Ortho 1 Flashcards
Columns that are parallel to long axis of bone
Osteon/Harvesian System
Concentric collagen fibers
Sheaths surround harvesian canal
Has lacunae
Lamellae
Canal between lamellae and harvesian canal
Osteocytes occupy this area
Lacunae
Oblique or transverse channels connecting osteons
Blood supply into bone or harvesian system
Volkmann’s canal
2 types of bone development
Endochondral/cartilaginous
Membranous
Bones from Endochondral/cartilaginous
Sternum Scapula Ribs Spine Pelvis Long bones
Bones from Membranous bone development
Facial bones
Cranial bones
Clavicle
HIghly specialized connective tissue composed of branching cells, the osteocytes calcified in organic matrix
Bone
COMPOSITION OF BONE? (and their percentage)
Organic - 20%
Inorganic - 70%
Water - 10%
COMPOSITION OF BONE
Collagen fiber type I?
Organic
COMPOSITION OF BONE
Hydroxyapatite?
Inorganic
Hydroxyapatite composition?
Calcium
Phosphate
Carbonate
Endochondral/cartilaginous phase
Hyaline cartilage will be derived from?
Mesenchymal tissue
Mature osteoblast
Osteocyte
Tiny, irregular channels that connects lacunae
Processes of osteocytes
Cannaliculi
PARTS OF LONG BONE
Bone ends?
Cancellous bone between epi & diaphysis?
Bone shaft?
Epiphyseal growth plate - between metaphysis & epiphysis?
Epiphysis
Metaphysis
Diaphysis
Physis
Fine layer of connective tissue in long bone?
Endosteum
Outer fibrous covering in long bone?
Periosteum
Every change in form & function is followed by definite change in its internal structure
Wolff’s Law
Bone mass density is achieved in?
First 3 decades
GS to assess BMD
DEXA
Dual Energy Xray Absorptiometry
BMD
Normal? Mod? Osteopenia Osteoporosis? Osteoporosis c fragility?
Above 1 SD Dec 1 SD 1-2 SD >2 SD \+/-2.5 SD
MC in all bone disorders in adults
Osteoporosis
OSTEOPOROSIS
Clinical finding?
Physical finding?
Codfish vertebra
Dowager’s hump
MOI of achondroplasia?
AD
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
AR
MOI of Chondroectodermal Dysplasia
AR
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?
I
LEFORT CLASSIFICATION
Floating maxillae?
II
LEFORT CLASSIFICATION
Floating face?
III
LEFORT CLASSIFICATION
Low maxillary fx?
I
LEFORT CLASSIFICATION
Pyramidal fx?
II
LEFORT CLASSIFICATION
Craniofacial dysfunction?
III
LEFORT CLASSIFICATION
Horizontal fx?
I
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)
