Path 4

Question 1

Stress Fracture

Answer 1

bone fractures after repeated extra stress

Question 2

Incomplete Fracture

Answer 2

bone is cracked, but not broken into two pieces

ex: greenstick fracture to childs long bone

Question 3

Closed Fracture

Answer 3

overlying tissues are intact

Question 4

Compound Fracture

Answer 4

“Open” “complicated”

-the bacteria have a route from the surface to the bone, bone can stick out

Question 5

Multifragmented Fracture

Answer 5

“comminuted”

-the bone is broken into several pieces

Question 6

Complex Fracture

Answer 6

ends of the bone fragments have done serious damage to the surrounding tissue

Question 7

Pathologic Fracture

Answer 7

intrinsic disease of the bone, force would not have broken normal bone
ex: osteoporosis, cancer, osteogenesis imperfects

Question 8

Skull Fracture

Answer 8

• flat bone

- not depressed, not displaced

Question 9

Callus Formation

Answer 9

1st: bleeding and formation of blood clot (dead bone b/c devascularization at edges of fracture)
2nd: recruitment & neovascularization, neutrophils, fibroblasts organize
3rd: ingrowth of osteocytes & new or woven bone formation, cartilage produced at surface of callus
4th: after many months, continued remodeling of bone with reduction of callus over time until complete healing

Question 10

Fibrous Nonunion

Answer 10

-pathological bone healing where fractured bones are not closely aligned with each other to form callus and to continue the remodeling process to make a perfectly healed bone

Question 11

How do we repair a fracture?

Answer 11

metal devices, plates, nails, screws

Question 12

Osteonecrosis

Answer 12

• spongy bone can be infarcted easily wherever it has an end-artery pattern of vascularization & the artery is compromised. Near convex surfaces of joints, feared result is detachment of the articular cartilage
• overlying cartilage & synovium/joint space will be spared. Infarction & necrosis in the shaft is more difficult b/c of collateral circulation - usually trauma

Question 13

Osteonecrosis of Femoral Head related to?

Answer 13

• sickle cell disease
• decompression sickness
• femoral neck fracture/dislocation
• alcohol abuse/glucocorticoid use

Question 14

Osteonecrosis in Sickle Cell

Answer 14

• Sickle is most common inherited blood disorder in US
• more than 70,000 people have it
• 1 in 500 AA
• 8% AA are carriers
• 2 million have trait
• 1 in 12 AA has trait
• multiple painful bone infarcts resulting in osteonecrosis
• **hypercellular marrow that interferes with blood low in the marrow and can lead to infarct and necrosis

Question 15

Osteomyelitis

Answer 15

bone infection

• often by pyogenic organisms (any can be)
• hematogenous spread(kids 2-5y/o), contiguous spread, or in patients with vascular insufficiency (poor wound healing)

no organism identified in 50%

Question 16

Risk Factors in Osteomyelitis

Answer 16

-presence of foreign materials, diabetes, orthopedic surgery, adjacent infection, peripheral vascular disease, sickle cell disease, congenital phagocyte function defect

Question 17

Pyogenic Osteomyelitis

Answer 17

begins in metaphysis and can spread hematogenously

• staph in 80-90%
• mixed bacteria in trauma/surgery
• Salmonella - Sickle Cell

Question 18

Tuberculous Osteomyelitis

Answer 18

Pott disease, vertebrae

Question 19

Syphilitic Osteomyelitis

Answer 19

neonates, saddle nose, saber shins

Question 20

Squamous cell carcinoma in Osteomyelitis

Answer 20

-develop in bone or sinus tract of long standing chronic osteomyelitis

Question 21

Involucrum

Answer 21

Subperiosteal shell of viable new bone, surrounding reactive bone

Question 22

Sequestrum

Answer 22

Inner native necrotic cortex, remaining fragment inside involucrum

Question 23

Osteomyelitis Micrograph of Dead Bone

Answer 23

• lots of polymorphoneclear leukocytes
• fibrin and old blood
• bony spicule have no osteocytes in lacunae-dead bone
• no lymphocytes present

Question 24

Osteomyelitis in Diabetes

Answer 24

-ulceration & necrosis

Question 25

Pott Disease

Answer 25

"tuberculous spondylitis" - oldest demonstrated disease - infection of vertebral bodies(spondylitis) and joint spaces (spondylarthritis)

Question 26

Syphilis

Answer 26

- spirochete "Treponema palidum" | - late disease affects skeletal system

Question 27

Primary Syphilis

Answer 27

- sexual contact with infectious lesions on a person with syphilis - 10-90 days after initial exposure, skin lesion appears at point of contact (genitalia)

Question 28

Secondary Syphilis

Answer 28

1-6 months ofter primary

Question 29

Tertiary Syphilis

Answer 29

1-10 years after primary

Question 30

Congenital Syphilis

Answer 30

"saber shin" -anterior deformity of the tibia due to periostits and an inflammatory reaction at the outside bony cortex "saddle nose" -destruction of nasal bone -result of transmission from a mother to her fetus

Question 31

Osteoarthritis

Answer 31

- degenerative joint disease, characterized by joint cartilage breakdown causing painful and stiff joints - "inflammation of joints" causes disability - no cure - only strikes one joint - stress like hip, back, knee, hand - painful use of joint, painful periods after use, joint discomfort after weather changes, swelling, stiffness, bony lumps in hands/fingers, decreased flexibility

Question 32

Bony Growth in Osteoarthritis

Answer 32

- result of body's attempt to repair the joint | - body makes it more difficult with the addition of these bony growths

Question 33

Risk Factors for Osteoarthritis

Answer 33

- female gender - age >45y/o - joint injuries - obesity - diseases that cause malformation/disfigurement of bone structure - weakened quads - other arthritis

Question 34

Rheumatoid Arthritis Pathology

Answer 34

-severe ulnar deviation with subluxation (incomplete luxation or dislocation "swan-neck" abnormality -small joints affected first (hands/feet) followed by wrists, elbows, ankles, knees

Question 35

Rheumatoid Nodule

Answer 35

-occur in 20% of patients -acellular center of eosinophilic material "fibrinoid" surrounded by palisaded histiocytes and other cells, maybe with a rim of granulation tissue -occur anywhere-extensor surfaces, pericardium, aortic valve (rare), lung perenchyma

Question 36

Pannus

Answer 36

"membrane of granulation tissue" forms in RA -after years, can proliferate and contribute to joint destruction, spreads over and erodes articular cartilage and bone leading to fibrosis of joint

Question 37

What do urate crystals look like under microscope?

Answer 37

Needle shaped, under parallel polarized light YELLOW

Question 38

What do Calcium Phosphate Crystals look like under microscope?

Answer 38

-polarize yellow when Perpendicular to long axis of crystals

Question 39

Pigmented Villonodular Synovitis

Answer 39

- localized, destructive lesion within a single joint (knee), with proliferation of synovium, hemosiderin pigmentation, and destruction of joint. - clonal - excision is usually curative - may recur