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1B Musculoskeletal > Treating MSK conditions > Flashcards

Treating MSK conditions Flashcards

1
Q

what are the 4 main types of bone cells?

A

osteogenic

osteoblast

osteocyte

osteoclast

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2
Q

what are osteogentic cells?

A

bone stem cells

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3
Q

what are osteoblasts?

A

bone forming

secrete osteoid

catalyse mineralisation of osteoid

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4
Q

what are osteocytes?

A

mature bone cells

formed when osteoid becomes embedded in its secretions

sense mechanical strain to direct osteoclast and osteoblast activity

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5
Q

what are osteoclasts?

A

bone breaking

dissolve and reabsorb bone by phagocytosis

derived from bone marrow

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6
Q

what form the compact organisation of bone?

A

osteons- form cortical aspect of bone

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7
Q

how are osteon arranged?

A
  • Few spaces
  • Provides protection, support and resists stressed produced by weight and movement
  • Made up of:
    • Repeated structural units of osteons
      • Concentric lamellae around a central haversian canal
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8
Q

what do haversian canals contain?

A

blood vells, nerves and lymphatics

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9
Q

what is between haversian canals?

A

volkmans canal- transverse perforating canals

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10
Q

where do osteocytes exist in bone?

A

within concentric lamellae- in lacunae (small spaces)

tint canaliculi radiate from lacunae filled with ECF

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11
Q

where are osteoblasts and osteoclasts?

A

lining of bone (endosteum and periosteum)

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12
Q

what is the structure of bone?

A
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13
Q

what does the medullary cavity contain?

A

yellow bone

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14
Q

what is the connective tissue covering bone?

A

periosteum

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15
Q

what is the proximal structure of long bones in children?

A
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16
Q

what are the mechanisms of bone fracture?

A
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17
Q

what are the pathological causes of bone fracture?

A
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18
Q

what are the fracture patterns?

A

soft tissue integrity (open or closed)

bony fragments (greenstick, simple, multifragmentary)

movement (displaced, undisplaced)

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19
Q

what is the process of fracture healing pathologically?

A
  1. Inflammation
    1. Hematoma formation
    2. Release of cytokines
    3. Granulation tissue and blood vessel formation
  2. Repair
    1. Soft callus formation (type II collagen- cartilage)
    2. Converted to hard callus (type I collagen-bone)
  3. Remodelling (endochondral ossification)
    1. Callus responds to activity, external forces, functional demand and growth
    2. excess bone is removed
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20
Q

what is wolff’s law?

A

bone grows and remodels in response to the forces that are placed on it

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21
Q

what are the clinical signs of fracture?

A
  • Pain
  • Swelling
  • Crepitus
  • Deformity
  • Adjacent structural injury (nerves, vessels, ligaments, tendons)
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22
Q

what are the investigations of a fracture?

A

radiograph

CT

bone scan

MRI

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23
Q

what are the different angles of fracture displacement description?

A
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24
Q

when describing a radiograph what is displacement described relative to?

A

lower joint

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25
Q

what is the management of fractures?

A
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26
Q

what are the types of reduction techniques?

A
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27
Q

what are the types of hold techniques?

A
28
Q

what are the types of fixation?

A
29
Q

what are the rehabilitation techniques?

A
30
Q

what are the general fracture complications?

A
  • Fat embolus (hours)
  • DVT (days-weeks)
  • PE
  • Infection/sepsis
  • Prolonged immobility (UTI, chest infections (not breathing as deeply), sores)
31
Q

what are the immediate local complications of fracture?

A
  • Local visceral injury
  • Nerve injury
  • Vascular injury
  • Compartment syndrome
  • Hemarthrosis
  • Infection
  • Gas gangrene
32
Q

what are the less urgent complications of fracture?

A
  • Fracture blister
  • Plaster sores
  • Pressure sores
  • Nerve entrapment
  • Myositis ossificans
  • Ligament injury
  • Tendon lesions
  • Joint stiffness
  • Chronic regnal pain syndrome
33
Q

what are the late local complications of fracture?

A
  • Delayed union
  • Malunion
  • Non-union
  • Avascular necrosis
  • Muscle contracture
  • Joint instability
  • Osteoarthritis
34
Q

what is the anatomy of the neck of femur?

A
35
Q

what are the types of neck of femur fracture?

A
36
Q

what are the causes of neck of femur fracture?

A
  • Osteoporosis (older)
  • Trauma (younger)
  • Combination
37
Q

what is the important history of neck of femur fracture?

A
  • Age
  • Comorbidity
    respiratory/cardiovascular/diabetes/cancer
  • Preinjury mobility
    independent/shopping/walking/sports
  • Social hx: relatives, stairs,
38
Q

what is the treatment for neck of femur fracture?

A
39
Q

what is the classification of joints?

A
40
Q

what are the types of synovial joints?

A
41
Q

what are synovial joints stabilised by?

A
  1. Bone surface congruity
  2. Ligaments that connect each bone to another bone
  3. Muscles/tendons that stabilise
  • These factors vary by joint
42
Q

what is cartilage composed of?

A
  • 1) specialized cells (chondrocytes)
  • 2) extracellular matrix: water, collagen and proteoglycans
  • (mainly aggrecan)

Cartilage is avascular – it has no blood supply

43
Q

what is aggrecan?

A
  • a proteoglycan that possesses many chondroitin sulfate and keratin sulfate chains
  • characterized by its ability to interact with hyaluronan (HA) to form large proteoglycan aggregates
44
Q

what is the pathophysiology of osteoarthritis?

A
  • a long-term chronic disease
  • deterioration of cartilage in joints which results in bones rubbing together and creating stiffness, pain, and impaired movement.
  • Degenerative disease of chondral cartilage
  • Inflammatory mediators include proteinases, e.g., matrix metalloproteinases (MMPs) and aggrecanases, and inflammatory cytokines, including interleukin (IL)-1β and tumor necrosis factor α (TNFα)
  • which enhance the synthesis of proteinases and other catabolic factors to degrade the articular cartilage membrane
45
Q

what are the early and late stages of oeteoarthritis?

A
46
Q

what are the main risk factors of osteoarthritis?

A
  • Age
  • Excess weight/obesity
  • Mechanical constraints (intense sport, some professions)
  • Heredity
  • Female, menopause
  • Osteonecrosis
  • Leg bone malalignment
  • Oestrogen deficiency
  • Metabolic syndrome
  • Advanced hip osteoarthritis caused by spondylarthritis or rheumatoid arthritis
47
Q

what are other risk factors of osteoarthritis?

A
  • Injury: cruciate ligament rupture
    • Meniscectomy (surgical removal of meniscus)
  • Metabolic diseases (chondrocalcinosis, genetic haemochromatosis)
  • Infectious diseases involving the bone
  • Rheumatoid arthritis sequalae
48
Q

what are the signs of osteoarthritis?

A
  • Pain (exertional/rest/night)
  • Disability: walking distance/stairs/giving way
  • Deformity
49
Q

what history should be found out for osteoarthritis?

A
  • Previous history: trauma/infection
  • Treatments given (physio/injections/operations)
  • Other joints affected
50
Q

what are the radiographic changes of osteoarthritis?

A

Osteoarthritis: (LOSS)

L- loss joint space

O- osteophyte

S- subchondral cysts

S- subchondral sclerosis

51
Q

what is the conservative management of osteoarthritis?

A
  • Analgesics
  • Physiotherapy
  • Walking aids
  • Avoidance of exacerbating activity
  • Injections (steroid/viscosupplementation)
52
Q

what is the operative management of osteoarthritis?

A
  • Replace (knee/hip)
  • Realign (knee/big toe)
  • Excise (toe)
  • Fuse (big toe)
  • Synovectomy (Rheumatoid)
  • Denervate (wrist)
53
Q

what is an infection of bone called?

A

osteomyelitis

54
Q

what is an infection of joint called?

A

septic arthitis

55
Q

what are the features of osteomyelitis?

A
  • Acute or chronic
  • Primary or secondary
  • Pain/swelling/discharge
  • Systemic signs:
  • Fevers, sweats wt loss
  • often bacterial straight to bone through blood or bacteria on metal from operation
56
Q

what are the features of septic arthritis?

A
  • Pain
  • Joint swelling/ stiffness
  • Fevers, sweats, wt loss
  • Bacteria in joint (attach joint and synovium) can produce pus
57
Q

what is septic arthritis?

A

bacterial infection of a joint (usually caused by spread from blood)

58
Q

what are the risk factors of septic arthritis?

A

immunosuppressed

pre-existing joint damage

intravenous drug use (IVDU)

59
Q

what is the treatment of septic arthritis?

A

medical emergency -> untreated= destroy a joint

  • Surgery: joint washout and drainage (repeated if required)
  • Iv antibiotics (days/weeks)
  • Immobilise joint in acute phase
  • Physiotherapy once over acute phase
60
Q

what joints are affected in septic arthritis?

A
  • Usually only 1 joint is affected* (monoarthritis)
    • *gonococcal septic arthritis is an exception:
      • It often affects multiple joints (polyarthritis)

It is less likely to cause joint destruction

61
Q

when should septic arthritic be considered?

A
  • Consider septic arthritis in any patient with an acute painful, red, hot, swelling of a joint, especially if there is fever
62
Q

what is the diagnosis of septic arthritis?

A

joint aspiration. Send sample for urgent Gram stain and culture

63
Q

what common organisms cause septic arthritis?

A

streptococci

gonococcus

staphylococcus aureus

64
Q

what blood results should be taken with bone infections?

A
  • CRP: acute marker
  • ESR slower response
  • WCC
  • TB culture/PCR
65
Q

what is the treatment of osteoarthritis?

A
  • Antibiotics: iv weeks
  • Surgical drainage: especially collections/sequestrum
  • Chronic: antibiotic suppression/dressings
  • ??amputation

1B Musculoskeletal (7 decks)

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