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MSK > Week 1 patho > Flashcards

Week 1 patho Flashcards

1
Q

When the basic framework of the organ is maintained such as the liver, the stable cells which are not injured will multiply, refill and regenerate (type of cell)

A

Stable cells

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2
Q

constantly multiplying like intestinal cribs (lining changes every 7 days) and the skin (type of cell)

A

Lebial cells

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3
Q

(neurons, cardiac muscles, skeletal muscles, lens of the eye) will not multiply. Except skeletal muscles which have some satellite cells which can regenerate (type of cell)

A

Perminant cells

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4
Q

definition of wound healing

A

tissue repair with replacement of damaged tissue with new healthy living tissue when resolution cannot occur

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5
Q

Two types of wound healing

A

1) regeneration: healing by the SAME type of tissue cells from surrounding viable cells
2) Fibrosis: healing by granulation tissue which matures and forms fibrous tissue (scars)
- organs with permanent/stable cells (EX: MI)
- Extensive tissue loss

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6
Q

Healing process divided into 4 distinct phases:

A
  • homeostasis phase
  • inflammatory phase
  • proliferative phase
  • remodeling phase
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7
Q

lamellar bone

A
  • collagen fibers arranged in parallel layers
  • normal adult bone
    cortical bone:
  • comprised of osteons (haversian system)
  • osteons communicate with medullary cavity by Volkmann’s canals
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8
Q

Woven bone (non-lamellar)

A
  • randomly oriented collagen fibers
  • in adults, seen at sites of fracture healing, tendon or ligament attachment and in pathological conditions
  • coarse with random orientation
  • weaker than lamellar bone
  • normally remodeled to lamellar bone
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9
Q

Bone composition

A

cells:
- osteocytes
- osteoblasts
- osteoclasts
Extracellular matrix
- Collagen type 1
- osteocalcin, osteonectin, proteogylcans, glycosaminoglycans, lipids

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10
Q

types of fractures: (8)

A
  • Greenstick - Incomplete fracture. The broken bone is not completely separated.
  • Transverse - The break is in a straight line across the bone.
  • Spiral - The break spirals around the bone; common in a twisting injury.
  • Oblique - Diagonal break across the bone.
  • Comminuted - The break is in three or more pieces and fragments are present at the fracture site.
  • Avulsion: Part of bone is pulled out
  • Impacted: 2 bones compact together
  • Fissure: Slight damage to external cortex “hairline fracture” or “pressure fracture”
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11
Q

Types of fractures:

6

A
  • simple (clean break)
  • comminuted (multiple bone fragments)
  • compound (breaking through overlying skin)
  • complicated (involving adjacent structures -blood vessels, nerves, etc.)
  • stress fractures: small linear fractures
  • PATHOLOGICAL FRACTURE: (not due to fall or trauma) fracture of bone weakened by disease (Ex: tumors, osteporosis, osteomalacia, Paget’s disease of bone)
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12
Q

Classification of fracture BY ETIOLOGY:

3

A
  • stress fractures: overuse injury due to repeated stress and impact (hairline fracture)
  • PATHOLOGICAL FRACTURE: (not due to fall or trauma) fracture of bone weakened by disease (Ex: tumors, osteporosis, osteomalacia, Paget’s disease of bone)
  • traumatic fracture: severe trauma
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13
Q

Healing of fractures:

Phases

A
  1. Reactive phase (inflammation)
  2. Reparative Phase
  3. Remodeling Phase
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14
Q

Reactive (inflammatory) Phase

A

bleeding from the fractured bone and surrounding tissue causes swelling:

  • hematoma
  • fibrin clot
  • inflammatory these are cells that will secrete cytokines and growth factors that will attract granulation tissue
  • Granulation tissue formation
  • osteoprogenitor cells
  • hematopoietic cells secrete growth factors
  • due to progenitor cells, blood vessels will proliferate locally and stem cells multiply so that there will be granulation tissue formation as well as fibroblasts which will produce healing, growth factors, and osteoprogenitor cells
  • *this stage begins the day 1 of the fracture and lasts about 2-3 weeks
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15
Q

Reparative Phase

A

Soft/Cartilaginous callus
- 2-3 weeks
- site of the fracture stiffens
- new bone begins to form (woven bone)
- cannot be seen on x-rays
- lasts until 4-8 weeks after the injury
•At site of fracture, because of laying down of collagen
fibers, mylocytes produce certain factors which will attract
periosteum off cells to lay down cartilage first, then they
Are replaced by osteocytes (bone cells)
Hard/Bony callus
- 4-8 weeks
- new bone begins to bridge the fracture
- bony bridge can be seen on x-ray (lamellar) (Used by doctors to see whether healing is taking
place properly or not)
- By 8-12 weeks new bone fills the fracture

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16
Q

Remodeling Phase

A

• Because soft callus is producing in great abundance and it needs to be converted into hard callus by growth of osteocytes into it and later depending on the bone involved, the pressure will cause
certain areas to lay down bone by osteoblasts and some areas to remove bone by osteoclasts
Bone remodelling
- Beginning 8-12 weeks
- fracture site remodels itself
- correcting deformities
- this stage can last several years

17
Q

Rate of remodeling varies by:

A

age. type of fracture, bone involved, and bone stablilization {Which is why
casts or plates or sutures are used: so that they heal by primary or secondary intention [• Primary intention: 2 ends of
bone are completely in contact with each other, immobilized and the haversian system itself takes on the healing
• Second intention: what had just been explained (by laying down new tissue)]}
- co-morbidity: (DM, malnutrition, peripheral vascular disease. hypothyroidism)
- medications (NSAIDs, corticosteroids, antibiotics, anticoagulants), smoking and alcohol consumption

18
Q

????

A 
1.Bleeding (hematoma) and
no blood supply will cause
death of bone
2. Attraction of Inflammatory
and granulation cells with
fibroblasts which initiate the
process of healing
4. Woven bone converted
into regular lamellar bone
3.Subperiosteum and periosteum
will secrete cartilage because of all
the growth factors and then you’ll
have subperiosteal bone
19
Q

Local regulation of bone healing

A

-growth factors
-cytokines
prostaglandins/leukotrienes
-hormones
-growth factor antagonists

20
Q

Local regulation of bone healing: growth factors

A 
-PLATELET-DERIVED GROWTH FACTOR
• stimulates bone cell growth
• increases type I collagen synthesis 
• stimulates bone resorption by increasing the number of osteoclasts
-INSULIN-DERIVED GROWTH FACTOR
• stimulates bone collagen and matrixx synthesis 
• stimulates replication of osteoblasts 
• inhibits bone collagen degradation
21
Q

cytokines responsible for excessive bone formation

A

IGF-1
IGF-2
FGF

**TGF-B , PDGF = bone formation and resorption

22
Q

cytokines responsible for excessive bone reabsorption

A

IL-1
TNF-a
TNF-B

**TGF-B , PDGF = bone formation and resorption

23
Q

Local regulation of bone healing: leukotrienes

-hormones

A
  • stimulate osteoblastic bone formation

- inhibit activity of osteoclasts (where it needs to be inhibited)

24
Q

Local regulation of bone healing: prostaglandins

A

-stimulate osteoblastic bone formation

25
Q

Local regulation of bone healing: hormones

A 
-Estrogen
• stimulates fracture healing
• modulates release of a specific inhibitor of IL-1 (IL-1 important for bone resorption so if estrogen inhibits that, it will stimulates fracture healing)
-thyroid hormones
• stimulate osteoclastic bone resorption
-Glucocorticoids
• increase osteoclastic bone resorption
26
Q

Local regulation of bone healing: vascular factors

A

-Metalloproteinases
• degrade cartilage and bone to allow invasion of vessels
-Angiogenic factors
• vascular-endothelial growth factors (mediate neo-angiogenesis & endothelial-cell proliferation)
• Angiopoietin (regulate formation of larger vessels and branches)

27
Q

Systemic factors: Factors that influence fracture healing

A
  • soft tissue injury
  • interruption of blood supply
  • interposition of soft tissue
  • bone necrosis: trauma, ischemia, infection, chemicals, etc.
  • involvement of joint structure
28
Q

Systemic factors: that decrease fracture healing

A

-malnutrition
• reduces activity and proliferation of osteochondral cells
• decreased callus formation
-smoking
• cigarette smoke inhibits osteoblasts
• nicotine causes VASOCONSTRICTION diminishing blood flow at fracture site
-Diabetes mellitus
• decreased collagen content
• defective cross-linking and alterations in collagen
• delay healing in every injury due to lack of collagen
-cardiovascular disease
-anti-inflammatory
• reduction in bone healing (such as NSAIDs)

29
Q

Factors which DELAY fracture healing: local factors

A
  • excessive movement of fractured bone during healing
  • type of fracture (Ex: extensive damage to fractured bone, i.e. bont necrosis in a comminuted fracture)
  • a poor intrinsic blood supply, e.g. lower tibia
  • severe local soft tissue injury or impaired blood supply
  • interruption of blood supply following fracture, e.g. head of femur, scaphoid
  • infection– only if overlying skin surface is broken, as in compound fracture
  • interposition of soft tissue in fracture gap, or wide separation of fracture ends
  • gross misalignment
30
Q

Factors which DELAY fracture healing: general factors

A
  • elderly patients
  • DM
  • drug therapy e.g. corticosteroids
  • any form of tobacco use
  • malnutrition (minerals, calcium intake, proteins and vitamin C deficiency)
31
Q

complications of fracture healing

A
  • DELAYED UNION
  • MALUNION (Bone didn’t heal straight and it healed in curved way)
  • NONUNION/PSEUDARTHROSIS (Two ends of bone don’t heal and in between there is fibrous tissue formation instead)
  • joint ankylosis, osteoarthritis
  • neurovascular injury
  • infection
  • growth abnormality
  • acute compartment syndrome

MSK (8 decks)

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