18.6.2013(ortho)41 Flashcards
(159 cards)
0
Q
Osteoblasts are derived from
A
Marrow stromal cells
Osteoblasts don’t divide
Endogenous from - lining of periosteum
Inducible from - pericytes
1
Q
Amount of NO in exhaled air in asthma
A
Increased
2
Q
Osteoblasts are rich in
A
Alkaline phosphatase
3
Q
Substances synthesised by osteoblasts
A
Type 1 collagen
Osteocalcin
Osteonectin
4
Q
Receptors for PTH and VitD3 are present on
A
Osteoblasts
They control osteoclastic activity
5
Q
Osteocytes are
A
Spent osteoblasts
6
Q
Osteoclasts are formed by
A
Fusion of mononuclear cells
7
Q
RER is abundant in
A
Osteoblasts
Osteoclasts are rich in mitochondria
8
Q
Osteoclasts attach to bone through
A
Integrins
9
Q
Enzymes present in osteoclasts
A
TRAP
carbonic anhydrase
10
Q
Hydroxy apatite
A
Ca10 (PO4)6 (OH)2
11
Q
Collagen types in bone
A
Type 1,6
12
Q
Bone Gla protein
A
Osteocalcin
13
Q
Signalling/adhesion proteins in bone
A
Thrombospondin
Osteopontin
Fibronectin
14
Q
Essential feature of all #
A
Partial or complete loss of continuity of bone
15
Q
$ Most characteristic clinical feature of #
A
Crepitus
16
Q
$ fracture caused due to direct blow
A
Transverse #
17
Q
Crushing forces cause
A
Comminuted #
18
Q
Transverse # is caused due to
A
Direct impact
Tension
19
Q
Fractures caused due to direct force
A
Direct impact
Crushing
20
Q
caused due to indirect force
A
Twisting(spiral)
Compression(short oblique)
Tension(transverse)
Bending(# with triangular butterfly fragment)
21
Q
Bones affected by pathological #,arrange in order from most common
A
Vertebral bodies(thoracic and lumbar)
Neck of femur
Lower end radius(colles#)
22
Q
Most common cause of pathological #
A
Osteoporosis
23
Q
Maffuci syndrome
A
Enchondromas
Multiple angiomas
24
Second most common cause of pathological #
Metastatic carcinoma
25
Bone tumor that doesnot cause pathological #
Osteochondroma
26
$ Rx of pathological #
Internal fixation
27
Banana #
Paget disease
| Seen over convexity of bent bone
28
Looser zone
```
Osteomalacia
# seen in concavity
```
29
Prophylactic IF in pathological #
Mirel score greater than 8
30
Tumors with worst prognosis after bone metastasis
1. Lung
| 2. melanoma
31
Most common bone to be involved in metastasis
Vertebra
32
Most common bone to be fractured in metastasis
Proximal femur
33
Criteria for predicting the risk of # in metastasis
Mirel
| Harrington
34
Risk factor for stress#
Increased intensity and frequency of training
Activities that produce repetitive loading
Leg length discrepency
35
Female athlete triad
Eating disorder
Osteopenia
Menstrual irregularities
36
Types of stress fractures
Fatigue
| Insufficiency(abnormal bone)
37
Hallmark of stress fracture
Focal bone tenderness
38
Most sensitive investigation for stress #
Three phase bone scintigraphy
| MRI(more specific too)
39
Rx of stress #
Cast with cessation of activity
40
Robert jones #
Pot hole injury
| Avulsion # of base of 5th metatarsal
41
Runner fracture
of distal shaft of fibula
42
Most common site of stress fracture
1. neck of second metatarsal
| 2. tibia
43
Most common site of upper limb stress fracture
1.olecranon
Humerus
Ulna
Distal radius
44
Stress fractures in pelvis and spine
Pubic rami and sacrum
| Pars interarticularis of 5th lumbar vertebra
45
Common sites of lower limb stress fractures
```
2nd MT
tibia
Femoral neck
Femoral shaft
Medial malleolus
Navicular
Calcaneum
```
46
Humeral stress # occur in
Baseball pitchers
47
First stage of # healing
Hematoma formation
48
Types of secondary callus healing
```
Hard callus(intra membranous ossification)
Soft callus(enchondral ossification)
```
49
Source of mesenchymal cells in blastema formation
1. determined osteogenic progenitor cells(derived from inner cambium layer of periosteum)
2. Inducible osteoprogenitor cells(derived from pericytes surrounding capillaries,arterioles,venules)
IOPC are involved if periosteum is compromised
50
Factors favouring differentiation of mesenchymal cells into chondrocytes following fracture
Low oxygen tension
Low pH
Movements
51
Factors favouring differentiation of mesenchymal cells into osteoblasts following fracture
High oxygen tension
High pH(aids alkaline phosphatase activity)
Stability
52
Initial callus prevents
Bending
Rotational forces
Less effective against shearing and axial deformation
53
Gap healing bone is
Coarse fibroid bone
54
Stage of remodelling involves
Replacement of woven bone by lamellar bone
55
__________ activity in tension site
Osteoclastic
Osteoblastic activity at compression site
56
Sources of callus
Medullary(cancellous)
| Periosteal(diaphyseal fracture)
57
Types of periosteal callus
```
Primary callus(from DOPC)
External bridging callus(from IOPC)
```
58
Periosteal callus formation is inhibited by
Rigid plating
Since periosteal callus needs micro movement
Favoured by Intramedullary nailing and cast immobilisation
59
Late medullary callus is dependant on
Intramedullary vascularity
60
Bone induction
Modification of undifferentiated cells to osteogenic cells
61
Creeping substitution occurs in
Cancellous bone
62
$ initial stage of clinical healing of bone is equivalent to
Woven bone
63
Packets of bone resorption
```
Howship lacunae(trabeculae)
Cutting cone(cortex)
```
64
Exceptions where bone formation takes place without resorption
Fracture healing
| Ossification of cancellous autograft
65
Bone apposition is best seen in
Howship lacunae(adults)
Epiphysis by enchondral ossification(children)
After cancellous grafting
Sub periosteal cambium layer(fracture)
66
Bones formed by endochondral ossification
Long bones
Vertebra
Pelvis
Base of skull
67
Bones formed by intramembranous ossification
```
Spongy bones
Skull vault
Maxilla
Parts of mandible
Clavicle
```
68
Percentage of quiescent bones in adults
90%
In young children it's only 10%
69
Bone formation occurs in response to stress. Which law states this?
Wolff law
70
More specific markers of bone resorption
Urine and serum N and C terminal telopeptide
Urine total free deoxypyridinoline
These are products of type 1 collagen degradation
71
Calcium binding proteins in bone
Osteonectin
| Bone sialoprotein
72
Rate of mineralisation of newly formed osteoid is estimated by
Labeled tetracycline
73
Types of non union
Hypertrophic(exuberant callus)
| Atrophic
74
Factors favouring callus formation
```
Head injury
High pH
High oxygen tension
Stability
Compression and intermittent shear force
Micromovements at fracture site
TGF beta
```
75
Drugs causing non union
Phenytoin
Anticoagulants
Indomethacin
Corticosteroids
76
in which non union is common
1.Neck of femur
1.Waist of Scaphoid
1.Body of Talus
Lateral condyle of humerus
Lower third of tibia and ulna
77
Causes of non union
Hypervitaminosis D
| Intact fellow bone
78
Common sites of malunion
Intertrochanteric #
Supra condylar # of humerus
Colles #
79
Causes of pseudoarthrosis
1. NF1
2. non union
3. congenital
4. idiopathic
5. osteogenesis imperfecta
6. fibrous dysplasia
7. cleidocranial dysplasia
8. Ankylosing spondylitis
9. post surgical(triple arthrodesis,spinal fusion)
80
Rx of crush injury
Forced mannitol alkaline diuresis
81
Compound # requiring vascular repair
Type III C
82
Type 1 compound fracture
Size less than 1 cm
Low velocity injuries
Clean
Simple bone # with Minimal communition
83
Type 2 compound #
1-10 cm
Moderate communition and contamination
Minimal crushing
no extensive soft tissue damage
84
Type 3 compound fracture
```
Extensive soft tissue injury and/or
Segmental diaphyseal loss
High velocity weapon injury
Farm injury of any size
Severe communition
High energy trauma
High speed crush injury
Severe contamination
```
85
Type 3B compound #
Periosteal stripping
| Requires local or free flap as cover
86
Type 3A compound #
Adequate periosteal cover
| Bone fragments covered
87
Grade 3 tscherene classification
Crush injury or compartment syndrome
88
Steps in management of compound #
Antibiotics
Aggressive wound debridement
Exfix(internal fixation for grade 1)
89
Substances to be removed in gunshot injury
All wadding
Shots within accessible areas
Lead shots in joints
90
Score which evaluates the chance of amputation in traumatised limb
MESS
| Mangled extremity severity score
91
Factors in MESS
Shock
Skeletal and soft tissue injury(energy of injury)
Ischemia
Age
92
Ischemia of more than _________ MESS is doubled
6 hours
93
Pirogoff amputation
Calcaneus is rotated forward to be fused with tibia after vertical section through its middle
94
Boyd amputation
Talectomy
Forward shift of calcaneus
Calcaneotibial arthrodesis
95
Distal tibial amputations
Syme(tibia and fibula 0.6cm proximal to periphery of ankle joint)
Sarmiento(tibia and fibula 1.3cm proximal to the ankle joint,excision of medial and lateral malleoli)
96
Stump length
AK(12cm from knee)
BK(14cm from knee)
Above elbow(20cm from shoulder)
Below elbow(18cm from elbow)
97
Ring sequestrum
Amputation stumps
| Around pin tracks
98
Rice grain sequestrum
TB
99
Tubular sequestrum
Hematogenous osteomyelitis
| Segmental #(middle segment)
100
Myodesis is contraindicated in
Ischemia
101
Myodesis
Muscle is attached to bone through drill holes
102
Myoplasty
Attachment of opposing group of muscles with each other across end of bone
103
Myofacial flaps
Attachment of muscles to fascia
104
Rate of regeneration of nerve
1mm/day
105
Repair of clean cut nerve
As soon as possible
106
Good prognostic factors in nerve injury
```
Young age
Neurapraxia
Distal lesions
Pure motor or sensory nerve
Early suturing
```
107
Gaps after nerve injury requiring grafting
```
More than 1-2cm
Except
2cm in median nerve
4-5cm in ulnar nerve
6-8cm in sciatic nerve
```
108
Prognosis after nerve suturing
Good
1. radial
2. median
3. ulnar
4. peroneal
5. sciatic
6. femoral
109
Sensory loss in brachial plexus injuries
Outer aspect of arm and forearm(erb)
| Ulnar aspect of forearm and hand(klumpke)
110
Most common cause of neurological deficit in UL
Erb palsy
111
Test which is done for prognosticating nerve injury
Strength duration curve(NCS)
112
Nerves involved in erbs palsy
Musculocutaneous
Axillary
Suprascapular
Nerve to subclavius
113
Muscles supplied by axillary nerve
Deltoid
| Teres minor
114
Muscles supplied by musculocutaneous nerve
Biceps
Brachialis
Coracobrachialis
115
Muscles supplied by suprascapular nerve
Supraspinatus
| Infraspinatus
116
Brachial neuritis,other name
Parsonage turner syndrome
117
Types of brachial neuritis
Idiopathic
| Inherited(due to mutations in septins,chr 17q)
118
Pain in brachial neuritis begins in
Right shoulder region
119
Pain in brachial neuritis is aggravated by
Movements of shoulder
Pain is not aggravated by neck movements
120
Causes of brachial neuritis
Viral infections(URTI)
Bacterial infections(diphtheria,typhoid,pneumonia)
Parasitic infections
Vaccinations(influenza,tetanus,diphtheria,small pox,swine flu,DPT)
Trauma(not related to shoulder)
Surgery
Child birth
Lumbar puncture,administration of radiographic dyes
PAN,SLE,lymphoma
Ehlers danlos syndrome
Temporal arteritis
121
Weakness in brachial neuritis appears
2 weeks after onset
122
Muscles causing abduction of shoulder
Supraspinatus (First 15 degrees)
Deltoid(15-90 degrees)
Serratus anterior and trapezius(>90 degrees)
123
Axillary nerve is injured in
```
# surgical neck of humerus
Inferior shoulder dislocation
```
124
Sensory supply of axillary nerve
Lateral cutaneous nerve of arm
| Regimental badge area
125
$ Compression of median nerve in carpal tunnel results in
Inability to oppose the thumb
Abduction is not fully impaired because of intact abductor pollicis longus
126
Median nerve enters forearm between
Pronator Teres and biceps tendon
127
Carpal tunnel is narrowest at the level of
Hook of hamate
128
Most sensitive test for diagnosis of carpal tunnel syndrome
Durkan test
| Pressing thumb over carpal tunnel for 30 seconds
129
Most sensitive sensory test for detecting early carpal tunnel syndrome
Semmes Weinstein test
| Measures a single nerve fiber innervating a receptor or group of receptors
130
Tests in carpal tunnel syndrome
Durkan test
Phalen test
Semmes Weinstein test
Innervation density test
131
Splint for carpal tunnel syndrome
Use of neutral splint at night
132
Most specific test for carpal tunnel syndrome
Hand diagram
133
Most sensitive symptom of CTS
Nocturnal pain
134
Tests in median nerve
Pen test
Pointing index
Benediction sign
Oschner clasp test
135
Anterior interossius nerve is a branch of
Median nerve
136
Autonomous zone of median nerve
Tip of index and middle finger
137
Autonomous zone of ulnar nerve
Tip of little finger
138
Inability to adduct the small finger
Wartenberg sign(weakness of palmar interossi)
139
Side to side movement of middle finger is lost
Positive egawa test
140
Intrinsic muscles of hand are supplied by median nerve in 7.5% of people through
Martin grubber anastamosis
141
Ulnar paradox
Claw hand is more in lower ulnar palsy
142
Posterior interossius nerve is injured in
Operations of radial head-neck
143
Presentation of posterior interossius nerve injury
No sensory deficit(it's a pure motor nerve)
Wrist extension is preserved(spared extensor carpi radialis longus)
Presents with loss of extension of MP joint
144
Autonomous zone for radial nerve
Dorsum of first web space
145
Branches of radial nerve above spiral grove
Long and medial head of triceps
| Posterior cutaneous nerve of arm
146
Branches of radial nerve in spiral groove
```
Nerve to anconeus
Lateral cutaneous nerve of arm
Posterior cutaneous nerve of forearm
Nerve to extensor carpi radialis
Triceps medial and lateral head
```
147
Emergency immobilisation,splint used
Crammer wire
148
femur(anywhere from neck to supracondylar region),splint used
Bohler brown splint
149
Knee immobilisation,splint used
Thomas knee splint
150
Axillary nerve palsy,splint used
Shoulder abduction splint
151
CTEV,splint used
Dennis brown
152
Common Peroneal or sciatic nerve palsy,splint used
Toe raising or foot drop splint
153
Finger immobilisation,splint used
Aluminium splint
154
Volkmann ischemic contracture,splint used
Volkmann turn buckle splint
155
Low back ache,splint used
Lumbo-sacral corset
156
Scoliosis,splint used
Milwaukee brace
| Boston brace
157
Cervical spine injury,splint used
```
Four post collar
SOMI brace(sterno,occipital mandibular immobilisation)
```
158
Dorsolumbar spine,splint used
Taylor brace
| ASHE(anterior spinal hyperextension) brace
