1
Q
what is the hard outer shell of the bone made of
A
cortical (compact) bone
2
Q
what is the interior of bone made of
A
cancellous (spongy) bone
3
Q
which portion of the bone contains nocireceptors, and is highly pain sensitive
A
periosteum
4
Q
does the bone marrow also have pain receptors?
A
yes
5
Q
how is pain from fx and OA characterized
A
deep somatic, dull, aching, poorly localized
6
Q
ossification centers are divided into
A
primary
secondary
7
Q
where is the primary ossification center located
A
diaphysis
8
Q
where is the secondary ossification center located
A
epiphysis
9
Q
name 4 things to look for in a bone xray
A
- bone destruction
- associated soft tissue changes
- alignment change
- bone deposition/proliferation
10
Q
how do you classify and describe fx’s? (8)
A
- age
- location
- number and nature of fragments
- open or closed
- direct, pattern, and type of fracture line
- relationship of fragments to one another
- subluxation or dislocation
- articular involvement
11
Q
what does distraction mean
A
increased length of bone (pulled apart)
12
Q
what does displacement mean
A
a gap forms where the bone breaks
13
Q
what does angulation mean
A
the ends of bone bone fragments are at an angle to each other
14
Q
how is angulation described (3)
A
- direction of distal fragment is angled in relation to proximal fragment
- varus/vagus
- direction apex is pointing relative to long axis of bone
15
Q
what is the most common type of angulation
A
direction of the distal fragment is angled in relation to the proximal fragment
16
Q
describe varus
A
inward angulation
(apex lateral)
17
Q
describe valgus
A
angled outward
(apex medial)
18
Q
what is an open (compound) fx
A
bone pokes thru the skin
19
Q
what is a closed fx
A
skin intact
20
Q
what is a major concern in a compound fx
A
osteomyelitis
21
Q
what 3 terms are used to describe fx location
A
- proximal
- mid-shaft
- distal
22
Q
what is this type of fx called
A
transverse fx
23
Q
what is this type of fx called
A
open/compound
24
Q
what is this type of fx called
A
oblique fx
25
what is this type of fx called
oblique, displaced
26
what is this type of fx called
comminuted
27
what is this type of fx called
segmental
28
what is this type of fx called
avulsion
29
what is this type of fx called
spiral
30
what is this type of fx called
greenstick
31
how do you describe the distal fragment of a fx in relation to the proximal fragment (4)
1. displacement
2. angulation
3. shortening
4. distraction
32
how do you describe this fx
distraction without displacement
33
how do you describe this fracture
lateral displacement without angulation
34
how do you describe this fx
complete lateral displacement with shortening and without angulation
35
how do you describe this fx
lateral angulation (30degrees) without displacement
36
how do you describe this fx
lateral displacement (~50%) and lateral angulation (about 45 degrees)
37
how do you describe this fx
complete medial displacement with shortening and lateral angulation (~45 degrees)
38
when you see a fracture in one part of a ring, what should you be looking for
a fracture in another part of the ring
39
how do you evaluate symmetry
compare it to the normal side
40
pediatric fractures at the end of long bones often involve
growth plates
41
what classification system is used to evaluate pediatric fractures
Salter-Harris
42
Salter-Harris - Normal
43
which type of Salter Harris fx is this
type I: complete physeal fx with or without displacement
44
which type of Salter Harris fx is this
type II - physeal fx that extends thru the metaphysis, producing a chip fx of the metaphysis, which may be very small
45
which type of Salter Harris fx is this
type III - physeal fx that extends thru the epiphysis
46
what type of salter harris fx is this
type IV - physeal fx PLUS epiphyseal and metaphyseal fx's
47
what type of salter-harris fx is this
type V - compression fx of the growth plate
48
a type II salter-harris fx extends thru the \_\_
and produces a \_\_
metaphysis
chip
49
a type III salter-harris fx extends thru the \_\_
epiphysis
50
a type IV salter-harris fx is a physeal fx that also involves fractures of the \_\_
and the \_\_
epiphysis
metaphysis
51
a type V salter-harris fx is a __ fx of the growth plate
compression
52
what type of fx is this
salter-harris type I
53
which class of salter-harris fx is this
salter harris type II
54
which class of salter-harris fx is this
salter-harris type 3
55
which class of salter-harris fx is this
type 4
56
which type of salter-harris fx is this
type V
57
why do salter-harris 5 fractures have a poor prognosis
they usually cause stunted growth
58
what does CRITOE refer to
ossification centers of the elbow
59
what does CRITOE stand for
capitellum → 2 years
radial head → 4 years
internal (medial) → 6 years
trochea → 8 years
olecranon → 10 years
external → 12 years
60
what type of pediatric fx is characterized by no discernable fx
bowing (bending) fx
61
what type of fx is this
greenstick → incomplete break in shaft
62
in what pt population do greenstick fx's usually occur
pediatrics → bones are more pliable
63
what type of fx 's are these
salter harris type 1
64
where do stress fx's usually occur
weight bearing bones →
tibia
metatarsals
femur
65
what type of pain do stress/fatigue fx's usually present with
nagging pain and tenderness
focal or generalized
66
stress/fatigue fx's may present with no
radiologic findings
67
stress/fatigue fx's may mimic
shin splints
68
what imaging might you order if you suspect a stress/fatigue fx, but xrays are normal
radionuclide bone scan
CT
MRI
69
name 3 common pediatric fx's
bowing (bending)
greenstick
buckle
70
toddler fx are __ tibial
2/2 to \_\_
spiral
twisting
71
when you are given a minimal or no hx of trauma, but find fx's in a child, what should you think about
child abuse
72
in pt's with child abuse fractures, what other injuries should you consider
subdural hematomas
subarachnoid hemorrhage
intracranial injury
brain injury
liver/spleen damage
73
what are 2 fx's characteristic of child abuse
1. bucket handle fx
2. corner fx
74
what is the mechanism of injury in child abuse fx's
direct blows and/or shearing injuries (twisting, pulling, shaking)
75
child abuse fx's are most commonly seen in what 2 age groups
1. infants → \<1 year
2. toddler → 1-3 years
76
multiple fx's separated by time and space, rib fx's, and skull fx's in pediatrics should make you consider
child abuse
77
what type of fx is this
bucket handle/corner fx
*classic metaphyseal injury*
78
what is the first step in evaluating spine films, especially c spine films
make sure the area of concern has been adequately imaged (the entire c-spine)
79
what pathology might wide interspinous spaces indicate
torn interspinous ligaments
80
fx's involving joints could lead to
arthritis
81
when assessing a fx, what surrounding structures should you document that you have evaluated
motor and sensory nerves distal to the fx
82
list 3 complications that could arise from fx if adjacent structures are damaged
compartment syndrome
DVT
pulmonary embolism
83
name 3 things to look for when evaluating joint xrays
joints involved
mineralization
joint space integrity
84
is there cartilage in the joints separating bone
no!
85
what do radiographic findings suggest
the underlying dx
86
arthritis is divided into what 2 classifications
clinical
radiographic
87
clinical dx of arthritis involves
evaluation of systemic dz w. joint manifestations
88
radiographic classification of arthritis invovles
dx of underlying dz
89
xrays in arthritis help determine
nature and extent of change after clinical evaluation
90
what types of arthritis involve clinical and systemic manifestations
non-tuberculosis pyogenic (septic) arthritis
advanced RA
psoriatic arthritis
hemophiliac joint dz
gout
neutrophic arthropathy
91
what types of arthritis involve xray as suggestive of the underlying dx
OA
early RA
chondrocalcinosis (pseudo gout)
ankylosing spondylitis
reactive arthritis
ochronosis
TB arthritis
aspetic
92
components of a synovial joint
synovial membrane
synovial fluid
articular cartilage
articular cortex
fibrous capsule
subchondral bone
associated ligamentous structure
→ arthritis can involve all
93
psoriatic arthritis is found in \_\_% of patients with
\_\_
23%
psoriasis
94
psoriatic arthritis is similar to
RA
95
5 presentations of psoriatic arthritis
small joints (fingers/toes)
asymmetrical
symmetrical polyarthritis → RA-like
arthritis mutilans → aggressive
psoriatic spondylitis → sacroiliac joints and spine
96
what is the most aggressive form of psoriatic arthritis
arthritis mutilans
97
leading cause of disability in elderly
OA of knee
98
what do you think when you see degenerative d.o → breakdown of articular cartilage in synovial joints, joint space narrowing, osteophytes, and loose bodies in joint space
OA
99
primary OA is
idiopathic
100
secondary OA is
2/2 to previously disturbed joint
101
\_\_ and
\_\_ joints are mc affected in OA
knee
distal interphalangeal
102
are women or men more affected by OA
women
103
septic arthritis is also called
pyogenic arthritis
104
septic arthritis (pyogenic) involves
rapid and severe joint destruction
105
septic (pyogenic) arthritis in adults mc affects
knee
106
septic (pyogenic) arthritis in kids mc affects
knee
hip
107
most common pathogen in spetic arthritis
s. aureus
108
what pathogens are more indolent and less destructive in → non pyogenic arthritis
TB
fungi
spirochaetes
109
what does this make you think of
septic arthritis
110
what is this showing
joint space loss
subchondral erosions
osteonecrosis
collapse of femoral head
→ **septic arthritis**
111
what are ensethiopathies
boney insertion sites of tendons and ligaments
112
what is chondrocalcinosis
calcification of soft tissue
build up of calcium compound crystals
113
mc affected sites in chondrocalcinosis
cartilage
menisci
cruciate ligaments
synovium
114
chondrocalcinosis is associated w. what diseases
lots! →
pseudogout
tophaceous gout
OA
familial CPPDDD
gout
hyperparathyroidism
hemochromatosis
and more!
115
what is this showing
chondrocalcinosis
116
what is this showing
chondrocalcinosis
117
what type of joint is the atlantoaxial joint
synovial
118
systemic manifestations of arthritis are diagnosed
clinically
Clin Med II - Exam 2
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