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Flashcards in Bones and joints Deck (68):
1

Types of bone and example

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

2

Structure of short, flat and sesamoid bones

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

3

Blood supply of bones before epiphyseal fusion

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

4

Blood supply of bones after epiphyseal fusion

Anastomoses between epiphyseal and metaphyseal arteries
Periosteal arteries
Nutrient artery

5

Where do metaphyseal arteries enter bone

Metaphysis at site of attachment of capsule

6

What does the periosteal artery supply

Periosteum
Outer 1/3 of cortex

7

Where does the nutrient artery enter bone

Diaphysis via nutrient foramen

8

How can avascular necrosis be caused
What can it lead to

Fracture
Dislocation
Steroids
Radiation
Decompression sickness (N2)

Leads to secondary osteoarthritis

9

What properties are joints classified by

Structural (tissue between articulating bones)
Functional (amount of movement)

10

What are the structural joint types

Fibrous
Cartilaginous
Synovial

11

What are the functional joint types

Synarthrosis - immovable
Amphiarthrosis - slightly moveable
Diarthrosis - freely moveable

12

Functions of skeleton

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

13

Types of fibrous joints
Give a short description of each

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

14

What occurs to suture joints on completion of growth

Synostosis - fusion of adjacent bones

15

Examples of syndesmosis joint

Inferior tibiofibular joint
Radioulnar interosseus membrane
Posterior sacroiliac joint

16

Examples of gomphosis joint

Teeth

17

Types of cartilaginous joints

Primary cartilaginous joint
Secondary cartilaginous joint

18

Describe primary cartilaginous joints

United by hyaline cartilage
Synarthrosis

19

Describe secondary cartilaginous joints

Articulating bones covered with hyaline cartilage with fibrocartilage between them
Amphiarthrosis

20

Examples of primary cartilaginous joints

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

21

Examples of secondary cartilaginous joints

Pubic symphysis
Intervertebral disc
Manubriosternal joint (sternal angle)

22

Describe synovial joints

Diarthrosis

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

23

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

Acromioclavicular
Sternoclavicular
Temperomandibular

Fibrocartilage

24

Describe fibrous capsule of synovial joints

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

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

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