Bone Growth Flashcards

1
Q

Describe the state of the ossification centres in a long bone at birth.

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

When does bone growth stop?

Describe the mechanism by which bone stops growing.

A
  • Growth in height ceases at the end of puberty.
  • Sex steroids stimulate a growth spurt but promote closure of the epiphyseal plates.
  • Growth in length ceases, cell proliferation slows and the plate thins.
  • The plate is invaded by blood vessels, epiphyseal and diaphyseal vessels unite.
  • May leave a visible line on X-rays.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Give examples of bones with only one ossification centre.

A
  • Carpals
  • Tarsals
  • Ear ossicles
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How many ossification centres does the head of the humerus have?

A

3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Name each of the zones of this epiphyseal plate.

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the function of the resting zone of the epiphyseal plate?

Give an example of a disease which can affect this zone.

A
  • Function = matrix production.
  • Diastrophic dysplasia causes defective collagen synthesis / processing of proteoglycans.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the function of the growth zone of the epiphyseal plate?

Give an example of a disease which can affect this zone.

A
  • Function = cell proliferation.
  • Achondroplasia, malnutrition or irradiation injury would all cause deficiency in cell proliferation and / or matrix synthesis.
  • Gigantism would cause increased cell proliferation.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the function of the hypertrophic zone of the epiphyseal plate?

Give an example of a disease which can affect this zone.

A
  • Function = calcification of the matrix.
  • Rickets would cause insufficiency of calcium or phosphate for normal calcification.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the function of the metaphysis zone of the epiphyseal plate?

Give an example of a disease which can affect this zone.

A
  • Functions = bone formation and vascularisation.
  • Osteomyelitis could be caused by a bacterial infection.
  • Osteogenesis imperfecta is an abnormality of osteoblasts and collagen synthesis.
  • Scurvy causes inadequate collagen turnover.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the effects of achondroplasia on the epiphyseal growth plate.

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe the effects of rickets on the epiphyseal growth plate.

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the substances required for normal bone growth?

A
  • Calcium
  • Phosphorus
  • Vitamins A, C and D
  • Balance between growth hormone, thyroid and parathyroid hormones, oestrogen and androgens.
  • Abnormalities of these can affect bone growth; also effects on fracture healing.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the different mechanisms of injury in a fracture?

A
  • Direction of force:
    • Direct vs angular
    • Rotational
    • Compression
  • Energy transfer
    • Cause
    • Site
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How do you describe a fracture?

A
  • Site
  • Open to surface
  • Contaminated
  • Associated soft tissue injury
  • Joint involvement
  • Number of pieces
  • Alignment
  • Degree of separation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the definition of a fracture?

A

A complete or incomplete break in a bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which type of fracture pattern is depicted?

A

Transverse

17
Q

Which type of fracture pattern is depicted?

18
Q

Which type of fracture pattern is depicted?

A

Oblique non-displaced

19
Q

Which type of fracture pattern is depicted?

A

Oblique displaced

20
Q

Which type of fracture pattern is depicted?

21
Q

Which type of fracture pattern is depicted?

A

Greenstick

22
Q

Which type of fracture pattern is depicted?

A

Comminuted

23
Q

What is an avulsion fracture?

A

A fragment of bone is separated from the main mass.

24
Q

What is a buckled fracture?

A
  • AKA impacted fracture; torus fracture.
  • Ends are drived into each other.
  • Commonly seen in arm fractures in children.
25
What is a pathologic fracture?
A fracture caused by a disease that weakens the bones.
26
What is a stress fracture?
A hairline crack in a bone.
27
How does bone heal after a fracture?
* Depends on the activity of the cells of the **periosteum.** * 'Bone remodelling units': * Consists of osteoclasts and osteoblasts * Keep adult bone mass relatively constant in the face of developmental, physiological and physical demands. * Bone has a remarkable capacity to heal well, unlike articular cartilage. * Fracture healing depends on the activity of **osteoblasts** in the **local periosteum.** * Takes 2-20 weks for healing, depending on: * Severity of fracture * Age of patient
28
There are 3 major phses of fracture healing. Describe the 1st phase.
* **Reactive phase** * Fracture and inflammatory phase (haematoma). * Fibroblasts in the periosteum proliferate to form granulation tissue around the fracture site.
29
There are 3 major phses of fracture healing. Describe the 2nd phase.
* **Reparative phase** * **​Callus formation -** osteoblasts quickly form woven bone, to bridge the gap. * **Woven bone** is weak as the collagen fibres are arranged irregularly. * **Lamellar bone** is laid down - collagen is organised in regular sheets to give strength and resilience.
30
There are 3 major phses of fracture healing. Describe the 3rd phase.
* **Remodelling phase** * Remodelling by osteoclasts to restore original bone shape.
31
Describe non-union fractures. What are the risk factors for non-union fractures?
* Complete cessation of reparative processes of bone healing. * Overall risk est. 1.9-4.9% * Tibial risk reported as high as 23% * **Atrophic** - inadequate biological factors. * **Hypertrophic** - excessive callus formation outwith the fracture site.
32
What is the conservative treatment for fractures?
* Indicated in simple fractures with low risk of non-union. * Dependent on natural healing process. * +/- immobilisation * Rehabilitation
33
What are the indications for intervention in fracture treatment?
* Fractures with limb threat or risk of non-union. * Augment natural healing with replacement or strengthening. * +/- immobilisation * Rehabilitation
34
What are the types of osteoconductive scaffolding which can be used in the treatment of fractures?
* Autologous bone graft * Often from iliac crests * Allografts * Cadaveric * Synthetic * Hydroxyapatite * Collagen
35
What are the other treatments with the potential to help heal fractures?
* Inducing mechanical strain * Shockwaves and low-intensity ultrasound * Growth factors and pharmacological interventions: * Parathyroid hormone * Bone morphogenic proteins * Anti-sclerostin abs * Statins * Dasatinib