Musculoskeletal part 1 Flashcards
normal bone mineral density
T score: -1 or greater
osteopenia
thinning of the trabecular matrix of the bone before osteoporosis
low bone mass
T score: between -1 and -2.5
osteoporosis
porous bone
T score: less than or equal to -2.5
severe osteoporosis
osteoporosis with a history of a fragility fracture
T score: less than or equal to -2.5
osteoporosis characteristics
-low bone mass
-micro architectural deterioration
-increase in bone fragility
-susceptibility to fracture high
osteoporosis
-actual breaks in the trabecular matrix have occurred
-usually bones in the hips, vertebrae, and wrists (trabecular bones)
major risk factors: osteoporosis
-aging
-female
-caucasian
-history fracture as adult
-family history
-body weight <127 lbs
-smoking
-alcohol
-corticosteroid therapy and immunosuppressive drugs
minor risk factors: osteoporosis
-thin, small frame
-lack of weight bearing exercise
-lack of calcium/vitamin D
-eating disorders
-gastric bypass surgery
-lack of estrogen/testosterone
-excessive caffeine consumption
osteoporosis patho
-increased bone resorption- osteoCLAST activity increased
-decreased bone formations-osteoBLAST activity decreased
-problem can be: failure to make new bone; too much bone resorption
manifestations of osteoporosis
early: none
-late: fractures, pain, loss of height, stooped posture (kyphosis)
complications of osteoporosis: hip fractures
-more common in those over 65
-more common in women
-most common location: proximal third of the femur
hip fracture clinical presentation
-sudden onset of hip pain before or after a fall
-inability to walk
-severe groin pain
-tenderness
-affected leg is externally rotated and shortened
fractures: definition and causes
-any break in the continuity of bone that occurs when more stress is placed on the bone that it is able to absorb
-traumatic- fall
-fatigue- repeated, prolonged stress
-pathologic- weakened bone, possibly spontaneous (highest risk in elderly)
closed vs. open fracture
-closed (simple): does not break through the skin
-open (compound)- fractured bone penetrates skin
fracture orientations:
-transverse: traumatic falls
-spiral: twisting injury
-comminuted: more than 1 fracture line and more than 2 bone fragments
-greenstick: incomplete break; mostly children
-stress: repeated use
clinical manifestations of fractures
-pain
-edema
-deformity: loss of function, abnormal mobility
3 phases of bone healing
- inflammatory- hematome
- reparative- fibrous cartilage, callous, ossification
- remodeling
complications of fractures
-delayed healing
-bone growth impairment
-compartment syndrome
-fat embolism syndrome
compartment syndrome
-seen with: crush injuries and cast
-results from increased pressure within limited anatomic space
-“tourniquet” effect- edema at fracture site puts intense pressure on soft tissue
-can lead to tissue hypoxia of muscles and nerves
-manifestations: edema, loss or weakened pulses, PAIN
fat embolism syndrome
-fat molecules in lung following: long bone fractures and major trauma
-how do they get there?
-fat molecules from bone marrow or traumatized tissue
-released into blood stream
-hypoxia, altered LOC, and petechiae (last symptom to occur)
osteomyelitis
-acute or chronic pyogenic (pus producing) infection of bone
-usual cause: bacteria- staph aureus
osteomyelitis risk factors
-recent trauma- open compound fracture
-diabetes
-hemodialysis
-IV drug use
-splenectomy
route of contamination: direct
-open wound
-open fracture
-gunshot
-puncture
-surgery
-surgery/insertion of meta plates or screws
route of contamination: indirect
-blood stream- most common
-bacteremia
osteomyelitis patho
-pressure increases within the bone
-causes local arteries to collapse
-decreases or eliminates supply of: oxygen, nutrition, immune cells, ANTIBIOTICS
-leads to impaired healing
-difficult to treat
osteomyelitis manifestations
-local: tenderness, warmth, redness
-wound drainage, restricted movement, spontaneous fracture
-systemic: fever, positive blood culture, leukocytosis
osteomyelitis pharm:
-obtain culture
-empiric antibiotic therapy: nafcillin, cefazolin, vancomycin
-bacteria specific therapy
