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Bones and joints Flashcards

1
Q

Types of bone and example

A 
Long - femur 
Short - carpals
Flat - scapula 
Sutural - within a suture in cranium 
Irregular - vertebra 
Sesamoid - patella
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2
Q

Structure of short, flat and sesamoid bones

A 
Mainly spongy bone
Bone marrow between trabeculae
Thin layer compact bone (covered in periosteum)
No epiphysis 
No diaphysis
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3
Q

Blood supply of bones before epiphyseal fusion

A

Epiphyseal arteries (only blood supply to epiphysis)
Bends of metaphyseal arteries
Periosteal arteries
Nutrient artery

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4
Q

Blood supply of bones after epiphyseal fusion

A

Anastomoses between epiphyseal and metaphyseal arteries
Periosteal arteries
Nutrient artery

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5
Q

Where do metaphyseal arteries enter bone

A

Metaphysis at site of attachment of capsule

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6
Q

What does the periosteal artery supply

A

Periosteum

Outer 1/3 of cortex

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7
Q

Where does the nutrient artery enter bone

A

Diaphysis via nutrient foramen

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8
Q

How can avascular necrosis be caused

What can it lead to

A 
Fracture
Dislocation
Steroids
Radiation
Decompression sickness (N2)

Leads to secondary osteoarthritis

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9
Q

What properties are joints classified by

A

Structural (tissue between articulating bones)

Functional (amount of movement)

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10
Q

What are the structural joint types

A

Fibrous
Cartilaginous
Synovial

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11
Q

What are the functional joint types

A

Synarthrosis - immovable
Amphiarthrosis - slightly moveable
Diarthrosis - freely moveable

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12
Q

Functions of skeleton

A 
Support
Protection
Movement - attachment site for muscles 
Mineral and growth factor storage (Ca, PO3, insulin like growth factor, transforming growth factors, bone morphogenetic proteins)
Haematopoeisis
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13
Q

Types of fibrous joints

Give a short description of each

A

Suture -restricted to cranium
Syndesmosis - immovable joint with CT between bones
Gomphosis - peg of bone fits into bone socket

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14
Q

What occurs to suture joints on completion of growth

A

Synostosis - fusion of adjacent bones

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15
Q

Examples of syndesmosis joint

A

Inferior tibiofibular joint
Radioulnar interosseus membrane
Posterior sacroiliac joint

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16
Q

Examples of gomphosis joint

A

Teeth

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17
Q

Types of cartilaginous joints

A

Primary cartilaginous joint

Secondary cartilaginous joint

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18
Q

Describe primary cartilaginous joints

A

United by hyaline cartilage

Synarthrosis

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19
Q

Describe secondary cartilaginous joints

A

Articulating bones covered with hyaline cartilage with fibrocartilage between them
Amphiarthrosis

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20
Q

Examples of primary cartilaginous joints

A 
First sternocostal joint 
Xiphisternal joint (end of sternum)
Epiphyseal growth plate
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21
Q

Examples of secondary cartilaginous joints

A

Pubic symphysis
Intervertebral disc
Manubriosternal joint (sternal angle)

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22
Q

Describe synovial joints

A

Diarthrosis

Made up of:
Articular cartilage
Fibrous capsule 
Synovial membrane 
Synovial fluid
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23
Q

What synovial joints don’t have hyaline as the articular cartilage
What do they have instead

A

Acromioclavicular
Sternoclavicular
Temperomandibular

Fibrocartilage

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24
Q

Describe fibrous capsule of synovial joints

A

Collagen
Poor blood supply
Encloses joint except at synovial protrusions
Stabilises joint

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25
Describe synovial membrane of synovial joints
``` Thin Highly vascularised Lines capsule Covers exposed osseus surfaces, tendon sheaths and bursae Doesn't cover articular cartilage Produces synovial fluid ```
26
Describe properties of synovial fluid
Clear/pale yellow Viscous Slightly alkaline
27
Composition of synovial fluid
Hyaluronic acid Lubricin Proteinase Collagenase
28
Functions of synovial fluid
Reduce friction Shock absorption Nutrient and waste transportation
29
Compare bursae and tendon sheaths
Bursa - synovial fluid filled sac lined with synovial membrane Tendon sheath - elongated bursa around tendon
30
Blood supply of articular cartilage of synovial joint
Avascular
31
Blood supply of synovial joints
Periarticular arterial plexus | This contains many vessels so movement doesn't cut off blood supply
32
What is hiltons law
Nerves supplying joint capsule also supply: Muscles moving joint Skin overlying insertion of these muscles
33
What are the types of synovial joints | Give examples for each
Planar - sternoclavicular, intercarpal, vertebral facet Hinge - knee, ankle Pivot - proximal radioulnar, atlantoaxial Condyloid/ellipsoidal - MCP, radiocarpal, atlantooccipital Saddle - CMC Ball and socket - hip, shoulder
34
Describe planar joint
Articulating surfaces are flat/slightly curved | Uni axial
35
Describe hinge joint
Convex surface of one bone fits into concave surface of another Uni axial
36
Describe pivot joint
Rounded surface of one bone articulate within a ring formed by: Concavity of another bone Fibrous ligament Uni axial
37
Describe Condyloid joint
Oval shaped condyle rests on elliptical cavity of another | Biaxial
38
Describe saddle joint
One bone is concavoconvex (saddle) and the other bone resembles legs of rider Biaxial
39
Describe ball and socket joint
Ball like surface of one bone fits into cup-like structure of another Multi axial
40
Describe cracking synovial joints
Bones pulled apart at joint so synovial cavity expands Synovial volume is constant so partial vacuum produced Gases dissolved in fluid are pulled out of solution making a popping sound
41
How does aging affect synovial joints
Articular cartilage thins Ligaments shorten Decreased flexibility Decreased production of synovial fluid
42
Describe Paget's disease
Increased bone turnover (especially spine and pelvis) New bone is weaker, less compact and more vascular Bone pain which is worse lying down
43
What is arthritis | What is the most common type
Inflammation and stiffness of a joint | Osteoarthritis
44
Describe rheumatoid arthritis
Autoimmune disorder where rheumatoid factor attacks the synovium causing synovial inflammation Women affect 2-3x more than men
45
X-ray features of RA
``` Narrow joint space Periarticular osteopenia (decreased bone mineral density at joint) Bony erosions near joint Subluxation Gross deformity ```
46
What does RA mainly affect
``` MCP joints Cervical spine Feet Eyes Skin Lungs Heart BVs Kidneys Blood ```
47
What local factors affect bone healing
Type of injury (soft tissue) Type of bone (cortical takes longer) Treatment - reduction, stabilised by plaster, infection
48
What regional factors affect bone healing
Blood supply | Muscle cover
49
What systemic features affect bone healing
Age Comorbities - e.g cardiac disease reduces blood supply Bone pathology Head injury (heals well)
50
What is malunion
Fracture heals but in wrong position
51
Causes of malunion
Deformity | Late arthrosis
52
What's non-Union
Fracture doesn't heal
53
Causes of non-Union
Hypertrophic - bones moving | Atrophic - poor bone quality or blood supply
54
Local early fracture complications
Neurovascular injury Compartment syndrome Avascular necrosis Infection
55
Systemic early fracture complications
``` Hypovolaemia Fat embolism Thromboembolism Acute respiratory distress syndrome Disseminated intravascular coagulation ```
56
Local late fracture complications
``` Delayed Union Non-Union Malunion Myositis ossificans Refracture ```
57
Regional late fracture complications
Osteoporosis Osteoarthrosis Joint stiffness Overreaction of SNS leading to increased blood supply and chronic regional pain syndrome
58
Predispositions to stress fractures
Osteoporosis Sports Eating disorders
59
Diagnosis of osteoporosis
DEXA scan assesses bone mineral density
60
What are T and Z scores
T is number of SD below mean for sex and race matched with young healthy adult population Z is number of SD below mean for age, sex and race matched with young healthy adult population
61
Risk factors for type 2 osteoporosis
Age Hyperparathyroidism Ca deficiency Affects men and women equally
62
What is type 1 osteoporosis
Affects post menopausal women
63
Treatment for osteoporosis
Bisphosphonates inactivate osteoclasts: Decrease bone turnover Increase bone mineralisation
64
What is OA
Disorder of synovial joints mostly affecting articular cartilage resulting in decreased joint space There is sclerosis and formation of osteophytes and bone cysts There can be mild synovitis
65
Clinical features of OA
Pain Stiffness Deformity Joint swelling
66
Treatment for OA
Weight loss Physiotherapy Analgesia/NSAIDs Joint injection Arthroscopy (endoscope inserted into joint - minimally invasive) Osteotomies Arthrodesis (induction of joint ossification) Arthroplasty (surgical restoration of joint function)
67
Local complications of hip replacement
``` Leg length inequality Dislocation Infection Loosening Neurovascular damage ```
68
Systemic complications of hip replacements
UTIs DVT Pulmonary embolism Mortality

MSK (87 decks)

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