Fractures, osteonecrosis, osteomyelitis

Question 1

Stress fractures

Answer 1

The bone fractures after repeated extra stress, i.e., there were some tiny microfractures (as in osteoporosis)

Question 2

Incomplete fracture

Answer 2

The bone is cracked, but not broken into two pieces. The best-known incomplete fracture is the fast-healing

Question 3

Greenstick Fracture

Answer 3

from an impact to a child’s supple long bone

Question 4

Closed simple fracture

Answer 4

The overlying tissues are intact

Question 5

Compound fracture

Answer 5

The bacteria have a route from the surface to the bone; perhaps the bone is even sticking out the wound.

Question 6

Multifragmented fracture

Answer 6

The bone is broken into several pieces.

Question 7

Complex fracture

Answer 7

A curious term for a fracture in which the ends of the bone fragments have done serious damage to the surrounding tissue.

Question 8

Pathologic fracture

Answer 8

Due to intrinsic disease of the bone; the force would not have broken a normal bone. Seen in osteoporosis, cancer, osteogenesis imperfecta.

Question 9

The process of bone healing involves the formation of a callus. How does this form?

Answer 9

The first thing that happens when the bone is fractured is bleeding and formation of clot.. So, you see the presence of blood clot in the fracture site with dead bone because of devascularization at the edges of the fractured bone. After several days, there is recruitment and ingrowth of neovascularization and fibroblast to begin to organize the clot and to begin the process of removal of dead cortex and other tissues.the next step in callus formation which is characterized by ingrowth of osteocytes and new or woven bone formation. Towards the end of the process of callus formation there is cartilage produced at the surface of the callus. After many months, we see the continued remodeling of bone with reduction over time in the callus, eventual complete bone healing.

Question 10

What is fibrous nonunion?

Answer 10

bone healing which is pathological and occurs when the ends of fractured bones are not closely enough aligned with each other to form callus and to continue the remodeling process to make a perfectly healed bone.

Question 11

What does a healing fracture look like histologically?

Answer 11

resolving hemorrhage, fractured bony spicules, new osteoid

Question 12

Where can spongy bone be infarcted?

Answer 12

Where ever there is an end-artery. Usually near convex surfaces of joints

Question 13

What is the feared result of spongy bone infarction

Answer 13

detachment of articular cartilage

Question 14

Why is infarction and necrosis in the shaft more difficult?

Answer 14

collateral circulation

Question 15

Osteonecrosis (of the femoral head?) is a complication of what?

Answer 15

sickle cell disease, decompression sickness, and of course femoral neck fracture or dislocation. There may be a link with alcohol and GC use

Question 16

How does sickle cell lead to osteonecrosis?

Answer 16

crisis often involves multiple painful bone infarcts resulting in osteonecrosis. Hypercellularity of bone marrow interferes with normal blood flow and can contribute.

Question 17

Hand foot syndrome may occur with osteonecrosis in sickle cell. What is this?

Answer 17

soft tissue swelling, periosteal new-bone formation and moth eaten lytic process

Question 18

Why might a bone following multiple infarcts in sickly cell look like?

Answer 18

irregular sclerosis, narrow cartilage

Question 19

Osteomyelitis is bone infection that is frequently caused by _____

Answer 19

pyogenic organisms

Question 20

How does osteomyelitis develop?

Answer 20

hematogenous spread, contiguous spread, or in patients with vascular insufficiency (poor wound healing)

Question 21

Hematogenous osteomyelitis is most common in what age group?

Answer 21

children 2-5 years old

Question 22

Risk factors for osteomyelitis

Answer 22

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

Question 23

Osteomyelitis primarily begins in the ____ of bone.

Answer 23

metaphysis

Question 24

ALmost all cases of osteomyelitis are due to _____

Answer 24

staph

Question 25

When may osteomyelitis due to mixed bacteria?

Answer 25

trauma or surgery

Question 26

When is osteomyelitis due to salmonella?

Answer 26

sickle cell

Question 27

What is Pott’s disease?

Answer 27

vertebral infection by tuberculosis with collapse of the vertebral column. TB osteomyelitis can lead to this. combined infection of vertebral bodies (spondylitis) and joint spaces (spondylarthritis).

Question 28

Neonatal gongential syphilis has what characteristic?

Answer 28

involving osteomyelitis of the bones of the nose and of the shins. Destructive remodeling of these areas causes a typical saddle nose that seen is in congenital syphilis as well as the production of malformed tibia or saber shins

Question 29

Is an organism ID all the time with osteomyelitis?

Answer 29

no, only half the time

Question 30

What is the relationship between squamous cell carcinoma and osteomyelitis?

Answer 30

squamous cell carcinoma can develop in the bone or sinus tract of long-standing chronic osteomyelitis.

Question 31

What is the involucrum?

Answer 31

surrounding reactive bone which is basically a subperiosteal formation of viable new bone (osteomyelitis)

Question 32

What is the sequestrum in osteomyelitis?

Answer 32

inner native necrotic cortex-remaining fragment of necrotic cortical bone

Question 33

Even in chronic osteomyelitis lasting many years, what inflammatory cell predominates?

Answer 33

polys

Question 34

What does microscopic osteomyelitis look like?

Answer 34

polys, fibrin, old blood and hemorrhage, empty lacunae- dead bone

Question 35

What serious comorbities occur with Potts?

Answer 35

permanent neurologic deficits and severe deformities. spine can kink 90 degrees!

Question 36

What are the 4 characteristic phases of syphillis?

Answer 36

primary, secondary, teritary, congential

Question 37

Describe primary syphillis

Answer 37

aquired via direct sexual contact, skin lesion after 10-90 days called a chancre and is firm, painless skinulceration. usually just one lesion for 4-6 wks that heals. local node swelling

Question 38

Describe secondary syphillis

Answer 38

contagious, 1-6 months after primary infection. symmetrical reddish-pink non-itchy rash on the trunk and extremities. The rash can involve the palms of the hands and the soles of the feet. In moist areas of the body, the rash becomes flat, broad, whitish lesions known as condylomata lata. Mucous patches may also appear on the genitals or in the mouth. All of these lesions are infectious and harbor active treponeme organismsfever, sore throat, malaise, weight loss, headache, meningismus, and enlarged lymph nodes. Rare manifestations include an acute meningitis that occurs in about 2% of patients, hepatitis, renal disease, hypertrophic gastritis, patchy proctitis, ulcerative colitis, rectosigmoid mass, arthritis, periostitis, optic neuritis, interstitial keratitis, iritis, and uveitis.

Question 39

Describe teritary syphillis

Answer 39

1-10 years after initial infection, gummas (soft tumor like granulomas) that are chronic and can be anywehere including the skeleton, neuropathic joint disease (loss of sensation and fine position sense) neurosyphillis, CV syphillis,

Question 40

Congenital syphillis

Answer 40

saber shin, saddle nose