Fractures

Question 1

Simple incomplete fracture?

Answer 1

Not completely fractured and not displaced

Question 2

Simple complete fracture?

Answer 2

Complete fracture but not displaced

Question 3

Compound fracture?

Answer 3

Displacement with penetration of the skin surface

Question 4

Comminuted fracture?

Answer 4

Complex fracture resulting in multiple fragments

Question 5

Stress fracture?

Answer 5

Bone fractures after repeated extra stress i.e. there were some tiny microfractures

Question 6

Greenstick fracture?

Answer 6

Best known incomplete fracture from an impact to a child’s supple long bone. Is fast healing.

Question 7

Pathologic fracture?

Answer 7

Due to intrinsic dz of the bone. The force would not have broken a normal bone. Osteoporosis, cancer, OI.

Question 8

Describe the process of bone healing.

Answer 8

1. Bleeding and clot formation
2. Ingrowth of neovascularization + FBs organize the clot and begin removal of dead cortex
3. Callus formation: ingrowth of osteocytes + new or woven bone formation
4. Cartilage produced at surface of callus
5. Months of bone remodeling
6. Reduction over time leads to complete bone healing

Question 9

What is a fibrous nonunion?

Answer 9

Pathological bone healing that occurs when the ends of the fractured bones are not closely enough aligned with each other to form a callus. Imperfect bone healing.

Question 10

What can easily happen to spongy bone where it has an end-artery pattern of vascularization and the artery is compromised?

Answer 10

Infarction/osteonecrosis

Question 11

Osteonecrosis is most likely to occur where?

Answer 11

Convex surfaces of joints. Feared result is detachment of articular cartilage.

Question 12

Osteonecrosis of the femoral head is a complication of what?

Answer 12

Sickle cell dz, decompression sickness, femoral neck fracture/dislocation. Also linked to alcohol abuse and glucocorticoid use.

Question 13

What is osteomyelitis?

Answer 13

Bone infection

Question 14

What is the most common agent of osteomyelitis?

Answer 14

Pyogenic organisms

Question 15

How does osteomyelitis develop?

Answer 15

Hematogenous spread, contiguous spread, or in pts with vascular insufficiency (poor wound healing)

Question 16

Hematogenous osteomyelitis is most common in what patient population?

Answer 16

Children 2-5 yo

Question 17

What are the risk factors for osteomyelitis?

Answer 17

Presence of foreign materials, diabetes, orthopedic surgery, adjacent infection, peripheral vascular dz, sickle cell dz, congenital phagocyte function defect.

Question 18

Pyogenic osteomyelitis begins where and is spread how?

Answer 18

Metaphysis and can spread hematogenously.

Question 19

What is the usual causative agent of pyogenic osteomyelitis?

Answer 19

S. aureus

Question 20

What is usual causative agent of pyogenic osteomyelitis in pts with sickle cell?

Answer 20

Salmonella

Question 21

What is Potts dz?

Answer 21

Vertebral infection by TB with collapse of vertebral column.

Question 22

Neonatal congenital syphilis has a characteristic feature of osteomyelitis in which bones?

Answer 22

Nose and shin bones. Leads to saddle nose and saber shins.

Question 23

What can develop in the bone or sinus tract of long-standing chronic osteomyelitis?

Answer 23

Squamous cell carcinoma

Question 24

What is a sequestrum?

Answer 24

When osteomyelitis spreads inside the bone resulting in necrosis and partial resorption of the bone.

Question 25

What is a involucrum?

Answer 25

When osteomyeltis forms surrounding reactive bone which is basically a subperiosteal formation of new viable bone.

Question 26

Histology of osteomyelitis?

Answer 26

1. Polys predominate no matter how long the infection (essentially no lymphocytes ever present) 2. Hemorrhage: fibrin + old blood 3. Bony spicule w/ empty lacunae 4. No osteocyte nuclei present in lacunae

Question 27

Pott dz can result in what?

Answer 27

Permanent neurologic defecits and severe deformities

Question 28

What is the causative agent of syphilis?

Answer 28

Treponema pallidum

Question 29

What is a chancre?

Answer 29

The initial skin lesion of primary syphilis present 10-90 days after initial exposure. It is a firm, painless skin ulceration localized at the point of exposure to the spirochete often on the penis, vagina, or rectum. May persist 4-6 weeks and usually heals spontaneously.

Question 30

What is a gumma?

Answer 30

Lesion of tertiary syphilis. Soft, tumor-like granulomas that can appear almost anywhere including the skeleton.

Question 31

What is another characteristic of tertiary syphilis?

Answer 31

Neuropathic joint dz which is a degeneration of joint surfaces resulting from loss of sensation and fine position sense.