Chronic conditions Flashcards
WHO definition of osteoporosis?
Bone mineral density T >-2.5 SD below the mean seen in peak bone mass of young (25-30) normal subjects
Factors of osteoporosis?
PTH
Vit D
Calcitonin
Estrogen
Glucocorticoids
How to classify osteoporosis?
Generalized vs localized
Primary vs Secondary [Congenital vs Acquired]
Primary osteoporosis types?
- Age-related, post-menopausal
- Mayo Clinic Classification
Mayo Clinic classification of primary osteoporosis?
Type 1 = post-menopausal women - wrist, vertebral crush
Type 2 = Age-related. Hip, vertebral wedge
Secondary osteoporosis types?
Congenital - Osteogenesis imperfecta, Ehler Danlos, Marfan’s, glycogen storage disorders, hypophosphatasia
What is wedge fracture characterized by?
Loss of height, mostly of anterior vertebral body, causing wedge-shaped vertebra
OSTA formula?
For osteoporosis
Age (years) - weight (kg)
How to use OSTA?
20 and above = high risk. Measure BMD
0-19 = Moderate risk. Check BMD if other RF
<0 = Low risk. Check BMD if there is hx of fragility fractures
Check BMD with DEXA
How do cellulitis and nec fasc spread?
Along soft tissue and fascial planes
Primary Mx for Nec fasc?
Primary survery ABC
2 large bore IV cannula + fluid resuscitation
Operative approach to septic arthritis?
IV Abx, operative irrigation and drainage of joint
Why is septic arthritis an orthopaedic emergency?
Irreversible joint damage -> severe cartilage destruction occur in 8 hrs
Mortality higher in elderly a/w comorbids
Common sites for septic arthritis
Knee
Hip
Elbow
Shoulder
Does OM progress to Septic arthritis in kids but not in adults?
Yes. Physis is closed and there is no blood supply in adults. Hence infection stays in bone and does not spread to joint
Types of Periprosthetic joint infection?
Acute PJI within 3-6 weeks = no biofilm formed. Can preserve implant
Chronic >6 wks = biofilm formed and seals off infection, preventing immune system from acting on bacteria. Implant must be removed.
biofilm created by all bacteria forms on implant in 4 weeks
Radiograph findings for PJI?
Periosteal reaction
Scattered patches of osteolysis
Bone resorption without implant wear
Transcortical sinus tracts
Implant loosening
What is rickets?
metabolic bone disease caused by a defective mineralization of osteoid matrix caused by inadequate calcium and phosphate that occurs prior to closure of the physes
Vitamin D and PTH play an important role in calcium homeostasis.
calcium/phosphate homeostasis is disrupted
Clinical presentation of rickets?
Brittle bones
Ligamentous laxity
Bowing of long bones
Enlargement of costal cartilage
PE of rickets?
Genu varum
Waddling gait
Tibial bowing
Dorsal kyphosis
In OA, how do osteophytes and sclerosis present on XR?
Sclerosis is thicker white on edge of bone.
Osteophytes and sclerosis come together.
XR findings of OA?
Subchondral cysts
Narrowing of joint space
Subchondral sclerosis
Osteophytes
