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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
what are the types of synovial joints?
``` plane pivot hinge condyloid saddle ball & socket ```
26
what are synovial joints classified as?
diarthrosis (allow free movement at the joints)
27
how are synovial joints stabilised?
muscles/tendons ligaments bone surface congruity
28
what are the two components of cartilage?
1) chondrocytes | 2) extracellular matrix (water, collagen, proteoglycans)
29
what is the main proteoglycan present in cartilage?
Aggrecan
30
what is the blood supply to the cartilage?
cartilage is avascular - it has no blood supply!
31
describe the structure and function of Aggrecan
made up of many chondroitin sulphate and keratin sulphate chains = can interact with hyaluronan to form proteoglycan aggregates
32
what is osteoarthritis?
chronic degradation of articular, chondral cartilage in joint = bones rubbing together increases friction, creating stiffness, pain, and impaired movement
33
name the inflammatory mediators involved in osteoarthritis
1) proteinases - matrix metalloproteinases (MMPs) - aggrecanase 2) inflammatory cytokines - TNFa - IL-1B
34
name the inflammatory cytokines involved in osteoarthritis
interleukin (IL)-1β tumor necrosis factor α (TNFα
35
what is the function of inflammatory cytokines in osteoarthritis?
enhance the synthesis of proteinases and other catabolic factors to degrade the articular cartilage membrane
36
how does the cartilage appear in early stage and late stage osteoarthritis?
early stage = cartilage oedema late stage = cartilage damage and loss
37
what are the risk factors for osteoporosis?
age hereditary female gender ``` excess weight/obesity osteonecrosis mechanical constraints joint injury metabolic disease infectious disease ```
38
when do you get pain associated with osteoarthritis?
- exertional - at rest (joint stiffness can occur, made better on movement) - at night
39
what causes osteoarthritis?
mainly joint injury | maybe infection
40
is osteoarthritis a monoarthritis or a polyarthritis?
develops in a singular joint at first BUT involves other joints as disease progresses
41
how is osteoarthritis assessed?
look feel (sweep test) move (flexion, extension) special tests (anterior/posterior draw, Lachmann's)
42
what key radiographic changes occur in osteoarthritis?
joint space narrowing osteophytes (bone growths) subchondral cysts subchondral sclerosis
43
how is osteoarthritis managed conservatively?
analgesics physiotherapy walking aids avoidance of exacerbating activity injections (steroid/viscosupplementation) = PAWAIN
44
how is osteoarthritis managed operatively?
replace (knee/hip) realign (knee/big toe) excise (toe) fuse (big toe) synovectomy (rheumatoid) denervate (wrist)
45
what is the term used to describe infection of bone?
osteomyelitis
46
what is the term used to describe infection of joint?
septic arthritis
47
how does osteomyelitis present compared to septic arthritis?
osteomyelitis = pain, swelling, discharge, fever, sweats, weight loss septic arthritis = joint stiffness, swelling, fever, sweats, weight loss
48
what causes septic arthritis?
bacterial infection of a joint (usually caused by spread from the blood)
49
what are the risk factors for septic arthritis?
immunosuppressed pre-existing joint damage intravenous drug use (IVDU)
50
what are the long-term effects of septic arthritis?
septic arthritis is a medical emergency! untreated, septic arthritis can rapidly destroy a joint
51
how many joints does septic arthritis affect?
monoarthritis usually
52
how is septic arthritis diagnosed?
joint aspiration send sample for gram stain, C&S
53
what are the most common causative organisms for septic arthritis?
Staphylococcus aureus Streptococci Gonococcus
54
how is septic arthritis treated?
intravenous antibiotics joint lavage (immobilise joint in acute phase, physiotherapy following acute phase)
55
what is different about gonococcal septic arthritis?
often affects multiple joints (polyarthritis) = less likely to cause joint destruction
56
which investigations are commonly done for septic arthritis?
investigations = plain film, MRI, CT, bone scan bloods = CRP, ESR, WBCC, TB culture/PCR (detects bacterial DNA in joint)
57
how is osteomyelitis treated?
intravenous antibiotics surgical drainage removal of diseased bone = possible amputation
58
what shoulder conditions occur most commonly in 15-45 year olds?
dislocations | fractures
59
what shoulder conditions occur most commonly in 45-60 year olds?
``` dislocation fractures ACJ osteoarthritis rotator cuff tears impingement ```
60
what shoulder conditions occur most commonly in >60 year olds?
fractures glenohumeral osteoarthritis rotator cuff tears impingement
61
what hip conditions occur most commonly in 15-45 year olds?
developmental dysplasia leg length discrepancy impingement
62
what hip conditions occur most commonly in 45-60 year olds?
osteoarthritis avascular necrosis impingement
63
what hip conditions occur most commonly in >60 year olds?
osteoarthritis | total hip replacement
64
what knee conditions occur most commonly in 15-45 year olds?
patellofemoral maltracking ACL/PCL meniscal tears fractures
65
what knee conditions occur most commonly in 45-60 year olds?
``` osteoarthritis patellofemoral maltracking ACL/PCL meniscal tears fractures ```
66
what knee conditions occur most commonly in >60 year olds?
osteoarthritis

brs (phase 1b) (71 decks)

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