Final Exam: Fractures - The End Flashcards
Overlying tissue is intact
Closed (simple) fractures
Fracture site communicates with skin
Compound fracture
Fractured bone undergoes splintering
Comminuted
‘Comminut-‘ Latin for “broken into pieces”
Ends of bone at fracture site become misaligned
Displaced
What type of fracture occurs in bone already altered by disease process (tumors, osteoporosis, etc)
Pathological fracture
What fracture develops slowly during a period of increased physical activity in which the bone is subjective to new repetitive loads
Stress fracture
Early reaction of bone fracture repair
Inflammation, phagocytosis
Later changes in bone repair characterized by (3)
- Formation of provisional callus: cartilage, bone, CT
- Bone adjacent to fracture becomes necrotic and is resorbed
- well-formed callus appears w/in weeks and undergoes remodeling
When bone repair goes very wrong:
- deformity if displaced fracture
- abnormality persists because bone fragments require resorption which delays healing and enlarges callus
- false joints (pseudoarthrosis) cause inadequate immobilization and movement inhibits callus formation
Unilateral inflammatory joint disease and (2) defining features
Septic (pyogenic) arthritis
- Red, hot, swollen joint
- 2+ days = severe damage
Asymmetrical inflammatory joint disease (most common joint disease) and (4) defining features
Osteoarthritis (DJD)
- joint mice (osteophites)
- subchondral cysts
- subchondral sclerosis
- NO BONY EROSIONS
What is a severe, destructive and chronic joint disease that causes bony erosions and can lead to fusion/ankylosing of joint? What blood test do you do to diagnose and what is the mechanism?
Rheumatoid arthritis (RA)
- RA factor
- mechanism is inflammatory synovial response “proliferative synovitis”
How does juvenile RA differ from RA? And 3 defining features
No Rf factor and rheumatoid nodules are usually absent
- more common in large joints
- systemic manifestations
- ANA
What is a variant of RA? And triad for diagnosis:
Felty’s syndrome
- RA
- splenomegaly
- low white blood count (anemia, leukopenia)
What is a common condition that is more severe in men and associated with HLA-B27?
Seronegative spondylo-arthropathies
What are the 3 Seronegative spondylo-arthropathies
- Ankylosing spondylitis
- Reiter’s AKA reactive arthritis
- Enteropathic arthropathy
Ankylosing spondylitis population of people, spine characteristics and where does it start?
- Men, 19-35 yo
- “Bamboo spine”
- Starts in SI region
Reiter’s syndrome is associated with (3)
Infectious arthritis
Conjunctivitis
Urethritis
Note: symptoms come and go and usually vanish after a few months
Enteropathic arthropathy is an result of what 2 things?
Ankylosing spondylitis and GI issue (e.g. crohn’s disease or ulcerative colitis, etc)
Hyperuricemia is associated with what
Gout and gouty arthritis
General features of gout (3)
- Tophi (lesions of chronic gout)
- Red, hot, swollen joint
- uric acid formation in kidneys (could lead to stone formation)
What is deposition of calcium pyrophosphate cyrstals in joint (e.g. knee, wrist)?
Chondrocalcinosis aka CCPD or pseudogout
What is loss of peripheral sensation due to DM, vitamin D deficiency or other neuropathy? And what can this lead to?
Charcot joint (neuropathic arthropathy)
Leads to excessive and repetitive joint trauma because they don’t know where their feet are.
Diverse groups of disease that affect muscle fibers
Myopathy
Muscular dystrophy is a group of hereditary myopathies. Features include (5):
- Gower’s sign, unusual method of standing up
- Pseudohypertrophy of muscles of calf due to fatty ingrowth of muscle
- Winged scapula
- Scoliosis
- Cardiomyopathy (female)
What is a functional blockade of myoneural junction
Myasthenia gravis where antibodies attach ACh receptors on postsynaptic membrane
Features of Myasthenia gravis (4)
- thymoma (thymus cancer)
- ptosis, double vision
- weakness of extremity muscles and limited endurance
- exacerbation and remissions
Altered composition of bone “other” diseases (3)
- Osteogenesis imperfecta - type 1 collagen deficiency
- Osteopetrosis - albers-schönberg disease, “marble bones”
- Achondroplasia - dwarfism
Type 1 collagen deficiency (name) and 4 features
Osteogenesis imperfecta
- Osteopenia - thinning and fracturing
- Blue sclera - choroid shows thorugh
- Hearing loss - abnormal ossicles
- Small, misshapen teeth
Overgrowth, sclerosis of bone (name) and 2 features
Osteopetrosis (Albers-schönberg disease, “marble bones”)
- thickening of cortex and narrowing of medullary cavity
- brittle and fracturing
Long bones that are short due to premature ossification of epiphyseal plates (name) and 2 features about the bone structure (skull, spine)
Achondroplasia - dwarfism
- skull = normal size
- length of spine is normal but kyphoscoliosis is common
Defect in collagen synthesis and structure (name) and 4 features
Ehlers-Danilo’s syndrome
- hypermobility in joint
- stretchy skin
- abnormal heart valve
- increased bruising
What is a disorder of CT from defect in gene regulating fibrilin? (Name)
Marfan’s syndrome
Fibrillin is a glycoproteins secreted by fibroblasts to forma. Microfibrillar network in ECM. Its absence appears to affect the proper deposition of CT fibers (elastin) and leads to changes in skeleton, eyes and cardiovascular system
In marfan’s syndrome, what are typical changes in skeleton, eyes and cardiovascular system (7)
- Tall, slender build with arachnodactylyl
- High, arched palate
- Thoracic abnormalities
- Hyperextensible joints
- Weak suspensory ligaments of the lens
- Weakening of aortic media which predisposes to dissecting aneurysm
- Weakened cardiac valves “floppy valve syndrome”
