Flashcards in Fractures, osteonecrosis, osteomyelitis Deck (40):
The bone fractures after repeated extra stress, i.e., there were some tiny microfractures (as in osteoporosis)
The bone is cracked, but not broken into two pieces. The best-known incomplete fracture is the fast-healing
from an impact to a child's supple long bone
Closed simple fracture
The overlying tissues are intact
The bacteria have a route from the surface to the bone; perhaps the bone is even sticking out the wound.
The bone is broken into several pieces.
A curious term for a fracture in which the ends of the bone fragments have done serious damage to the surrounding tissue.
Due to intrinsic disease of the bone; the force would not have broken a normal bone. Seen in osteoporosis, cancer, osteogenesis imperfecta.
The process of bone healing involves the formation of a callus. How does this form?
The first thing that happens when the bone is fractured is bleeding and formation of clot.. So, you see the presence of blood clot in the fracture site with dead bone because of devascularization at the edges of the fractured bone. After several days, there is recruitment and ingrowth of neovascularization and fibroblast to begin to organize the clot and to begin the process of removal of dead cortex and other tissues.the next step in callus formation which is characterized by ingrowth of osteocytes and new or woven bone formation. Towards the end of the process of callus formation there is cartilage produced at the surface of the callus. After many months, we see the continued remodeling of bone with reduction over time in the callus, eventual complete bone healing.
What is fibrous nonunion?
bone healing which is pathological and occurs when the ends of fractured bones are not closely enough aligned with each other to form callus and to continue the remodeling process to make a perfectly healed bone.
What does a healing fracture look like histologically?
resolving hemorrhage, fractured bony spicules, new osteoid
Where can spongy bone be infarcted?
Where ever there is an end-artery. Usually near convex surfaces of joints
What is the feared result of spongy bone infarction
detachment of articular cartilage
Why is infarction and necrosis in the shaft more difficult?
Osteonecrosis (of the femoral head?) is a complication of what?
sickle cell disease, decompression sickness, and of course femoral neck fracture or dislocation. There may be a link with alcohol and GC use
How does sickle cell lead to osteonecrosis?
crisis often involves multiple painful bone infarcts resulting in osteonecrosis. Hypercellularity of bone marrow interferes with normal blood flow and can contribute.
Hand foot syndrome may occur with osteonecrosis in sickle cell. What is this?
soft tissue swelling, periosteal new-bone formation and moth eaten lytic process
Why might a bone following multiple infarcts in sickly cell look like?
irregular sclerosis, narrow cartilage
Osteomyelitis is bone infection that is frequently caused by _____
How does osteomyelitis develop?
hematogenous spread, contiguous spread, or in patients with vascular insufficiency (poor wound healing)
Hematogenous osteomyelitis is most common in what age group?
children 2-5 years old
Risk factors for osteomyelitis
Presence of foreign materials, diabetes, orthopedic surgery, adjacent infection, peripheral vascular disease, sickle cell disease, congenital phagocyte function defect
Osteomyelitis primarily begins in the ____ of bone.
ALmost all cases of osteomyelitis are due to _____
When may osteomyelitis due to mixed bacteria?
trauma or surgery
When is osteomyelitis due to salmonella?
What is Pott's disease?
vertebral infection by tuberculosis with collapse of the vertebral column. TB osteomyelitis can lead to this. combined infection of vertebral bodies (spondylitis) and joint spaces (spondylarthritis).
Neonatal gongential syphilis has what characteristic?
involving osteomyelitis of the bones of the nose and of the shins. Destructive remodeling of these areas causes a typical saddle nose that seen is in congenital syphilis as well as the production of malformed tibia or saber shins
Is an organism ID all the time with osteomyelitis?
no, only half the time
What is the relationship between squamous cell carcinoma and osteomyelitis?
squamous cell carcinoma can develop in the bone or sinus tract of long-standing chronic osteomyelitis.
What is the involucrum?
surrounding reactive bone which is basically a subperiosteal formation of viable new bone (osteomyelitis)
What is the sequestrum in osteomyelitis?
inner native necrotic cortex-remaining fragment of necrotic cortical bone
Even in chronic osteomyelitis lasting many years, what inflammatory cell predominates?
What does microscopic osteomyelitis look like?
polys, fibrin, old blood and hemorrhage, empty lacunae- dead bone
What serious comorbities occur with Potts?
permanent neurologic deficits and severe deformities. spine can kink 90 degrees!
What are the 4 characteristic phases of syphillis?
primary, secondary, teritary, congential
Describe primary syphillis
aquired via direct sexual contact, skin lesion after 10-90 days called a chancre and is firm, painless skinulceration. usually just one lesion for 4-6 wks that heals. local node swelling
Describe secondary syphillis
contagious, 1-6 months after primary infection. symmetrical reddish-pink non-itchy rash on the trunk and extremities. The rash can involve the palms of the hands and the soles of the feet. In moist areas of the body, the rash becomes flat, broad, whitish lesions known as condylomata lata. Mucous patches may also appear on the genitals or in the mouth. All of these lesions are infectious and harbor active treponeme organismsfever, sore throat, malaise, weight loss, headache, meningismus, and enlarged lymph nodes. Rare manifestations include an acute meningitis that occurs in about 2% of patients, hepatitis, renal disease, hypertrophic gastritis, patchy proctitis, ulcerative colitis, rectosigmoid mass, arthritis, periostitis, optic neuritis, interstitial keratitis, iritis, and uveitis.
Describe teritary syphillis
1-10 years after initial infection, gummas (soft tumor like granulomas) that are chronic and can be anywehere including the skeleton, neuropathic joint disease (loss of sensation and fine position sense) neurosyphillis, CV syphillis,