Ortho 1 Flashcards by Theresa Casinillo

Columns that are parallel to long axis of bone

Osteon/Harvesian System

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Concentric collagen fibers
Sheaths surround harvesian canal
Has lacunae

Lamellae

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Canal between lamellae and harvesian canal

Osteocytes occupy this area

Lacunae

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Oblique or transverse channels connecting osteons

Blood supply into bone or harvesian system

Volkmann’s canal

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2 types of bone development

Endochondral/cartilaginous

Membranous

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Bones from Endochondral/cartilaginous

Sternum
Scapula
Ribs
Spine
Pelvis
Long bones

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Bones from Membranous bone development

Facial bones
Cranial bones
Clavicle

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HIghly specialized connective tissue composed of branching cells, the osteocytes calcified in organic matrix

Bone

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COMPOSITION OF BONE? (and their percentage)

Organic - 20%
Inorganic - 70%
Water - 10%

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COMPOSITION OF BONE

Collagen fiber type I?

Organic

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COMPOSITION OF BONE

Hydroxyapatite?

Inorganic

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Hydroxyapatite composition?

Calcium
Phosphate
Carbonate

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Endochondral/cartilaginous phase

Hyaline cartilage will be derived from?

Mesenchymal tissue

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Mature osteoblast

Osteocyte

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Tiny, irregular channels that connects lacunae

Processes of osteocytes

Cannaliculi

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PARTS OF LONG BONE

Bone ends?
Cancellous bone between epi & diaphysis?
Bone shaft?

Epiphyseal growth plate - between metaphysis & epiphysis?

Epiphysis
Metaphysis
Diaphysis

Physis

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Fine layer of connective tissue in long bone?

Endosteum

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Outer fibrous covering in long bone?

Periosteum

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Every change in form & function is followed by definite change in its internal structure

Wolff’s Law

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Bone mass density is achieved in?

First 3 decades

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GS to assess BMD

DEXA

Dual Energy Xray Absorptiometry

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BMD

Normal?
Mod?
Osteopenia
Osteoporosis?
Osteoporosis c fragility?

Above 1 SD
Dec 1 SD
1-2 SD
>2 SD
\+/-2.5 SD

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MC in all bone disorders in adults

Osteoporosis

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OSTEOPOROSIS
Clinical finding?
Physical finding?

Codfish vertebra

Dowager’s hump

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MOI of achondroplasia?

MC form of short limb dwarfism?

Achondroplasia

Gap between 3rd and 4th fingers in achondroplasia?

Main en trident hand

FORMS OF SHORT LIMB DWARFISM | Similar to rickets?

Metaphyseal chondroplasia

FORMS OF SHORT LIMB DWARFISM Stippled calcification in epiphysis Mongoloid faces

Chondrodysplasia Punctata

FORMS OF SHORT LIMB DWARFISM | Similar to achondroplasia but milder form

Hypochondroplasia

FORMS OF SHORT LIMB DWARFISM | Not obvious at birth

Pseudoachondroplasia

FORMS OF SHORT LIMB DWARFISM Polydactyly Dysplastic fingers, distal shortening of FA & leg

Chondroectodermal Dysplasia

Chondroectodermal Dysplasia aka?

Ellis van creveld

FORMS OF SHORT LIMB DWARFISM Ext. ear deformity Kyphoscoliosis Clubfoot Hitchhiker's thumb

Diastrophic dwarfism

MOI of Diastrophic dwarfism

MOI of Chondroectodermal Dysplasia

Condition where there is increased bone density

OSTEOSCLEROSIS

2 types of OSTEOSCLEROSIS

Osteopoikilosis | Osteopetrosis

OSTEOSCLEROSIS | Spotted bones?

Osteopoikilosis

Osteopetrosis aka?

Marble bone disease | Albers-Schonberg Disease

(+) celery stalk - bone within bone

Osteopetrosis

Failure of osteoclastic activation

Osteopetrosis

Transforms muscle & fascia into immobile structures

Progressive M.O

Progressive diaphyseal dysplasia aka?

Engelmann's disease

Lack of vitamin D in infant

Rickets

Purpose of vit D

Increase absorption of Calcium

Lack of vitamin D in adults

Osteomalacia/Adult rickets

Lack of vit C

Scurvy

Purpose of vit C

collagen synthesis

Thickening of cranium Thickening & bowing of long bones Kyphosis Deafness

PAGET'S DISEASE

Increase osteoblastic activity | Increase osteoclastic activity

PAGET'S DISEASE

MC site for compression fx?

T8-L3

Describe the greenstick fx

Fx in convex side | Bent in concave side

Most stable fx

Impacted fx

Growth arrest in SALTER-HARRIS

Type IV

LEFORT CLASSIFICATION | Floating palate?

LEFORT CLASSIFICATION | Floating maxillae?

LEFORT CLASSIFICATION | Floating face?

III

LEFORT CLASSIFICATION | Low maxillary fx?

LEFORT CLASSIFICATION | Pyramidal fx?

LEFORT CLASSIFICATION | Craniofacial dysfunction?

III

LEFORT CLASSIFICATION | Horizontal fx?

LEFORT CLASSIFICATION | Bones affected in II?

Nasal bone Maxilla Inferior orbital rim

MOI of hangman's fx?

Hyper/ of the upper cervical spine

MOI of teardrop fx? | Affected?

hyperflexion of the spine (axial compression) | Anterior inferior of c. vertebral body

Fx of spinous process of C6C7T1

Clay shoveler's fx

Horizontal fx of T12 L1 L2

Chance/Lapbelt/Seatbelt fx

Galleazi fx aka?

Reverse Monteggia Dupuytren Fx of necessity Piedmont

Colle's fx aka?

Silverfork deformity | Poteau's fx

Smith fx aka?

Garden-spade deformity | Reverse colle

Fx of ulna

Nightstick fx

Fx of radial styloid process

Chauffer's fx

MC fx in automobile operator

Chauffer's fx

MONTEGGIA FRACTURE | Type I?

Fx of ulna diaphysis | anterior disloc of radius

MONTEGGIA FRACTURE | Type II?

Fx of ulna diaphysis | posterior disloc of radius

MONTEGGIA FRACTURE | Type III?

Fx of ulna metaphysis | anterolateral disloc of radius

MONTEGGIA FRACTURE | Type IV?

Fx of ulna and radius | disloc of radial head

MONTEGGIA FRACTURE TYPES MC? LC?

I | IV

Alvulsion fx in the base of 1st MCP?

Bennet's fx

Comminuted Bennet fx

Rolando fx

Boxer's fx

Neck of 5th MCP

Fx in the articular cartilage of capitulum

Kocher-Lorenz fx

Complete fx of capitulum

Hein-Steinthal fx

Palmar rim fx

Leutenner's fx

Fx/DL of wrist and carpal rim - Intra articular fx of distal radius - DL of radiocarpal joint

Barton's fx

Double vertical fx of pelvis

Malgaigne's fx

Avulsion fx of iliac wing

Duvurney's fx

Double vertical fx of pubis

Straddle fx

Ischioacetabular fx

Walther's fx

MC fx in elderly (LE)

Subtrochanteric fx

Type of fx where there is crushed cuboid

Nutcracker fx

Fx of lateral tubercle of talus

Shepherd's fx

MOI of Shepherd's fx

DF + Eversion

Trimalleolar fx of ankle

Cotton fx

MOI of Cotton fx

Forceful inv/ev

Fx of the shaft of 2nd MTT

March fx

Fx of the base of 5th MTT

Jone's fx

Fx of medial malleolus

Pott's fx

Fx of distal tibia and malleoli

Paratrooper's fx

Fx of fibula; 3-4 inches above ankle mortise

Maisonneuve's fx

LATE BONE COMPLICATIONS | Failure of the bones to consolidate in a given amount of time

Delayed union

HEALING IN FX UE? LE?

3-12 weeks | 12-18 weeks

5 stages in bone remodeling (in fracture)

``` Activation Resorption Reversal Formation Quiescence ```

SKIN TRACTION Pounds? For children?

5-6lbs Russel's Buck's

SKELETAL TRACTION Pounds? Commonly attached to?

20-30lbs Prox tibia

Attached to the skeletal traction to allow/permit MINIMAL FLEXION

Pearson attachment

Osteogenesis Imperfecta aka?

Brittle bones | Fragilitas Osium

Triad of Osteogenesis Imperfecta

Brittle bones Wedge-wood blue sclera Hearing loss (conductive)

Lysosomal storage disorder caused by enzymatic deficiency and intracellular accumulation and mucopolysaccharide

Mucopolysaccharidoses (MPS)

MC type of MPS

Type I: Hurler's Syndrome

Hallmark of Hurler's Syndrome

Hepatosplenomegaly

Only x-linked disorder in MPS

Type II: Hunter's Syndrome

MPS TYPES

``` I: Hurler's II: Hunter's III: San Filippo IV: Morquio's V & 7: no names VI: Maroteaux-Lamy ```

CONGENITAL AMPUTATION MC limb deficiency? MC birth fracture?

L terminal transverse radial limb Clavicle

ACQUIRED AMPUTATION Minor amputation? Major amputation?

Distal to MCP/MTP | Prox to MCP/MTP

Separation of distal radius and ulna to create a crude pinching mechanism

Krukenberg amputation

Hand deformity seen in pts with achondroplasia where in the thumb is proximally set and full ABD of thumb

Hitchhiker's thumb

TYPES OF FLAP AK? BK?

Fishmouth flap | Posterior flap

Function of the skin

PIRATESCO ``` Protection Insulation Receptors in dermis Aids in homeostasis Temperature regulation Elimination Synthesis of vit D Cosmesis Oil production ```

Epidermis regenerates every?

4-6 weeks

EPIDERMIS LAYERS

Come Let's Grab Some Beer ``` Stratum Corneum Stratum Lucidum Stratum Granulosum Stratum Spinosum Stratum Basale/Germinativum ```

EPIDERMIS LAYERS Waterproof characteristics Protection against infection

Stratum Corneum

EPIDERMIS LAYERS | Found only palm and soles

Stratum Lucidum

EPIDERMIS LAYERS Water retention Heat regulation

Stratum Granulosum

EPIDERMIS LAYERS | Protects basale

Stratum Spinosum

EPIDERMIS LAYERS (+) melanocytes Epidermal regeneraton

Stratum Basale/Germinativum

Dermis aka?

Corium/True skin

2 layers of dermis

Papillary | Reticular

DERMIS LAYERS | Contains fingerprint & footprint

Papillary (pingerprint & pootprint)

Hypodermis aka?

Subcutaneous tissue

Functions of Subcutaneous tissue

SICS Support Insulation Cushion Stores energy for the skin

SENSORY RECEPTOR - FNE Location? Sensation mediated?

Epi, dermis Pain, itch

SENSORY RECEPTOR - Merkel's disc Location? Sensation mediated?

Stratum spinosum Touch (M&M)

SENSORY RECEPTOR - Meissner's corpuscle Location? Sensation mediated?

Papillary dermis Touch

SENSORY RECEPTOR - Ruffini's Location? Sensation mediated?

Papillary dermis Heat/warmth (ruffinit)

SENSORY RECEPTOR - Krause's end bulb Location? Sensation mediated?

Papillary dermis Cold

SENSORY RECEPTOR - Pacinian corpuscle Location? Sensation mediated?

Reticular dermis Vibration, pressure

3 CONCENTRIC LAYER OF THE HAIR (from outer to inner)

Outer: cuticle Middle: cortex Inner: medulla

2 types of hair

Terminal hair | Vellus hair

Sweat glands aka?

Sudoriferous glands

2 types of Sweat glands?

Eccrine/Merocrine | Apocrine

Types of Sweat glands Found widely distributed on skin Help control body temp

Eccrine/Merocrine

Types of Sweat glands Found in axilla and genital areas

Apocrine

CAUSES OF DERMATITIS (ECZEMA)

Triple A Allergic Actinic Atopic

Superficial skin infection caused by staphy- & strepto-

Impetigo

(+) fever | caused by strepto- or staphy-

Cellulitis

Skin in Cellulitis is?

HER Cell Hot Edematous Red

A cavity containing pus & surrounded by inflamed tissue Caused by staphy infection

Abscess

Cold sore or fever blister in children

Herpes 1 (Herpes simplex)

Vesicular eruptions on genitalia

Herpes 2

HERPES ZOSTER | CN3 involvement?

Eye pain | Corneal damage

HERPES ZOSTER | CN5 involvement?

Loss of vision

Usually accompanied by fever, chills, malaise, GI disturbances

HERPES ZOSTER

Common, benign, caused by HPVs

Warts

``` Scalp ringworm? Beard ringworm? Body ringworm? Nail ringworm? Jock itch? Athlete's foot? ```

``` Tinea capitis Tinea barbae Tinea corporis Tinea unguium Tinea cruris Tinea pedis ```

Caused by mites that burrow unto skin causing inflammation, itching, redness & possibly pruritus

Scabies

Lice aka?

Pediculosis

Psoriasis commonly seen on?

``` Ears Scalp Elbows Fingers Knee Feet Genitilia ```

SLE that only affects skin that have flare ups c skin exposure

Discoid Lupus Erythematosus

In SLE, commonly affects what gender?

Young women

A collagen, vascular disease

SLE

Thickening, hardening of the skin

Scleroderma

Scleroderma - CREST Syndrome

``` Calcinosis Raynaud's Phenomenon Esophageal dysfunction Sclerodactyly Telangiectasis ```

Skin lesions accompanied by dermatitis

Dermatomyositis

A disease of connective tissue characterized by skin lesions with atrophy of proximal muscles

Polymyositis

Benign Tumors in skin

Seborrheic Keratosis Actinic Keratosis Common Mole/Nevus

BENIGN TUMORS IN SKIN | Proliferation of basal cells leading to raised lesions

Seborrheic Keratosis

BENIGN TUMORS IN SKIN | Proliferation of squamus cells

Actinic Keratosis

BENIGN TUMORS IN SKIN | Proliferation of keratocytes

Common Mole/Nevus

Malignant Tumors in skin

Basal cell carcinoma Squamus cell carcinoma Malignant Melanoma

SLOW GROWING epithelial basal cell tumor

Basal cell carcinoma

FAST GROWING tumor in skin

Squamus cell carcinoma

MALIGNANT TUMORS IN SKIN Characterized by ivory appearance Rolled border c indented center

Basal cell carcinoma

MALIGNANT TUMORS IN SKIN Flat, red area Ulcer, no nodule Poorly defined border

Squamus cell carcinoma

MC type in malignant melanoma

SSM | Superficial spreading melanoma

Clinical manifestations in malignant melanoma

ABCDE's ``` Asymmetry Border Color Diameter Evolving ```

Bluish discoloration of skin caused by extravasation of blood into the subcutaneous tissue

Ecchymosis

Itching aka?

Pruritus

Smooth, red elevated patches | Hives

Urticaria

Brawny edema

Non pitting edema

Excessive dryness of skin

Xeroderma

Example of Xeroderma

Harlequin type ichthyosis

SKIN LESIONS - Flat spots Less than 1cm >1cm

Macule | Patch

SKIN LESIONS -Palpable Elevated solid mass Less than 1cm? >1cm? Marble like lesion? Irregular, localized skin edema?

Papule Plaque Nodule Wheal

SKIN LESIONS - Flat spots Less than 1cm? >1cm? Containing pus?

Vesicles Blister/bulla Pustule

BURN WOUND CLASSIFICATION (+) blanching Brisk capillary refill

Superficial partial-thickness

BURN WOUND CLASSIFICATION (+) blanching Slow capillary refill

Deep partial-thickness

BURN WOUND CLASSIFICATION (-) blanching Poor distal circulation

Full-thickness

BURN WOUND CLASSIFICATION | Severe pain

Superficial partial-thickness

BURN WOUND CLASSIFICATION | Little to no pain

Deep partial-thickness

BURN WOUND CLASSIFICATION | Anesthetic

Full-thickness

BURN WOUND CLASSIFICATION | Intact blisters

Superficial partial-thickness

BURN WOUND CLASSIFICATION | Broken blister

Deep partial-thickness

``` BURN WOUND CLASSIFICATION Excessive scarring (raised scars) ```

Deep partial-thickness

BURNS - FORMATION OF RAISED SCARS Within boundary? Beyond boundary? Maturation of scars?

Hypertrophic Keloid 2 years

BURN WOUND ZONES

CaSH Zone of coagulation Zone of stasis Zone of hyperemia

SEVERITY OF BURN INJURY - 2ND DEGREE BURN Min? Mod? Major/Critical?

Less than 15% 15-30 >30%

SEVERITY OF BURN INJURY - 3RD DEGREE BURN Min? Mod? Major/Critical?

Less than 2% 2-10% >10%

Other criteria to be classified in major/critical in 3rd degree burn

``` Electric burn Smoke inhalation injury Burn with fractures Burn with complications Burn on face, hands, feet, perineum ```

MC of death in burns

Infections

Complications of electrical burn

SARC SCI Arrhythmias Renal failure Cataract formation

SKIN GRAFTS | Cadaver skin

Homograft/Allograft

SKIN GRAFTS | Animal skin

Heterograft/Xenograft

SKIN GRAFTS | Contains collagen & synthesis

Biosynthetic graft

BURNS - DEFORMITIES & ORTHOSIS >Neck POD? TOP? Orthosis?

Flexion Hyper/ Soft collar (cervical)

BURNS - DEFORMITIES & ORTHOSIS >Shoulder or axilla POD? TOP? Orthosis?

ADDIR Abd 90 ER Slight shoulder flexion Airplane (axillary) splint

BURNS - DEFORMITIES & ORTHOSIS >Elbow POD? TOP? Orthosis?

Flexion, FA pronation Extension, FA supination Posterior elbow splint

BURNS - DEFORMITIES & ORTHOSIS >Hand & wrist POD? TOP? Orthosis?

Intrinsic minus (claw hand) ``` Intrinsic plus Wrist / 15-20 MCP flexion 70 IP / Thumb slightly ABD ``` Resting hand splint

BURNS - DEFORMITIES & ORTHOSIS >Hip POD? TOP? Orthosis?

FADDIR EXABD & neutral rotation Post. hip splint

BURNS - DEFORMITIES & ORTHOSIS >Knee POD? TOP? Orthosis?

Flexion / Post. knee splint

BURNS - DEFORMITIES & ORTHOSIS >Ankle POD? TOP? Orthosis?

PF DF Plastic AFO

MC site for pressure ulcer in infants

Occiput

ULCER STAGES Shallow crater? Deep crater? Undermining/tunneling/rimming?

II III IV

WOUND DRESSINGS - DRY WOUNDS Best? Materials?

Hydrogel Hydrogel Transparent film Wet-to-wet/Continuous wet

WOUND DRESSINGS - MIN TO MOD EXUDATE Best? Materials?

Hydrocolloids Hydrocolloids Wet to dry

WOUND DRESSINGS - DRY WOUNDS | It can also use in stage 1 and 2 ulcer

Transparent film

WOUND DRESSINGS - MOD TO HEAVY EXUDATE Best? Materials?

Calcium Alginate | ``` CaSe IoCo Dry Calcium alginate Semipermeable film Iodosorb Collagen dressing Dry to dry / continuous dry ```

DAKIN'S SOLUTION Composed of? For?

Boric acid + bleach | HIV / AIDS

INFECTED WOUND 1st choice of solution? 2nd choice? 3rd choice?

PiNa HyPer ``` Povidone-Iodine (betadine) Na Hypochlorite (bleach & zonrox) Hydrogen Peroxide (agua oxinada) ```