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Orthopaedics > Bone Necrosis > Flashcards

Bone Necrosis Flashcards

1
Q

What is Osteochondritis

A

localised necrosis of bone due to underlying ischaemia from a reduction in blood supply - caused by increased repetitive stress (compression or traction).

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2
Q

Age group most commonly affected by osteochondritis

A

children and young adults

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3
Q

Pathophysiology of osteochondritis

A

recurrent impact or traction injuries causes bleeding and oedema in bone, resulting in capillary compression. This leads to necrosis and separation of bone.

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4
Q

Freiburg’s disease

A

Osteochondritis of the 2nd metatarsal head

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5
Q

Kohler’s disease

A

Osteochondritis of the navicular bone

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6
Q

Keinbock’s disease

A

Osteochondritis of the lunate bone

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7
Q

Panner’s disease

A

Osteochondritis of the capitellum of the elbow

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8
Q

Scheuermann’s disease

A

Osteochondritis in the spine causing vertebral compression

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9
Q

Osgood-Schlatter disease

A

Traction osteochondritis at the tibial tubercle where the tendon attaches

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10
Q

Sever’s disease

A

Traction osteochondritis at the calcaneus where the tendon attaches

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11
Q

Osteochondritis dissecans

A

Fragmentation with separation of bone and cartilage within a joint

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12
Q

Sites predisposed to osteochondritis dissecans

A

Lateral part of medial femoral condyle
Anteromedial talar dome
Superomedial femoral head
Humeral capitellum

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13
Q

Presentation of osteochondritis dissecans

A

Pain
Effusions
Locking
Giving way of the weight bearing joint

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14
Q

Tx of compression types of osteochondritis

A

Restriction of activities is usually enough

splintage in the wrist or foot

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15
Q

Tx of traction types of osteochondritis

A

self limiting & settles with rest

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16
Q

Tx of osteochondritis dissecans

A

surgical pinning of fragments

removal of detached fragments

17
Q

Sites most prone to AVN

A 
femoral head 
femoral condyles 
head of humerus 
capitellum 
proximal pole of scaphoid 
proximal part of talus
18
Q

Age group most commonly affected by AVN

A

adults

19
Q

Causes of AVN

A 
Alcohol 
Steroid abuse 
Idiopathic 
Secondary to fractures 
Thrombophilia 
Sickle cell disease
Antiphospholipid syndrome 
Caisson's disease
20
Q

Why do alcohol and steroid abuse cause AVN

A

They alter metabolisation of fat - gets into circulatory capillaries and sludges them up and promotes coagulation. Increased fat content in the marrow compresses venous outflow causing stasis.

21
Q

Why does Caisson’s disease cause AVN

A

This is decompression sickness.

Nitrogen gas bubbles form in the circulation after to fast decompression from deep sea diving.

22
Q

AVN appearance on xray

A

patchy sclerosis
subchondral collapse
irregular articular surfaces
secondary OA changes

23
Q

Tx of AVN

A

Depends on stage of disease

Early -
if articular surface has not collapsed,
drilling under fluoroscopy to decompress the bone

Late -
if articular surface has collapsed,
joint replacement

24
Q

What is osteomyelitis

A

infection of the bone including compact and spongy bone, and bone marrow

25
Q

How do the organisms causing osteomyelitis infect bone

A

Directly - penetrating trauma, surgery

Indirectly - haematogenous spread from an infection or bacteraemia at distant site

26
Q

Patients most susceptible to osteomyelitis

A

Immunocompromised
patients with chronic disease
elderly
young

27
Q

Pathogenesis of osteomyelitis

A

Once infection is present in the bone, enzymes from leukocytes cause local osteolysis and pus forms which impairs local blood flow

28
Q

What is a sequestrum

A

A dead fragment of bone which forms in osteomyelitis that usually breaks off

29
Q

What is the consequence of a sequestrum being present in osteomyelitis

A

It means that antibiotics alone will not cure infection

30
Q

What is an involucrum

A

New bone formation around the area of necrosis in osteomyelitis

31
Q

What is a Brodie’s abcess

A

A subacute steomyelitis found in children, which presents insidiously and where the bone reacts by walling off the abscess with a thin rim of sclerotic bone

32
Q

Why are children at risk of osteomyelitis

A

The emtaphyses of lone bones contain abundant tortuous vessels with sluggish flwo that can result in the acucmulation of bacteria, and infection spreads towards the epiphysis

33
Q

Most common bones in adults affected by osteomyelitis

A

Axial skeleton (spine and pelvis)

34
Q

Most common sources of infection for osteomyelitis in adults

A

Pulmonary infections (incl TB)
Urinary infections
Discitis
Previous open fracture or internal fixation

35
Q

Most common causative organism for osteomyelitis

A

Staph. aureus

36
Q

Tx acute osteomyelitis

A

“best guess” IV Abx (usually high dose fluclox)

37
Q

Tx chronic osteomyelitis

A

Surgery to access deep bone tissue, remove any sequestrum and excise infected bone

38
Q

Predisposing conditions to osteomyelitis

A 
Diabetes mellitus 
Sickle cell anaemia 
IVDU 
Immunosuppression 
Alcohol
39
Q

Ix for osteomyelitis

A

MRI

Orthopaedics (16 decks)

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