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Musculoskeletal dysfunction > Bone and joint pathology > Flashcards

Bone and joint pathology Flashcards

1
Q

What is the role of osteoclasts?

A

Bone resorption

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2
Q

What is the role of osteoblasts?

A

Synthesis and secretion of bone matrix

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3
Q

What does the classification of a fracture depend on?

A

Anatomical location

Extent of bone damage

Direction of fracture line

Number of fragments

Stability

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4
Q

Define diaphyseal

A

fracture of the midshaft

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5
Q

Define metaphyseal

A

Fracture within the metaphyseal region of the bone

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6
Q

Define epiphyseal

A

fractuce or the epiphyseal plate

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7
Q

Define condylar

A

fracture through one condyle

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8
Q

Define a complete fracture

A

Extends all the way through the bone

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9
Q

Define an incomplete fracture

A

Fracture does not extend full thickness

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10
Q

Define a greenstick fracture

A

Incomplete fracture in immature bone. Bone bends and fractures through the outside cortex

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11
Q

Describe a fissure fracture

A

Crack formation but periosteum remains intact

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12
Q

Define a transverse fractuce

A

Perpendicular to the long axis

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13
Q

Define an oblique fracture

A

Runs at an angle to the long axis

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14
Q

Define a spiral fracture

A

Spirals along the long axis

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15
Q

Define a comminuted fracture

A

Overlapping fracture lines - fragments

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16
Q

Define a stable fracture

A

not displaced and some weight bearing force can be applied

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17
Q

Define an unstable fractuce

A

Cannot withstand any force without displacing

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18
Q

Describe an avulsion fracture

A

Caused by intrinsic pull from muscle contraction

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19
Q

Describe primary bone healing

A

Occurs when there is anatomical reduction of fracture fragments

Minimal interfragmentary strain

Good blood supply

Fracture gap <1mm

e.g. fissures or surgically fixated fractures (plates)

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20
Q

Describe secondary bone healing

A

Most common

Fracture gap and/or interfragmentary strain

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21
Q

What happens within the interfragmentary gap (<1mm)

A

Granulation tissue and angiogenesis

Within days, lamellar bone deposited

Transverse to long axis

In approx. 3 weeks:

Haversian remodeling

New lamellar bone is orientated longitudinally

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22
Q

What are the three stages of secondary/indirect bone healing?

A

Inflammatory (2 - 3 weeks)

Repair (2 weeks – 12 months)

Regeneration (can be years!)

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23
Q

Describe the inflammatory stage

A

Periosteum, soft tissue and blood vessels are torn.  haematoma

Acute inflammatory cells to migrate to the area (chemotaxis).

Phagocytosis of necrotic debris

Angiogenesis and mesenchymal stem cells migrate

Fibroblasts then create a ‘soft callus’ containing type III collagen.

24
Q

Describe the repair stage

A

Mesenchymal cells  chondrocytes  cartilage

Endochondral ossification

Soft callus is mineralised to woven bone.

Immature bone

Irregularly arranged collagen fibres

First ‘hard’ or ‘primary’ callus

25
Q

Describe the remodelling phase

A

Woven bone is remodelled to lamellar bone

Haversian remodelling of cortical bone

Callus reduces so that bone is back to normal shape/size

Can take years!

26
Q

What complications can occur?

A

Soft tissue trauma

Introduction of infection

Malunion

Non-union

Viable vs non-viable

Implant failure

27
Q

Describe osteitis

A

Osteo-’  relating to bone

‘-itis’  inflammation of

Can be introduced by

Penetrating injury

Spread from surrounding tissues

Extension of suppurative arthritis

Haematogenous spread

Bone loss via necrosis stimulates new bone growth

Bacteria can reside in cavities / areas of necrosis  treatment difficult!

28
Q

Describe panosteitis

A

‘Growing pains’

Young, growing large breed dogs

German shepherd dogs

Golden retriever

Basset hound

Dobermans

Labrador retriever

29
Q

What are the clinical signs of panosteitis?

A

Clinical signs present at around 5 – 18 months of age

Long bone lameness of 2-5 weeks duration

Shifts legs

Recurs

Eventually remodelled and excess bone removed

30
Q

Describe metaphyseal osteopathy

A

hypertrophic osteodystrophy’

Young, growing giant breeds

Great Dane

Wolf hound

Unknown aetiology

?Inappropriate supplementation vit/min

?live canine distemper vaccination

31
Q

What are the clinical signs of metaphyseal osteopathy?

A

Clinical signs

Lameness

Fever / pyrexia

Swollen, painful metaphyses of long bone

Most animals respond spontaneously

32
Q

Describe craniomandibular osteopathy

A

Non-neoplastic

Developmental disease affecting growing terrier breeds

Genetic link

Resorption of bone leads to replacement with immature bone

Targets bones of the skull

33
Q

Describe the clinical signs of craniomandibular osteopathy?

A

Clinical signs

4-8 months of age

Swollen mandible

Difficultly in opening mouth

Dysphagia (difficulty eating)

Usually self-limiting at approx. 1 year of age

Slow replacement with mature bone

Pain relief and soft diet

34
Q

Describe osteoporosis

A

Condition that leads to reduced bone mass

Combination of factors

Calcium deficiency

Starvation

Reduced activity

Can be reversible in young animals – not adults!

35
Q

Explain the process of osteoporosis

A

Cortical and trabecular bone is reduced in thickness

Trabeculae are eventually lost

Bone lacks density

Prone to pathological fractures

36
Q

Describe rickets and osteolamacia

A

Rickets – young animals

Osteomalacia – mainly adult animals

Vitamin D or phosphorous deficiency

Dysfunction of mineralisation

Accumulation of unmineralised bone

37
Q

What are the clinical signs of rickets?

A

Disease of cartilage undergoing endochondral ossification at the growth plate

Clinical signs

Bone pain and swelling

Stiff gait

Lameness

Bowed limbs

Folding fractures

38
Q

What are the clinical signs of osteomalacia?

A

Disease affecting the osteoid

Clinical signs

Failure to thrive

Pathological fractures

Deformities of spine (lordosis, kyphosis etc)

39
Q

Describe fibrous osteodystrophy

A

Widespread resorption of bone

Primary hyperparathyroidism – tumours of the parathyroid gland

Secondary hyperparathyroidism – an increase in PTH which is renal or nutritional in origin

40
Q

Describe nutritional secondary hyper-parathyroid hormone

A

Young animals

Diet deficient in calcium / excessive in phosphorous  PTH secretion

All meat diets in dogs/cats

High bran/grain diet in horses

Increase in osteoclast resorption and proliferation of fibrous tissue

41
Q

Describe renal secondary hyper-parathyroid hormone

A

Chronic renal failure

Inability to excrete phosphorous  hypocalcaemia  PTH secretion

Reduction in the production of vitamin D

Reduction in calcium absorption

42
Q

What are the clinical signs of fibrous osteodystrophy?

A

Bone pain

Deformity of mandibular / maxilla

Due to loss of bone and replacement with fibrous tissue

‘Rubber jaw’

43
Q

Describe neoplasia

A

Most common is osteosarcoma

‘Away from the elbow – towards the knee’

Present with:

Lameness

++ pain

Swelling

+/- pathological fracture

44
Q

Describe angular limb deformities (small animal)

A

Most common in the forelimbs – radius and ulna

Immature animals:

Osteotomy of the ulna

Animals close to skeletal maturity:

Corrective osteotomy of radius and ulna

Realigns the joints

Stabilisation – ECF +/- internal plate.

+/- limb lengthening

45
Q

Describe how the joint responds to injury

A

Inflammation leads to a loss of matrix components

Altered pressure and permeability of joint

Reduction of joint lubrication

Disruption of collagen fibres of cartilage

46
Q

Describe cartilage repair

A

Limited blood supply

If just articular cartilage damaged:

Chondrocytes do not fill defect

? Some cartilaginous flow when loaded

If subchondral bone involved:

Highly vascularised

Fibrous tissue fills the defect  fibrocartilage

47
Q

Describe pannus

A

‘Inflammatory granulation tissue’

Occurs in response to injury to synovial membrane

Arises from insertion of membrane

Spreads over articular cartilage

Fibrovascular and histiocytic  lysis of cartilage

48
Q

Describe arthritis

A

‘Arth’ – relating to the joint

‘-itis’ – inflammation of

Inflammation of the articular structure

Categorised based on

Cause

Duration

Exudate

49
Q

Describe degenerative joint disease

A

Osteoarthritis

Destructive disease of articular cartilage

Young or adult animals

Due to:

Abnormal loading e.g due to trauma

Infection

Immune mediated

Developmental

50
Q

Describe treatment of osteoarthritis

A

Medical

Weight loss

Controlled exercise

Pain relief

Surgical

Joint replacement

Arthrodesis

51
Q

Describe bacterial arthritis

A

More common in farm animals and horses

  1. Bacteraemia secondary to

Navel ill

Ingestion

Inhalation

  1. Puncture wounds

Treatment is debridement and flushing of the joint + ABx

52
Q

Describe rheumatoid arthritis

A

Chronic, erosive polyarthritis

Immune mediated

Antibodies produced due to unknown stimulus

Immune complex ingested by neutrophils

Produce enzymes that injury surface

Treatment

Pain relief

Steroids

+/- chemotherapy

53
Q

Describe osteochondrosis

A

Focal/multifocal areas of failure of endochondral ossification

Involves growth plate and articular / epiphyseal complex

No exact cause known

Nutrition

Excessive growth

Trauma

54
Q

Describe the process of osteochondrosis

A

Delay in endochondral ossification

Abnormal vascularisation and mineralisation

Cartilage weakens

Cracks/fissures/flaps form

Flaps can fracture off

55
Q

Describe treatment for osteochondrosis

A

Pain relief!

Surgery always recommended

Remove flap and joint mice

Curette subchondral bone

Stimulates fibrocartilage production

Musculoskeletal dysfunction (12 decks)

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