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Pathophysiology 2 > Exam 2 - MSK 1B bone fx and healing > Flashcards

Exam 2 - MSK 1B bone fx and healing Flashcards

1
Q

Define fracture

A

Any defect in the continuity of a bone

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2
Q

What are the three etiology classes of fractures?

A
  1. Sudden traumatic fx
  2. Stress or fatigue fx
  3. Pathological fx
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3
Q

Describe Sudden Traumatic Fx, Stress/Fatigue Fx, and Pathological Fx

A

Sudden Traumatic=sudden episode of excessive force
Stress/Fatigue=Repetitive normal force. Doesn’t appear on xray until healing
Pathological Fx=Normal force on abnormal bone d/t bone failure

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4
Q

Definite Comminuted Fx, Pathological Fx, and Incomplete Fx

A

Communited=fx of 3+ fragments
Pathological=fx in area of preexisting bone disease
Incomplete=fx does not span across entire cross-section, no separate segments

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5
Q

Define Semental Fx and Butterfly Segment Fx

A

Segmental=middle fragment separated by proximal and distal segments
Butterfly Segment=Like Segmental but not through cross-section

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6
Q

Define Stress Fx and Avulsion Fx

A

Stress=fx caused by repeated loading of bone

Avulsion=tendon or ligament pulls off bone from insertion site

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7
Q

Define Displacement fx

A

Proximal and Distal segments not lining up

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8
Q

Define Angulation fx

A

Direction where the distal fracture “points”

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9
Q

What are the differences between Primary and Secondary Bone Healing

A

Primary=rigid bone stabilization takes longer, no calus formed
Secondary=less rigid bone stabilzation, early calus forms to provide stabilization

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10
Q

What are the three phases and time ranges of Secondary Bone Healing?

A
  1. Inflammatory Phase (1-2 weeks) “acute”
  2. Reparative Phase (Several months)
  3. Remodeling Phase (months to years)
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11
Q

What happens during the Inflammatory Phase of Secondary Bone Healing?

A

Increased blood flow forming hematoma. Osteoclasts remove damaged bone. Growth factors stimulate fibrobasts, osteoblasts, etc. Fx line on xray.

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12
Q

What happens during the Reparative Phase of Secondary Bone Healing?

A

Soft Callus forms and turns into Hard Callus by Osteoblasts mineralizing. Considered immature bone. Fx line starts to disappear.

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13
Q

What happens during the Remodeling Phase of Secondary Bone Healing?

A

Immature bone replaced by mature bone. Fx line disappears.

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14
Q

What are the two types of Primary Bone Healing? Describe.

A
  1. Gap Healing-Rigid fixation with small gaps and no movement at fx site
  2. Contact Healing-Rigid fixation with no gaps and no movement
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15
Q

Kid, Adolescent, and Adult fx healing times

A

Kids=4-6 weeks
Adolescents=4-8 weeks
Adults=10-18 weeks

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16
Q

Casts, Intramedullary rods/nails, Pins, wires, and screws are what kind of bone healing?

A

Secondary

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17
Q

Compression plate is what sort of bone healing? How does it differ from the other?

A

Primary. No weight bearing which takes longer. No periosteal callus formation.

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18
Q

What is different in External Fixation with “less rigid fixation” and “very rigid”?

A

Less rigid=Secondary healing. Callus forms.

Very rigid=Primary healing. No callus forms.

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19
Q

What is Wolff’s Law?

A

Mechanical stress leads to more bone density. Removal of mechanical stress decreased bone density.

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20
Q

Describe “delayed” or “non-union” healing complication

A

Segments don’t join back together. Might have a little bump.

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21
Q

Describe Avascular Necrosis and two most common sites

A

Cell death at site of fx. Scaphoid and Femoral Head.

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22
Q

Which part of the bone is called the “growth plate”?

A

Epiphyseal Plate

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23
Q

Define Type 1 Salter Harris

A

Disruption of the growth plate. Distraction or slip injury.

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24
Q

Define Type 2 and Type 3 Salter Harris

A

Type 2=Fx line through growth plate and metaphysis

Type 3= Fx line through growth plate, metaphysis, epiphysis

25
Q

Define Type 4 and Type 5 Salter Harris

A

Type 4=Fx through metaphysis, growth plate, and epiphysis

Type 5=compression injury of growth plate

26
Q

Osteoperosis, Osteomalacia, and Paget’s Disease represent what type of disease of the bone?

A

Metabolic disease. Increased or decreased bone density.

27
Q

Apophysitis (epiphysitis) and Osteonecrosis (avascular necrosis) are what types of bone disorders? Related to where?

A

Osteochondroses. Related to secondary ossification center.

28
Q

What is Osteopenia?

A

Low Bone Mineral Density. SD 1-2.5. Not severe enough to be osteoperosis.

29
Q

What is Osteoperosis (in general)? What SD and cell activity?

A

Severe decrease of BMD, SD 2.5+. Osteoclastic activity more than Osteoblastic activity.

30
Q

Define Primary Osteoperosis vs Secondary Osteoperosis

A

Primary=General decrease in bone density unrelated to underlying disease, condition, or medication

Secondary=Bone density loss due to disease or medication

31
Q

Describe Type 1 and Type 2 of Primary Osteoperosis

A

Type 1=Post-menopausal women. Primarily in cancellous bone.

Type 2=Age related (over 75). In both cancellous and cortical bone.

32
Q

What are the describe the three phases of bone mass growth and loss

A
  1. Growth Phase=90% of bone density formed. Until growth plates close.
  2. Consolidation Phase=10% formed until Peak Bone Mass reached
  3. Involution Phase=Gradual loss of bone density from normal and pathological factors
33
Q

Describe Peak Bone Mass and age when it happens

A

Bone forming faster then resorption. Around 30 y/o.

34
Q

Define and describe the Involution Phase

A

Normal age-related bone loss. 0.5-1% per year.

35
Q

Define and describe Post-Menopausal Bone Loss

A

Estrogen protects women from bone loss which accelerates to 3-5% for first ten years after menopause then slows down.

36
Q

Estrogen loss in menopause leads to higher levels of ______ and reduced levels of _____

A

Higher levels of RANKL, reduced levels of OPG

RANKL=promotes osteoclast maturation
OPG=inhibits osteoclast maturation

37
Q

What does Raloxifine do to OPG levels?

A

Stimulates more OPG production, which inhibits osteoclast maturation

38
Q

What type of bone is most effected by post-menopausal osteoperosis? Two bones in particular?

A

Cancellous (trabecular) bone

Metaphysic of long bone-wrist and femur

39
Q

Which bone type is most sensitive to conditions that alter osteoblast and osteoclast activity? Why?

A

Cancellous (aka Trabecular) bone. Large surface area and not a “large bone mass” to begin with compared to cortical bone

40
Q

Which bone type loses more mass and more sensitive to loss in post-menopausal women?

A

Trabecular (aka Cancellous) bone.

41
Q

What are some risk factors of osteoperosis?

A

Hormonal status (low estrogen), physical inactivity, genetics, medications, tobacco, alcohol, diet

42
Q

What is the “Female Triad”?

A

Eating disorder, amenorrhea, osteoperosis

43
Q

What is a BMD test? What is the “gold standard” and scores?

A

Bone Mineral Density test. DEXA is gold standard.

Normal=BMD less than 1
Osteopenia=BMD between 1 and 2.5
Osteoperosis=BMD above 2.5

44
Q

Define Osteomalacia and etiology

A

Insufficient mineralization of bone but no actual bone loss. “Soft bones.” Poor nutrition (such as VitD) or diseases/meds.

45
Q

What are “Loozer Zones” and “Milkman Fractures”?

A

Pseodofractures perpendicular to bone from poorly mineralized osteoid matrix. Osteomalacia.

46
Q

What is Ricket’s

A

Childhood osteomalacia. Bowing of legs with gravity. Type of Osteomalacia.

47
Q

What is Paget’s Disease? Who get it and what bone does it effect?

A

Enlarged, deformed bone of poor quality. Distortion of bone formation for resorption in trabecular (cancellous) bone. Men over 50 more than women.

48
Q

What is Osteochondroses? Age group? Two examples?

A

Self-limiting disorder of bone growth involving ossification centers. In kids.
1. Osteonectrosis (avascular necrosis)-death of bone d/t loss of blood supply from fx or other pathology

  1. Apophysitis (epiphysitis)-traction (too much torque) of secondary ossification centers
49
Q

What is Osgood-Schlatter Disease?

A

Type of apophysitis. Patella ligament pulling/traction on tibial tuberosity. Type of Osteochondrosis.

50
Q

What is Olecranon Apophysitis?

A

Type of Osteochondrosis. In young throwing athelets. Triceps tendon pulling on secondary ossification center of Olecranon.

51
Q

What is Sever’s Disease?

A

Type of Osteochondrosis. Achilles tendon traction (“pulling”) on secondary ossification center of calcenous.

52
Q

Define Osteomyelitis

A

Inflammation of bone cause by bacteria or other infectious agent

53
Q

What is “lift-off” in Osteomyelitis? Who gets it?

A

Kids. Inflammation which “lift offs” periosteum from sub-periosteal abscess and disrupts blood supply.

54
Q

What is a Squestrum?

A

Necrosis of bone from osteomyelitis in kids.

55
Q

Where do adults and kids get osteomyelitis? How does it present in each?

A

Adults=lumbar spin. Low fever with back pain.

Kids=metaphysis near growth plate in long bone. High fever with local pain, redness, and swelling.

56
Q

Describe Primary Benign Bone Tumor vs Primary Malignant Bone Tumor

A

Benign=slow growing, well-differentiated, bone contains tumor in sclerotic rim

Malignant=Aggressive, fast growing, spread beyond cortical bone

57
Q

Moth Eaten bone consistent with which cancer? Describe.

A

Myeloma. Less defined margins, surrounding lytic or partially lytic area.

58
Q

Permeative bone consistent with which cancer? Describe.

A

Ewing Sarcoma. Poorly defined margins. Abnormal lytic bone merged throughout bone.

Pathophysiology 2 (15 decks)

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