Fractures, Osteonecrosis, Osteomyelitis Flashcards
The bone fractures after repeated extra stress, i.e., there were some tiny microfractures (as in osteoporosis)
stress fracture
The bone is cracked, but not broken into two pieces
incomplete fracture
What is a greenstick fracture?
incomplete fracture in kids that results from impact to thier “supple” long bones
closed fracture
overlying tissue is in fact
The bacteria have a route from the surface to the bone; perhaps the bone is even sticking out the wound.
compound, open fracture
The bone is broken into several pieces.
multifragmented (comminuted) fracture
A curious term for a fracture in which the ends of the bone fragments have done serious damage to the surrounding tissue.
complex fracture
Due to intrinsic disease of the bone; the force would not have broken a normal bone. Seen in osteoporosis, cancer, osteogenesis imperfecta.
pathologic fracture
Describe the process of callus formation after a bone fracture
- bleeding and formation of clot
- devascualrization of edges of fractured/dead bone
- recruitment and ingrowth of neovascualization
- fibroblasts organize clot
- removal of dead cortex
- ingrowth of osteocytes
- new/woven bone formation
- cartilage produced at surface of callus
- continued remodeling (over months)
- complete bone healing (loss of cartilage cap)
T or F: the fractured ends of bone must be perfectly aligned to begin the process of healing/callus formation
F: but they must be in close proximity
What happens if the fractured ends of a bone are not in close enough proximity for healiing?
the callus cannot form an there is a “fibrous nonunion” of the ends
= fibrous replacement of tissue between the ends
**pathologic
Microscopically, during bone healing, fractured bony spicules are being joined together by…
new osteiod
Why are metal pins surgically inserted after some fractures?
to produce the conditions necessary for appropriate callus formation and bone healing.
= align the ends
Where on the bone does osteonecrosis most likely occur?
convex surface of joints
*usually spares the synovium/joint space
What is the feared result of osteonecrosis
detachment of the articular cartilage
osteonecrosis can be a complication of what 3 conditions?
- femoral neck fracture or disslocation
- sickle cell
- decompression sickness
Osteonecrosis has a mysterious link to..
alcohol abuse and glucocorticoid use
How can sickle cell disease lead to osteonecrosis?
sickled RBCs occlude vessel
hypercellularity of the marrow can interfere with normal blood flow in the marrow
soft tissue swelling with periosteal new-bone formation and a moth-eaten lytic process
hand foot syndrome
*seen in sickle cell dz
XR manifestation of bone with chronic infarcts and secondary osteoarthritis (seen in sickle cell)
irregular sclerosis and lucency (infarcts)
bone-in-bone appearance (infarcts)
narrowed cartilage and irregular joint surfaces (OA)
Bone within bone appearance on XR can indicate
- **sclerosis, resulting from multiple infarctions
* think sickle cell dz
osteomyelitis is caused by ___ organisms that spread
pyogenic
*most commonly staphylcoccus (80-90%)
that spread hematogenously, contiguously, or in pts with vascualr insufficiency
*hematogenous is most common in kids
What are risk factors for developing osteomyelitis
DM periph vascualr dxz sickle cell congenital phagocyte function defect presence of foreign materials ortho surgery adjacent infections
TB osteomyelitis
Name of dz?
what bones are affected?
Pott Dz
vertebrae (causes collapse –> kypohosis)
What organism is assc with osteomyelitis in sickle cell pts
salmonella
Mixed bacterial osteomyelitis is assc with
trauma or surgery
congenital syphilitic osteomyelitis is assc with
saber shins and saddle nose
mom passes syphillis to fetus
chronic osteomyelitis can give rise to
squamous cell carcinoma
On what part of the bone does osteomyelitis typically begin
metaphysis
spreads internally and externally from here +/- sinsus tracts
sinus tracts in bone
osteomyelitis
In chronic osteomyelitis what is happening outside the bone and inside the bone at the site of infection?
outside = bone growth = reactive = involucrum
inside = bone necrosis = partial reabs = sequestration
subperiosteal shell of viable new bone
involucrum
*chronic osteomyelitis
inner necrotic cortex
sequestrum
*chronic osteomyelitis, necrosis is purulent
empty lacunae in spicules implies
dead bone
T or F: poly predominant in CHRONIC osteomyelitis
T
NO LYMPHOCYTES present
What immune cells are present in acute osteomyelitis? Chronic?
neutrophils! NO lymphocytes
prob some fibroblasts and maybe macrophages too
marked ulceration and necrosis of calcaneus
osteo in DM
spinal tuberculosis is a combined infectious of
vertebral bodies (spondylitis) and joint spaces (spondylarthritis)
gibbus deformity
severe kyphosis from vertebral collapse
- can be seen with Pott Dz
manifestation of primary syphillis
chancre = skin lesion at point of contact (usually genitals or anus)
*can last 4 to 6 weeks and heals spontaneously
manifestation of secondary syphillis
- 1-6 mos after primary
- Chondylomata lata: symmetrical reddish-pink non-itchy rash on the trunk and extremities (can be on palms and soles) that contain ACTIVE treponeme = CONTAGIOUS
manifestations of tertiary syphillis
-1-10 years after primary
- gummas = chronic soft, tumor like granulomas due to the immune sys inability to clear the org
- -> chronic infalm state
- neuropathic joint dz = degeneration of joint surfaces –> loss of sensation and fine position sense (proprioception)
- neuro syphillis
- CV syphillis
Nolan Never Gets Cold bc he has the syph
