Disorders of the Skeletal System : Trauma, Infection, Neoplasms, Childhood Disoders Flashcards
How are bones Classified? What are they?
by shape and size
Long, Short, Flat, Irregular
What are the functions of bone?
support
help determine our size and proportion
protection
Metabolic Function (hematopoiesis and Calcium storage)
Bone are made of
living connective tissue
intracellular matrix made of collagen fibers and calcium phosphate salts and together they form a rigid structure
Describe the shape of Long Bones and give examples.
hollow shaft and two bulbous ends
humerous, radius, ulna, femur, metacarpals, metatarsals, clavicles
Describe the shape of Short Bones and give examples.
What are the function of Short Bones?
square (as wide as they are long)
ankles and wrists (tarsals and carpals)
function: to support, add stability don’t have movement
Describe the shape of Flat Bones and give examples.
thin and curved
the bones of the skull
Describe the shape of Irregular Bones and give examples.
vary in shape
often have projections
mandible, vertebrae
Articulation
between bones, forming a joint
What are the 3 types of joints?
Synarthroses
Ampiarthroses
Diarthroses
Synarthroses
immovable moveable joints
Ex: sutures in the skull
Amphiarthroses
slightly moveable joints, connection with cartilage
Ex: junction between ribs and sternum
Diarthroses
freely moving joints
most common type
Ex: knees elbows
What are the functions of skeletal muscle
movement (by muscle contraction)
body position and tone (constant partial muscle contractions)
Stabilization (helps prevent excessive movements)
temperature (heat produced by muscle contraction)
tendons
attach muscle to bone
composed of collagen fibers arranged in bundles
cant stand significant stress
little blood supply
Ligaments
attach bone to bone
little blood supple
skeletal muscles are…
voluntary muscles
bundles of muscle fibers covered in connective tissue
involuntary…with out deliberate intent (happening without thinking about it but still voluntary… respiratory movement, postural adjustments, blinking eyes, shivering, facial expressions)
Why is recovery for damaged ligaments and tendons slow?
lack of blood supply
contusion
bruise
generally from direct trauma
true disability isn’t usual, it just hurts
skin intact, swelling
muscle bruising
deeper injury, more force required to get bruising here
ecchymotic area
bruise
microscopic rupture of blood vessels
Hematoma
larger area of local hemorrhage
can push on nerve endings, more pain
“blood blister”
longer to heal
Strain
partial tear in muscle or muscle tendon union , often from a sudden stretch
inflammation at site of injury, as it repairs itself it will form fibrous tissue (scar)
presents with pain, more with stretch, stiff, swelling
more common in middle age adults because they have less elasticity
common places : lower back, shoulders
athletes: quadriceps and hamstrings
Sprain
involve ligaments
S/S resemble a strain
but pain and swelling subsides more slowly
abnormal or excessive movement of joint
ankles, knees elbows
dislocation
displacement of the articulating surfaces (joints) where the bone ends and the joint are partially in contact
S/S: pain and deformity , limited movement
shoulder
one of the largest and most complex joints in the body
ball in socket
humerous fits loosely in shoulder giving wide range of motion and move vulnerable to injury
rotator cuff
collection of muscles in the shoulder
gives support allowing for wide ROM
bursa
a small sac of fluid that cushions and protects the tendons
4 muscles of the rotator cuff
Supraspinatous muscle
Subscapularis Muscle
Infraspinatous muscle
Teres Minor Muscle
what is the rotator cuff vulnerable to?
Fractures, dislocations, degenerative processes (more we move)
Rotator Cuff injuries commonly result from
excessive use, a direct blow or stretch injury usually involving throwing, swinging
acromioclavicular joint
a common site of sprains in athletes and physically active persons
usually Injured by Direct Blow
falling on outstretched arm or elbow
glenohumoral
one of the most commonly displaced joint
Usually injured by stretch
hurt by being abducted and forcefully extended
knee injuries
common site of injury, esp with sports
repetition leads to degenerative joint disease
ligament injuries
most serious
forceful stress against the knee
“popping” sound, tearing, sudden pain, cant bare weight, can hemorrhage
Meniscus
C shaped cartilage between the condyle of the femur and the tibia
major role player in weight baring, shock absorbing, stabilizing the knee and assists with lubrication
how do we injure meniscus
rotational injuries…..
often in conjunction with something else
Subluxation
incomplete or partial dislocations
ex: young kids who dislocate the patella
Hip injuries
dislocation of the femoral head - the femoral head is displaced from the acetabulum
often from severe trauma
knee being struck while hip and knee in FLEXED position (sitting driving..and POOF..car wreck… ouch! the dashboard hit my legs and dislocated my hip! call the ambulance!)
S/S
pain, shortening of leg, limited mobility,cant put weight on it
High Risk: Osteoporosis
Why is hip dislocation serious
great pressure put on vasculature
whose at risk for breaking hip
osteoporosis (esp post menopausal women)
older people (falls)
How are fractures classified?
classified by location, direction of the fracture line and type
- open/closed
- complete/incomplete
- pathological stress
- characteristics of fracture pieces
Important factor of fractures…
open versus closed
what are you at risk for with open fractures?
infection (not a sterile environment)
complete versus incomplete fractures
complete- bone all the way broken
incomplete - cracked
cast used with what kind of fractures
incomplete fractures
Pathological Stress Fractures
disease process that weakens area of the bone, cancers, osteoporosis and Degenerative bone diseases can get stress fractures in the spine
Manifestations of fractures
numbness and tingling if there is nerve damage (could be localized right after injury esp. closed although we don’t know why)
pain, tenderness, swelling
open will have bleeding, closed will have bruising
crepitus- grinding of bone on bone, grading
DEFORMITIES - long bone angulation, rotation, shortening
crepitus
grading of bone against each other
Simple fracture
closed
Compound fracture
open
risk of infections
Why do we take Xrays?
to see what the chips look like (complete versus incomplete)
complete
fragments are separated
incomplete
bone fracutres are partially joined
greenstick
young soft bone
partially bends and partially breaks
why kids end up with casts a lot of times
linear fracture
parallel to the bones long axis
transverse fracture
across
at right angle
Spiral Fracture
from twisting force
Comminuted Fracture
broken into several pieces (crumbly), hard to repair
Impacted Fracture
bone fragments drive into each other
lots of force (POOF)
Compression Fracture
due to osteoporosis, tumors
how do bones heal themselves?
- After fracture hematoma forms in the area of injury -Bleeding into area and forms a clot inbetween the two pieces
- Then a fibrin mesh seals off fracture site
- New capilarries forms granulation tissue
- Start to get fibroblast and bone marrow invades this area which forms a fibrocartiligenous callus —soft but bridges two parts together
- Fibrocartiligenous callous turns from soft to hard
- During remodeling damage parts of the bone will be removed and eventually replaced with spongy bone material
hematoma
must form before anything else happens
Fibrocartiliginous
soft callus
What does healing depend on?
fracture its self( how bad where)
how well hematoma forms
stability
How does healing of a broken bone in a child differ from the healing of a broken bone in an older adult?
in a child it will occur faster (4-6 weeks) than with that of an adult (10-18 weeks)
When does function return
after 6 months after union is complete
How can they tell in child abuse cases if there have been fractures
because of the scar tissue on the bone
Malunion
heal with a deformitiy
when you don’t go to the hospital
Delayed
failure of it to unite within a decent time frame
b/c of complicated fracture, infection
nonunion
failure to it to repair
What are the factors that can affect bone healing
malunion, delayed union, nonunion, fracture blisters
Compartment syndrome
usually in long bones… increased risk of pressure
vasculature is impeded (patient will complain of …can’t feel my toes, discomfort, loss of sensation)
death of muscle tissue nerves
EMERGENCY
long bone fractures are at a greater risk for
increased pressure in fixed places
What do we check for with fracture patients?
capillary refill….sensation (numbness, tingling)
how fast can necrosis start?
as little as four hours after pressure increases
What do they do for compartment syndrome
cut open to relieve pressure on vasculature
How else can we get compartment syndrome?
casts and dressings that are too tight
Bone infection
with open fracture
surgery (think about infections here too)
Osteomallitis
Bone infection
can also be caused by bone marrow ischemia
hard to get rid of
people with bone infections usually get central lines.
Neoplasms
benign - slow, don’t metabolise can weaken bones resulting in stress fragment
maligmnet (osteosarcoma)
osteosarcoma
worst malignant, most trestment, usually in lower leg and knee
Ewing sarcoma
teenage years
usually in femur
Condrasarcoma
second most common of the bone cancer
where the muscles attach to the bone
Metastatic bone disease
cancer from somewhere else,
most often with breast and prostate cancers
