Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

BRS Year 2 > How to Treat MSK Conditions Tutorial > Flashcards

How to Treat MSK Conditions Tutorial Flashcards

1
Q

What is Greek for bone?

A

Osteo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 4 types of bone cells?

A

Osteogenic cell = precursor, bone ‘stem cell’
Osteogenic cells give rise to:

Osteoblasts :

  • ‘Bone forming’
  • Secretes ‘osteoid’
  • Catalyse mineralisation of osteoid

Osteocyte:

  • ‘Mature’ bone cell
  • Formed when an osteoblast becomes imbedded in its secretions
  • Sense mechanical strain to direct osteoclast and osteoblast activity

Osteoclast:

  • ‘Bone breaking’
  • Dissolve and resorb bone by phagocytosis
  • Derived from bone marrow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

The balance between which 2 types of bone cells is responsible for the turnover of bone?

A

Osteoblast and osteoclast activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the organisation of the cortical (compact) bone?

A

Cortical bone= osteons
Osteons are made of concentric lamellae around central Haversian canal

Haversian canal contains blood vessels, nerves and lymphatics
Lacunae are small spaces containing osteocytes with canaliculi raiding out and filled with ECF
Volkmann’s canals are transverse canals which connect to Haversian canals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is an osteon?

A

Repeated structural units

contain concentric ‘Lamellae’ (made up of osteocytes) around a central ‘Haversian Canal’

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the structure of a cross section of long bones?

A

Periosteum – Connective tissue covering
Outer Cortex – compact (cortical) bone
Cancellous bone
Medullary cavity - central part of the bone, contains yellow bone marrow and cancellous bone
Nutrient Artery
Articular cartilage: on surface of bone at a joint only

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How do bones grow in children?

What is the structure of the long bone?

A

Growth plate proximally AND distally in long bones - known as the physis

Above the physis (closest to the joint) is the epiphysis and below is the metaphysis
Main body of the bone = diaphysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the 3 mechanisms of fracture?

A
  1. Trauma - low energy or high energy
  2. Stress - abnormal stresses on normal bone
  3. Pathological - normal stresses on abnormal bone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Why might the bone be abnormal pathologically?

A

Pathological causes of abnormal bone =
Osteoporosis - low bone mineral density
Low bone mineralisation e.g. Vit D deficiency, osteomalacia / rickets
Malignancy - primary bone cancer or bone metastases
Infection e.g. osteomyelitis
Osteogenesis imperfecta
Pagets - degenerative turnover of bone that leads to abnormal bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the difference between pathological VS insufficiency fractures?

A 
Pathological = all abnormal bone
Insufficiency = subgroup of pathological, usually applies to abnormalities due to metabolic diseases e.g. age related osteoporosis, or abonrmal mineralisation due to vitamin d deficiency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How are fracture patterns described?

A
  1. Soft tissue integrity - open (breached) VS closed
  2. Bony fragments - greenstick, simple, or multifragmentary (comminuted)
  3. Movement - displaced or undisplaced
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the 3 phases of fracture healing?

A
  1. Inflammation - bone bleeds, blood brings swelling but also cells and cytokines that eventually produce new blood vessels and osteoblasts gradually start producing collagen
  2. Repair - soft callus formation (type II collagen - cartilage) initially, that then turns into type I collagen forming a hard callus (bone)
  3. Remodelling - overtime, osteoclasts and osteoblasts remodel bone according to the stresses placed on it
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is Wolff’s law?

A

Bone grows and remodels in response to the forces that are placed on it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the clinical signs of a fracture?

A

Pain
Swelling
Crepitus - abnormal popping or cracking of a joint
Deformity
Adjacent structural injury e.g. nerves, vessels, ligaments, tendons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the investigations of fracture?

A

X-ray = first line investigation for suspected fractured bone
CT scan = used to assess exact architecture of a fracture as they only tell you about bones
MRI = mainly for soft tissue information
Bone scan = rarely used, but used for multiple fragments OR spread of infection so they are not performed without very good reason due to dye injection, exposure of radiation etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How are fractures described on radiographs?

A 
Location - which bone and which part of the bone? (use thirds or diaphysis/metaphysis/epiphysis)
Pieces -  simple or multifragmentary?
Pattern - transverse, oblique or spiral?
Displacement - displaced or undisplaced?
Translated or angulated?
Plane - X, Y or Z plane?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the 2 types of displacement?

A
  1. Translation - lateral (along a straight line)

2. Angulation - fracture is angled (no longer in a straight line)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the different types of translation?

A

Up or down = proximal / distal
Side to side = medial or lateral
Forward or backward = anterior / posterior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the different types of angulation?

A

Distal fragment moving away from the midline = valgus
Distal fragment moving towards the midline = varus
Backwards = volar
Front = Dorsal
Look at patient feet up - Internal (towards midline) / External (away from midline) rotation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the general principles of fracture management?

A

Reduce - open or closed
Hold - metal or no metal
Rehabilitate - move, physiotherapy, use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How can fractures be reduced?

A

Closed:
Manipulation
OR
Traction - pulling the skin or place pins in the bone (skeletal)

Open:
Mini-incision
OR
Full exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How can fractures be held?

A

Closed:
Plaster
OR
Traction (skin or skeletal)

Open:
Fixation (using metal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the different types of fixation?

A

Fixation uses metal and there are two methods: internal VS external

Internal (metal underneath the skin) =
Intramedullary = through the central canal of the bone using pins or nails
OR
Extramedullary = surface of the bone using plate/screws or pins

External (through the skin) =
Monoplanar
OR
Multiplanar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How can patients be rehabilitated?

A

Using the limb - use pain relief and retrain
Move
Strengthen
Weight bear - put stresses along the limb to remodel the bone in the right fashion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are some possible fracture complications?
General (complications affecting the whole body) - can be early or late: - Fat embolus - fat globules from bone marrow can enter the blood from the fracture, usually occurs within a few hours - DVT (deep venous thrombosis) - blood clot in the vein, that can become a thromboembolus - PE (pulmonary embolism) - fat embolus travelling to the lungs - Systemic sepsis from an infection that is spreading - Prolonged immoblity can increase risk of UTI, chest infection, pressure sores on the area of the body you are sitting on OR Local (complications just affecting the area around the fracture): Can be divided into urgent, less urgent and late
26
What are some urgent local complications of fractures?
Local visceral injury Vascular injury Nerve injury Compartment syndrome (bleeding into a compartment leading to inc. pressure which can cut off blood supply) Haemarthrosis Infection Gas gangrene - infection caused by clostridium
27
What are some less urgent, local complications of fractures?
``` Fracture blisters Plaster sores Pressure sores Nerve entrapment Myositis ossificans -metaplasia of myocytes into osteocytes following injury = stiff and painful muscles Ligament injury Tendon lesions Joint stiffness Algodystrophy ```
28
What are some late local complications of fractures?
``` Delayed union - the bone hasnt healed in the time it normaly takes Malunion Non-union Avascular necrosis (loss of bone blood supply) Muscle contracture (tightening or shortening of muscle) Joint instability Osteoarthritis ```
29
What is important to note in the history of a patient with a fracture?
Age Comorbidity: respiratory/cardiovascular/diabetes/cancer Preinjury mobility: independent/shopping/walking/sports Social hx: relatives, stairs, alcohol
30
What are the causes of a neck of femur (NoF) fracture?
Old age: Insufficiency fracture from osteoporosis Younger age: trauma OR combination of both
31
What is the anatomy of the neck of a femur (NoF)?
``` Articular cartilage on the femoral head Femoral head attached to neck Neck attached to shaft 2 lumps - greater and lesser trochanters Inter-trochanteric line inbetween ```
32
How do you classify an intra VS extra capsular NoF fracture?
In front or behind trochanteric line: Above the intertrochanteric line = intracapsular Below the intertrochanteric line = extracapsular
33
How do you decide whether to fix or replace a NoF fracture?
Based on location / displacement and age: Location = if extracapsular, usually try to fix it as there is minimal risk to the blood supply and avascular necrosis (AVN), so can be fixed using plates and screws (dynamic hip screw) If intracapsular: if undisplaced, less risk to blood supply so fix with screws, if displaced, 25-30% risk AVN so replace in older patients, and fix in younger patients (<55)
34
If the patient has a displaced intracapsular fracture and they are over 65, how do you decide whether they need a total or partial hip replacement?
Total hip replacement = Walks >mile a day Independent Minimal co-morbidities Heiarthroplasty (half hip replacement) - metal rubs on socket = Lower morbidity Multiple comorbidities
35
What are the 3 classifications of joints?
1. Fibrous = e.g. skulls, contain sutures, syndesmosis and interroseous membranes 2. Cartilaginous = synchondroses e.g. sppone, symphyses e.g. pubic 3. Synovial = calssified in how the move: plane, hinge, condyloid, pivot, saddle, ball and socket
36
How are synovial joints stabilised?
The proportions of the 3 components: Bone surface congruity Ligaments Muscles / tendons
37
What are the components of the synovial joint?
2 bones encases in a capsule Synovial membrane lines the capsule - this secreted synovial fluid that nourishes and lubricates the joint Both heads of the bone have hyaline articular cartilage
38
What is the hyaline articular cartilage composed of?
Composed of: 1) specialized cells (chondrocytes) 2) extracellular matrix: water, collagen and proteoglycans (mainly aggrecan) Cartilage is avascular – it has no blood supply Surface = horizontal collagen arrangement with horizontal cellular arrangement
39
What is aggrecan?
A proteoglycan that possesses many chondroitin sulfate and keratin sulfate chains Characterised by its ability to interact with hyaluronan (HA) to form large proteoglycan aggregates
40
What is arthritis and what are the 2 major divisions?
Osteoarthritis (OA) = wear and tear of articular cartilage Inflammatory arthritis = inflammation of the synovial membrane Each can lead to each other
41
How can OA lead to inflammatory arthritis as well?
Articular cartilage becomes eroded and worn So the bones begin to produce more bone leading to sunchondral sclerosis and osteocytes This then creates some inflammation as a by-product
42
What is the WHO definition of OA?
A long-term chronic disease characterized by the deterioration of cartilage in joints which results in bones rubbing together and creating stiffness, pain, and impaired movement
43
What are the risk factors of OA?
``` Age Excess weight / obesity Mechanical constraints (e.g. intense sport) Hereditary Female, menopause Osteonecrosis Leg bone malalignment Oestrogen deficiency Metabolic Syndrome Secondary to spondylarthritis or RA Injury e.g. to cruciate ligament, meniscectomy Metabolic diseases Infectious diseases involving the bone RA sequellae ```
44
How does OA present clinically?
Pain (exertional / rest / night Diability - walking distance / stairs / giving way Deformity Previous history - trauma, infection etc. Treatments given - physio, injections, operations, etc. Other joints affected
45
How do you assess for OA?
Look Feel Move Special tests
46
What is seen on a radiograph (x-ray) showing OA?
Osteophyte Loss of joint space Subchondral cysts Sclerosis
47
How is OA managed conservatively and operatively?
``` Conservative: Analgesics Physiotherapy Walking aids Avoidance of exacerbating activity Injections (steroid, viscosupplementation) ``` ``` Operative / surgical: Replace knee / hip Realign knee / hip Excise - toe Fuse - big toe Synovectomy - RA Denervate - wrist ```
48
What are the 2 main types of bone infection?
Osteomyelitis - infection in the shaft of the bone | Septic arthrtiis - if the infection is in the joint
49
How are osteomyelitis and septic arthritis differentiated?
Mainly location | Can be localised / confirmed using an X-ray or an MRI
50
How does osteomyelitis present clinically?
``` Refer to pathology lectures Acute or chronic Primary or secondary Pain/swelling/discharge Systemic signs: Fevers, sweats wt loss ```
51
How does septic arthritis present clinically?
Pain Joint swelling/stiffness Fevers, sweats, wt loss Usually one joint affected - a painful, red, hot, swollen joint with fever
52
What causes septic arthritis?
Bacterial infection of a joint (usually caused by spread from the blood) - e.g. Staphylococcus aureus, Streptococci, Gonococcus
53
What are the risk factors for septic arthritis?
Immunosuppressed Pre-existing joint damage Intravenous drug use (IVDU)
54
Why is septic arthritis a medical emergency?
Untreated, septic arthritis can rapidly destroy a joint
55
How is septic arthritis diagnosed?
Joint aspiration - fluid sent out to lab for urgent gram stain and culture
56
What are other investigations can help diagnose septic arthritis?
``` Radiology: Plain films MRI scans: bony architecture/collections CT if MRI not available Bone scans: multifocal disease Labelled White cell scans ``` ``` Bloods = usually non-specific but sitll tell you if there is an infection: CRP: acute marker ESR slower response WCC TB culture/PCR ```
57
What is the treatment for osteomyelitis VS septic arthritis?
Osteomyelitis: Antibiotics: iv weeks Surgical drainage: especially collections/sequestrum Chronic: antibiotic suppression/dressings Worst case scenario: amputation ``` Septic Arthritis: Surgery: joint washout and drainage (repeated if required) Iv antibiotics (days/weeks) Immobilise joint in acute phase Physiotherapy once over acute phase ```
58
What shoulder conditions are more prevalent in these groups: 15-45 46- 60 >60
15-45: Dislocation, fractures 45-60: Impingement, dislocation, ACJ OA, Rotator cuff tears, fractures >60: Glenohumeral OA, Impingement, Cuff tears, fractures
59
What hip conditions are more prevalent in these groups: 15-45 46- 60 >60
15-45 developmental dysplasia, leg length discrepancy, impingement 46- 60 OA, avascular necrosis, impingement >60 OA, post total hip replacement
60
What knee conditions are more prevalent in these groups: 15-45 46- 60 >60
15-45 patellofemoral maltracking, ACL/PCL, meniscal tears, fractures 46- 60 OA, patellofemoral maltracking, ACL/PCL, meniscal tears, fractures >60 OA
61
What supplies blood to the femoral head of the femur?
Medial circumflex artery | Gives of lateral epiphyseal arteries
62
What are the different neck of femur fractures?
subcapital: femoral head/neck junction transcervical: midportion of femoral neck intertrochanteric: base of femoral neck
63
What type of NOF fracture is most likely to compromise blood and lead to necrosis?
Intracapsular fracture

BRS Year 2 (110 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions