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Patho Summer Test #1 > MSK #1A - Bone: Normal Structure and Trauma > Flashcards

MSK #1A - Bone: Normal Structure and Trauma Flashcards

1
Q

What are the types of bones?

A

Long Bones (Humerus, femur, tibia)

Short Bones (Carpals/Tarsals

Flat Bones (Protective –> Skull)

Irregular Bones (vertebrae, facial bones)

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2
Q

What is the diaphysis?

A

Primary ossification center

Body of bone

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3
Q

What is the metaphysis?

A

Flattened portion of the diaphysis

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4
Q

What is the epiphysis?

A

Secondary ossification center (develop after birth)

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5
Q

What is the epiphyseal plate?

A

Cartilagenous growth plate between diaphysis and epiphysis

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6
Q

What are the 2 types of bone?

A

Compact (cortical)

Spongy (cancellous, trabecular)

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7
Q

How much of the skeleton is made of compact bone?

A

80%

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8
Q

What is the turnover rate of compact bone?

A

Slow

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9
Q

Describe the organization of compact bone

A

Dense tightly packed osteons w/ haversian canal system

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10
Q

What is the Haverisan system?

A

Haversian canal surrounded by lamelle

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11
Q

What does the haversian canal contain?

A

Blood vessel and nerve

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12
Q

What do the blood vessel and nerve of the haversian canal do?

A

Communicate w/ periosteum

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13
Q

What are lamelle?

A

Concentric layers of bone surround haversian canal

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14
Q

Where are osteocytes found in the haversian system?

A

W/ in concentric layers

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15
Q

What is volkman’s canal?

A

Horizontal canal system connecting to periosteum

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16
Q

How much of the skeleton is made of cancellous bone?

A

20%

**less dense but “large” surface area

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17
Q

What is the turnover rate of cancellous bone?

A

High turnover rate

**undergoes remodeling according to line of stress

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18
Q

What is Wolff’s Law?

A

Increased mechanical stress will increase bone density

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19
Q

What is the periostium?

A

Thin, double-layered, tough fibrous membrane that surrounds the bone

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20
Q

Where will you find periostium?

A

Surrounds all bone EXCEPT @ ligament or tendon insertion sites

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21
Q

What does the outer layer of the periostium contain?

A

Capillaries

Nerves

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22
Q

What does the inner layer of the periostium contain?

A

Sharpey’s fibers

If active bone formation –> osteoblasts

If inactive bone formation –> fibroblasts (can become osteoblasts if new growth occurs)

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23
Q

What do sharpey’s fibers do?

A

Anchor periostium, tendons, ligaments to cortical bone

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24
Q

Where is bone marrow found?

A

In cavities between osseous component of bone

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25
Q

What does bone marrow consist of?

A

Blood vessles

Nerves

Mononuclear Phagocytes

Stem Cells

Blood Cells in various stages of differentiation

Fatty Tissue

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26
Q

What is the function of bone marrow?

A

Formation of blood cells

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27
Q

What are the 2 types of marrow in adults?

A

Red (active)

Ylleow (inactive)

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28
Q

Where is active bone marrow found?

A 
Trabecular or spongy bone regions of 
      Pelvis bones
      Vertebrae
      Cranium
      Mandible
      Sternum
      Ribs
      Proximal femur
      Humerous
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29
Q

Where is inactive bone marrow found?

A

Medullary cavity of long bone

**fatty cells

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30
Q

What is the primary source of blood to the bones?

A

Nutrient arteries

**usually enter middle of diaphysis

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31
Q

What are the other arteries that supply bone?

A

Epiphysiseal/metaphyseal arteries

Periosteal Cappilaries

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32
Q

Why is blood supply critical to bones?

A

Fracture Repair

Maintain Bone Health

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33
Q

In healthy remodeling, where do you have bone remodeling?

A

Both cortical and cancellous bone

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34
Q

When does general healthy remodeling occur?

A

Throughout life

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35
Q

In healthy remodeling what is the relationship between osteoblasts and osteoclasts?

A

Balance between them

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36
Q

In osteoporosis what is the relationship between osteoblasts and osteoclasts?

A

Osteoblast activity < Osteoclast activity

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37
Q

What are the phases of bone remodeling?

A

Activation

Resorption

Reversal

Formation

Quiescence

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38
Q

What is the stimulus for activation of bone remodeling?

A

Hormones

Drugs

Physical Stimulus

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39
Q

What happens after bone remodeling is activated?

A

Resting osteoblasts stimulated to signal activation of osteoclastic activity

40
Q

What is the action of the resorption phase of bone remodeling?

A

Osteoclasts break down bone –> create resorption cavity

41
Q

What does the resorption cavity follow in compact bone?

A

Longitudinal axis of haversian’s canal

42
Q

What does the resorption cavity follow in canncellous bone?

A

Surface of trabeculae

43
Q

What happens during the reversal phase of bone remodeling?

A

Macrophages “clean up” site and prepare it for laying down new bone

44
Q

What is the action of the formation phase of bone remodeling?

A

Osteoblasts lay down new bone in resorption cavity

45
Q

Explain the formation phase of bone remodeling in compact bone

A

Bone laid down in concentric layers until small canal is formed (haversian’s canal)

46
Q

Describe the formation phase of bone remodeling in cancellous bone

A

Trabeculae are broken down and new ones are formed

47
Q

What is the quiescence phase of bone remodeling?

A

Osteoblasts rest and become “bone lining cells” on the newly formed bone surface

48
Q

What is a fracture?

A

Any defect in the continuity of a bone

49
Q

What are the 3 basic etiological classifications of fractures?

A

Sudden traumatic fracture –> single episode of excessive force

Stress or fatigue fracture –> repetitive episodes of “normal” force

Pathological fracutre –> “normal” force on abnormal bone

50
Q

How are fractures “described”

A

Anatomical location of fracture –> name of bone

Region of bone that is fractured –> diaphysis, metaphysis, physis, epiphysis

Direction of the fracture line –> transverse, oblique, spiral

51
Q

What is a comminuted fracture?

A

Fx w/ 3+ fragments

52
Q

What is a pathological fracture?

A

Fx in area of pre-existing bone dz

53
Q

What is an incomplete fracture?

A

Fx doesn’t span entire cross section of bone

54
Q

What is a segmental fracture?

A

Fx middle fragment of bone surrounded by proximal and distal segments

55
Q

What is a butterfly segment fracture?

A

Similar to segmental fx except fx doesn’t span entire cross section of bone

56
Q

What is a stress fracture?

A

Small fx caused by repetitive loading of bone

57
Q

What is an avulsion fracture?

A

Portion of bone is separated from bone caused from pulling of tendon or ligament @ insertion site

58
Q

What is a closed fracture?

A

Fx not exposed to external environment

59
Q

What is an open fracture?

A

Fx exposed to external environment

60
Q

What is displacement (translation) of a fracture?

A

Describes the position of DISTAL FRAGMENT –> anterior/posterior, medial/lateral

61
Q

What is rotation of a fracture?

A

IR/ER w/ observation

62
Q

What is shortening of the fracture?

A

Ends of the fx overlap

63
Q

What is angulation?

A

Direction in which the DISTAL FRAGMENT point –> ie lateral/medial angulation

64
Q

What happens to the bone upon the initial fracture?

A

Periosteum and blood vessels in the cortex and marrow are ruptured

65
Q

What are the 3 phases of bone healing and how long do they last?

A

Inflammatory (days up to 1 - 2 wks)

Reparative (up to several months)

Remodeling (months to years)

66
Q

Describe the inflammatory phase of bone healing

A

Increased blood flow into the area after acture response to fracture

Hematoma forms

Osteoclastic activity removes damaged bone

Growth Factors stimulate fibroblasts, osteoblasts @ site

67
Q

What does the x-ray look like during the inflammatory phase?

A

Fracture line becomes more visable as necrotic tissue is removed

68
Q

What forms during the reparative phase?

A

Soft fibrous callus forms –> hard callus (immature bone)

69
Q

What is responsible for soft callus mineralizing into the hard callus?

A

Osteoblasts

70
Q

What does the x-ray look like during the reparative phase?

A

Fracture line begins to disappear

71
Q

What happens during the remodeling phase?

A

Immature bone is replaced by organized mature bone

Fracture line disappears

72
Q

What is the criteria that goes into deciding when a fracture is healed?

A

Clinical judgement (pts pain, etc)

Radiographic apperance (callus formation and disappearance of fx line)

Anatomical location of fracture and device (different bones heal @ different rates)

73
Q

What are the factors that will vary healing time?

A

Age

Location

Type

Severity

74
Q

What are the clinical signs/symptoms of fractures?

A

Approriate history –> trauma, pathological, stress fracture

Localized pain

Pain w/ weight bearing

Edema/ecchymosis (bruising)

Loss of function and mobility

75
Q

What are the immobilization devices that promote secondary healing w/ periosteal callus formation?

A

Cast

Intramedullary rods/nails

Pins/wires/screws

External fixator –> less rigid fixation

76
Q

What type of healing does a compression plate use?

A

Primary bone healing –> NO periosteal callus formation –> longer healing time

77
Q

What is closed reduction?

A

Manual manipulation of the extremity to align the fracture fragments (when you broke your pinky)

78
Q

What is open reduction?

A

Surgical reduction of extremity to align the fracture fragments –> ORIF - open reduction and internal fixation

79
Q

What are some complications that can happen as fractures heal?

A

Delayed healing or non union –> avascular necrosis (femur head/scaphoid)

Infection

80
Q

What are some potential secondary complication of fractures (5 things)?

A

Potential growth impairments in kids

Long term disuse can have significant impact on elderly

Cardiopulmonary complications d/t immobilization

Bone - localized osteoporosis

Transient muscle atrophy

81
Q

What are the 5 types of salter harris fractures in developing bone?

A

Type 1 = disruption of growth plate (distraction or slip injury)

Type 2 = fx line through growth plate and metaphysis

Type 3 = fx line through growth plate and epiphysis

Type 4 = fx through metaphysis, growth plate, epiphysis

Type 5 = compression injury of growth plate

82
Q

What are the 2 types of bone formation?

A

Intramembranous ossification

Endochondral ossification

83
Q

What types of bone undergo intramembranous growth?

A

Flat bones: skull, face, mandible, clavicle

84
Q

How does intramembranous growth occur?

A

W/o cartilage model

85
Q

What is stage 1 of intramembranous ossification?

A

Undifferentiated mesenchymal cells differentiate into osteoblasts –> bone

86
Q

What is stage 2 of intramembranous ossification?

A

Osteoblast secretes bony matrix in surrounding fibrous membrane

Matrix –> clacified

Osteoblast = osteocytes “trapped” w/ matrix

87
Q

What is stage 3 of intramembranous ossification?

A

Formation of trabeculae - obsteoid form around invaginating blood vessels

Periosteum forms from mesenchymel cells

88
Q

What is stage 4 of intramembranous ossification?

A

Bone collar of compact bone forms

Red marrow is now formed w/ in trabeculae

89
Q

How does endochondral ossification growth occur?

A

Cartilage model –> bone REPLACES cartilage (cartilage not converted into bone)

90
Q

When does endochondral ossification occur?

A

Longitudinal bone growth during development

Appositional growth (widening) during early development

91
Q

What are the 2 cartilagenous growth zones that exist in immature long bone?

A

Spherical zone

Physis (epiphyseal plate)

92
Q

Where is the spherical zone found?

A

Around the end of the epiphysis (allows for growth of epiphysis)

93
Q

Where is the epiphyseal plate (aka grwoth plate) found?

A

Between metaphysis and epiphysis (allows for longitudinal growth)

94
Q

What are the 3 layers of the epiphysis?

A

Reserve Zone (early stages of cartilage cell)

Proliferative Zone (Mature Cartilage Cell)

Hpertrophic Zone (Cartilage cell hypertrophies, accumulate calcium then die –> obsteoblasts enter and form new bone)

95
Q

When do the epiphyseal plates fuse?

A

14 - 21 years

**earlier in females vs. males (earlier puberty)

96
Q

Which bones are 80% grown by age 8?

A

Spine

**premature closure of lower extremity growth plates will influence height more than spine

97
Q

During childhood which bones grow faster?

A

Extremities

Patho Summer Test #1 (8 decks)

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