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Year 2 > MSK: Part 8 > Flashcards

MSK: Part 8 Flashcards

1
Q

Define fractures

A
  1. Soft tissue injury in which there is a break in the continuity of surface of substructure of the bone
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2
Q

Where do high energy injuries take place

A

Pelvic or femur fracture

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3
Q

What is the bone shaft in children called

A

Diaphysis

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4
Q

What is the peri-articular part of the bone called (ends of long bones)

A

Metaphysics

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5
Q

What is physics

A

Growth plate that has not fused

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6
Q

Blood supply of the epiphysis

A

Endoosteal and periosteal blood supply

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7
Q

Why is healing of bone better in children than adults

A

Children have an EXCELLENT PERIOSTEAL BLOOD SUPPLY so their rate of healing is MUCH HIGHER and is thus SIMPLE

More cancellous bone present in children which is softer - simple repair needed

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8
Q

Why are ligament damages in children very rare

A

They are extremely strong

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9
Q

Why do ligament injuries in children cause fractures

A

So strong - bone to bone

If they tear, they take the bone with it

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10
Q

Common fracture site in neonates

A

Humerus and clavicle due to fracture from birth

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11
Q

Common fracture site in infants

A

Radius

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12
Q

Common fracture site in children

A

Fibula, radius and femur

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13
Q

Common fracture site in adolescent

A

Tibia

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14
Q

What is an oblique fracture

A

Diagonal tear

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15
Q

What is a transverse fracture

A

Horizontal

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16
Q

What is a linear fracture

A

Vertical

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17
Q

What is a spiral fracture

A

Diagonal around the bone perimeter

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18
Q

What is a comminuted fracture

A

Section between bone is fragmented and separates the bone

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19
Q

What usually causes comminuted fracture

A

High energy impact

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20
Q

What causes a spiral fracture

A

Twisting injury

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21
Q

Where is an oblique fracture found

A

Ankle due to axial load injury

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22
Q

What age group is effected by greenstick fracture

A

SPECIFIC to children

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23
Q

What is a greenstick fracture

A

Unicortical fracture in which the bone bends and breaks due to thick periosteum

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24
Q

How easy is it to treat a greenstick fracture

A

EASILY because bone is not completely broken down

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25
Q

What is the salter-Harris fracture classification

A

Classification for fractures involving the physics (growth plate) - higher the number the more damage and worse prognosis

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26
Q

What are the most common parts of the bone that get fractures in children

A

Epiphysis

Metaphysis

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27
Q

Major complication of Salter-Harris fracture classification

A

GROWTH ARREST

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28
Q

How are fractures managed

A
  1. Reduce fracture -> restore length, alignment and rotation -> immobilise (to allow healing) -> rehabilitate
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29
Q

How do most kids fractures heal

A

Non-operatively due to extremely quick healing as a result of their thick periosteum with excellent blood supply

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30
Q

What deformity will be remodelled if there is more than 2 years growth left in a bone

A

Angular deformities

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31
Q

What deformity will not be remodelled if there is more than 2 years growth left in a bone

A

Rotational deformity

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32
Q

How do we tell if a child has angular or rotational deformity

A

Regular X-rays to ensure no rotational/angular movement

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33
Q

Treatment for paediatric fractures

A
  1. Internal operational fixation

2. External fixation

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34
Q

What is Internal operational fixation

A
  1. Plate, screws, intramedullary nails or K-wire
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35
Q

Complication of internal operational fixation

A

If nails or K-wire INVADE the physics (growth plate) then there will be growth arrest

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36
Q

When are external fixations done

A

Lots of soft tissue swellings and damage so don’t want to open skin to reduce risk of infection and bad healing

Ex-fix or Lizard flame

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37
Q

Complication of an open fracture

A

Infection

38
Q

Complication of fractures in general

A

Neuromuscular compromise
Malunion - bone heals with DEFORMITY
Non-union - Failure of bone to heal
Compartment syndrome

39
Q

What is compartment syndrome

A
  1. Painful condition in which the pressure within the fascia builds to dangerous levels usually caused by bleeding within the fascia
40
Q

Where is compartment syndrome common

A

Tibia

41
Q

What causes compartment syndrome

A

Cast (too tight) or post-op bleeding of fascia

42
Q

How is compartment syndrome treated

A

Fasciotomy where fascia is removed

43
Q

How do radiographs work

A

X-ray beam is directed through the body part under investigation and then into a plate

Various tissues absorb different amounts of X-ray beams

X-rays reach plate and are converted to light by phosphorescent effect

Light is then digitally recorded

The more X-ray radiation that reaches the detector, the darker the image becomes

44
Q

What colour is bone on X-ray

A

White

45
Q

What colour is soft tissue on x-ray

A

Light grey

46
Q

What colour is fat on x ray

A

Dark grey

47
Q

Cons of X-ray (non safety related)

A

Fractures take time to appear on X-ray

Early arthritis and early infection do not show

48
Q

When requesting a radiograph what do we need to ask for to get a full picture of the injury

A

TWO VIEWS of the body

49
Q

How does a CT work

A

Radiation source is fired through patient and then what passes is detected

Multiple slices of the body seen

AXIAL

50
Q

What people is CT dangerous for

A

Foetus and children are sensitive to radiation

Pregnancies unless condition is life-threatening

51
Q

How many days of background radiation is CT equivalent to

A

3 days

52
Q

When is a CT useful

A

Assess ACUTE injuries when X-rays are inadequate
Give greater information about known fractures
Assess fracture healing and complications such as infection
Look for loose bone fragments in joints
Gives excellent detail of bone and joint pathology

53
Q

When is an MRI preferred to CT in fractures

A

Soft tissue injuries

54
Q

How does a Ultrasound scan work

A

HIGH FREQUENCY SOUND WAVES pass through soft tissues and reflected at tissue interfaces - good res

Reflected waves or echoes are measured by probe

55
Q

Difference between normal ultrasounds and MSK ultrasounds

A

Uses highest frequency, linear array probes for better res of small soft tissue structures

56
Q

Why re ultrasounds safe

A

NO Radiation or magnetic field

57
Q

What sound wave should not be used in foetal scanning

A

Power doppler

58
Q

When is USS used

A

Tendon and ligament soft tissue injuries and anatomy

assessment for joints and synovial abnormalities, effusions and cortical erosions

Guide biopsies and fluid drainage

59
Q

How does an MRI function

A
  1. Patient is placed in a powerful magnetic field
  2. 30,000 x stronger than the earth’s magnetic field
  3. Scanner is narrow and often induces claustrophobia
60
Q

How does an MRI work

A
  1. T1 energy: released from spinning proton to surrounding lattice
  2. T2 energy relaxation: Released from spinning proton to adjacent spinning protons
61
Q

Pathology of MRI

A
  1. Abnormal tissues contain more water than normal tissues

diseases appear DARKER on T1 and brighter on T2

62
Q

Why are MRIs safe

A

No harmful effects from magnetic fields

63
Q

When is MRI contraindicated

A

Patients with electronic implants and metallic heart valves, neurosurgical clips, metallic foreign objects in the eye

64
Q

Consequence of metallic foreign objects in the eye if MRI is used

A

Transient tissue warming and visual disturbances

65
Q

Why should MRI be avoided in pregnancy

A

uncertain foetal safety

66
Q

Why is MRI used to assess bone fractures

A

Soft tissue pathology around bones and joints

Information on characteristics of tissue and pathology

Useful early in disease when plain radiographs may be normal

67
Q

Con of MRI

A

Early diseases can’t be seen

68
Q

When is Aldendronate given

A

Osteoporosis
Hypercalcaemia of malignancy
Myeloma and breast cancer bone metastasis as it reduces need for radiotherapy or surgery
Paget’s disease to reduce bone turnover and pain

69
Q

How do bisphosphonates function

A

Inhibit osteoclasts and promoting apoptosis

70
Q

Adverse effects of bisphosphonates

A
  1. Oesophagitis (orally)
  2. Hypophosphataemia
  3. Jaw osteonecrosis
71
Q

When should bisphosphonates be avoided

A
  1. Severe renal impairment
  2. Hypocalcaemia
  3. Upper GI disorders
72
Q

What compounds contraindicate bisphosphates

A

Absorption reduced by calcium products (antacids and iron salts)

73
Q

When is calcium and vit D given

A
  1. Osteoporosis
  2. CKD to stop secondary hyperparathyroidism and renal osteodystrophy
  3. Calcium used in severe hyperkalaemia in arrhythmias
  4. Symptomatic hypocalcaemia
  5. Rickets and osteomalacia (VIT D)
74
Q

What controls calcium homeostasis

A
  1. Parathyroid hormone and Vit D which increases serum calcium levels and bone mineralisation
  2. Calcitonin which reduces serum calcium levels

Restoring positive calcium balance reduces the rate of bone loss and prevents fractures

75
Q

Adverse effects of calcium and vit D oral medications

A
  1. Dyspepsia and constipation
  2. DO NOT USE in hypercalcaemia
  3. Calicum reduces absorption of iron, bisphosphonates and tetracycline antidepressants
76
Q

Example of Xanthine oxidase inhibitors

A

ALLOPURINOL

77
Q

Is allopurinol a chemotherapy drug

A

Yes - stops hyperuricaemia and tumour lysis syndrome

78
Q

How does allopurinol effect the plasma uric acid concentration

A

Lowers it

79
Q

Contraindications for xanthine oxidase inhibitor

A
  1. SKIN RASH
  2. not with ACUTE GOUT ATTACKS - worsens these
  3. recurrent skin rash already on the drug
  4. IF patient is on azathioprine
  5. Amoxicillin, ACEI or thiazides increase hypersensitivity risk
80
Q

Why is xanthine oxidase contraindicated with azathioprine

A

Requires xanthine oxidase for metabolism so allopurinol may increase their activity

81
Q

name an anti-gout agent

A

Colchicine

82
Q

Mechanism of colchicine

A

Inhibits neutrophil motility and activity which leads to a net anti-inflammatory effect which is useful in acute attacks

83
Q

Contraindications for colchicine

A
  1. GI disturbances
  2. fatigue due to anaemia
  3. Renal impairment
  4. Peripheral neuropathy due to peripheral nerve damage
  5. Toxicity enhanced when using statins
84
Q

How does methotrexate function

A

Inhibits dihydrofolate educates which converts dietary folic acid to FH4 (tetrahydrofolate) which is required for DNA and protein synthesis

85
Q

What is FH4 needed for

A

Lack prevents cellular respiration

Anti-inflammatory and immunosuppressive effects mediated by IL-6 and TNF-alpha

86
Q

Contraindications of methotrexate

A
  1. Sore mouth, GI upset, bone marrow suppression
  2. Hepatic cirrhosis and pulmonary fibrosis
  3. Severe renal impairment and abnormal liver function
87
Q

What is Dupytren’s contracture

A
  1. Where fingers become permanently bent in a flexed position
88
Q

What is hypothenar hammer syndrome

A

Occlusion of the ulnar artery and superficial palmar arch

89
Q

What is Cozen’s test

A

TEST FOR LATERAL EPICONDYLITIS:

Rested wrist extension causing pain in lateral epicondyle - extensor carpi radialis causes this

90
Q

What is repetitive strain disorder’s differential diagnosis

A

Tenosynovitis and epicondylitis

Year 2 (155 decks)

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