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130 Cards in this Set
- Front
- Back
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Osteomyelitis
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an acute or chronic pyogenic infection of the bone
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What are the 2 causes of osteomyelitis?
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contiguous: direct extension of an open fracture or wound
hematogenous: seeding through the bloodstream |
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Contiguous spread osteomyelitis is most commonly from what?
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direct contamination from an open wound
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Prosthetic joint infections present with what signs and symptoms?
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joint pain, fever, cutaneous drainage
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Contiguous spread osteomyelitis signs and symptoms are?
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persistent fevers, increased pain at trauma site, poor incisional healing, continued wound drainage and wound separation
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What is the treatment of contiguous spread osteomyelitis?
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antibiotics prophylactically and at early signs of infection; surgery if needed
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Hematogenous Osteomyelitis occurs most often in what population?
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children
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In what types of adult patients do you see Hematogenous Osteomyelitis?
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debilitated patients, patients with chronic skin infections, chronic UTIs, immunocompromised patients, IV drug users
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What are sequestra?
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devascularized fragments of bone formed during osteomyelitis
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What are Involucrum?
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a lesion in which bone information forms a sheath around the necrotic sequestrum
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Hematogenous Osteomyelitis affects what areas in children?
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long bones of the appendicular skeleton
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Hematogenous Osteomyelitis affects what areas in adults?
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vertebrae, sternoclavicular joint, sacroliliac joint, symphisis pubis
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Sign and symptoms of Hematogenous Osteomyelitis in children?
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abrupt high fever, irritability, malaise, restriction of mvmt in the involved extremity, signs of localized inflammation
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Signs and symptoms of hematogenous osteomyelitis in adults?
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insidious onset like a chronic infection
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What diagnostic test can be indicative of hematogenous osteomyelitis in the early stages?
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Bone Scan (changes can be seen 10-14 days before an xray)
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Treatment of hematogenous osteomyelitis include what?
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culture of blood and bone aspirate, abx, rest of affected limb, pain meds, possible debridement and surgical drainage
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Chronic osteomyelitis is seen in adults usually secondary to what?
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an open wound nearby
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Acute osteomyelitis becomes chronic when?
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at 6-8 weeks or when symptoms persist beyond normal healing time
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What are the signs and symptoms of Chronic osteomyelitis?
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non-healing ulcer or draining sinus, a sequestrum forms, an involucrum forms
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What is the treatment for Chronic Osteomyelitis?
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abx for possibly >6 wks, pain meds PRN, surgical debridement, amputation if necessary
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Osteomyelitis with vascular insufficiency is most common on what group of patients?
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Patients with chronic or ischemic foot ulcers in persons with longstanding DM or other vascular disorder
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What are signs of osteomyelitis with vascular insufficiency?
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local cellulitis, inflammation, necrosis
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What is the treatment of osteomyelitis with vascular insufficiency?
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debridement and abx, amputation if necessary
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TB of the bone and/or joint is caused by what?
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Mycobacterium TB
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How does TB travel to the bone?
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TB spreads from lungs or lymph nodes to bone
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TB of the bone is seen most often where?
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50% of cases are in the vertebrae
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What is the treatment for TB of the bone?
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AntiTB drugs are the first therapy and then surgery if needed
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Osteonecrosis is defined as what?
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Also called Avascular necrosis; defined as death of a segment of bone caused by interruption of blood supply to the marrow, medullary bone, or cortex
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What are the most common sites of osteonecrosis?
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1. femoral head
2. femur at the knee 3. humoral head |
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What are the most common post-traumatic sites of osteonecrosis?
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femoral head, humeral head, body of talus, carpal scaphoid
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What is the timeline for chance of osteonecrosis in a hip dislocation?
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>12 hours = 52% chance of necrosis
<12 hours = 22% chance of necrosis |
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What are the causes of osteonecrosis?
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fracture of the femoral neck, hip dislocation, decompression sickness, sickle cell, radiotherapy, Gaucher disease, high-doses corticosteroids
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What is the most common sign of osteonecrosis?
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pain, worsening with activity
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What is the treatment of osteonecrosis?
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treat the underlying cause, surgery as needed, NSAIDS/Acetominophen
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Primary malignant tumors of the bone are uncommon. True or False
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False
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Metastatic disease of the bone is relatively common.
True or False |
True
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Most common bone cancers occur in what patient population?
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children and young adults
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What are the most common bone cancers in children/young adults?
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osteosarcoma, Ewing's Sarcoma
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What is the most common bone cancer in adults?
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Chondrosarcoma
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What are the 3 major symptoms of bone tumors?
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pain, presence of a mass, impairment of function
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What characteristic of pain is suggestive of malignancy?
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pain that persists at night and is not relived by rest
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What are 3 characteristics of benign bone tumors?
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1. limited to the confines of the bone
2. have well-demarcated edges 3. surrounded by a thin rim of sclerotic bone |
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What are the 4 most common types of benign bone tumors?
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osteoma, chondroma, osteochondroma, giant cell tumor
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What benign bone tumor is found on the surface of a long bone, flat bone, or the skull?
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osteoma
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What is a tumor composed of hyaline cartilage found most commonly on hands and feet?
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chondroma
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This is the most common form of benign tumor in the skeletal system?
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osteochondroma
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This benign bone tumor grows only during times of skeletal growth and originates in the epiphyseal plate.
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osteochondroma
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This benign bone tumor is an aggressive tumor of multinucleated cells.
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giant cell tumor (also called osteoclastoma)
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This benign tumor often metastasizes to the bloodstream.
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Giant Cell Tumor
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This benign tumor occurs usually in pts in their 20s-40s and is most common in knee, wrist, and shoulder.
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Giant Cell Tumor
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Pathologic fractures are common in this benign tumor.
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Giant Cell Tumor
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What is the treatment for Giant Cell Tumor?
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surgical removal followed by radiation
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What are 3 characteristics of malignant bone tumors?
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1. tend to be ill defined
2. lack sharp borders 3. extend beyond the confines of the bone |
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The most common PRIMARY malignancy to AFFECT the skeletal system.
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Multiple Myeloma
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The most common primary malignant BONE tumor.
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Osteosarcoma
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Where is the most common location of osteosarcoma?
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vicinity of the knee
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This malignant bone tumor metastasizes often to the lung but seldom to the lymph nodes.
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osteosarcoma
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Diagnosis of a malignant bone tumor involves which tests/exams.
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radiologic staging; xray, CT, MRI, Bone Scan; Biopsy to confirm type of cancer
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After a diagnosis of osteosarcoma is made, which tests should be ordered?
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xray of the affected site and lungs (mets); MRI, CT, Bone Scan; Biopsy to confirm
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What is the treatment of osteosarcoma?
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surgery and malignant chemotherapy; Radiation does NOT work
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What are the most common sites of Ewing's Sarcoma?
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1. femur (usually teh diaphysis)
2. pelvis |
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What are the signs and symptoms of Ewing's Sarcoma?
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pain, limitation of motion, tenderness of involved area, fever, weight loss, pathologic fractures
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What are the most common sites of mets in Ewing's Sarcoma?
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lungs, bone marrow, other bones
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What is the second most common type of primary bone tumor in children and adolescents?
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Ewing's Sarcoma
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What is the treatment for Ewing's Sarcoma?
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chemo and surgery and radiation (the W = 3 fingers, so 3 txs)
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A tumor of cartilage that can develop in the medullary cavity or peripherally.
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Chrondrosarcoma
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The second most common form of malignant bone tumor.
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Chondrosarcoma
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This malignant bone tumor occurs in middle or later life, is slow growing, and is often PAINLESS.
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Chondrosarcoma
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What is required for diagnosis of Chondromsarcoma?
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biopsy
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What is the treatment for Chondrosarcoma?
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total surgical resection; chemo or radiation will NOT work
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More than 85% of bone mets are from which types of cancer?
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breast, lung, prostate
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Pain with evidence of impending fracture, usually worse at night, is a major symptom of what?
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metastatic bone disease
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What lab values are often elevated in metastatic bone disease?
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serum alk phos and calcium
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What is the treatment for metastatic bone disease?
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chemo, irradiation, surgical stabilization, bisphosphonates, treat hypercalcemia
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Forms the long axis of the body
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Axial Skeleton
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Includes the appendages: bones of the upper and lower limbs, shoulder and hip girdles
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Appendicular Skeleton
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How many bones are in the body?
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206
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What are the 2 connective tissues found in the body?
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cartilage and bone
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Connective tissue in which the intercellular matrix has been impregnated with inorganic calcium salts.
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Bone
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What are the types of bone?
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Compact and cancellous (spongy)
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Forms the outer shell of a bone
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Compact bone
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Composed of trabeculae or spicules of bone that form lattice-like pattern
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Cancellous Bone
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What are the types of bone cells and their "job" in the body?
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Osteogenic: pre-osteoblasts
Osteoblasts: builders Osteocytes: maintenance Osteoclasts: reclamation |
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What are the types of intercellular fibers found in skeletal tissue?
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collagen and elastin
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What are the 4 stages of Intramembranous Ossification?
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1. An ossification center appears in the tissue membrane
2. Bone matrix is secreted within the fibrous membrane 3. Woven bone and periosteum form 4. Bone collar of compact bone forms, and red marrow appears |
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Cartilage cells undergo mitosis, pushing the epiphysis away from the diaphysis: What functional zone is this?
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Growth Zone
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Older cells enlarge, the matrix becomes calcified, cartilage cells die, and the amtrix begins to deteriorate: What functional zone is this?
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Transformation Zone
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New bone formation occurs: What functional zone is this?
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Osteogenic Zone
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What element is essential for mineralization of bone?
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alkaline phosphatase
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Calcium is necessary for which functions in the body?
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1. transmission of nerve impuses
2. muscle contraction 3. blood coagulation 4. secretion by glands and nerve cells 5. cell division |
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What are the 2 control loops that regulate bone remodeling?
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1. hormonal mechanism maintains calcium homeostasis in the blood
2. mechanical and gravitational forces acting on the skeleton |
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A bone grows or remodels in response to the forces or demands placed upon it. This is the definition of what?
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Wolff's Law
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Location of hematopoietic tissue in adults.
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Diploe of flat bones (sternum, pelvis) and the head of the femur and humerus
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Location of hematopoietic tissue in infants.
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medullary cavity and all areas of spongy bones
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Define osteocytes, lacunae, and canaliculi with regard to the structure of compact bone.
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Osteocytes: mature bone cells
Lacunae: small cavities in bone that contain osteocytes Canaliculi: hairlike canals that connect lacunae to each other and the central canal |
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What is the inorganic part of the composition of bone?
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mineral salts
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What are the organic parts of the composition of bones?
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osteoblasts, osteocytes, osteoclasts, osteoid
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This type of cartilage contains no blood vessels or nerves.
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Skeletal Cartilage (3 types: hyaline, elastic, fibrocartilage)
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What is the most abundant skeletal cartilage?
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Hyaline Cartilage
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Found in the menisci of the knee and in intervertebral discs.
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Fibrocartilage
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Name the classifications of bones.
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Long bones
Short bones (aka Irregular Bones) Flat Bones |
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Lack of a joint cavity; move little or not at all. Name this class of joints.
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Synarthroses
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Connection by cartilage, limited mvmt. Name this class of joints.
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Synchondroses
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Fibrous disc and interosseous ligaments. Name this class of joints.
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Syndemosis.
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Freely movable joints. Name this class of joints.
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Diarthroses.
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What is the most common congenital foot deformity?
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toeing-in
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What is the usual cause of congenital metatarsus adductus?
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fetal position maintained in utero
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What is the most common cause of toeing-in in children younger then 2?
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internal tibial torsion
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Children with this problem often sit in the W position and treatment is sitting in tailor position.
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Internal Femoral Torsion
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Left untreated, Internal Femoral Torsion will cause what?
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the tibiae to become externally rotated (the knees turn in but the feet do not)
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What should be ruled out in the case of unilateral external femoral torsion?
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slipped capital femoral epiphysis
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An outward bowing of the knees >1 inch when the medial maleoli are touching.
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Genu Varum
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A deformity in which the medial malleoli cannot touch when the knees are touching.
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Genu Valgum
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A deformity of the medial half of the proximal tibial epiphysis that results in a progressive varus angulation below the knee.
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Blount's Disease
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Blount's Disease is seen most often in what patient population?
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black children, females, obese children, early walkers
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All children <2-3 yrs have flat feet. True or False.
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True
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Name and describe the types of flat feet.
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Flexible: arch decreases with weight bearing; less prone to pain and injury
Rigid: fixed flat feet with no arch at any time; seen with congenital conditions such as tight heel cords, JRA, cerebral palsy |
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When is the most vulnerable period for the development of limb deformities?
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4-7 weeks gestation
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OI is a hereditary disease characterized by defective synthesis of what?
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Type 1 collagen
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Describe Developmental Dysplasia of the hip. Which hip is affected more? More in girls or boys? What type of birth?
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Left hip is 3x more likely; 6x more likely in girls; 30-50% of DDH cases are breech
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What is used to treat DDH?
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Mild instability often resolves without treatment; Pavlik harness can be used
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What are the tests/exams you can do to diagnose DDH?
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Gelazzi Test, Ortolani Test, Barlow Test
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What patient population is most commonly seen in congenital clubfoot?
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males (2:1) and Hispanics
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What is the treatment for congenital clubfoot?
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if it can be passively corrected, no tx is needed; if not, serial manipulations and casting or surgery
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This disease is an osteonecrotic disease of the proximal femoral capital epiphysis.
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Legg-Calve- Perthes Disease
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What are the main symptoms of Perthe's Disease?
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pain in the groin, thigh or knee, difficulty in walking; may have painless limp
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This disease involves microfractures in the area where the patellar tendon inserts into the tibial tubercle.
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Osgood-Schlatter Disease
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In what patient population is Osgood-Schlatter Disease more common?
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boys 11-15 and girls 8-13
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When do symptoms of Osgood-Schlatter usually resolve?
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after closure of the growth plate
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What is the most common hip disorder in adolescents?
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SCFE
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