fractures and bone radiology

Question 0

comminuted

Answer 0

type of simple fracture- >line, >2 pieces

Question 1

simple

Answer 1

simple- one line cuts bone to 2 pieces

Question 2

Open (compound) fractures

Answer 2

skin is violated by broken bone ends or by external trauma, increasing contaimination risk

Question 3

how to take care of open fractures

Answer 3

sterile dressing (saline not betadine)
splint
tetanus and IV abx prophylaxis
surgical emergency- irr & debride

Question 4

transverse fracture pattern

Answer 4

tension

Question 5

oblique fracture pattern

Answer 5

compression

Question 6

spiral fracture pattern

Answer 6

torque

Question 7

butterfly fracture pattern

Answer 7

bending (center fragment is triangular shaped)

Question 8

valgus

Answer 8

distal part is deviated laterally–>fibula

Question 9

Healing

Answer 9

produces healthy tissue that is identical to the original instead of the scar

• inflammatory: 0-2 weeks
• reparative: 2-12 weeks
• remodeling

Question 10

inflammatory phase

Answer 10

hematoma and acute inflammation response to dead bone by surrounding the peri/endosteum

Question 11

reparative phase

Answer 11

organized hematoma–>mesenchymal precursors from periosteum and endosteum–>callus (fibrous, cartilage, immature bone)–>collagen increases–>Ca hydroxyapatite deposits

callous engulfs bone ends–>union

Question 12

remodeling phase

Answer 12

balance of osteoclast and osteoblast activity

Question 13

TGF beta

Answer 13

transforming growth factor that promotes proliferation and differentiation of mesenchymal precursors to osteoblasts, osteoclasts, and chondrocytes–>endochondral and intramembranous bone growth–> synthesis of cartilage specific proteoglycans and collagen type II–>collagen synthesis by osteoblasts

Question 14

BMPs

Answer 14

dimeric ligands that seem to stimulate cartilage growth
crucial in all 3 healing steps as well as secondary effects (regulate HPsis, increase ECM synthesis, and cell survial and death)

Question 15

BMP3

Answer 15

mesenchyme differentiation to bone

Question 16

BMP 2 and 7

Answer 16

endochondrial bone formation (ossification) in segmental defects

Question 17

BMP 1

Answer 17

regulates ECM production

Question 18

FGF1 and FGF 2 (fibroblast growth factors)

Answer 18

increase proliferation of chondrocytes and osteoblasts, enhance callus formation

Question 19

FGF2

Answer 19

angiogenesis

Question 20

PDGF

Answer 20

dimer of PDGFA and B–>MC forms in circulation are BB abd AB–>increases bone growth by increasing osteoblatss–>increases collagen 1 synthesis

Question 21

dimer BB also

Answer 21

increases osteoclasrts–>increases bone resorption

Question 22

IGF1

Answer 22

produced by liver secondary to GH stimulation–>increases B collagen and matrix syntehsis, increases osteoblasts and decreases bone degeneration

Question 23

Interleukins

Answer 23

increase bone resorption

IL1 most potent

Question 24

estrogen

Answer 24

function in healing and to release IL1 inhibitor

Question 25

thyroid hormone

Answer 25

osteoclastic bone resorption

Question 26

PTH

Answer 26

increase bone density in osteoporosis and is used as anabolic rxn for functions

Question 27

glucocorticoids

Answer 27

block Ca absorption from gut therefore increase PTH and increase osteoclastic bone resorption

Question 28

local anatomic factors that influence functional healing

Answer 28

soft tissue injury interruption of local blood supply interposition of soft tissue at fracture site bone death causes by radiation, thermal or chemical burns or infection

Question 29

reduction

Answer 29

realigning a fractured limb by incision (open) or without (closed)

Question 30

immobilization

Answer 30

necessary until union occurs if cast isnt enough, we need to fix the limb internall- pins, screws, rod externall-if internal contraindicated, external fixator

Question 31

most common places for fracture

Answer 31

wrist (fall on outstretched hand), ankle (twisting)m hip(elderly) femur (major violence in young adults)

Question 32

multiple trauma and window of opportunity

Answer 32

make sure to fix the fracture early because it makes mobilization easier and also decreases complication risk (fat emboli, DVT)

Question 33

greenstick fx

Answer 33

younger patients, one cortex fractures while the other bends instead of breaking

Question 34

tx of greenstick fx

Answer 34

completing the fracture by cracking the unbroken cortex

Question 35

buckle/torus

Answer 35

seen in young babies with compression mechanism where one cortex fails by forming a wrinkle while the other appears intact

Question 36

impacted fracture

Answer 36

piece of bone is driven into softer metaphyseal bone

Question 37

pathologic fracture

Answer 37

fracture in bone thats weakend by a pathology | ex- tumor, mets, osteoporosis

Question 38

joint space narrowing uniform

Answer 38

inflammatorry

Question 39

nonuniforn joint space narrowing

Answer 39

degenerative--reflects regional loss of articular cartilage

Question 40

marginal erosion

Answer 40

destruction of bone by INFy pannus | occurs first at uncovered bone at the margin of the joint

Question 41

sublaxation

Answer 41

incomplete or partial dislocation due to laxity of disruptuon of ligament

Question 42

sublax w/ erosions

Answer 42

RA

Question 43

sublax w/o erosions

Answer 43

SLE