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brs (phase 1b) > (msk) management of common orthopaedic conditions > Flashcards

(msk) management of common orthopaedic conditions Flashcards

1
Q

name the four types of bone cells

A

osteogenic cells
osteoblasts
osteoclasts
osteocytes

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2
Q

what are osteogenic cells?

A

bone ‘stem cells’

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3
Q

what are osteoblasts?

A

bone-forming cells

  • secrete osteoid
  • catalyse the mineralisation of osteoid
  • become trapped in the mineralised bone matrix
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4
Q

what are osteoclasts?

A

bone-breaking cells

  • dissolve and resorb bone via phagocytosis
  • derived from bone marrow
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5
Q

what are osteocytes?

A

mature bone cells

  • form when osteoblasts get trapped in their osteoid secretions and bone mineral matrix
  • detect mechanical strain & coordinate osteoblast and osteoclast activity
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6
Q

what do osteocytes do?

A
  • detect mechanical strain

- coordinate osteoblast and osteoclast activity

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7
Q

where are osteoclasts derived from?

A

bone marrow

unlike other bone cells which come from osteogenic cells

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8
Q

what are the types of bone?

A

first:

1) weak woven (made first, immature)
2) strong lamellar (replaces woven bone after mineralisation)

second: types of lamellar
1) cortical = compact/dense, useful for weight-bearing
2) cancellous/trabecular = spongy/honeycomb like, not for weight-bearing

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9
Q

describe the structure of cortical bone

A

made up of osteons

one osteon =

1) Haversian canal of blood vessels, nerves and lymphatics are surrounded by concentric lamallae
2) osteocytes are embedded in the lacunae of the lamellae
3) tiny canaliculi radiate from the lacunae + are filled with ECF to allow movement and migration
4) Volkman’s canal are perpendicular canals formed to connect adjacent Haversian canals

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10
Q

what do Haversian canals contain?

A

blood vessels, nerves and lymphatics

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11
Q

what are the lacunae of cortical bone?

A

osteocytes are embedded in the lacunae of the lamellae

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12
Q

what are the tiny canaliculi of cortical bone?

A

adiate from the lacunae + are filled with ECF to allow movement and migration

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13
Q

what are Volkman’s canals?

A

perpendicular canals formed to connect adjacent Haversian canals

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14
Q

describe the structure of long bones

A

1) periosteum = connective tissue covering
2) articular cartilage = on the surface of bone at a joint only
3) outer cortex = compact bone
4) cancellous/spongy bone = ends of long bones (red bone marrow)
5) medullary cavity =contains yellow bone marrow
6) nutrient artery

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15
Q

what are the functions of bone?

A

support

protection = surrounds major internal organs and vasculature

locomotion = joints to allow flexibility

haematopoiesis = red bone marrow

lipid and mineral storage = adipose tissue in yellow bone marrow & calcium in hydroxyapatite crystals

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16
Q

what are the three mechanisms of bone fracture?

A

trauma (low or high energy)

stress (abnormal stress on normal bone)

pathological (normal stress on abnormal bone)

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17
Q

what are some possible causes of pathological fractures?

A

osteoporosis

malignancy (primary or bone mets)

vitamin D deficiency (osteomalacia or rickets)

osteomyelitis

osteogenesis imperfecta

Paget’s

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18
Q

what are open and closed fractures?

A

open = fractured bone has pierced skin

closed = fractured bone has not pierced skin

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19
Q

what are the local complications of fractures?

A

urgent

  • nerve injury
  • vascular injury
  • local visceral injury
  • compartment syndrome

less urgent
- ligament or tendon injury

late

  • non-union
  • malunion
  • delayed union
  • avascular necrosis
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20
Q

what are the three types of joints?

A

fibrous
cartilagenous
synovial

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21
Q

what are the three types of fibrous joints?

A

sutures

syndesmosis

interosseous membrane

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22
Q

what are fibrous joints classified as?

A

synarthroses (allow no movement at the joints)

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23
Q

what are the two types of cartilaginous joints?

A

synchondroses (e.g. spine) = hyaline cartilage

symphyses (e.g. pubic symphysis) = fibrocartilage

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24
Q

what are cartilaginous joints classified as?

A

amphiarthrosis (allow limited movement at the joints)

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25
Q

what are the types of synovial joints?

A 
plane
pivot
hinge
condyloid
saddle
ball & socket
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26
Q

what are synovial joints classified as?

A

diarthrosis (allow free movement at the joints)

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27
Q

how are synovial joints stabilised?

A

muscles/tendons

ligaments

bone surface congruity

28
Q

what are the two components of cartilage?

A

1) chondrocytes

2) extracellular matrix (water, collagen, proteoglycans)

29
Q

what is the main proteoglycan present in cartilage?

A

Aggrecan

30
Q

what is the blood supply to the cartilage?

A

cartilage is avascular - it has no blood supply!

31
Q

describe the structure and function of Aggrecan

A

made up of many chondroitin sulphate and keratin sulphate chains

= can interact with hyaluronan to form proteoglycan aggregates

32
Q

what is osteoarthritis?

A

chronic degradation of articular, chondral cartilage in joint

= bones rubbing together increases friction, creating stiffness, pain, and impaired movement

33
Q

name the inflammatory mediators involved in osteoarthritis

A

1) proteinases
- matrix metalloproteinases (MMPs)
- aggrecanase

2) inflammatory cytokines
- TNFa
- IL-1B

34
Q

name the inflammatory cytokines involved in osteoarthritis

A

interleukin (IL)-1β

tumor necrosis factor α (TNFα

35
Q

what is the function of inflammatory cytokines in osteoarthritis?

A

enhance the synthesis of proteinases and other catabolic factors to degrade the articular cartilage membrane

36
Q

how does the cartilage appear in early stage and late stage osteoarthritis?

A

early stage = cartilage oedema

late stage = cartilage damage and loss

37
Q

what are the risk factors for osteoporosis?

A

age
hereditary
female gender

excess weight/obesity
osteonecrosis
mechanical constraints
joint injury
metabolic disease
infectious disease
38
Q

when do you get pain associated with osteoarthritis?

A
  • exertional
  • at rest (joint stiffness can occur, made better on movement)
  • at night
39
Q

what causes osteoarthritis?

A

mainly joint injury

maybe infection

40
Q

is osteoarthritis a monoarthritis or a polyarthritis?

A

develops in a singular joint at first BUT involves other joints as disease progresses

41
Q

how is osteoarthritis assessed?

A

look

feel (sweep test)

move (flexion, extension)

special tests (anterior/posterior draw, Lachmann’s)

42
Q

what key radiographic changes occur in osteoarthritis?

A

joint space narrowing

osteophytes (bone growths)

subchondral cysts

subchondral sclerosis

43
Q

how is osteoarthritis managed conservatively?

A

analgesics

physiotherapy

walking aids

avoidance of exacerbating activity

injections (steroid/viscosupplementation)

= PAWAIN

44
Q

how is osteoarthritis managed operatively?

A

replace (knee/hip)

realign (knee/big toe)

excise (toe)

fuse (big toe)

synovectomy (rheumatoid)

denervate (wrist)

45
Q

what is the term used to describe infection of bone?

A

osteomyelitis

46
Q

what is the term used to describe infection of joint?

A

septic arthritis

47
Q

how does osteomyelitis present compared to septic arthritis?

A

osteomyelitis = pain, swelling, discharge, fever, sweats, weight loss

septic arthritis = joint stiffness, swelling, fever, sweats, weight loss

48
Q

what causes septic arthritis?

A

bacterial infection of a joint (usually caused by spread from the blood)

49
Q

what are the risk factors for septic arthritis?

A

immunosuppressed

pre-existing joint damage

intravenous drug use (IVDU)

50
Q

what are the long-term effects of septic arthritis?

A

septic arthritis is a medical emergency!

untreated, septic arthritis can rapidly destroy a joint

51
Q

how many joints does septic arthritis affect?

A

monoarthritis usually

52
Q

how is septic arthritis diagnosed?

A

joint aspiration

send sample for gram stain, C&S

53
Q

what are the most common causative organisms for septic arthritis?

A

Staphylococcus aureus

Streptococci

Gonococcus

54
Q

how is septic arthritis treated?

A

intravenous antibiotics

joint lavage

(immobilise joint in acute phase, physiotherapy following acute phase)

55
Q

what is different about gonococcal septic arthritis?

A

often affects multiple joints (polyarthritis)

= less likely to cause joint destruction

56
Q

which investigations are commonly done for septic arthritis?

A

investigations = plain film, MRI, CT, bone scan

bloods = CRP, ESR, WBCC, TB culture/PCR (detects bacterial DNA in joint)

57
Q

how is osteomyelitis treated?

A

intravenous antibiotics

surgical drainage

removal of diseased bone = possible amputation

58
Q

what shoulder conditions occur most commonly in 15-45 year olds?

A

dislocations

fractures

59
Q

what shoulder conditions occur most commonly in 45-60 year olds?

A 
dislocation
fractures
ACJ osteoarthritis
rotator cuff tears
impingement
60
Q

what shoulder conditions occur most commonly in >60 year olds?

A

fractures
glenohumeral osteoarthritis
rotator cuff tears
impingement

61
Q

what hip conditions occur most commonly in 15-45 year olds?

A

developmental dysplasia
leg length discrepancy
impingement

62
Q

what hip conditions occur most commonly in 45-60 year olds?

A

osteoarthritis
avascular necrosis
impingement

63
Q

what hip conditions occur most commonly in >60 year olds?

A

osteoarthritis

total hip replacement

64
Q

what knee conditions occur most commonly in 15-45 year olds?

A

patellofemoral maltracking
ACL/PCL
meniscal tears
fractures

65
Q

what knee conditions occur most commonly in 45-60 year olds?

A 
osteoarthritis
patellofemoral maltracking
ACL/PCL
meniscal tears
fractures
66
Q

what knee conditions occur most commonly in >60 year olds?

A

osteoarthritis

brs (phase 1b) (71 decks)

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