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Orthopaedics > Anatomy Of Bone > Flashcards

Anatomy Of Bone Flashcards

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1
Q

Bone is made up of

A
  1. Organic component/osteoid
  2. Water: Higher in children (Bones -> Softer)
  3. Inorganic component: Ca hydroxyapatite (Principal mineral)
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2
Q

Organic component/Osteoid is composed of

A
  1. Cells (5-10%)
    > Osteoblast
    > Osteoclast
    > Osteocyte
  2. Proteins (90-95%)
    > Collagen: Type 1 (Principla protein)
    > Osteocalcin
    > Osteonectin
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3
Q

Cell type of Osteoblast

A

Mononuclear cells

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4
Q

Cell type of Osteoclast

A
  1. Monocyte aggregates
  2. Multinucleated giant cells
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5
Q

Cell type of Osteocyte

A

Mature/resting osteoblast

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6
Q

Function of Osteoblast

A

Lays down osteoid matrix (Collagen)
| Mineral deposition
V
Bone/osteon

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7
Q

Functions of Osteoclast

A
  1. Phagocytic
  2. Bone resorption and remodelling
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8
Q

Features of Osteocyte

A
  1. Most abundant
  2. Longest life span
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9
Q

________________ is rich in alk phosphatase

A

Osteoblast

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10
Q

________________ is rich in TRAP and carbonic anhydrase

A

Osteoclast

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11
Q

Types of Bone markers

A
  1. Formation markers
  2. Breakdown markers
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12
Q

Types of Formation markers

A
  1. Pro collagen
  2. Osteocalcin
  3. Osteonectin
  4. Alk phosphatase
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13
Q

Types of Breakdown markers

A
  1. Hydroxy proline
  2. Hydroxy lysine
  3. N & C telopeptide
  4. Tartrate resistant acid phosphatase (TRAP)
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14
Q

____________ markers increase in bone resorption

A

Bone formation

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15
Q

_______ increases in osteoporosis

A

TRAP (D/t inc in osteoclast activity

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16
Q

Parts of bone

A

Epiphysis
Diaphysis
Metaphysis

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17
Q

Metaphysis contains

A

Spongy/cancellous bone (Medulla)

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18
Q

Diaphysis contains

A

Compact/cortical bone (Cortex)

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19
Q

Function of Sharpey’s fibers

A

Anchors periosteum to bone

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20
Q

Function of Growth plate

A

Longitudinal/interstitial growth

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21
Q

Layers of Growth Plate

A

Based on direction of growth:
1. Germinal layer (Most imp)
2. Proliferating layers
3. Hypertrophic layer (Weakest)
4. Layer of calcification
5. Layer of ossification

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22
Q

Layer M/C involved in traumatic injury

A

Hypertrophic layer

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23
Q

Injury to which layer affects growth

A

Germinal layer

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24
Q

Salter and Harris classification of Physeal injuries

A

Mnemonic: SALTER
Type 1: Split fracture
Type 2: Away (M/C)
Type 3: Lower
Type 4: Through everything)
Type 5: Rammed/crushed

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25
Features of Type 1 physeal injury
Fracture splits the growth plate without injuring germinal layer (Thru hypertrophic layer) Normal growth on reducing the fracture
26
Features of Type 2 of physeal injuries
Fracture splits the growth plate Fracture line goes towards the Metaphysis No injury to the germinal layer Normal growth on reducing the fracture Metaphyseal fragment: Thurston hollland
27
Features of Type 3 of physeal injuries
Fracture line splits the growth plate and goes towards the epiphysis Germinal layer will be injured No growth on reducing the fracture
28
Features of Type 4 of physeal injuries
Fracture line through all layers Germinal layer injured Growth is impacted even on reducing the fracture
29
Features of Type 5 of physeal injuries
Impaction injury: Crushes growth plate Fracture is missed on X ray (No obvious # line) Late presentation with limb length discrepancy
30
Causes of fractures
1. Significant trauma 2. Insignificant trauma
31
Types of fractures happening d/t insignificant trauma
1. Stress fracture 2. Pathological fracture
32
What is Stress fracture?
Normal bone; abnormal loading Point tenderness +
33
What is Pathological fracture?
Abnormal/weak bone Pain before fracture d/t pre-existing lesion
34
Localized causes of Pathological fracture
1. Infection 2. Ischemia 3. Lesions 4. Cysts 5. Radiation
35
Generalised causes of Pathological fractures
1. Osteoporosis(M/C): Spine>Hip>Colle’s 2. Metastasis: Proximal femur and spine 3. Osteogenesis imperfect a 4. Osteoporosis 5. Scurvy, Rickets/osteomalacia 6. Paget’s disease
36
Subtrochanteric proximal femur # is also called as
Banana fracture
37
Vertebral compression fractures are also called as
Wedge fractures
38
What is Mirel’s criteria?
Criteria to plan prophylactic fixation of pathological # Score >8: Prophylactic internal fixation
39
What is Stress fracture?
Pain after activity (Sudden inc in intensity/frequency) Lower limb bones > Upper limb bones
40
Investigations of Stress fractures
X ray positive: 2-3 weeks later IOC: MRI (Soft tissue edema +) -> Detects occult fractures Multiple stress #: Bone scan
41
Sites of Stress fractures
1. Tibia 2. Metatarsal: March fracture (Happens d/t marching in parade) 2nd > 3rd
42
Types of fracture healing
1. Primary healing 2. Secondary healing
43
Type of healing in Primary healing
Direct/intramembranous healing
44
Type of healing in Secondary healing
Indirect/endochondral healing
45
Callus formation in both types of fracture healing
1. Primary: Negative 2. Secondary: Positive
46
Movement at # site in Primary healing
Absolute stability
47
Movement at # site in Secondary healing
Micromovements + (Relative stability)
48
Devices helping in Primary healing
1. Compression plates 2. Lag screws
49
Devices helping in Secondary healing
1. Pop/braces 2. External fixation 3. Bridge plating 4. Intramedullary nailing
50
Stages of Secondary healing
1. Hematoma formation (2-3 days) 2. Granulation tissue formation (2-3 weeks): Inflammation + fibroblasts 3. Callus formation (2-3 months): Fibrolblasts -> Osteoblasts 4. Consolidation (2-3 years) 5. Bone remodelling (3 years): Woven bone -> Lamellar bone
51
Factors affecting fracture healing
1. Patient: Age, nutrition, tobacco, alcohol 2. Treatment: Improper immobilisation(M/C); inadequate reduction 3. Type of #: Open, contaminated, interposed 4. Tissue: Ischemia
52
Types of Non-union
1. Hypertrophic 2. Atrophic
53
Callus formation in Hypertrophic non-union
Exuberant
54
Callus formation in Atrophic non-union
Absent
55
Bone biology in Hypertrophic and Atrophic non-union
H: Good A: Abnormal
56
Treatment of Non-union
H: Immobilisation A: Autologous bone grafting
57
M/C site for bone graft
Iliac crest MOA: Creeping substitution (Canvas for bone to grow)
58
What is Malunion?
Healing in abnormal abnormal position
59
Treatment of choice for Malunion
Osteotomy (Cut, realign and fix bone)
60
Bones with inc risk of Malunion
1. Clavicle (M/C) 2. Supra-condylar humerus 3. Colle’s 4. Intertrochanteric (Extracapsular) femur
61
Bones with inc risk of Non-union
1. Lower 1/3rd of tibia (M/C) 2. Scaphoid 3. Lateral condyle of humerus 4. Neck of femur (Intrscapsular) 5. Neck of Talus
62
Management of Intra-articular fracture (involves articular surface)
Open reduction + Internal fixation with plates and screws
63
Management of Extra-articular fracture
Conservative management: POP/cast, slab, traction Surgical management (Definitive): 1. Upper limb: Plating with screws 2. Lower limb: Intramedullary rods/ nails with interlocking screws
64
Management of Patella/olecranon (Fragment pulled by attached tendons)
Tension band wiring device with K wire and stainless wires
65
What are Fractures of Necessity?
Require surgical management 1. Intra-condylar # 2. Monteggia/Galeazzi # 3. Lateral condylar humerus # 4. Neck of femur#
66
What are Open fractures?
Fracture + Break in skin and underlying soft tissue
67
M/C pathogen involved in Open fractures
Staph. Aureus
68
M/C open fracture involves
Tibia and phalanges
69
Classification of Open fractures
Gustilo Anderson classification: Type 1: Wound <1 cm long Type 2: Wound 1-10 cm Type 3a: Open fracture + contaminated environment(Sewage, farms or firearm injury) Type 3b: Opn fracture with periosteal stripping Type 3c: Open fracture + vascular injury(Distal pulses not palpable)
70
Management of Open fractures
1. Wound management: > Broad spectrum antibiotics > Debridement > Wound wash with sterile normal saline, providing saline or H2O2 > Wound closure delay if * >6 hour old injury * New neurovascular injury * Edges cannot be approximated 2. Fracture management: > External fixation -> Wound management and closure -> Definitive surgery
71
Types of External fixators
1. Schantz pin with external rod 2. Illizarov ring fixator 3. Rail fixators/limb reconstruction system 4. Spanning external fixators
72
Types of Schantz pin with external rod
1. Uniplanar EF with one rod 2. Multiplanar EF with 4 rods 3. Uniplanar EF with 2 rods
73
Indications/use of Ilizarov ring fixator
1. Open fracture 2. Non union 3. Infected non union 4. Fracture with bone loss 5. Limb lengthening 6. Deformity correction/malunion
74
What is Distraction osteogenesis?
Surgical technique that induces new bone formation by gradually separating bone segments With Ilizarov ring fixator: At 1 mm/day
75
Use of Spanning external fixator
Periarticular fractures (Distal femur/proximal tibia #)
76
Advantage of Spanning external fixator
Spans across joint -> Inc in stability
77
Complication of managing open fracture
Ring sequestrum Occurs at pin tract sites Causes: 1. Heat necrosis d/t drilling 2. Direct infection
78
Stability of EF is improved by
Inc in no of pins, rods, planes
79
Different types of Trauma scores
1. Mangled extremity severity score (MESS) 2. Limb salvage score 3. Ganga score
80
Mangled extremity severity score (MESS) Just study
Mnemonic: VISA 1. Velocity of injury or soft tissue coverage 2. Ischemia time (Most important) 3. Shock 4. Age of patient Score >=7: Amputation
81
What is Amputation?
Cutting limb through the bone
82
What is Disarticulation?
Cutting limb through a joint
83
Types of Lower limb amputation
1. Hip disarticulation 2. Midthigh/above knee (transfemoral) amputation 3. Knee disarticulation 4. Below knee (transtibial) amputation (M/C)
84
Types of Foot amputation
1. Syme amputation 2. Chopart amputation: Intertarsal joint amputation 3. Lisfranc amputation: Tarsometatarsal joint amputation 4. Transmetatarsal amputation
85
Types of Prosthesis
1. SACH (Solid ankle cushion heel) prosthesis 2. Jaipur foot prosthesis (Better)
86
Order of intervention in ATLS
ABCDE 1. Airway: Chin lift/ jaw thrust with restriction of cervical spine motion 2. Breathing 3. Circulation (Stop the bleeding) 4. Disability or neurological status 5. Exposure (Undress) and environment (Temperature control)
87
Fractures causing the most amount of blood loss
Pelvis>Femur
88
Pelvic fracture management Just study
Can cause 1.5-2 L of blood loss -> Hemorrhage and death 1. Pelvis binder/hands/bedsheets: Tamponade the blood loss 2. IV fluids: RL>NS 3. External fixation of pelvis (In compression)
89
Types of Avascular necrosis/Osteonecrosis
1. Traumatic 2. Non-traumatic
90
Traumatic avascular necrosis can take place in
1. # Neck of femur: AVN of head of femur 2. # Waist of scaphoid: AVN of proximal pole of scaphoid 3. # Neck of talus: AVN of body of talus
91
Non traumatic AVN takes place in
Inc in intraosseous pr -> Dec in blood flow 1. Idiopathic (M/C) 2. Steroid use 3. Sickle cell disease 3. Gaucher’s disease 4. Alcohol abuse 5. Perthe’s disease 6. Caisson disease
92
X ray of AVN of a bone
Dead bone appears white/sclerosed with jagged edges Changes appear very late
93
IOC of AVN
MRI (For early diagnosis)
94
Treatment of choice of AVN
Total hip replacement

Orthopaedics (12 decks)

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