 10 - no bone death and Haversian remodeling occurs

> 10 - bone heals w/secondary bone

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45
Q

Cortical Bone Healing: Proliferative stage

A

Fibrin clot (osteogenic and condrogenic cells, osteoclasts) –> soft callus (fibroblasts, blood vessels, cartilage and new bone)

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46
Q

Cortical Bone Healing: Reparative stage - ossification phase

A

Callus absorbed and replaced by woven bone

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47
Q

What is a clinical union and what stage is it found in

A

Callus has united at fx site –> during proliferative site

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48
Q

what is an early union and what stage is it found in

A

trabecular fx pattern identifiable and crosses fx lines –> in ossification phase of reparative stage

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49
Q

Cortical Bone Healing: Reparative stage - consolidation phase

A

14-40 days after fx w/osteoclasts and osteoblasts filling in the gaps b/t the fragments w/new bone

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50
Q

what is an established union and what stage is it found in

A

Appearance of cortical structure and remodeling occurs along the lines of stress –> during consolidation phase of the reparative stage

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51
Q

In what stage of cortical bone healing can you be FWB

A

Consolidation phase of reparative phase

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52
Q

what is a fibrous union

A

clinically stable, pain-free fx w/o radiological evidence of fracture line repair remaining

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53
Q

When is the repair of a fx complete

A

when the bone density is normal

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54
Q

How does cancellous bone heal

A

little to no callus formation, intramembranous ossification

55
Q

Timeline of fx healing:

UE vs LE

A 
Callus visible by x-ray:
2-3 weeks BOTH
Ossification: 4-6 weeks UE, 8-12 weeks LE
Consolidation:
6-8 weeks UE, 12-16 weeks LE
56
Q

What is reduction and when should you do it

A

It is the realignment of a fx site, done w/in 24 hours before swelling makes it difficult

57
Q

what is a closed reduction

A

Nonsurgical reduction for minimal displaced fx
1 - distal part pulled in line
2 - reposition
3 - adjust align in each plane
4 - checked w/radiography after the reduction

58
Q

what is an open reduction

A

requires surgery & done when closed reduction fails. Soft tissue in b/t fx ends

59
Q

What are the ways to splint a fracture

A

Continuous traction - gravity alone, skin traction, skeletal
Cast
Functional bracing

60
Q

What is involved with internal fixation

A

Rods/Nails for stability
compression plate to shield fx site from stress
buttress plates - to absorb some of the stress

61
Q

What are some common complications of internal fixation

A

infection
non-union
implant failure
re-fracture

62
Q

what are indications for external fixation

A
  • fx w/severe soft tissue damage
  • nerve or blood vessel damage
  • severely comminuted/unstable
  • pelvic
  • infected
63
Q

What are the benefits to external fixation

A
  • more mobile,
  • maintain alignment and length
  • stress sharing
64
Q

What are the complications of external fixation

A

infections

delayed union

65
Q

What are the 4 major functions of bone

A 
Provide:
- structural support
- protection of vital organs
- environment for marrow
To act as mineral reservoir for Ca+ homeostasis in the body
66
Q

What are osteogenic cells

A

(from mesenchymal layer) Precursor to osteoblasts located in the endosteum and periosteum of bone

67
Q

what are osteoblasts

A

sticky bone forming cells found near the surface of the bone layer that function in synthesis in secretion of osteoid.
(Can’t divide. Mobilized by thyroid)

68
Q

what are osteoids

A

organic, un-mineralized component of cell matrix secreted by osteoblasts to provide the foundation for the minerals (like Ca+) to be deposited into

69
Q

what is the bone matrix

A

formed from osteoid and inorganic mineral salt deposited within the osteoid

70
Q

what are osteocytes

A

osteoblasts that have become trapped within the bone matrix and now function to maintain it

71
Q

what are osteoclasts

A

derived from macrophage-monocyte system, multi-nucleated bone absorbing cells found on the bone surface to secrete hydrolytic enzymes to dissolve bone

72
Q

what are osteonss

A

bone cylinders that contain the osteocytes and the bone matrix –> consists of lamellae and haversian canals

73
Q

how can you differentiate osteoclasts from osteoblasts

A

osteoclasts have a ruffled border to increase SA and are multinucleated

74
Q

What are the three types of bone

A

Woven
Lamellar, primary
lamellar, secondary

75
Q

Which bone type is the weakest

A

woven bone

76
Q

Where do you find wonven bone

A

adult tooth sockets, sutures of the skull

77
Q

What type of bone is the first formed following a fracture

A

woven bone

78
Q

what is woven bone

A

It consists of collagen fibers irregularly woven, osteocytes in lacunae irregularly dispersed to serve as a model from which primary and secondary bone can develop

79
Q

What is a haversian system

A

a structural unit w/long cylinder parallel to long axis of bone for blood flow

80
Q

What is lamellar primary bone

A

Compact/cortical bone (dense w/o marrow spaces) composed of haversian, circumferential, and interstitial systems

81
Q

What is primary cancellous bone

A

Trabecular/Spongy bone that is oriented according to the stress placed on the bone (wolff’s law)

82
Q

what is secondary bone

A

It is present during bone healing

83
Q

What is the difference between secondary and primary osteons

A

Secondary are larger, have larger haversian canals, and are surrounded by a cement line b/t the osteon and the bone matrix

84
Q

what is the periosteum

A

Dense fibrous connective tissue and inner cellular layers that acts as the external lining of all bone except at joints

85
Q

what is the endosteum

A

a single layer of osteoprogenitor cells, osteoblasts, osteoclasts nad a small amount of CT that acts as the inner lining of thing specialized CT

86
Q

What 3 events occur during bone remodeling?

A

ARF
Activation
Resorption
Formation

87
Q

What is remodeling

A

The resorption and replacement of existing bone

88
Q

What are the triggers for start of bone remodeling

A 
Low serum Ca+
High blood Ca+
Skeletal microdamage
Mechanical stimulus
Mass needs of skeleton
89
Q

What happens if there is low blood calcium

A

Parathyroid gland sense low blood Ca+ –> secrete PTH –> stimulates osetoclast activity –> reabsorb Ca+ from broken down bone –> blood Ca+ rises to normal

90
Q

What happens if high blood calcium

A

thyroid gland senses high blood Ca+ –> secretion of calcitonin–>hormone stim osteoblast activity –> form of bone to remove Ca+ –> blood Ca+ falls to normal

91
Q

What is the norm for Ca+ blood levels

A
  • 10s for teens and YA

9s in adult hood

92
Q

What is resorption

A

osteoclastic torpedo shape front line that secretes acid phosphatase, and other proteolytic enzymes to cut through bone

93
Q

What is formation

A

osteoblasts follow osteoclastic front and deposit new bone (slower than osteoclast) that will calcify 8-10 days after matrix deposited

94
Q

Timeline for bone healing

A

2.5 weeks usually

1 week after start of osteoclast –> formation –> 8-10 days later it calcifies

95
Q

at what age is there an accelerated decline of bone

A

55 +

96
Q

how much bone density is lost per year

A

approx 1% w/women more than men

97
Q

what happens to bone as you age

A

Decreased minerals, water, and proteoglycans in the bone, causing it to be more likely to break.
Overall loss of bone tissue due to balance in abs and formation changing, leading to osteoporosis development.

98
Q

What are the 4 main categories of Bone diseases/disorders

A

Bone death
Infection
Disruption of deposition/resorption
Bone tumors

99
Q

What is the pathology behind osteonecrosis

A

Loss of blood supply causing death of bone and bone marrow (NO INFECTION), can be caused by trauma, stress, fluid buildup or genetic factors

100
Q

What areas are commonly affected by osteonecrosis

A

Hip and shoulder!

knee, talus, jaw, carpals

101
Q

Risk factors for oseonecrosis

A
  • Corticosteroid use
  • Men
  • Alcohol abuse
  • Secondary to sickle-cell anemia, gaucher, lupus, cassion’s disase, etc
102
Q

What are the clinical manifestations of osteonecrosis

A

Insidious onset of localized bone pain w/WB in LE and swelling

103
Q

What is trademark of osteonecrosis on imaging

A

Snowcap sign = dense sclerosing over the joint surface head

104
Q

Stages of osteonecrosis

A
  1. abnormal scan - intense pain inc w/ WB
  2. radio show sclerosing (MRI best)
  3. bone begins to decay and collapse
  4. bone collapses, joint space narrows, bone cells die
105
Q

Osteonecrosis in children

A

Interruption of blood supply to the bone (particularly the epiphysis)
AKA: aseptic necrosis (newborns), osteochondritis, legg calve perthes

106
Q

What is Potts disease

A

tuberculosis that has progressed to the spine (mainly thoracic) causing an inflammatory process where granulation tissue erodes the cartilage and cancellous bone, causing demineralization and fractures

107
Q

What are the s/s of tb

A

pain localized/referred, fever, chills, weight loss, fatigue, pain
Dx w/PA chest x-ray, TB tests, tissue cultures and tissue biopsy

108
Q

What’s the onset of TB

A

insidious w/2-3 years after primary TB infection

109
Q

what is osteomyelitis

A

Infection of bone marrow introduced into body through some sort of trauma, including iatrogenic sources (more commonly in spongy bone)

110
Q

what is the pathology of osteomyelitis

A

Leukocytes enter infected area releasing an enzyme to lyse bone causing bus to enter blood stream and impair blood flow, leading to necrosing bone

111
Q

S/S Osteomyelitis

A 
fever 
fatigue
edema
erythema
tenderness 
LOF
112
Q

What is the treatment for osteomyelitis? PT?

A

Antibiotics w/PT low key until infection under control as they are at risk for fractures w/WB activities

113
Q

What are two types of disruption of deposition/resorption of bones

A

Osteomalacia (RICKETS)

Osteoporosis

114
Q

What is osteomalacia

A

A metabolic bone disease from a lack of vitamin D either due to reduced absorption or increased loss of renal phosphates that can develop at the epiphyseal plate in kids (Rickets) leading to decreased bone strength

115
Q

What are the risk factors of osteomalacia

A
  • little exposure of sunlight
  • inadequate diet, increase in antacid
  • housebound
  • GI disorders
116
Q

Clinical Manifestations

off Osteomalacia

A 
Chronic Fatigue
Generalized bone pain
Muscle weakness
Hypocalcemia
Psuedofractures
Postural deformities
Late stages: waddling gait, difficulty climbing stairs or getting up from a seated position
117
Q

What medical tests do you do for osetomalacia

A 
Lab tests
Urine analysis (Ca+ and phosphate)
Bone scan - bone metabolic activity
Radiograph - looser's zones
Bone biopsy
118
Q

Define osteoporosis

A

decrease in bone mass and increase in susceptibility to fracture bone in the absence of bone loss
(increased haversian canals, incomplete refilling)

119
Q

What are risk factors to osteoporosis

A

Females after menopause

120
Q

S/S Osteoposrosis

A
  • Bone pain w/fx
  • Kypotic deformity after fx (compression fx)
  • 30-50% bone loss to show on x-ray
  • Nuclear bone scan > radiography
121
Q

Treatment for Osteoporosis

A
  • CANT GET BACK TO NORMAL
    Rx: preventative, med, bracing, general conditioning w/WB, Vit D and Ca+
  • Sx: if progressive and isntabilty of spine
122
Q

List the types of bone tumors

A
  • Benign Bone Tumors
  • Osteoid Osteoma
  • Osteosarcoma
  • Osteoblastoma
  • Ewings Sarcoma
123
Q

What is a neoplasm

A

An abnormal growth of cells that can be malignant or benign

124
Q

What are benign bone tumors

A

Like a bone island that is round/oval in shape and small in size (<1cm)

125
Q

What is an osteoid osteoma

A

A rare benign vascular osteoblastic tumor found in the cortex of long bones, more common in males < 25 yo.

126
Q

What is an osteoblastoma

A

A benign reactive lesion that is more aggressive and will expand, typically found in the sacrum, spine, and flat bones in men < 30 yo.

127
Q

Symptoms of osteoid osteoma vs osteoblastoma

A

Osteoid osteoma has a local gradual increase in pain that can be relieved by aspirin whereas an osteoblastoma is pain not relieved with aspirin.

128
Q

What is an osteosarcoma

A

A malignant, destructive tumor that destorys bone cortex, mostly in the long bones and spine in males <30 yo

129
Q

What are the s/s of osteosarcoma

A

Severe pain for > 1 month, edema, decreased ROM, and tenderness

130
Q

What is ewings sarcoma

A

A cancerous tumor of bone or soft tissue more commonly in the pelvis or LE in those <20 yo

131
Q

What are the risk factors of ewings sarcoma

A

Caucasian
Family exposure to pesticides, fertilizers (farmers)
Second hand smoke (parental smoking)

132
Q

What are the sx of ewings sarcoma

A

Local bone pain edema

133
Q

Difference b/t:

  • osteoid osteoma
  • osteoblastoma
  • osteogenic sarcoma
A
  • small benign tumor in cortex –> slightly larger in cortex into trabecula –> malignant and covering whole bone
134
Q

What is multiple myeloma

A

A primary cancerous caner that involves bone marrow w/s/s of osteopenia, holes, sclerosing of bone, deep bone pain

UM - MSK (9 decks)

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