How to Treat MSK Conditions Flashcards
What is an osteogenic cell?
A bone stem cell
What is an osteoblast?
Bone forming cell
What do osteoblasts secrete?
Osteoid
What do osteoblasts catalyse the mineralisation of?
Osteoid
What are osteocytes?
Mature bone cells
What is the role of osteocytes?
Sense mechanical strain to direct osteoclast and osteoblast activity
How are osteocytes formed?
When osteoblasts become imbedded in secretion
What are osteoclasts?
Bone breaking cells
What do osteoclasts do?
Dissolve and resorb bone by phagocytosis
What are osteoclasts derived from?
Bone marrow
What structure does compact bone have?
Osteons
What are osteons?
Repeated structural units made of concentric ‘lamellae’ around a central ‘Haversian Canal’, they have few spaces
What is the role of osteons?
Provides protection, support and resists stresses produced by weight of movement
What does the haversian canal in an osteon contain?
Blood vessels
Nerves
Lymphatics
What are lacunae?
Small spaces containing osteocytes
What are Volkman’s canals?
Transverse perforating canals
Where is the epiphysis of long bones found?
Near the joint
What are the 3 pathologies of fracture?
Trauma
Stress
Pathological
How are stress fractures caused?
Abnormal stress on normal bone
How are pathological fractures caused?
Normal stress on abnormal bone
What are pathological causes of fractures?
Osteoporosis Malignancy Vitamin D deficiency Osteomyelitis Osteogenesis imperfecta Paget's disease
What are the 3 ways fractures are classified?
Soft tissue integrity: open or closed
Bony fragments: greenstick, simple or comminuted
Movement: displaced or undisplaced
What are clinical signs of a fracture?
Pain
Swelling
Crepitus
Deformity
How should you describe a fracture?
Location (what bone and what part of it)
Pieces (simple or multifragmentary)
Pattern (transverse, oblique spiral etc)
Displaced or undisplaced
What are 2 categories in fracture displacement?
Translation (lateral/medial/proximal/distal)
Angulation (internal or external rotation/varus or valgus/dorsal or volar)
What are the 4 principals of fracture management?
Reduce
Hold
Fix
Rehabilitate
What do we mean by general fracture complications?
They affect the whole body or the part of the body where the fracture is from
What are some common general fracture complications?
Fat embolus DVT PE Infection/sepsis Prolonged immobility
What are urgent local fracture complications?
Local visceral injury Vascular injury Nerve injury Compartment syndrome Haemarthrosis Infection Gas gangrene
What are causes of fractures at the neck of the femur?
Osteoporosis (common in older people)
Trauma (common in younger people)
Combination of above
What are important points in the history of the head of femur fracture?
Age
Co morbidities (respiratory/cardiovascular/diabetes/cancer)
Pre injury mobility
Social history
How are extracapsular neck of femur fractures treated?
Internal fixation
How are intracapsular neck of femur fractures treated?
If displaced replace if they are above 65 years and reduce and fix if they are younger than 55
If undisplaced fix with screws
Why can undisplaced neck of femur fractures be fixed with screws?
There is minimal risk to blood supply and AVN
What are the 3 types of joints?
Fibrous
Cartilaginous
Synovial
How are synovial joints stabilised?
Depending on how much bony congruity they have, this relies on the proportion of muscles/tendons to ligament to congruity
What is cartilage composed of?
Specialised cells=chondrocytes
Extracellular matrix
What specialised cells are present in cartilage?
Chondrocytes
What is present in ECM of cartilage?
Water
Collagen
Proteoglycans (mainly aggrecan)
What is blood supply to cartilage like?
Cartilage is avascular
What is aggrecan?
A proteoglycan that possesses many chondroitin sulfate and keratin sulfate chains
What does aggrecan interact with?
Hyaluronan (HA) to form large proteoglycan aggregates
What are the 2 main types of arthritis?
Osteoarthritis (degenerative)
Inflammatory (mainly rheumatoid)
How do radiographs of rheumatoid and osteoarthritis differ?
There is no subchondral sclerosis or osetophytes in rheumatoid but there is in oseto
There is no osteopenia or bony erosions in osteo but there is in rheumatoid
What is arthritis?
A degenerative disease of chondral cartilage
When does inflammation occur in arthritis?
Late
What are the main risk factors for developing arthritis?
Age Excess weight Mechanical stress (sports, profession etc) Hereditary Females (inc menopause) Metabolic syndrome
What should you ask about in osteoarthritis history?
Pain (exertional/rest/night)
Disability (walking/stairs/do their legs give way/)
Deformity
Previous history (of trauma/infection etc)
Treatments given
If other joints are affected
How should you assess for osteoarthritis?
Look, feel, move
What does conservative management of osteoarthritis include?
Analgesics Physiotherapy Walking aids Avoidance of exacerbating activity Injections (steroid/viscosupplementation)
What does operative management of osteoarthritis include?
Replace (knee/hip) Realign (knee/big toe) Excise (toe) Fuse (big toe) Synovectomy (Rheumatoid) Denervate (wrist)
What is infection of the bone called?
Osteomyelitis
What are systemic signs of osteomyelitis?
Fevers
Weight loss
Sweats
What are the classifications of osteomyelitis?
Acute or chronic
Primary or secondary
What is infection of a joint called?
Septic arthritis
How does septic arthritis manifest?
Pain
Joint swelling
Stiffness
What is septic arthritis caused by?
Bacterial infection of a joint (usually caused by spread from the blood)
What are risk factors for septic arthritis?
Immunosuppressed
Pre-existing joint damage
Intravenous drug use (IVDU)
How urgent is septic arthritis? Why?
It is a medical emergency, if left untreated it can destroy a joint
When should you consider a diagnosis of septic arthritis?
In any patient with an acute painful, red, hot, swelling of a joint, especially if there is fever
What test diagnoses septic arthritis?
Joint aspiration
What is septic arthritis called if it affects one joint and if it affects multiple?
One=monoarthritis
Multiple= polyarthritis
How is septic arthritis treated?
Surgical wash-out (‘lavage’) and intravenous antibiotics
The joint is immobilised in the acute phase then physiotherapy when the acute phase is over
How is osteomyelitis treated?
IV antibiotics
Surgical drainage
If chronic antibiotic suppression or dressings can be used
Amputation may be required
