musculoskeletal Flashcards
what is compartment syndrome?
fracture in area, tight facial planes, swelling/bleeding, increased pressure = numbness/no blood supply
what is a le fort 1 fracture?
through palate
le fort 2?
through nasal bridge
le fort 3?
through zygomatic bone
3 phases of fracture healing?
- inflammatory
- reparative
- remodelling
what happens during inflammatory stage of healing?
bleeding + clot acute inflammatory resposne bone necrosis at fracture end macrophage removes dead material formation of vascular granulation tissue
which stage of healing do bisphosphonate impede?
inflammatory
at what time period does the reparative stage happen?
6-12 weeks
at what time period foes the remodelling stage happen?
up to 2 years
what is ORIF?
open reduction internal fixation
bone broken/reduced/put back in place
internal fixation device placed on bone e.g. plates, screws nails
4 stages of fracture management?
- reduction
- fixation
- immobilsation
- rehabilitation
complications of fracture fixation?
immediate - haemorrhage, tissue loss, nerve/vessel damage, compartment syndrome
local - necrosis, infection, failure to alignment
general - fat embolism, crush syndrome, DVT/PE
do patients with joint replacements require antibiotic proph?
no
where is calcium found in the body?
absorbed in intestine
stored in bones
stored in ECF In blood
excreted through kidneys
how is calcium carried in ECF in blood?
ionised calcium or protein bound
ionised = active
how does vit D effect calcium absorption?
increases absorption
how does PTH effect serum calcium?
increases serum calcium by increasing bone turnover
4 steps of bone turnover?
- osteoclasts
- osteoclast apoptosis
- osteoblasts
- resting phase
what protein is calcium bound to in blood?
albumin
active form of calcium in blood?
ionised
what does alkaline phosphatase levels mean and when is it increased?
shows levels of osteoblasts
increased in fracture + liver problems
what does high phosphate in blood suggest?
kidney failure
what do beta cross laps levels show?
osteoclastic activity
4 types of imaging to show fracture?
- xray
- ct/mri
- radioisotope scanning
- DEXA
2 types of hyperparathyroidism?
- primary - caused by tumour, high Ca + PTH
2. secondary - homeostatically correct caused by low Ca
what does vit d deficiency cause in adults?
osteomalacia
what does vit d deficiency cause in children?
rickets
3 causes of rickets?
low vit d, low ca intake, phosphaturia
why must patients with renal disease + hypoparathyroidism be given active metabolites calciferol + alphacalcidol instead of just vit D meds?
kidnes cannot activate precursors
what is pages disease?
disease of unknown aetiology causing uncoordinated bone remodelling
pain, deformity, increased fracture risk, compression of nerves (palsies, deafness)
most common treatment for pages disease?
bisphophanates - inhibit osteoclastic activity + prevent resorption
4 bone conditions bisphophonates are used for?
- pagets - high
- bone metastases - high
- hypercalcaemia - higher dose
- osteoporosis - low
prevent bone resorption in all
what Is osteoporosis?
generalised skeletal disorder
reduced bone density + impaired structure + increased fracture risk
causes of osteoporosis?
age post menopause steroid treatment (Cushings syndrome) chronic liver + kidney disease nutritional disorders affecting Ca + vit D
imaging for osteoporosis?
DEXA
treatment options for osteoporosis?
bisphophonates - low dose HRT Ca + vit D denosumab - monoclonal antibody injected 6 monthly PTH injections
which bisphophonates are taken orally weekly?
alendronate + risedronate
which bisphophonates are injected quarterly or annually?
ibandroante or zoledronate
what are bone metastases?
secondary malignant growths at distance from primary cancer
common primary sites of bone metastases?
breast, lung, prostate
what is myeloma?
malignancy of plasma cells in bone marrow
stimulates osteoclasts but not osteoblasts - can cause hypercalcaemia
what is the name for active vit D that increases ca absorption?
calcitrol
treatment for bone metastases?
radiotherapy
surgery for complications
pain relief
high dose IV bisphophonates or denosumab can reduce progression
what does the WHO ICF 2001 assess?
international classification of functioning, disability + health
impairments, activity limitations, participation restrictions
7 examples of inflammatory rheumatological disorders?
- rheumatoid arthritis
- psoriatic arthritis
- enteropathic
- ankylosing spondylitis
- reactive arthritic
- juvenile idiopathic arthritis
- gout
3 categories of rheumatological diseases?
inflammatory
mechanical
connective tissue disease
3 examples of rheumatological connective tissue disease?
- sjogrens syndrome
- SLE
- scleroderma
an example of mechanical rheumatoligcal disorder?
osteoarthritis
MOA of osteoarthritis?
wear of cartilage –> bone less protected –> pain –> less movement –> muscle atrophy
symptoms of osteoarthritis?
localised pain
pain on weight baring
advanced = non-weight baring
short lived early morning stiffness <30mins
pharmacological management of osteoarthritis
analgesics
NSAIDs
steroid injections
typical features of rheumatoid arthritis?
symmetrical hand joints at least 3 areas morning stiffness >60mins rheumatoid nodules serum rheumatoid factor
presentation of rheumatoid arthritis on radiograph?
inflammation causes bone loss
early - peri-articular osteoporosis + erosions
late - joint space narrowing, dislocation, ankylosis
3 pharmacological options for RA?
painkillers
NSAIDs
DMARD
what are DMARDs?
disease modifying anti-rheumatic therapy
5 commonly used DMARDs
- methotrexate
- sulphasalazine
- leflunomide
- hydroxychloroquine
- steroids
common DMARDs triple therapy?
methotrexate, sulphasalazine, hydroxychloroquine
why must you look harder if patients on biologics?
less likely to notice disease e.g. abscess
what do most DMARDs biologics end in?
-mab
what is ankylosing spondylitis?
inflammatory disease causing vertebrae to fuse
4 other manifestations of anklylosing spondylitis?
- iritis + conjunctivits
- pulmonary fibrosis
- fatigue
- aortic valve disease
what is the action of biologic DMARDs?
anti-TNF (high in inflammatory)
3 pharmacological treatments for anklylosing spondylitis
NSAIDS/coxibs
DMARDs - for peripheral arthritis
anti-TNF - for peripheral + spinal disease
clinical features of ankylosing spondylitis?
gradual onset teens/twenties morning/nigh stiffness persistence >6/52 improvement with exercise improvement with NSAIDs
clinical features of psoriatic arthritis?
dactylitits
iritis
enthesitis
RF is usually negative
what is reactive arthritis?
arthritis triggered by infection elsewhere
typically asymmetrical oligoarthritis
10-14days after infection
what is reiters syndrome?
reactive arthritis, urethritis + conjunctivitis
clinical features of sjogrens syndrome?
dry eyes + mouth
arthritis
chronic + incurable
risk of transformation to lymphoma originating within salivary gland
how do you position neck in patient with RA?
jaw thrust instead of neck lift/head tilt
why might osteogenesis imperfects be dentally relevant?
brittle bone disease - chest deformities - complicate GA/IV sedation
sign = blue sclera
what is osteopetrosis?
bone becomes harder - spongy bone not present, bone compacts, marrow space disappears
as marrow absent, less haematopoisis = anaemia
how might osteopetrosis effect XLA?
possible osteomyelitis caused by tooth snapping in socket as brittle + bone doesn’t loosen
what is fibrous dysplasia?
bone replaced with fibrous tissue
painless hard swelling in jaw
‘Chinese letter’ on xray
what is cherubim?
bilateral variant on fibrous dysplasia + giant cells
exclude hyperparathyroidism with blood tests
why are extractions difficult in pages disease?
hypercementosis of roots
complications of pages disease?
cardiac
chest deformaties
dentures get tighter
> 55yrs common
what happens to hands in RA?
ulnar deviation - OH hard
how to avoid osteoradionecrosis?
extractions prior to radiotherapy advised + cover bone with soft tissue
avoid extractions first 6months - 1 year after
don’t use vasoconstrictor
oral relevance of marfans syndrome?
high arched palate
patients with gout have increased risk of what 3 conditions?
hypertension
ischaemic heart disease
diabetes mellitus
dental anomalies in cleidocranial dysostosis?
delayey/no eruption
supernumerary teeth
