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Pathophys II MHM - Exam 1 > MSK Module 1A > Flashcards

MSK Module 1A Flashcards

1
Q

Diaphysis of long bone

A

Primary ossification center

Body of bone

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2
Q

Metaphysis of long bone

A

Flattened portion of diaphysis

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3
Q

Epiphysis of long bone

A

Secondary ossification center (develop after birth)

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4
Q

Epiphyseal plate of long bone

A

Cartilagenous growth plate between diaphysis and epiphysis

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5
Q

Two types of bone tissue

A
  • Cortical

- Cancellous (spongy/trabecular)

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6
Q

Describe cortical bone

A
  • Compact bone
  • 80% of skeleton
  • Slow turnover rate
  • Dense tightly packed osteons with Haversian canal system
  • Volkman’s canal
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7
Q

Describe the Haversian system (osteon)

A
  • Structure of cortical bone

- Consists of: Haversian (central) canal, lamelle (concentric layers of bone), osteocytes within lamelle

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8
Q

What is Volkman’s canal?

A
  • Cortical bone

- Horizontal canal system connecting to periosteum

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9
Q

What are lamelle?

A
  • Cortical bone

- Concentric layers of bone surrounding Haversian canal

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10
Q

Describe cancellous bone

A
  • Trabecular/spongy
  • 20% of skeleton
  • Less dense but large SA
  • Higher turnover rate
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11
Q

Cancellous bone undergoes remodeling according to:

A

Line of stress

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12
Q

What is Wolff’s Law?

A

Increased mechanical stress will increase bone density

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13
Q

What is the periosteum?

A
  • Thin double layered fibrous membrane that surrounds bone

- EXCEPT at ligament or tendon insertion sites

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14
Q

What does the outer layer of periosteum contain?

A

Capillaries and nerves

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15
Q

What does the inner layer of periosteum contain?

A
  • Sharpey’s fibers (anchors periosteum to cortical bone)
  • Osteoblasts (if active bone formation)
  • Fibroblasts (if inactive formation, can become osteoblasts if new growth needed)
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16
Q

What is the function of bone marrow and what are the types?

A
  • Formation of blood cells
  • Red (active, spongy bone)
  • Yellow (inactive, medullary cavity of long bone)
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17
Q

What is the blood supply of bone?

A
  • Nutrient arteries
  • Epiphyseal/metaphyseal arteries
  • Periosteal capillaries
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18
Q

What are the phases of bone remodeling?

A
  1. Activation
  2. Resorption
  3. Reversal
  4. Formation
  5. Quiescence (resting)
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19
Q

What stimulates activation of bone remodeling? What is the action of activation?

A
  • Hormone, drug, physical

- Resting osteoblasts signal activation of osteoclasts

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20
Q

Describe the phase of resorption in bone remodeling

A
  • Osteoclasts break down bone

- Create a resorption cavity

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21
Q

Where is the resorption cavity in compact bone?

A

Follows longitudinal axis of Haversian canals

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22
Q

Where is the resorption cavity of cancellous bone?

A

Follows surface of trabeculae

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23
Q

Describe the reversal phase of bone remodeling

A

Macrophages clean up and prepare resorption cavity for laying down new bone

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24
Q

Describe the formation phase of bone remodeling

A
  • Osteoblasts lay down new bone in resorption cavity
  • Compact: concentric layers until canal is formed
  • Cancellous: trabeculae broken down and new ones formed
25
Q

Describe quiescence phase of bone remodeling

A

Osteoblasts “rest” and are now bone lining cells on newly formed bone surface

26
Q

Etiological classifications of fractures

A
  • Sudden traumatic (single episode of excessive force)
  • Stress/fatigue (repetitive episodes of normal force)
  • Pathological (normal force on abnormal bone)
27
Q

Systems of classifying fractures

A
  1. Anatomical location
  2. Region of bone (e.g. diaphysis)
  3. Direction of fracture line (transverse, oblique, spiral)
  4. Condition of bone (e.g. comminuted, incomplete)
  5. Condition of soft tissue (open, closed)
  6. Deformities of the fracture
28
Q

Define comminuted fracture

A

3+ fragments

29
Q

Define segmental fracture

A

Middle fragment of bone is fractured surrounded by proximal and distal segments

30
Q

Define butterfly segment fracture

A

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

31
Q

Define avulsion fracture

A
  • Portion of bone is separated from bone

- Caused from pulling of tendon or ligament at insertion site

32
Q

Displacement (translation) fracture

A

Position of distal fragment (anterior/posterior, medial/lateral)

33
Q

Define shortening of the fracture

A

Ends of the fracture overlap

34
Q

Define angulation of the fracture

A

Direction in which distal fragment points

35
Q

What is primary bone healing?

A
  • Bone stabilization very rigid
  • NO callus formation
  • Longer time until stable
36
Q

What is secondary bone healing?

A
  • Bone stabilization less rigid
  • Callus formation
  • Callus provides earlier stability
37
Q

Phases of bone healing

A
  1. Inflammatory
  2. Reparative
  3. Remodeling
38
Q

Inflammatory phase of bone healing

A
  • Days to 1-2 wks
  • Increased bloodflow into area
  • Hematoma forms
  • Osteoclasts remove damaged bone
  • GFs stimulate fibroblasts, osteoblasts
39
Q

When does fracture line become more visible on x-ray?

A

During inflammatory phase of healing as necrotic tissue is “removed”

40
Q

Reparative phase of bone healing

A
  • Up to several months
  • Soft fibrous callus forms initially, followed by hard callus (caused by osteoblasts)
  • Hard callus is considered immature bone (stable but weak)
41
Q

When does fracture line on x-ray begin to disappear?

A

During reparative phase of bone healing (months)

42
Q

Remodeling phase of bone healing

A
  • Months to years
  • Immature bone is replaced with mature bone
  • Fracture line disappears
  • Process begins during reparative phase
43
Q

Goals of fracture management

A
  • Achieve anatomic reduction
  • Restore stability
  • Promote joint ROM
  • Pre injury function
44
Q

How is a fracture determined healed?

A
  • Clinical judgment
  • Radiographic appearance
  • Anatomical location of fracture and device
45
Q

Methods of immobilization of fractures

A
  • Cast
  • Intramedullary rods/nails
  • Pins, wires, screws
  • Compression plate
  • External fixator
46
Q

Which immobilization methods are primary vs. secondary bone healing?

A 
Primary = compression plate (and external fixator in certain cases)
Secondary = everything else
47
Q

Define closed reduction and internal fixation (CRIF)

A
  • Manual manipulation of the extremity to align the fracture fragments
  • Should be done ASAP
48
Q

Define open reduction and internal fixation (ORIF)

A

Surgical reduction of extremity to align fracture fragments

49
Q

Fracture healing complications

A
  • Delayed or non-union
  • Avascular necrosis
  • Infection
50
Q

What is nonunion of fracture?

A

Localized pain and tenderness to fracture that persists longer than expected healing time

51
Q

Salter Harris (pediatric) fracture types

A

1: Disruption of growth plate
2: Fracture line through growth plate and metaphysis
3: Through growth plate and epiphysis
4: Through metaphysis, growth plate, and epiphysis
5: Compression injury of growth plate

52
Q

Intramembranous growth of bone

A
  • Formation of flat bones
  • Occurs w/o a cartilage model
  • Undifferentiated mesenchymal cells differentiate into osteoblasts
53
Q

Endochondral ossification growth of bone

A
  • Cartilage model

- Bone replaces cartilage

54
Q

Stages of intramembranous ossification

A
  1. Cluster of osteoblasts
  2. Bone matrix is secreted
  3. Formation of trabeculae
  4. Bone collar of compact bone forms and red marrow appears
55
Q

Two cartilagenous growth zones in immature long bone:

A
  • Spherical zone (around end of epiphysis, allows for growth)
  • Physis (epiphyseal plate, “growth plate”, allows for longitudinal growth)
56
Q

Layers of the physis (epiphyseal plate)

A
  1. Reserve zone - early stages of cartilage cell
  2. Proliferative zone - mature cartilage cell
  3. Hypertrophic zone - cartilage cell accumulates Ca and then dies, osteoblasts then enter and form new bone
57
Q

When do epiphyseal plates typically fuse?

A

Between ages 14-21

*Occurs earlier in females d/t earlier puberty

58
Q

80% of full spine growth has occurred by age:

A

8

59
Q

Extremities grow at a ____ rate throughout childhood than axial skeleton

A

Faster

Pathophys II MHM - Exam 1 (9 decks)

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