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Pathophys Exam I > MSK Mod 1 > Flashcards

MSK Mod 1 Flashcards

1
Q

describe short bones

examples of short bones

A

tend to be equal in both dimension - cuboidal shape

carpals of wrist, tarsals of foot

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2
Q

function of flat bones and example

A

protective

skull

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3
Q

examples of irregular bones

A

vertebrae, facial bones

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4
Q

characteristics of long bone

A
  1. diaphysis
  2. metaphysis
  3. epiphysis
  4. epiphyseal plate
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5
Q

what is the diaphysis

A

primary ossification center

body of bone

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6
Q

what is the metaphysis

A

flattened portion of the diaphysis

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7
Q

what is the epiphysis

A

secondary ossification center (develop after birth)

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8
Q

what is the epiphyseal plate

A

cartilagenous growth plate bw diaphysis and epiphysis

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9
Q

two types of bone tissue

A 
compact (cortical)
and spongey (cancellous, trabecular)
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10
Q

cortical bone
how much of skeleton does it make up
turn over rate

A

forms 80% of human skeleton
slow turn over rate
dense, tightly pack osteons with Haversian canal system

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11
Q

what is the haversian system

A
  1. haversian canal - each canal contains blood vessel and nerve that communicate with periosteum
  2. concentric layers of bone surround the canal - lamelle
  3. osteocytes found within concentric layers
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12
Q

what is the canal system connecting to periosteum

A

Volkman’s canal - horizontal canal system

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13
Q

cancellous bone

A

20% of skeletal mass
less dense but large surface area
higher turnover rate
undergoes remodeling according to line of stress

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14
Q

what is Wolff’s law

A

increased mechanical stress will increase bone density

applies to cancellous bone

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15
Q

what is periosteum

A

thin, double layered, tough fibrous membrane that surrounds the bone
surrounds all of bone except at ligament or tendon insertion sites
-difficult to separate the periosteum from the bone

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16
Q

2 layers of periosteum

A
  1. outer

2. inner

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17
Q

what does the outer layer of periosteum contain

A

contains capillaries and nerves

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18
Q

what does inner layer of periosteum contain

A

-Sharpey’s fibers anchor periosteum (as well as tendons and ligaments) to the cortical bone

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19
Q

if there is active bone formation then the inner layer of periosteum contains

A

osteoblasts

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20
Q

if there is inactive bone formation then the inner layer contains

A

fibroblasts that can become osteoblasts if new growth is needed

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21
Q

what is the bone marrow

A

confined to cavities bw osseous component of bone

aka myeloid tissue

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22
Q

bone marrow consists of

A 
blood vessels
nerves
mononuclear phagocytes
stem cells
blood cells in various stages of differentiation
fatty tissue
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23
Q

function of bone marrow

A

formation of blood cells

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24
Q

two types of marrow in adults

A
  1. red

2. yellow

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25
Q

what is red bone marrow

A

active marrow
not all bones have active marrow
-pelvic bones, vertebrae, cranium and mandible, sternum and ribs, proximal femur, and humerus
-found in trabecular or spongy bone regions

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26
Q

what is yellow bone marrow

A

inactive marrow
yellow represents more of fatty cells
found in medullary cavity of long bone

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27
Q

3 examples of blood supply to bone

A
  1. nutrient arteries
  2. epiphyseal and metaphyseal arteries
  3. periosteal capillaries
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28
Q

what is the primary source of blood to the bone

A

nutrient arteries - enter middle of diaphysis

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29
Q

blood supply to the bone is critical for what

A

fracture repair and to maintain bone health

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30
Q

general healthy remodeling occurs in both

A

cortical and cancellous bone

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31
Q

bone remodeling happens when in life

A

throughout life

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32
Q

osteoporosis and relationship of osteoblast activity vs osteoclast acitivity

A

osteoblast activity

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33
Q

phases of bone remodeling

A
  1. activation
  2. resorption
  3. reversal
  4. formation
  5. quiescence
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34
Q

activation phase of bone remodeling

A

stimulus - hormone, drug, physical stimulus

action - stimulus activate resting osteoblasts to signal activation of osteoclastic activity

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35
Q

resorption phase of bone remodeling

A

action - osteoclasts break down bone, create a resorption cavity

  1. compact bone - resorption cavity follows longitudinal axis of Haversian’s canals
  2. cancellous bone - resorption cavity follow surface of trabeculae
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36
Q

reversal phase of bone remodeling

A

action - macrophages clean up the site and prepare it for laying down new bone

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37
Q

formation phase of bone remodeling-action

A

action - osteoblasts lay down new bone in resorption cavity

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38
Q

formation phase of bone remodeling - compact bone vs cancellous bone

A

compact bone - bone is laid down in concentric layers until small canal is formed (haversian’s canal); Haversian systems are constantly broken down with new ones being formed

cancellous bone - trabeculae are broken down and new ones formed

39
Q

quiescence phase of bone remodeling

A

action - osteoblasts rest and are now bone lining cells on the newly formed bone surface

40
Q

define a bone fracture

A

any defect in the continuity of a bone

41
Q

3 basic etiological classifications of fractures

A
  1. sudden traumatic fracture - single episode of excessive force
  2. stress or fatigue fracture - repetitive episodes of normal force
  3. pathological fracture - normal force on abnormal bone
42
Q

fracture classifications (3 parts)

A
  1. anatomical location of fracture (name the bone)
  2. region of the bone (diaphysis, metaphysis, physis, epiphysis)
  3. direction of fracture line (transverse, oblique, spiral)
43
Q

define comminuted fx

A

fx with 3 or more fragments

44
Q

pathological fracture

A

fx in area of preexisting bone dz

45
Q

define incomplete fx

A

fx does not span entire cross section of bone, bone is not broken into separate segments

46
Q

define segmental fx

A

fx middle fragment of bone surround by proximal and distal segements

47
Q

define butterfly segment fx

A

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

48
Q

define stress fx

A

small fx caused by repetitive loading of bone

49
Q

define avulsion fx

A

portion of bone is separated from bone caused from pulling of tendon or ligament at the insertion site

50
Q

what is a closed fx

A

fx not exposed to the external environment

51
Q

what is an open fx

A

fx exposed to the external environment

52
Q

deformities of fx - displacement

A

aka translation

describes the position of the distal fragment (ant/post, medial/lateral)

53
Q

deformities of fx - rotation

A

IR/ER with observation

54
Q

deformities of fx - shortening of fx

A

ends of fx overlap

55
Q

deformities of fx - angulation

A

direction in which the distal fragment points

ex. lateral/medial angulation

56
Q

bone healing with inital fx

A

periosteum and blood vessels in the cortex and marrow are ruptured

57
Q

3 phases of bone healing

A
  1. inflammatory phase
  2. reparative phase
  3. remodeling phase
58
Q

inflammatory phase of bone healing

  • what happens during
  • xray shows?
A

increased blood flow into area after acute response to fx
hematoma forms
osteoclastic activity removes damaged bone
growth factors stimulate fibroblasts, osteoblasts at site
xray - fx line becomes more visible as necrotic tissue is removed

59
Q

reparative phase of bone healing

  • whats happening?
  • xray shows?
A

soft fibrous callus forms initially followed by a hard callus

  • osteoblasts are responsible for mineralized soft callus causing hard callus to form
  • hard callus is considered immature bone - stable compared to soft callus but weak compared to mature bone
  • xray - fx line begins to disappear
60
Q

remodeling phase of bone healing

A

immature bone is replaced by organized mature bone
fracture line disappears
process begins during reparative phase

61
Q

length of inflammatory phase of bone healing

A

days up to 1-2 weeks

62
Q

length of reparative phase of bone healing

A

up to several months

63
Q

length of remodeling phase of bone healing

A

months to years

64
Q

goals of fx management

A
  1. achieve anatomic reduction
  2. restore stability
  3. create environment conducive to fx healing
  4. return pt to pre-injury function
  5. achieve acceptable cosmesis
65
Q

criteria to determine when a fracture has healed

A
  1. clinical judgement - pt’s pain
  2. radiographic appearance - callus formation with disappearance of fx line
  3. anatomical location of fx and device - different bones heal at different rates
    - ex. distal radial fx approx 6-8weeks vs mid diaphyseal fx approx 3 months
66
Q

avg healing time bw:
kids
adolescents
adults

A

kids - 4-6 weeks
adolescents - 4-8 weeks
adults - 10-18 weeks

67
Q

clinical s/s of fx

A
  1. trauma, pathological, stress fractures
  2. localized pain
  3. general rule of thumb - focused portion of bone regardless of direction of palpation
  4. pain with wt bearing
  5. edema, ecchymosis
  6. loss of function and mobility
68
Q

examples of long bones

A

humerus, femur, tibia

69
Q

examples of how to immobilize a fracture

A
  1. cast
  2. intramedullary rods/nails
  3. pins,wire,screws
  4. compression plates
  5. external fixator
  6. closed reduction
  7. open reduction
70
Q

how does a cast help immobilize a fx

A

secondary healing with periosteal callus formation

71
Q

how does intramedullary rods/nails immobilize fx

A

secondary healing with periosteal callus formation

72
Q

how does pins, wire, screws immobilize fx

A

secodnary healing with periosteal callus formation

73
Q

how does compression plate immobilize fx

A

primary bone healing, NO periosteal callus formation

-slower thus longer period of non-wt bearing

74
Q

how does external fixator immobilize fx

A

either primary or secondary healing will occur

  • if less rigid fixation: callus formation, secondary healing
  • if very rigid: no callus formation, primary bone healing
75
Q

how does closed reduction immobilize fx

A

manual manipulation of the extremity to align the fx fragments

76
Q

how does open reduction immobilize fx

A

surgical reduction of extremity to align the fx fragments

-ex. ORIF - open reduction and internal fixation

77
Q

healing complications of fx’s

A
  1. delayed or non-union
  2. avascular necrosis - femur head & scaphoid are common examples
  3. infection
78
Q

potential secondary complications of fx’s

A
  1. potential growth impairments in children
  2. long term disuse can have significant impact on elderly
  3. cardiopulmonary complications d/t immobilization
  4. bone - localized osteoporosis
  5. transient muscle atrophy
79
Q

what are pediatric fx called?

A

Salter Harris Fractures

80
Q

5 types of Salter Harris Fx’s

A

Type 1: disruption of growth plate - distraction or slip injury
Type 2: fx line thru growth plate and metaphysis
Type 3: fx line thru growth plate and epiphysis
Type 4: fx thru metaphysis, growth plate, epiphysis
Type 5: compression injury of the growth plate

81
Q

two types of bone formation

A
  1. intramembranous ossification

2. endochondral ossification

82
Q

what is intramembranous bone growth

A

formation of flat bones; occurs in skull, face, mandible and clavicle

83
Q

intramembranous growth pathophys

A
  • occurs without a cartilage model

- undifferentiated mesenchymal cells differentiate into osteoblasts which then form the bone

84
Q

stage one and two of intramembranous ossification

A
  1. cluster of osteoblasts form ossification center within fibrous connective tissue membrane
  2. osteoblast secretes bony matrix in surrounding fibrous membrane
    - matrix is then calcified - osteoblast are now osteocytes trapped within matrix
85
Q

stage three and four of intramembranous ossification

A
  1. formation of trabeculae - osteoid from around invaginating blood vessels; periosteum forms from mesenchymal cells
  2. bone collar of compact bone forms; red marrow is now formed within trabeculae
86
Q

what is endochondral ossification

A
  • has a cartilage model

- bone replaces cartilage (cartilage NOT converted to bone)

87
Q

endochondral ossification is responsible for

A
  1. longitudinal bone growth during development

2. appositional growth (widening)during early development

88
Q

what 2 cartilagenous growth zones exists in immature long bone

A
  1. spherical zone - around the end of epiphysis, allows for growth of epiphysis
  2. physis (epiphyseal plate) - between metaphysis and epiphysis; referred to as growth plate; allows for longitudinal growth
89
Q

3 layers of physis

A
  1. reserve zone - early stages of cartilage cell
  2. proliferative zone - mature cartilage cell
  3. hypertrophic zone - cartilage cell hypertrophies, accumulate calcium and then dies; osteoblasts then enter and form new bone
90
Q

epiphyseal plates typically fuse when?

A

bw 14-21 yo

91
Q

epiphyseal plates fuse earlier in males or females?

A

females - d/t earlier puberty of females

92
Q

how much of your spine is formed by the age of 8

A

80%

93
Q

extremities grow at a __________ rate than axial skeletal throughout childhood

A

faster

-premature closure of lower extremity growth plates will influence ht more than spine

Pathophys Exam I (9 decks)

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