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Artritis > Skeletal Trauma > Flashcards

Skeletal Trauma Flashcards

1
Q

complete or incomplete disruption in continuity and structure of
the bone and/or cartilage.

A

Fracture

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2
Q

bone is ______,
(unequal in strength) and can withstand
mechanical forces differently

A

anisotropic

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3
Q

Cortical bone is stronger on

A

compression

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4
Q

Cortical bone is less resilient to

A

distraction

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5
Q

Cortical bone is most vulnerable to

A

shearing forces

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6
Q

situations that increase risk of fracture?

A
  • repeated loading and the resulting fatigue
  • local/systemic pathology
  • surgical pin holes or bone resection
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7
Q

Surgical pin holes or a site of bone resection may weaken the bone, known
as a?

A

stress raiser

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8
Q

seen in children as 3-types

A

incomplete fracture

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9
Q

3-types of incomplete fracture

A
  • Torus
  • Green stick
  • Plastic deformity
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10
Q
  • cortical buckling on compression
A

Torus

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11
Q

incomplete fracture on tension

A

Green stick

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12
Q

bending of the bone without angular break and

remodeling

A

Plastic deformity

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13
Q

transverse, oblique and spiral

A

Complete fracture

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14
Q

fragment of bone being detached by the tension from

muscles or ligaments

A

Avulsion fracture

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15
Q

typically corner fracture that is chipped rather than avulsed

A

Chip fracture

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16
Q

results in telescoping of osseous

trabeculae

A

Impaction (compression)

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17
Q

No typical radiolucent line is seen on radiographs and instead
a zone of sclerosis or condensation may be present describes what type of fracture?

A

Impaction (compression)

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18
Q

typically in the calvaria (cranial vault) and

occasionally in Tibial plateau

A

Depression fracture

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19
Q

repeated stress applied to normal bone –> marrow hyperemia and resorption

A

Stress (fatigue) fracture

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20
Q

examples of Stress (fatigue) fracture

A

March fracture of 2nd

or 3d Metatarsal bone, Tibial stress fractures in runners etc

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21
Q

normal stresses i.e. normal weight bearing, walking

applied to osteoporotic (involuted/insufficient) bone.

A

Insufficiency fracture

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22
Q

vertebral

osteoporotic fracture is an example of an Insufficiency OR pathologic fracture?

A

Insufficiency fracture

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23
Q

bone weakened by things such as neoplasms,

infection, congenital defect of collagen?

A

Pathologic fracture

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24
Q

more than 2-segments

A

Comminution (comminuted) fracture

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25
Q

2-subtypes of comminuted fracture

A

Segmental fracture and Butterfly fragment-

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26
Q

two separate fracture lines producing an isolated

segment of bone

A

Segmental fracture

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27
Q

wedge shaped fragment produced at the apex of the

maximum force

A

Butterfly fragment

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28
Q

Fx due to trabecular

telescoping and buckling

A

Torus fracture

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29
Q

deminiralised

bone is unable to adequately respond to normal mechanical stresses

A

insufficiency fracture

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30
Q

impaction/compression fracture of the anterior humeral head due to
posterior shoulder dislocation and compression by the posterior glenoid rim, so-called…

A

“trough sign”

during posterior GHJ dislocation

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31
Q

Depressed fracture most seen in what bones?

A

flat

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32
Q

skin intact and no exposure to outside aire = Closed fracture

A

Closed fracture

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33
Q

Position of fractures based on?

A

regions of the bone (metaphysis vs

diaphysis

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34
Q

Intra-articular fracture extension can lead to what type of complications?

A
  • delayed/abnormal healing
  • chondrolysis
  • secondary osteoarthritis
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35
Q

bone ends are not aligned is loss of?

A

apposition

36
Q

overlap of one fragment over another

A

Bayonet apposition

37
Q

complete loss of apposition

A

Distraction

38
Q

classification of pediatric growth plate injury

A

Salter-Harris classification

39
Q

classification of pediatric growth plate injury

A

Salter-Harris classification

40
Q

most vulnerable regions in the pediatric

skeleton

A

epiphyseal growth

plate and growth apophysis

41
Q

Why are the epiphyseal growth

plate and growth apophysis most vulnerable?

A

from the cartilagenous nature and metabolic activity

42
Q

fracture through growth plate itself often unrecognized

because of minimal displacement

A

Salter-Harris 1

43
Q

most common (>75%), fracture through physis and a part
of metaphysis forming a Thurston-Holland fragment. Good healing
prospects.

A

Salter-Harris 2-

44
Q

through the plate and into epiphysis

A

Salter-Harris 3

45
Q

fracture traverses metaphysis, physis and into epiphysis

A

Salter-Harris 4

46
Q

crush injury to growth plate, often unrecognized or

confused with type 1 but essentially damages physeal blood supply.

A

Salter-Harris 5

47
Q

which Slater-harris types are rare but show highest complications?

A

4 & 5

48
Q

Salter-Harris type 4 and 5 can lead to…

A

premature

plate closure, limb deformities, shortening and other sequela

49
Q

subtype of insufficiency fracture that develops

in bones with insufficient osteoid

A

Pseudo-fracture

50
Q

Fracture most seen in Rickets & Osteomalacia

A

Pseudo-fracture

51
Q

which type of fracture show very characteristic appearance on x-rays as
widened transverse radiolucent lines oriented at the right angle typically
to the medial cortex?

A

Pseudo-fracture

52
Q

Pseudo-fractues are also referred to as…

A
  • Looser zones
  • Milkman lines
  • umbau zones
53
Q

Typically found along the medial aspect of the cortex of long bones

A

Pseudo-fractues

54
Q

intra-osseous edema

A

bone bruise

55
Q

not detected by conventional radiographs and best

seen on MR imaging

A

bone bruise

56
Q

when injury and intra-osseous edema have
occurred
(Osteoclasts will become activated)

A

Occult fractures

57
Q

Best example of an occult fracture is Injuries to

A

carpal navicular or

scaphoid bone

58
Q

Occur in bones due to a mismatch of bone strength and chronic mechanical
stress

A

stress fracture

59
Q

complete loss of articular contact/alignment with resultant injury
to periarticular restraints

A

Dislocation

60
Q

partial loss of articular alignment

A

Subluxation

61
Q

separation of fibrous joints or fibrocartilagenous joints often seen
as suture diastasis in the scull and symphysis pubis

A

Diastasis

62
Q

Develops prior closure

of skull sutures (<3 y.o) as a result of tear in the dura

A

Growing skull fracture or leptomeningeal cyst (not true cyst)

63
Q

traumatic disruption of bone and periosteum causes

significant hemorrhage that initiates

A

fracture healing

64
Q

3-main phases of fracture healing:

A

1) Inflammatory (48-hours)
2) Repair (7-14-days)
3) Remodeling (9-24 months)

65
Q

Requirements for fracture healing:

A

a) good fragments apposition and normal blood supply
b) sufficient immobilisation with adequate physiological stress
c) absence of infection
d) absence of systemic factors

66
Q

hematoma and inflammatory mediators within first
48-hours initiate chemotaxis with phagocytes and repair cells being drawn
to fracture site (shortest phase)

A

Inflammatory phase

67
Q

cells involved during initial inflammation will gradually begin
to form granulation tissue and remove unwanted material and damaged
cell.

A

Repair phase

68
Q

During this phase within 7-14 days hematoma becomes vascularised
and may appear more translucent on x-rays.

A

Repair phase

69
Q

Damaged tissue will gradually become populated by fibroblasts and
chondrocytes and bone remodeling will begin

A

Repair phase

70
Q

Fracture callus still remains very vulnerable to shearing forces but may
be better stimulate if limited axial forces are applied.

A

Repair phase

71
Q

when population of cells will sufficiently evolve into
fibroblasts, chondrocytes and osteoblasts the osteoid and bone
mineralisation will continue.

A

Remodeling phase

72
Q

Remodeling phase on average may take

A

9-24

months

73
Q

pediatric fractures heal quicker due to _______ of the periosteum.

A

vascularity

74
Q

takes twice as long as physiologically expected

A

Delayed union

75
Q

no healing for >9-months:

A

Non-union (pseudoarthrosis

76
Q

2 types of Disturbed fracture healing

A
  1. Delayed union

2. Non-union

77
Q

3 types of non-union

A

a. hypertrophic
b. Hypotrophic
c. atrophic

78
Q
  • abnormal exuberant callus
A

hypertrophic non-union

79
Q

week callus with insufficient vascularisation and new bone

formation

A

Hypotrophic non-union

80
Q

absent callus often with synovial fluid or infected exudate

intervening between fracture ends

A

atrophic non-union

81
Q

healing occurred in abnormally positioned fracture ends

A

Malunion

82
Q
  • neurological and vascular injury
  • acute compartment
    syndrome and renal failure
  • pulmonary fat embolism
  • gas gangrene
A

IMMEDIATE complications of fracture

83
Q
  • osteomyelitis
  • sepsis
  • complex regional pain syndrome
    formerly known as RSDS
  • non-union/malunion
A

INTERMEDIATE complications of fracture

84
Q
  • ischemic necrosis (AVN)

- secondary osteoarthritis

A

LATE complications of fracture

85
Q

What type of fracture may sometimes cause

lead toxicity

A

Gun shot wound (GSW)

if bullet was lodged in peritoneal cavity

Artritis (7 decks)

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