Bone Diseases Flashcards
Clinical Healing of bone healing
healing of pain and swelling
Radiographic healing of bone healing
healing of 3 of 4 cortices
What does Wolff’s law state
bone will adapt to a load/pressure
What are the stages of bone healing and their descriptions (5)
- 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)
2 mechanisms of bone healing
-Primary bone healing, membranous, direct healing
Secondary bone healing, spontaneous, indirect, enchondral healing
Describe primary bone healing
1) Contact healing/Haversian remodeling: occurs when there is
Describe secondary bone healing
- 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
Description of woven bone
- unorganized collagen fibers
- mechanically weak
- produced when osteoid is produced rapidly
Description of Lamellar bone
- Parallel alignment of collagen
- Mechanically strong
- Replaces woven bone eventually
What are the zones of an epiphyseal growth plate(4)
- Zone of proliferation/growth
- Zone of maturation
- Zone of transformation
- Zone of provisional calcification
What is the description and location of the zone of proliferation/growth
- site of chondrocyte replication
- it is located closest to the epiphysis
What is the description of the zone of maturation
- chondrocyte hypertrophy
- Weak due to loss of intracellular matrix
What is the description of the zone of transformation
-chondrocytes become calcified
What is the description and location of the zone of provisional calcification
-Between growth plate and metaphysis. Closest to the shaft
Comorbidities that result in significant nonunion of bone
- Diabetes
- Osteoporosis
- Vitamin D deficiency
- Osteogenesis imperfecta
- Osteomyelitis
Social history that results in significant nonunion of bone
- smoking
- poor nutritional status
- poor bone quality
- infection
- ETOH consumption
Medications that result in significant nonunion of bone
-Chronic steroid use
–NSAIDS
- immunosuppressants
- Chemotherapy
Conservative treatments for nonunion of bone
- oral calcitonin
- Functional bracing
- Bone stimulator
What is the mechanism, duration and contraindication for bone simulator use
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
4 categories of bone grafts
- 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
Description of cancellous graft healing (5)
- revascularization occurs in 2 weeks
- gain strength with growth pattern
- results in a complete remodeling
- Many osteocytes are present in this type of healing
Description of cortical graft healing
- 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
What are the stages of bone graft healing (5)
- 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
What osteobiologics help with osteoinduction phase
- BMP: stimulates osteoblast production
- MSC allograft
- PRP: provides growth factors
- BMA- provides MSC
What osteobiologic helps with osteoconduction phase
- ceramic/bioactive glass: this is osteoconductive, osteoinductive and antibacterial
- DBM : some osteoinduction
What are the main osteobiologics used for bone grafts
- PRP
- Stem cells
- Cartiform
- Biocartilage
- Arthroflex
What is PRP and what are the two main types
buffy coat layer (leukocyte rich)
plasma based(leukocyte poor) better for OA treatment
What is Cartiform
chondral mesh of osteochondral allograft
what is biocartilage
an ECM scaffold for cells to augment microfractured defects
What is arthroflex
a soft tissue scaffold.
What are the advantages of external fixation (2)
Decreased soft tissue dissection
Can be used with infection
What is Dynamization
before ex fix removal pins are loosened and patient allowed to WB.
-axial load without distraction strengthens bone, induces callus formation and faster healing
What is the piezogenic effect
stress generates electric potentials in bone results in callus formation
What is the Calandruccio triangular compression device
Tri-planar compression
External frame good for ankle arthrodesis
One pin through tibia one through talus
What is the classification system for nonunions
Weber and Cech
What is the Weber and Cech classification system
- Hypertrophic:
- –Elephant foot: best chance for healing
- –Horse foot: poor callus
- –oligotrophic: no callus
- Avascular:
- –atrophic
- –comminuted
- –defect
- –torsion wedge
What are the main bone healing complications (4)
- Delayed union
- Nonunion
- Malunion
- Pseudoarthrosis
What is the characteristic and treatment of delayed union
- when there is no evidence of union for 6-9 months
- Treatment consists of immobilization
What is the characteristic and treatment of nonunion
- when there is no evidence of union for > 9 months
- treatment consists of bone stimulator and bone graft
What is the characteristic of malunion
when bone is reduced and heals in an improper position
What is the characteristic and treatment of pseudoarthrosis
Fibrocartilaginous surface at bone fracture site, joint space contains synovial fluid
-treatment is operation
What is osteonecrosis
ischemic death of bone and bone marrow
What is the etiology of osteonecrosis
- trauma
- alcoholism
- methylmethacrylate
How do you diagnose osteonecrosis
- bone scintigraphy
- MRI
- CT
What is Osteochondrosis
disease of growth center, epiphysis or apophysis
degeneration/necrosis followed by regeneration/recalcification
What is the treatment of osteochondrosis
Treat with serial casting
What is Kohler’s disease
-description
Navicular
-Coin sign, coin on edge, or silver dollar sign
Freiberg’s infraction
of the 2nd metatarsal head
Mueller-Weiss
adult osteochondrosis of the navicular
Buschke disease
cuneiform
Severe’s apophysitis
calcaneus
-Pain with squeeze
Iselin’s disease
5th met base
Osgood Schlatter
tibial tubercle
Blount’s disease
Medial tibial plafond
Legg Calve Perthes disease
femoral head
Most common of the osteochondrosis
Diaz/ Mouchet
Talus
Thiemann’s
Phalanges
Lewin
Distal tibia
Ritter
proximal fibular head
Treve
fibular sesamoid
Renandier
tibial sesamoid
Lance
Cuboid
Assmann
1st met head
Etiology and clinical presentation of Freiberg’s infraction
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
What is the classification for Freiberg’s infraction
Smillie classification
Describe Smillie classification
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
What are the conservative treatment options for Freiberg’s
immobilization with below knee cast
orthotic with MT bar
wide toe box, rigid shank, rocker bottom
What are the surgical treatment options for Freiberg’s
Distal MT osteotomy, implant arthroplasty
- Interpositional grafting
- rotational osteotomy
- OATS
Patterns of destruction seen with bone tumors… and their severity of aggression (3)
- Geographic: slow growing
- Moth-eaten: more aggressive
- Permeative: most aggressive
Periosteal reactions seen with bone tumors from least to most severe
- Buttressing
- Lamellated/onion skin
- Sunburst
- Hair on end/spiculated
- Codman’s triangle
What are the malignant bone tumors
osteosarcoma and Ewing’s sarcoma
Osteosarcoma epidimiology and CP
20-30 year old
CP: Codman’s triangle
Most common malignant bone tumor
Ewing’s sarcoma epidiomogy and what to look for
4 YO with elevated WBC and ESR
permeative lytic lesion with onion skinning
Osteochondroma:
-etiology
- progression
- age
- radiograph
- histology
- size
etiology: disruption in development of the cortex
progression: slower growing
- age: adolescent
- Radiograph: cancellous bone
Histology: hyaline cartilage cap
Size: much larger than exostosis
Subungual exostosis
-etiology
- progression
- age
- radiograph
- histology
- size
- etiology: trauma
- progression: slow pre-puberty
- age: 20-40 years old
- radiograph: cortex confluent with underlying bone
histology: fibrocartilage cap
Osteochondroma
CP
most common of the benign bone tumors
CP: commonly subungual
boney outgrowth with cartilaginous cap that looks like mushroom
Osteoma
where
x-ray
located in skull periosteum
X-ray osteochondroma with cartilgenous cap
enostosis: definition
bone island
osteoblastoma
what is it known as and pathognomonic sign
AKA giant osteoid osteoma, nigh pain not relieved with aspirin
Osteoid osteoma
nigh pain is relieved by aspirin
Enchondroma:
where
what part
fancy names
found in phalanges
tumor of the hyaline cartilage
Ollier’s disease: multiple enchondromas
Maffuci’s syndrome: enchondroma associated with soft tissue hemangioma
Unicameral bone cyst
What is the sign
What is it
Fallen fragment sign
Fluid filled in calcaneus
Aneurysmal bone cyst what is it
filled with blood
Giant cell tumor: similar to what
similar to aneurysmal bone cyst
What is an intra-osseous lipoma
calcaneal bone cyst with intra-osseous calcification
What does fibrous dysplasia look like: ground glass appearance
ground glass, more centered
ossifying fibroma: where is it found
prediliction for mandible
Where are non-ossifying fibromas found
in connective tissue at the muscle tendon insertion
What is a brown tumour indicitave of
hyperparathyroidism
What is Paget’s disease associated with and what are the X-ray appearances
Paget’s disease is associated with osteosarcoma, chondrosarcoma and fibrosarcoma.
will find flame like lesions and appear as “blades of grass”
Melorheostosis: x-ray findings
wavy inner or outer cortex
will appear as wax flowing down a candle
What is Ricket’s/ osteomalacia and what are x-ray findings
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
Scurvy: due to what and what are the x-ray signs
due to vitamin D deficiency
- Wimburger sign- ring epiphysis
- Pelken Spur: beaky outgrowth in scurvy
osteopetosis:
bone within bone appearance
Osteopoikilosis
multiple bone islands.
