Fractures And Associated Issues Flashcards
What is another term for incomplete fractures?
Green stick fractures
Incomplete fractures are more common among what group of people?
Children
What is the term for an open fracture that ruptures the skin?
Compound fracture
What is a risk with compound fractures?
Infections
What is the type of fracture where the overlying tissue remains intact?
Closed fracture
What is the term for a fragmented or splintered fracture?
Comminuted
What type of fracture has a distal segment that is malaligned?
Displaced fracture
What is another name for a displaced fracture?
Nightstick fracture
What are examples of things that can cause pathological fractures?
Bone cyst, tumor, brown tumor
What is a stress fracture?
Fractures that develop slowly over time due to repetitive injury
What is the most common location of stress fractures?
Lower legs and feet
At what time after a fracture is the bony callus revealed and casts are typically taken off?
6-8 weeks
Can stress fractures be visible on X-rays?
No; microfractures occur
What is another term for avascular necrosis (AVN)?
Osteonecrosis
What causes the bony necrosis with AVN?
Ischemia
What is the most common cause of AVN?
Vascular disruption via fracture
What makes AVN worse?
Time, physical activity, pathological fracture
What areas are largely affected by AVN?
Subchondral areas of hip, knee, shoulder, wrist, ankle (large round joints)
Possible collapse with AVN creates a risk for what condition?
Osteoarthritis
What is “creeping substitution” seen with AVN?
Eventual new bone growth can occur over the damaged area
What is the most common form of osteomyelitis?
Acute
What condition is known as “bone-marrow-inflammation”?
Osteomyelitis
What is specifically infected in osteomyelitis?
Bone marrow
What is the most common mode of infection with osteomyelitis?
Hematogenous (sepsis)
What destroys the bone in osteomyelitis?
Leukocytes
What are other modes of infection for osteomyelitis besides the most common one?
Adjacent infection or traumatic implantation
What are signs and symptoms of osteomyelitis?
Acute fever, intense malaise, throbbing pain
What is usually the bacterial cause of osteomyelitis?
Pyogenic bacteria
Can the single microbe be found as the cause of osteomyelitis all of the time?
No; 50% of the time we are unable to identify the agent
What is the most common pyogenic bacteria to cause osteomyelitis?
Staphylococcus aureus
What are the most common pyogenic bacteria to cause osteomyelitis in neonates?
E. coli and group B streptococci
What is the most common pyogenic bacteria to cause osteomyelitis in patients with sickle cell anemia?
Salmonella spp
How is osteomyelitis diagnosed?
Radiography, biopsy, blood culture
In pyogenic osteomyelitis, what is the reactive woven/lamellar bone that surrounds the infected bone called?
Involucrum
In pyogenic osteomyelitis, what is that dead bone seen at the site of infection?
Sequestrum
In pyogenic osteomyelitis, what is the ruptured periosteum that leads to an abscess in the surrounding soft tissue?
Draining sinus
What is another name for tuberculous osteomyelitis?
Skeletal TB
Skeletal TB occurs in what percentage of overall TB cases?
3%
Caseous granulomas are seen among which osseous condition?
Skeletal TB (tuberculous osteomyelitis)
What is the most common form of spread in tuberculous osteomyelitis?
Hematogenous (other form would be lymphatics)
What is Pott disease?
Tuberculous osteomyelitis that has ended up in the spinal column
Which is more common: secondary or primary bone tumors?
Secondary
What six factors indicate a larger risk of a bone tumor being the cause of low back pain?
50 years of age or older, history of cancer, unexplained weight loss, failure to improve after a month of conservative care, unrelieved with bed rest, and pain duration longer than one month
What is fibrous dysplasia?
Arrested development of bone resulting in a benign lesion (failure of bone differentiation)
McCune-Albright syndrome is part of what category of fibrous dysplasia?
Polystotic + café-au-lait spots & endocrinopathy
What category of fibrous dysplasia is most commonly represented?
Monostotic (70%)
What is the age range of monostotic fibrous dysplasia?
10-30
What is the typical location of monostotic fibrous dysplasia?
Ribs, femur, tibia, jawbones, calvaria, humerus
What category of fibrous dysplasia is asymptomatic and results in minimal bony distortion or enlargement?
Monostotic
Does polystotic fibrous dysplasia have any endocrinopathy?
No
When does polystotic fibrous dysplasia typically develop?
Late childhood and adolescence (earlier than monostotic)
Craniofacial involvement is present in about half of the cases of which category of fibrous dysplasia?
Polystotic
The “ground glass” appearance on X-ray is characteristic of what bone condition?
Fibrous dysplasia
How can you distinguish Paget’s disease from fibrous dysplasia on X-ray?
Fibrous dysplasia tends to be focused on the proximal region of the bone, while Paget’s disease is throughout the entire bone
What is the treatment for fibrous dysplasia?
Excision, othropedic hardware
McCune-Albright syndrome is more common among what gender?
Females
What types of endocrine hyperfunction is associated with McCune-Albright syndrome?
Hyperthyroidism, pituitary adenoma, and adrenal hyperplasia
What usually prompts the evaluation leading to McCune-Albright syndrome?
Precocious puberty
Are the skin and bony lesions of McCune-Albright Syndrome commonly unilateral or bilateral?
Unilateral
What is PNET?
Primitive neuroectodermal tumor
What causes Ewing sarcoma or PNET?
Translocations of genetic bits of information
“Small round cell tumors of bone” is associated with what bone condition?
Ewing sarcoma or PNET
What is the appearance of the cells involved with an Ewing sarcoma?
Highly primitive and undifferentiated
What is the second most common pediatric bone cancer (#1 osteosarcoma)?
Ewing sarcoma
What is the difference between Ewing sarcoma and PNET?
PNET has some neural differentiation while Ewing sarcoma is virtually completely undifferentiated
What is the most common age range of Ewing sarcoma and PNET?
10-20
What race is more likely to be affected by Ewing sarcoma or PNET?
Caucasians (9X)
What gender is at a greater risk for Ewing sarcoma and PNET?
Males
What is the most common location of bone for Ewing sarcoma or PNET?
Femur
What effect does an Ewing sarcoma or PNET mimic?
That of infection: pyrexia, leukocytosis, increased erythrocyte sedimentation rate
“Onion-skinning” appearance of the periosteum is associated with what bone condition?
Ewing sarcoma
What percentage of patients with Ewing sarcoma or PNET end up with complete remission?
50%
Ewing sarcoma can sometimes mimic what other bone condition?
Osteosarcoma
Homer-Wright pseudo rosettes are associated with what bone condition?
PNET
What is the age range for giant-cell tumors of bone (GCT)?
20-40
What is the most common location for giant-cell tumors of bone?
Knee
What type of bone condition produces arthritis like pain, is osteolytic, and is painful?
Giant-cell tumor of bone
What is the most common location of metastasis for a giant-cell tumor of bone, although it rarely metastasizes?
Lungs
The “soap bubble” appearance on X-ray is associated with which bone condition?
Giant-cell tumor of bone
What types of cancer may spread to bone?
Any
What is the metastatic pathway of sarcomas?
Hematogenous
What is the metastatic pathway of carcinomas?
Lymphatic
What is the most common type of secondary metastasis to bone?
Mixed- both osteoblastic and osteolytic
What part of the skeleton is the most common location for secondary metastasis of bone?
Axial skeleton
Why is the axial skeleton the most common location for secondary metastasis to bone?
Heavy bone marrow
What are the most common forms of secondary metastasis to bone in adults?
Prostate (blastic), breast (lytic), lung
What are the most common forms of secondary metastasis to bone in children?
Neuroblastoma, Wilm’s tumor, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma
