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Pod practice > Bone Diseases > Flashcards

Bone Diseases Flashcards

1
Q

Clinical Healing of bone healing

A

healing of pain and swelling

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2
Q

Radiographic healing of bone healing

A

healing of 3 of 4 cortices

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3
Q

What does Wolff’s law state

A

bone will adapt to a load/pressure

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4
Q

What are the stages of bone healing and their descriptions (5)

A
  • Inflammatory stage: pain/hyperemia/edema. Induction of growth factors. Differentiation of MSC into osteoblasts and chondrocytes (immediately)
  • Hematoma formation: fibriblast/platelet differentiation (immediately)
  • Soft callus: Cartilage (4 days to 4 weeks)
  • Hard Callus: calcification (4 weeks to 4 months)
  • Remodeling: Wolff’s law (4 months- 2 years)
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5
Q

2 mechanisms of bone healing

A

-Primary bone healing, membranous, direct healing

Secondary bone healing, spontaneous, indirect, enchondral healing

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6
Q

Describe primary bone healing

A

1) Contact healing/Haversian remodeling: occurs when there is

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7
Q

Describe secondary bone healing

A
  • formation of bone callus… followed by resorption of callus. Wide gaps are filled with cortical bone via Haversian remodeling
  • Motion allowed at the fracture site
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8
Q

Description of woven bone

A
  • unorganized collagen fibers
  • mechanically weak
  • produced when osteoid is produced rapidly
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9
Q

Description of Lamellar bone

A
  • Parallel alignment of collagen
  • Mechanically strong
  • Replaces woven bone eventually
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10
Q

What are the zones of an epiphyseal growth plate(4)

A
  • Zone of proliferation/growth
  • Zone of maturation
  • Zone of transformation
  • Zone of provisional calcification
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11
Q

What is the description and location of the zone of proliferation/growth

A
  • site of chondrocyte replication

- it is located closest to the epiphysis

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12
Q

What is the description of the zone of maturation

A
  • chondrocyte hypertrophy

- Weak due to loss of intracellular matrix

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13
Q

What is the description of the zone of transformation

A

-chondrocytes become calcified

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14
Q

What is the description and location of the zone of provisional calcification

A

-Between growth plate and metaphysis. Closest to the shaft

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15
Q

Comorbidities that result in significant nonunion of bone

A
  • Diabetes
  • Osteoporosis
  • Vitamin D deficiency
  • Osteogenesis imperfecta
  • Osteomyelitis
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16
Q

Social history that results in significant nonunion of bone

A
  • smoking
  • poor nutritional status
  • poor bone quality
  • infection
  • ETOH consumption
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17
Q

Medications that result in significant nonunion of bone

A

-Chronic steroid use

–NSAIDS

  • immunosuppressants
  • Chemotherapy
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18
Q

Conservative treatments for nonunion of bone

A
  • oral calcitonin
  • Functional bracing
  • Bone stimulator
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19
Q

What is the mechanism, duration and contraindication for bone simulator use

A

Mechanism: Electronegative charge used to stimulate bone growth at areas of growth and repair.

Duration: 3-6 months

Contraindication: not for use in synovial pseudoarthrosis, gaps >1cm or 50% of bone diameter

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20
Q

4 categories of bone grafts

A
  • Bone grafts- for small defects
  • Intercalary graft-from fresh frozen femoral head. For defects < 5 cm
  • Trabecular cage
  • Vascularized graft- for large defects 10-40cm
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21
Q

Description of cancellous graft healing (5)

A
  • revascularization occurs in 2 weeks
  • gain strength with growth pattern
  • results in a complete remodeling
  • Many osteocytes are present in this type of healing
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22
Q

Description of cortical graft healing

A
  • revascularization occurs in 2 months
  • lose strength in the first 6 months with this type of growth pattern
  • Remodeling is incomplete with necrotic pockets with this type of remodeling.
  • Not as many osteocytes present in this type of healing
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23
Q

What are the stages of bone graft healing (5)

A
  • Vascular ingrowth
  • osteogenesis: osteoblasts from the bone graft cause bone growth
  • osteoinduction: regular bone growth with many growth factors
  • osteoconduction: bone graft serves as scaffold/framework for osteoblasts to conduct and spread
  • Graft remodeling: according to Wolff’s law
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24
Q

What osteobiologics help with osteoinduction phase

A
  • BMP: stimulates osteoblast production
  • MSC allograft
  • PRP: provides growth factors
  • BMA- provides MSC
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25
Q

What osteobiologic helps with osteoconduction phase

A
  • ceramic/bioactive glass: this is osteoconductive, osteoinductive and antibacterial
  • DBM : some osteoinduction
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26
Q

What are the main osteobiologics used for bone grafts

A
  • PRP
  • Stem cells
  • Cartiform
  • Biocartilage
  • Arthroflex
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27
Q

What is PRP and what are the two main types

A

buffy coat layer (leukocyte rich)

plasma based(leukocyte poor) better for OA treatment

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28
Q

What is Cartiform

A

chondral mesh of osteochondral allograft

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29
Q

what is biocartilage

A

an ECM scaffold for cells to augment microfractured defects

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30
Q

What is arthroflex

A

a soft tissue scaffold.

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31
Q

What are the advantages of external fixation (2)

A

Decreased soft tissue dissection

Can be used with infection

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32
Q

What is Dynamization

A

before ex fix removal pins are loosened and patient allowed to WB.

-axial load without distraction strengthens bone, induces callus formation and faster healing

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33
Q

What is the piezogenic effect

A

stress generates electric potentials in bone results in callus formation

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34
Q

What is the Calandruccio triangular compression device

A

Tri-planar compression

External frame good for ankle arthrodesis

One pin through tibia one through talus

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35
Q

What is the classification system for nonunions

A

Weber and Cech

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36
Q

What is the Weber and Cech classification system

A
  • Hypertrophic:
  • –Elephant foot: best chance for healing
  • –Horse foot: poor callus
  • –oligotrophic: no callus
  • Avascular:
  • –atrophic
  • –comminuted
  • –defect
  • –torsion wedge
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37
Q

What are the main bone healing complications (4)

A
  • Delayed union
  • Nonunion
  • Malunion
  • Pseudoarthrosis
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38
Q

What is the characteristic and treatment of delayed union

A
  • when there is no evidence of union for 6-9 months

- Treatment consists of immobilization

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39
Q

What is the characteristic and treatment of nonunion

A
  • when there is no evidence of union for > 9 months

- treatment consists of bone stimulator and bone graft

40
Q

What is the characteristic of malunion

A

when bone is reduced and heals in an improper position

41
Q

What is the characteristic and treatment of pseudoarthrosis

A

Fibrocartilaginous surface at bone fracture site, joint space contains synovial fluid

-treatment is operation

42
Q

What is osteonecrosis

A

ischemic death of bone and bone marrow

43
Q

What is the etiology of osteonecrosis

A
  • trauma
  • alcoholism
  • methylmethacrylate
44
Q

How do you diagnose osteonecrosis

A
  • bone scintigraphy
  • MRI
  • CT
45
Q

What is Osteochondrosis

A

disease of growth center, epiphysis or apophysis

degeneration/necrosis followed by regeneration/recalcification

46
Q

What is the treatment of osteochondrosis

A

Treat with serial casting

47
Q

What is Kohler’s disease

-description

A

Navicular

-Coin sign, coin on edge, or silver dollar sign

48
Q

Freiberg’s infraction

A

of the 2nd metatarsal head

49
Q

Mueller-Weiss

A

adult osteochondrosis of the navicular

50
Q

Buschke disease

A

cuneiform

51
Q

Severe’s apophysitis

A

calcaneus

-Pain with squeeze

52
Q

Iselin’s disease

A

5th met base

53
Q

Osgood Schlatter

A

tibial tubercle

54
Q

Blount’s disease

A

Medial tibial plafond

55
Q

Legg Calve Perthes disease

A

femoral head

Most common of the osteochondrosis

56
Q

Diaz/ Mouchet

A

Talus

57
Q

Thiemann’s

A

Phalanges

58
Q

Lewin

A

Distal tibia

59
Q

Ritter

A

proximal fibular head

60
Q

Treve

A

fibular sesamoid

61
Q

Renandier

A

tibial sesamoid

62
Q

Lance

A

Cuboid

63
Q

Assmann

A

1st met head

64
Q

Etiology and clinical presentation of Freiberg’s infraction

A

Fracture of the 2nd met head

An osteochondrosis of 2nd MT head due to acute injury or repetitive micro trauma to an open physis

-CP: is a young female athlete with MT pain

65
Q

What is the classification for Freiberg’s infraction

A

Smillie classification

66
Q

Describe Smillie classification

A

0: normal radiograph
1: epiphysis fissure fracture with joint space widening
2: Central depression of the MT head
3: Lateral projections “crescent sign”
4: Fracturing of the lateral projections and loose bodies
5: Flattened MT head

67
Q

What are the conservative treatment options for Freiberg’s

A

immobilization with below knee cast

orthotic with MT bar

wide toe box, rigid shank, rocker bottom

68
Q

What are the surgical treatment options for Freiberg’s

A

Distal MT osteotomy, implant arthroplasty

  • Interpositional grafting
  • rotational osteotomy
  • OATS
69
Q

Patterns of destruction seen with bone tumors… and their severity of aggression (3)

A
  • Geographic: slow growing
  • Moth-eaten: more aggressive
  • Permeative: most aggressive
70
Q

Periosteal reactions seen with bone tumors from least to most severe

A
  • Buttressing
  • Lamellated/onion skin
  • Sunburst
  • Hair on end/spiculated
  • Codman’s triangle
71
Q

What are the malignant bone tumors

A

osteosarcoma and Ewing’s sarcoma

72
Q

Osteosarcoma epidimiology and CP

A

20-30 year old
CP: Codman’s triangle

Most common malignant bone tumor

73
Q

Ewing’s sarcoma epidiomogy and what to look for

A

4 YO with elevated WBC and ESR

permeative lytic lesion with onion skinning

74
Q

Osteochondroma:
-etiology

  • progression
  • age
  • radiograph
  • histology
  • size
A

etiology: disruption in development of the cortex
progression: slower growing
- age: adolescent
- Radiograph: cancellous bone

Histology: hyaline cartilage cap

Size: much larger than exostosis

75
Q

Subungual exostosis
-etiology

  • progression
  • age
  • radiograph
  • histology
  • size
A
  • etiology: trauma
  • progression: slow pre-puberty
  • age: 20-40 years old
  • radiograph: cortex confluent with underlying bone
    histology: fibrocartilage cap
76
Q

Osteochondroma

CP

A

most common of the benign bone tumors

CP: commonly subungual

boney outgrowth with cartilaginous cap that looks like mushroom

77
Q

Osteoma
where
x-ray

A

located in skull periosteum

X-ray osteochondroma with cartilgenous cap

78
Q

enostosis: definition

A

bone island

79
Q

osteoblastoma

what is it known as and pathognomonic sign

A

AKA giant osteoid osteoma, nigh pain not relieved with aspirin

80
Q

Osteoid osteoma

A

nigh pain is relieved by aspirin

81
Q

Enchondroma:

where

what part

fancy names

A

found in phalanges

tumor of the hyaline cartilage

Ollier’s disease: multiple enchondromas

Maffuci’s syndrome: enchondroma associated with soft tissue hemangioma

82
Q

Unicameral bone cyst

What is the sign

What is it

A

Fallen fragment sign

Fluid filled in calcaneus

83
Q

Aneurysmal bone cyst what is it

A

filled with blood

84
Q

Giant cell tumor: similar to what

A

similar to aneurysmal bone cyst

85
Q

What is an intra-osseous lipoma

A

calcaneal bone cyst with intra-osseous calcification

86
Q

What does fibrous dysplasia look like: ground glass appearance

A

ground glass, more centered

87
Q

ossifying fibroma: where is it found

A

prediliction for mandible

88
Q

Where are non-ossifying fibromas found

A

in connective tissue at the muscle tendon insertion

89
Q

What is a brown tumour indicitave of

A

hyperparathyroidism

90
Q

What is Paget’s disease associated with and what are the X-ray appearances

A

Paget’s disease is associated with osteosarcoma, chondrosarcoma and fibrosarcoma.

will find flame like lesions and appear as “blades of grass”

91
Q

Melorheostosis: x-ray findings

A

wavy inner or outer cortex

will appear as wax flowing down a candle

92
Q

What is Ricket’s/ osteomalacia and what are x-ray findings

A

Vitamin D deficiency

-Xray: will see bowing, looser zone, milkman zone, mataphyseal cupping/fraying

White line of Frankel: transversee line of increased density

-Scurvy line: dark line

93
Q

Scurvy: due to what and what are the x-ray signs

A

due to vitamin D deficiency

  • Wimburger sign- ring epiphysis
  • Pelken Spur: beaky outgrowth in scurvy
94
Q

osteopetosis:

A

bone within bone appearance

95
Q

Osteopoikilosis

A

multiple bone islands.

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