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344 Cards in this Set
- Front
- Back
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What type of disease is RA?
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Inflammatory/autoimmune
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what is the most common chronic inflammatory arthritide?
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RA
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what percentage of the pop is affected by RA?
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1%- gen pop
2%- of the pop over 60 yrs old |
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what are the criteria for diagnosing RA?
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must have at least 4...
1.stiff in the morning (at least 1 hr) jelling phenomenon 2. swelling (3+ joints) 3. swelling (wrist, pip, mcp) 4. swelling (symmetric) 5. Rheumatoid nodules 6. Pos Rheumatoid factor test 7. Radiographic changes ` |
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what anatomical structure does RA affect?
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synovial lining
inflammatory enthesopathy synovial lining of tendon sheaths and burasae |
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What are the positive lab findings for RA?
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1.+ RA factor (sheep. agglutination test)
2. decreased mucin precipitate (synovial fluid) 3. synovium - villous hypertrophy, superficial synovial cell proliferation, marked inflammatory cell infiltrate fibrin deposition, foci of cell necrosis 4. nodules - granulomas with central necrosis, proliferated fixed cells, peripheral fibrosis, chronic inflammatory cell infiltrate. 5. uniform joint space loss, marginal erosions |
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what is the classical distribution of RA?
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Bilateral and symmetrical
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typical Age of onset for RA?
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20-60 yrs
peak onset - 40-50yrs |
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RA - most commmon in women or men?
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women - 3:1
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Classic place of distribution?
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Hands and feet - PIPs, MCP, wrists (proximal)
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when the SI joint is affected by RA is it most commonly affected unilaterally or bilaterally?
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unilaterally
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define jelling phenomenon.
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a stiffness w/inactivity or disuse
starts w/ PIPs and moves proximally |
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what percentage of pts with RA in hands will also dev changes in their cervical spine?
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80%
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what percentage of pts dev rheumatoid nodules?
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20% - extensor surfaces, non-tender
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what are Haygarths nodes?
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swelling of the MCP joints
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4 clinical findings assoc with RA?
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Raynauds phenomenon
tendon rupture pannus formation sjogrens syndrome |
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What is sjogrens syndrome?
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keratoconjunctivitis sicca (dry eyes)
xerostomia (dry mouth) RA |
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what type of anemia is assoc with RA?
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normochromic , normocytic
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how does RA affect the leukocyte count?
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normal or increased
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what does RA do to the ESR and c-reactive protein levels?
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increases
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what percentage of pts with RA have RA factor?
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70%
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what is a Pannus?
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granulation tissue and inflamed synovium
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what forms around the pannus?
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marginal erosions
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what is the first radiographic sign of RA?
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periarticular soft tissue swelling
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what are the radiographic findings of RA?
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1. periarticular soft tissue swellign
2. juxtaarticular osteoperosis 3. uniform loss of joint space 4. marginal "rat bite" erosions 5. juxta-articular periostitis 6. large pseudocysts 7. deformities |
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what is the earliest sign of RA?
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soft tissue swelling around the joint
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what is the earliest joint alteration of RA?
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marginal erosions - 2nd and 3rd met heads and the PIPs. (radial side)
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what deformities are associated with RA?
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Swan neck- flex dip, ext PIP
Boutoniere- flex PIP, ext DIP ulnar deviation |
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what is usually the first site of wrist involvment for RA?
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distal ulna
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In RA, erosion of the lateral ulna styloid is caused by what?
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extensor carpi ulnaris
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what is the spotty carpal sign associated with RA?
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multiple erosions of carpals
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what other conditions also have the spotty carpal sign?
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CPPD, infections, PA, Gout
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What is the zig zag sign assoc with RA?
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Radial deviation of the proximal row with ulnar deviation of the fingers
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what is the terry thomas sign assoc with RA?
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scapholunate dislocation
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what is the m/c site of erosions in the foot b/c of RA?
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5th MTP - lateral side
all other erosions - medial side |
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what is the lanois deformity assoc with RA?
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fibular deviations and dorsal subluxations of the MTP jts
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what is the m/c migration of the femoral head in RA?
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axial migration
m/c bilateral protrusio acetabulae |
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what joints in the shoulder are m/c affected by RA?
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Glenohumoral
A/C |
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which way does the humorous m/c migrate?
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superior
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what percentage of RA pts have an abnormal fat pad?
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90%
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what are fad pads caused by?
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intraarticular efusion (swelling in the joint)
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in the knee RA causes a large posterior soft tissue mass called?
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bakers cyst
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location of m/c involvement of foot joints ?
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tarsal and mortise jt/s (eventually ankyloses)
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what are the radiographic signs d/t RA in the cervical spine?
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dens ersosions
widened ADI - 3mm - adults - 5 mm kids subluxations below cervical level facet erosions loss of disc space (pannus) |
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what radiographic changes are seen on the occiput/c1 with RA?
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atlas collapse
dens protrudes into foramen magnum (causes basilar invagination) ankylosis neck shortens w/ dens invagination |
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what causes instability in the c1/c2 area with RA?
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ligamentous laxity/disruption
increased ADI |
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what is the name for erosions on the dens?
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whittleing of the dens
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what deformity gives the vertebra a sharpened pencil appearance?
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erosion of the spinous process
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what happens to the vertebra to give them a step ladder appearance ?
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anterior displacements of the vertebra
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what conditions are considered juvenile rheumatoid arthritis ?
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PA, JRA, AS, all prior to 16yrs old
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what inflammatory conditions are considered Juvenile chronic arthritis?
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PA, AS, JRA , prior to 16 yrs old
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what makes an inflammatory condition seropositive?
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presence of RA factor
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what percentage of JRA types are seropositive?
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10% - poorest prognosis
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what RA diseases are considered seronegative?
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classic systemic disease (20%)
polyarticular diesease pauciarticular/monoarticular stills |
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what signs and symptoms are associated with classic systemic disease?
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High, acute, intermittent fever
Lymphadenopathy Hepatosplenomnegaly Polyserositis Carditis Leukocytosis |
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what is the m/c form of JRA?
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polyarticular disease - 50%
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does polyarticular disease affect males or females more?
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females 2:1
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what is the most common form of seronegative JCA to demostrate definite radiographic changes?
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pauciarticular disease
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how many joints are involved in pauciarticular/monoarticular disease?
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4 or fewer
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what percentage of JRA patients develop pauciarticular/monoarticular disease?
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30%
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patients with pauciarticular/monoarticular disease also may develop iridocyclitis . what is iridocyclitis?
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inflammation of the iris and ciliary body that can cause you to go blind
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what are pathological changes associated with JCA?
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inflammation of the synovium
bony ankylosis (RA is fibrous ankylosis) Growth disturbances |
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what are radiological features associated with JCA?
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soft tissue swelling
periostitis osteoperosis articular erosions ballooning (metaphyseal overgrowth) bony ankylosis fusion of growth plates uniform loss of joint space |
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what is the main target of JCA?
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hands and feet (spares the DIPS)
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In JCA where is ankylosing m/c seen?
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wrist - mid and hind
foot IP joints |
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what disease is the tibiotalar slant deformity seen?
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JRA
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what pathological changes are seen in the knee with JCA/JRA?
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Squaring” of the inf pole of the patella
Widening of the intercondylar notch Ballooning of the epiphysis |
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what is the m/c c/s level affected by JRA/JCA?
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C1-C4
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what c/s levels are most affected by ankylosing of the facets d/t JRA/JCA?
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C2-C4
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aka for ankylosing spondylitis?
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marie strumpells disease
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define avulsion fracture.
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a fracture at the attachment of a ligament or tendon pulled from the parent bone
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define comminuted fracture.
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two or more fractures/ fragments/line - result of greater force or more rapid application. butterfly, wedge shaped fragment in shaft or long bone at apex or injury
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define diastatic fractures
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separation injury of synarthrodial joint
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define occult fracture
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fracture with out radiographic evidence . re-exame 10-14 days to better visualize the fracture line
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what is the m/c area affected by a salter-harris fracture?
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radial epiphysis
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what is a type 1 salter harris fracture?
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isolated injury through physis (growth plate)
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what is a type 2 salter-harris fracture?
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fracture through physis to metaphysis - small metaphyseal portion = thurston holland
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what is a type 3 salter harris fracture?
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through physis into epiphysis - m/c distal tibia . intra-articular and secondary changes may result from the injury
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what is a type 4 salter harris fracture?
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fracture extends through all 3 layers. metaphysis , physis, epiphysis. oblique or spinal fractures . m/c lateral condyle of humerous
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what is a type 5 salter harris fracture?
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compression injury to physis with no associated fracture to the epiphysis or metaphysis. looks normal on x-ray
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what are two types of impaction fractures?
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depression
compression |
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describe what a depression fracture is.
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one bone is driven into the adjacent bone
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what is a compression fracture?
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articular surfaces of bone approximate on one another
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what are two types of stress fractures?
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fatigue fx
insufficiency fx |
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what is the difference between a fatigue fx and a insufficiency fx?
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fatigue - d/t abnormal stress (repeated)
insufficiency - d/t normal stress (repeated) |
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define - aviator fx
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compression fx of the talar neck
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define barroom fx
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transverse fx of neck of 4th and 5th metacarpal
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define bartons fx
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RIM fx. interarticular fx of the posterior rim of distal radius
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define a bedroom fx
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fx of phalanx in foot (bed post)
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define bennetts fx
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fx-dislocation , intra-articular fx of metacarpal base with dorsal radial displacement of the shaft
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define a boxer fx
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transverse fracture of neck of the 2nd and 3rd metacarpal neck
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define a bucket-handel fx
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superior dislocation and fx of the posterior acetabular rim
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define bumper fx
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compound fx of lateral tibial plateau caused by valgus force
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define a chance fx
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aka seat belt fx, fulcom fx, transverse fx, through the spinous process and neural arch that extends into and possibly through the vertebral body
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define chauffeurs fx
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aka back tire, aka hutchinson, undisplaced fx of radial styloid
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define chisel fx
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proximal radius fx orientated with the long axis of the bone
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what is a clay shovelers fx?
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aka root pullers fx, avulsion of the spinous process of lower cervical spine
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what is a colles fx ?
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fall on an outstretched hand . fx of distal radius with posterior angulation of the distal fragment. producing a dinner or silver fork deformity
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what is a dancers fx?
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avulsion fx of the base of the 5th metatarsal
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what is a dashboard fx?
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knee hits dashboard in a car accident. fx of the posterior rim of the acetabulum by the femoral head
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T/F: Scleroderma is not an autoimmune disease.
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False
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aka Progressive Systemic Sclerosis
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Scleroderma
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What organ system is most commonly affected in scleroderma (besides skin)?
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GI
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CREST stands for...
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Calcinosis
Raynaud's Esophageal dysmotility Sclerodactyly Telangectiasia |
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Scleroderma - sex
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Female
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Scleroderma - age
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30-50
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Mauskaupff or "mouselike facies" are associated with this arthropathy.
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Scleroderma
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T/F: ESR is not elevated in scleroderma.
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False
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Positive Lab Testing for Scleroderma
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ESR, RA factor, ANA
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Antinuclear antibodies(ANA) are present in all of the following conditions except:
a) Psoriatic arthritis b) Scleroderma c) Systemic Lupus Erythematosus |
A
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T/F: The most obvious changes seen in scleroderma are seen in the hands.
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True
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Soft-tissues of the distal digits showing atrophy and retraction associated with what conditions?
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Scleroderma and PA
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aka distal tuft resorption
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Acroosteolysis
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Acroosteolysis associated with which condition?
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Scleroderma and PA
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define duverney fx.
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transverse, oblique or vertical fracture of iliac wing. m/c direct lateral blow to ilium
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define explosion fx
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fracture of distal tibia metaphysial interarticular extension
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define fishers fx
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(triquetrum), dorsal avulsion of radiotriauetral or lunotriquetral ligament
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define flap fx
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glenohumoral dislocation with fx of greater tuberosity
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define galeazzi fx
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fx of distal radius with dislocation of the distal radioulnar joint
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define gamekeepers fx
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1st MCP (ski pole fx) avulsion fo the ulnar collateral ligament
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define golfers fx
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lateral rib fx that occurs when a golf club strikes the ground instead of the ball
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define hangmans fx
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bilateral avulsion of the neural archs from the vertebral body with or without subluxation
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define jeffersons fx
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burst fx of the atlas
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define maissoneuve fx
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fx of proximal fibula with rupture of the distal tibiofibular ligaments and interosseous membrane extending proximal to the fibular fracture
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define malgaigne fx
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fx of pelvic ring composed of individual fx of the superior and inferior pubic rami
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define march fx
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stress fx distal 1/3 of one of the metatarsals
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what is a monteggia fx?
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fx involves the proximal ulna with dislocation of the radial head
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what is a nightstick fx?
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fx occurs to distal third or middle third ulnar shaft
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what is a rolandos fx?
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a comminuted intra-articular fracture through the base of the first metacarpal bone (the bone located just proximal to the thumb)
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what is a second fx?
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avulsion fx of the lateral capsular lig secondary to internal tibial rotation while the knee is flexed
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what is a smiths fx?
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(reversed colles) direst blow to the back of the wrist . fx of distal radius with anterior angulation of distal radius
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what is a straddle fx?
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double vertical pubis. fx of all 4 pubic rami
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what is a teardrop fx?
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triangular fragment at the ant portion of the vertebra
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what is a toddlers fx?
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spiral fx to distal tibia
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T/F: Actual cause of psoriatic arthritis is unknown.
|
True
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Psoriatic Arthritis - age
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20-50
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Pitting, ridging, discoloration, loss of nail or thickening under nail tip(aka subungal hyperkeratosis) is associated with which condition?
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Psoriatic arthritis
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Psoriatic arthritis - location
|
Distal joints of the hand
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Swelling of the whole digit caused by tenosynovitis seen in psoriatic arthritis is called what?
|
Cocktail sausage
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Arthritis mutilans is associated with which arthritis?
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Psoriatic
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Psoriatic Arthritis - labs that are positive
|
ESR and HLA-B27
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Radiographic abnormalities in psoriatic arthritis include all of the following except:
a) Uniform loss of joint space b) Soft-tissue swelling c) Nodules d) Tapering bones e) Periostitis f) Ankylosis |
C
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Ivory phalanx is a radiographic feature of which condition?
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Psoriatic arthritis
|
|
|
amphetamines
(Dexedrine, Dextrostat) |
Schedule II
|
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Acroosteolysis is a part of which 2 arthropathies?
|
Scleroderma and Psoriatic arthritis
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Pencil and cup sign is seen in which arthropathy?
|
Psoriatic Arthritis
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"Balancing pagoda" is seen in which arthropathy?
|
Psoriatic Arthritis
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______ arthritis spares the MCPs while ______ arthritis spares the DIPs.
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Psoriatic; Rheumatoid
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Psoriatic Arthritis - location
|
DIPs of hands
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what are the two maiin types of proximal femoral fx's?
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extracapsular and intracapsular
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what are the 3 subtypes of extracapsular proximal femoral fx's?
|
intertrochanteric- between trochanters
subtrochanteric- distal to intertrochanteric trochanteric- through trochanter |
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what are the 3 subtypes of intracapsular proximal femoral fx's?
|
subcapital- fx of head - neck
transcervical- accross middle of femoral neck basicervical- accross base of femoral neck |
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what is the most common carpal bone to fracture?
|
scaphoid
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what is the ssecond most comon carpal bone to fx?
|
the triquetrum
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what is th most common carpal bone to dislocate?
|
lunate
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what is the sign assoc with the dislocation of the lunate?
|
Pi sign
c sign spilled tea cup sign |
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what the types of shoulder dislocations?
|
glenohumoral dislocation
inferior superior a/c separations posterior |
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what is the m/c direction for glenohumoral dislocation?
|
anterior - 95%
aka's - hill-sachs (hatchet) flap - greater tuberosity bankart lesion |
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what sign is associated with a posterior glenohumoral dislocation?
|
rim sign
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T/F: S/I involvement of psoriatic arthritis (PA) is bilateral but asymmetrical.
|
True
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Ankylosis is likely to be seen in which of the following conditions in decreasing order of frequency:
a) AS, RA, PA b) AS, PA, RA c) PA, RA, AS d) RA, AS, PA |
B
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Erosions and proliferation of the Achilles and plantar ligaments of the calcaneus is seen in which arthritis?
|
Psoriatic
|
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M/C area of the spine affected in psoriatic arthritis
|
Thoracolumbar
|
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Non-marginal osteophytes are seen in which of the following arthritises? (MACA)
a) AS b) RA c) Reactive arthritis d) PA e) Scleroderma |
A, B, D
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how many types of Ac separation are there?
|
6.
|
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what is the m/c fx of the elbow for an adult? child?
|
child - supracondylar fx of humorus
adult- radial head |
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define lipohemarthrosis
|
mixture of blood and fat in a joint capsule following trauma. will see fluid-fluid level
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what is the m/c location for lipohemarthrosis to occur?
|
the knee (1st)
also seen in hip and elbow |
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what is the substance deposited in the joint that produces gout?
|
monosodium urate
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what is a mass of monosodium urate deposited in the joint called?
|
tophus
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aka for gout
|
podagra- gout in the foot
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does gout m/c affect males or females?
|
males - 20:1
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m/c age of onset for gout?
|
40yrs old
|
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family history of gout affects males or females more?
|
females
|
|
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what is gouts ethnic preference?
|
polynesian
new zealand filipino |
|
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what are 4 classifications of gout?
|
asymptomatic hyperuricemia
acute gouty arthritis polyarticular gouty arthritis chronic tophaceous gout |
|
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where and what symtoms are assoc with acute gouty arthritis?
|
lower extremity, 1st mtp, intertarsal joints, knees - a few joints or less. acute inflammation in the early morning
|
|
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what areas are affected by polyarticular gouty arthritis?
|
small joints of the hand, wrist and elbow.
1st mtp, intertarsal joints, knees |
|
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where does chronic tophaceaus gout take place?
|
multiple attacks on the elbow , hand, wrist , knee, foot and synovium. the tophi deposit in avascular areas.
|
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m/c location of arterial injury as related to fracture
|
Popliteal artery
|
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|
If blood supply becomes cut off due to injury causing a rise in pressure this clinical syndrome results immediately.
|
Compartment syndrome
|
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T/F: Compartment syndrome is a medial emergency.
|
True
|
|
|
This infection often follows 1-3 days after an open fracture or bowel perforation.
|
Gas Gangrene (Clostridium perfringens)
|
|
|
Aka Sudeck's atrophy
|
Reflex Sympathetic Dystrophy
|
|
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what are laboratory findings assoc with gout?
|
increased ESR
increased leukocytosis increased uric acid |
|
|
how do we manage gout in the acute phase?
|
Colchicine, ACTH, & phenylbutazone
Avoid aspirin, low calorie diets, & diuretics |
|
|
how do we manage long term gouty arthritis?
|
Drugs that promote uric acid secretion
Increase fluids, decrease purine intade, avoidance of salicylates |
|
|
what radiographic changes are assoc with gout?
|
Soft tissue: increase in density "lumpy bumpy", periarticular
uniform loss of joint space bone erosions: marginal- pannus "bare area", periarticular- dense sclerotic overhanging margin sign metaphyseal/diaphyseal, intraosseous- tophi collect inside the bone and create punched out lesion appearance in the subchondral bone normal bone density secondary degenerative changes chondrocalcification AVN |
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what area is most affected by gout?
|
lower extremity
|
|
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Infection that occurs in 15% of open fractures but is rare in closed fractures.
|
Osteomyelitis
|
|
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Heterotopic bone formation at the site of injury of a muscle.
|
Myostitis ossificans
|
|
|
Complication of fracture where bony fusion occurs between two bones that are close to each other.
|
Synostosis
|
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|
aka osteonecrosis
|
Avascular necrosis
|
|
|
M/C location of post-traumatic osteolysis
|
Distal clavicle
|
|
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Cause of osteonecrosis
|
Blood supply has been interrupted
|
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T/F: DJD is a delayed complication of a traumatic injury.
|
True
|
|
|
Disuse can lead to this delayed complication following traumatic injury.
|
Osteoporosis
|
|
|
Lack of immobilization, altered circulation and infection can lead to this delayed complication following traumatic injury.
|
Nonunion
|
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This delayed complication of traumatic injury can result in pseudoarthrosis.
|
Nonunion
|
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Top 2 m/c sites of nonunion following a traumatic fracture.
|
Scaphoid and midclavicle
|
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Normal osseous healing with abnormal positioning is called...
|
Malunion
|
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Lead arthropathy and toxicity is a delayed complication that typically occurs following this specific traumatic injury.
|
Gunshot
|
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How many types of Salter-Harris fractures are there?
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5
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aka Salter-Harris fractures
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Epiphyseal fractures
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what joint is m/c affected by gout?
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1st MTP, with met head erosions
overhanging margins. tophi |
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what radiographic changes are assoc with gout in the hands?
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asymmetric distribution
erosions soft tissue swelling normal bone density |
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what radiographic changes are assoc with gout in the knee?
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erosions of the me
dial and lateral condyles prepatellar tophi |
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what radiographic changes are assoc with gout in the elbow?
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erosions of the olecranon
soft tissue swelling tophi in the olecranon bursa "rising sun appearance" |
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what is a fracture?
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interruption of the bony cortex
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Isolated injury through the physis (growth plate) describes this type Salter-Harris fracture.
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Type I
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Fracture through the physis and a small portion of the metaphysis describes this type of Salter-Harris fracture.
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Type II
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Fracture through the physis and into the epiphysis describes this type of Salter-Harris fracture
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Type III
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Fracture extending through the metaphysis, physis and epiphysis describes this type of Salter-Harris fracture
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Type IV
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Compressive injury to the physis with no associated fracture to the epiphysis or metaphysis describes this type of Salter-Harris fracture
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Type V
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Slipped Capital Femoral epiphysis is an example of this Salter-Harris fracture type.
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Type I
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M/C Salter-Harris fracture type
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Type II
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Small metaphyseal portion of the Type II Salter-Harris fracture is called what?
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Thurston-Holland fragment
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M/C site of Type III Salter-Harris fracture
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Distal tibia
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Type of Salter-Harris fracture considered an intra-articular fracture.
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Type III
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Oblique or spiral fractures in the long bones are typical with this type of Salter-Harris fracture
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Type IV
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M/C location of Type IV Salter-Harris fracture for a pt <10 yoa
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Lateral condyle
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M/C location of Type IV Salter-Harris fracture for a pt >10 yoa
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Distal tibia
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Surgical intervention may be necessary on these two Salter-Harris type fractures.
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Type III and IV
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Common residual effect of this type of Salter-Harris fracture is limb shortening secondary to premature closure of the physis.
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Type V
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what is a closed fracture?
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A fracture that does not communicate with the outside environment
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what is an open fracture?
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a fracture that communicates with the outside environment
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what is a comminuted fracture?
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A fracture with two or more bony fragments
An isolated triangular fragment is called a “butterfly” fragment |
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what is a non-comminuted fracture?
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A complete fracture that has only one fragment
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what is the first and best imaging modality to use for fractures?
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conventional radiography
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when is stress radiography most commonly used?
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AC joint, knee and ankle injuries
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when is CT used for fractures?
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regions of complicated anatomy - spine , facial bones, pelvis, mid/hindfoot
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when is MRI used best when dealing with fractures?
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single regions that require a high specificity
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when is scintography helpful for fractures?
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when someone has a stress fracture
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when is angiography useful when dealing with fractures?
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when vascular abnormalities are suspected.
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define avulsion fx
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occurs at attachment of a ligaent or tendon. fragment is pulled from the bone
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define dislocation
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complete loss of articular congruity
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define subluxation
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partial separation of joint surfaces w/o complete incongruity of the joint components. (not a chiropractic subluxation)
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what is diastatic?
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separation injury of a synarthrodial joint
ex: symphysis pubis, sutures |
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define occult.
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fracture w/o radiographic evidence
use bone scan or MRI, re-examine 10-14 days to visualize fx |
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define pathological fx.
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bone weakend by disease
typically a transverse fx |
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define stress fx.
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occurs from repeated stress.
m/c MRI used high t1, high t2 with a linear area of low intensity |
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what happens with the pt clinically with a stress fx?
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pain with activity relieved by rest
tenderness, soft tissue swelling |
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what are two types of stress fx's?
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fatigue and insufficiency
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what is the diff between a fatigue fx and an insufficiency fx?
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fatigue: abnormal stress on a bone
insufficiency: normal stresses on an abnormal bone |
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what causes a bone bruise?
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trabecular microfractures typically the result of compression or impaction
very high on T2 |
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what are chondral and oteochondral fx's?
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fx through the joint cartilage or through the cartilage and subchondral bone
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what are some classic examples of chondral and/or osteochondral fx's?
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glenoid region following dislocation
patella/lateral femoral condyle following patellar dislocation osteochondritis dissecans |
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what are the differences between neurologically unstable and unstable fractures?
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unstable- displace when reduced nonsurgically or immobilized
neurologically unstable - in danger of damaging neural structures |
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oblique fx's are transverse lines in the bone. but at what degree?
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45
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what forces typically cause a oblique fx?
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compression
bending torsion |
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what degree to the long bone does a transverse fx run?
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90 degrees
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what commonly causes a trasverse fx?
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bending force
avulsion fx's, and pathological fx's |
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what type of force causes a spiral fx?
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torsion and axial compression
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what bones are commonly affected by spiral fx's?
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tibia and humerous
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what areas are commonly affected by stellate fx's?
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flat bones or patella where the line extends radially from the center point
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what type of force causes a stellate fx?
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direct blow
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what is an angular deformity?
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directional change of the fracture fragment relative to the long bone
distal vs proximal |
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how has a fracture fragment moved if it is considered varus? valgus?
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varus - toword midline
valgus - away from midline |
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what is apposition of a fx?
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amount of transverse displacement or bony contact of a long bone shaft
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how is apposition described?
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a percentage of cross-sectional diameter of the dominant(proximal) fragment
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define complete apposition.
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100% undisplaced
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what is seen when the two ends of the broken bone overlap.
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overriding or bayonet appearance
(bone shortens) |
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what is distraction of a fx?
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longitudinal separation of the fracture fragment.
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define rotation of a fx.
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twisting of one fracture fragment relative to another around the long axis of the bone. (torsion)
ref both prox and distal joints |
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what are two types of fracture reduction?
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closed - manipulation and casting of the extremity
open- surgery and harware used to align the broken bones |
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what are two types of fracture fixation?
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internal- placement of cortical plate with pins or screws
external- pins through the skin into the bone. this is used for an infected area or near the end of the bone |
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how long does a fx take to heal in kids/adults?
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kids- 4-6 wks
adults- 6-12 weeks |
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what factors determine how fast a fx heals?
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age
location bone/soft tissue devitalization fragment apposition immobilization |
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what are the 3 stages of healing?
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circulatory(inflammation)
reparative (metabolic) remolding (mechanical) |
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what are the 3 sub-phases of circulatory phase?
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cellular-
vascular primary callus |
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what happens during the cellular subphase?
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hematoma forms
inflammatory reaxn granulation tissue brings undifferentiated mesenchymal cells |
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what hppens during the vascular subphase?
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new blood vessels form
decreased hyperemia |
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what happens during the primary callus subphase?
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rapid deposition of ostoid
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describe the reparative (metabolic) phase of fx healing.
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40% of healing,
callus secrretion woven bone replaced by mature bone |
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describe remolding (mechanical phase of fx healing
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50-70% of healing
bone remodeling and callus along stress lines restoraiton of marrow cavity |
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What are the akas for AS?
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Marie-Strumpell’s disease, von Beckterew, rheumatoid spondylitis
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AS is an inflammatory __________ ____________
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Seronegative spondyloarthropathy
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Most commonly affects young adult _______
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males
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Distribution is mostly limited to the _____ skeleton and large _______ joints
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axial, proximal
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Choose that apply to AS
Tachycardia conduction defects Bradycardia conduction defects Pulmonary insufficiency Aortic insufficiency Myocardial fibrosis Aortitis/Aneurysms |
Tachycardia conduction
Aortic insufficiency Myocardial fibrosis Aortitis/Aneurysms |
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Pulmonary - Fibrosis of the upper/lower lung fields?
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upper
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Inflammatory reaction is similar to RA but much more intense (T/F)
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F- less intense
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Pannus formation occurs in the affected synovial joints (T/F)
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T
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It also attacks the cartilaginous joints of the spine and enthuses “whiskering” (T/F)
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T
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Referring to the question above- it is inflammation at the costovertebral junction followed by a healing response of the bone (T/F)
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F- discovertebral junction
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Eventual conversion to bone of the outer layers of annular fibers occurs and is called a ____________
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syndesmophyte
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Put the formation of syndesmophytes in the correct order
A- Appears a “shiny” corner sign followed by ossification of the outer layers of the annulus B- Romanus lesion occurs C- Creates a squared contour on the vertebral body |
B C A
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What is the laboratory test for AS that is positive (>90%)
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HLA B27
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ESR (increased/decreased), Rhematoid factor (positive/negative),
ANA (positive/negative) |
increased , neg , neg
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What is the hallmark of AS?
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bilateral sacroillitis
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Bilateral (symmetrical/ asymmetrical) changes are typical
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symmetrical
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What are the three stages of AS?
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1- Pseudowidening, loss of distinct articular margins
2- Erosive and sclerotic changes, “Rosary bead” appearance 3- Ankylosis- Narrowing and obliteration of the joint spoace, “Ghost” joints, “Star” sign |
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Spondylitis in the thoracic/ Lumbar occurs in about 65% of patients (T/F)
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F-50%
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Referring to the question above, as a rule it develops after SI disease (T/F)
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T
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Thoracolumbar is the most common site of involvement in AS, and it typically progresses symmetrically without skip lesions (T/F)
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T
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In Cervical, May see erosions of the ______ and an increased ADI (> ____mm in adults)
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dens, 3mm
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What sign is present in the Cervical with AS?
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shiny odontoid sign. increased density of the odontoid
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What cervical segments have syndesmophyte formation?
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C2/3
C6/7 |
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What is the most common peripheral joint involved?
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Hip Joint
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In the Hip Joint: ______ migration with (uniform/non-uniform) loss of joint space
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axial , uniform
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AS in the Hip can lead to protrusi acetabuli, and progress to bony ankylosis (T/F)
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T
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Hip is the most common peripheral joint, what is the second most common?
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shoulder
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Erosion of the entire lateral aspect of the humeral head is “______ sign”
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Hatchet
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Ankylosed segments are subject to fracture termed “_______-______” fracture
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carrot stick
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What are the DDX for Anderson lesions (pseudoarthrosis- a level becomes mobile resulting in instability and adjacent destruction)?
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infection, neuropathy
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Name two neurospinal complications associated with AS?
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spinal stenosis
cauda equina syndrome-arachnoid diverticula |
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What are the most common locations for spinal trauma?
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c1-2, C5-7, T12-L2
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What are the percentages of fractures in the cervical/thoracic/thoracolumbar regions that are associated with neurological damage?
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cervical - 40%
thoracic spine- 10% thracolumbar junction- 4% |
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______% of spinal fractures are associated with other fractures, ____% of spinal injuries have no associated fracture
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20%, 10%
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What is the most common line of force?
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flexion
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What imaging modality has been shown to demonstrate nearly 100% of cervical spine fractures?
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CT
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What is the modality of choice to demonstrate soft tissue, neurological and vascular damage?
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MRI
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What are the three column models proposed by Denis (what does each model include) and what are they designed for?
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Originally designed for thoracolumbar injuries but can be extrapolated for the cervical spine
-Anterior: includes 2/3rd of the vertebral body, IVD and ALL - Middle: includes the posterior 1/3rd of the vertebral body, IVD and PLL -Posterior: includes the posterior osseous arch and posterior ligaments -Capsular ligaments -Ligamenta flava -Interspinous -Supraspinous |
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What column is the most important in determining the potential for instability?
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middle column
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Grounds for removal of Trustee include:
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(i) a serious breech of trust (ii) lack of cooperation among co-trustees (iii) unfitness, unwillingness, or persistent failure to administer or (iv) a substantial change in circumstances.
Key: |
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List three types of spinal instability?
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First degree (mechanical)
Second degree (neurologic) Third degree (mechanical and neurologic) |
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What type of spinal instability is it for these cases:
1-The spine is insufficiently constrained against buckling and angulation (this type places the patient at risk for progressive chronic kyphosis) 2- Includes cases in which progressive osseous displacement and progressive neurologic injury may develop 3- Applies to patients at risk for delayed neurologic compromise even if no deficit exists at presentation |
1-First degree
2-Third degree 3-Second degree |
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What is Vertebral body squaring?
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Loss of normal anterior vertebral body concavity
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what is a Shiny corner sign?
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-Transient reactive sclerosis adjacent to Ramanus lesion. A precursor to syndesmophyte formation
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what is a trolley track sign?
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Ossification of the apophyseal joints, interspinous and supraspinous ligaments
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what is bamboo spine? aka poker spine?
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Secondary to uniform and symmetric bridging of syndesmophytes, undulating and segmented appearance of the spine, aka
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what is a Ghost joint?
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Visualization of articular cortex through an ankylosed joint
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what is a star sign?
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Ossification of superior sacroiliac ligaments, creates a triangular opacity
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what are syndesmophytes?
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Inflammatory ossification of a spinal ligament, marginal or non marginal, marginal are suggestive of AS/Enteropathic
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what creates a dagger sign?
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Ossification of the supraspinous and interspinous ligaments
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what creates a romanus lesion?
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An erosion of anterior vertebral body margin at the annulus insertion. A precursor to syndesmophyte formation
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what creates a railroad track sign?
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Ossification of the apophyseal joints only
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what creates a rosary bead appearance?
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Undulating appearance of sacroiliac articular margins
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gazpacho means ...
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Andalusian soup made from tomatoes, cucumbers, pepers and bread, served chilled
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sobaco means...
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armpit
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huerta means...
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truck farm
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Dorsal subluxation of MTPs w/ fibular deviation seen in RA.
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Lanois deformity
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M/C location of RA below C1/C2
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C2-C4
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SLE - gender
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Female
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SLE has ANA antibodies?
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yes
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T/F: RA has reducible/reversible deformities while SLE does not.
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False. (Switch it).
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aka osteonecrosis
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AVN
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Orthopedic tests used for AS:
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1) Amoss's sign
2) Chest expansion 3) Forestier's bowstring |
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Marginal syndesmophytes are suggestive of RA/Reiter's or AS/Enteropathic?
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AS/Enteropathic
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Microbes associated with enteropathic arthropathy
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1) salmonella
2) Shigella 3) Yersina |
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Most significant physical correlation of PA
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Nail involvement
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Lesions on soles of feet and palms of hands as seen in Reiter's
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Keratoderma blennorrhagica
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Reiter's triad
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1) Conjunctivitis
2) Urethritis 3) Arthritis |
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Periostitis of calcaneus as seen in Reiter's
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Lover's heel
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