Skeletal System

Question 1

What are the 2 classifications of skeletal fractures?

Answer 1

Complete - bone is broken entirely
incomplete - bone is damaged but still in one piece (common in children)

Question 2

What are the types of complete fractures?

Answer 2

Comminuted - two or more fragments
Spiral - encircles bone
Transverse - straight across
Oblique - at an angle
Linear - lengthwise

Question 3

what are the types of incomplete fractures?

Answer 3

Greenstick - one side is broken
Torus - outer portion of bone buckles but doesn’t break
Bowing - Bone pairs (tibia/fibula, radius/ulna) one bone breaks, the other one bends (difficult to treat)

Question 4

Define open vs closed fracture

Answer 4

Open (compound) skin is broken and bone showing

Closed (simple) Skin in=s intact

Question 5

What are the causes of bone fractures?

Answer 5

Sudden injury - fall, blow, or massive muscle contraction
Pathologic - prior bone-weakening disease (eg. tumour, infection, osteoporosis)
Stress - repeated stress (sports)

Question 6

How to bone fractures heal?

Answer 6

similar to soft tissue healing
involves formation of a callus, with bone remodeling
No scar tissue is made during healing

Question 7

What are the steps in healing?

Answer 7

1. Clot forms in medullary cavity (hollow part of bone)
2. Adjacent bone tissue dies (necrosis)
3. Necrosis starts inflammation
4. Phagocytic cells remove dead tissue, fibrocartilaginous callus makes a bridge called the procallus between bone ends
5. Osteoblasts calcifies bone matrix, making a bony callus
6. callus is remodeled by osteoblasts/clasts

Question 8

Describe dislocation and the joints most affected.

Answer 8

displacement of one or more bones in a joint where surfaces lose all contact
Shoulder, elbow, wrist, knee, finger, hip

Question 9

Define subluxation

Answer 9

same as dislocation but there is still some level of contact between surfaces

Question 10

What are the 3 alterations in posture?

Answer 10

Kyphosis, Lordosis, and Scoliosis

Question 11

Define Kyphosis and its cause

Answer 11

Increased curvature of upper spine
caused by diseases causing loss in bone density in vertebrae or fusion of joints between vertebrae

Question 12

Define Lordosis and its cause

Answer 12

Excessive curvature of lower spine
caused by misaligned vertebrae

Question 13

Define scoliosis and its causes

Answer 13

Lateral deviation of spine with/without rotation
can be idiopathic, systemic conditions (eg cerebral palsy), or indirect conditions

Question 14

Define strain and where it occurs

Answer 14

tearing or stretching of a muscle or tendon
occurs anywhere in body, commonly lower back or neck (whiplash)

Question 15

Define Sprain

Answer 15

tearing of a ligament
most common in ankle, also wrist, elbow, and knee

Question 16

Define avulsion

Answer 16

complete separation of ligament from a bone
(Full sprain)

Question 17

What is osteoporosis? What’s the general process?

Answer 17

It’s the decrease in mineralized bone mass. Old bone is reabsorbed faster than new bone is produced, causing low density

Question 18

How does osteoporosis change with age?

Answer 18

Peak bone mass at 30yo
We have less active osteoblasts as we age
can be present for ears before fracture
Not always an age disease (not all old people have it)

Question 19

What is post-menopausal osteoporosis? How does estrogen affect it?

Answer 19

In women, most bone density is lost in years just after menopause
estrogen inhibits osteoclast activities by decreasing cytokine production and increasing number of cells for bone reabsorption.

Question 20

How does osteoporosis affect men vs women?

Answer 20

testosterone and estrogen are bone protecting hormones.
These hormones decrease more gradually in men than women, so bone loss is slower in men
Men also start with denser bones so it hits them later in life

Question 21

What are the risk factors of osteoporosis? What do they do?

Answer 21

Long term corticosteroid use (reduce bone formation)
Endocrine disorders (increase bone reabsorption)
alcoholism (directly inhibits osteoblasts)

Question 22

What are the clinical manifestations of osteoporosis?

Answer 22

kyphosis: hunched back
loss of height
Common fractures in spongy and porous bone
fractures in long bones (femur, hip, radius, ribs, and vertebrae)

Question 23

Define osteomyelitis

Answer 23

An infectious bone disease

Question 24

What are the 2 types of osteomyelitis? What are their causes?

Answer 24

Exogenous osteo: most common, caused by pathogens from open wounds
Hematogenous osteo: caused by pathogens in blood from infection in the body

Question 25

How does osteomyelitis stages affect children?

Answer 25

1, affects area close to growth plate in long bones 2. exudate forms in bone and under periosteum, cutting blood supply and bone death 3. When periosteum lifts, osteoblasts are stimulated

Question 26

Define sequestrum and involucrum

Answer 26

when exudate cuts off blood supply and causes bone necrosis when osteoblasts lay layers of bone on top of sequestrum

Question 27

How does osteomyelitis affect adults?

Answer 27

long bones lose conditions that favour bacterial attachment, affecting the axial skeleton

Question 28

What is osteoarthritis? is it autoimmune?

Answer 28

an age-progressive, inflammatory, degenerative joint disorder Not autoimmune in nature

Question 29

What are the causes of osteoarthritis?

Answer 29

Primary: intrinsic defects in cartilage (natural variation) Secondary: congenital joint defects, trauma/injury, crystal deposits, wear & tear, inflammatory diseases

Question 30

How is articular cartilage lost

Answer 30

1. in early disease, cartilage flakes off, underlying cracks develop 2. Exposed bone hardens, may develop cysts 3. cartilage may grow out of joint and alter the anatomy 4. thus may break and enter synovial cavity 5. joint capsule becomes thicker and stick to underlying bone, restricting movement.

Question 31

What are the clinical manifestations of osteoarthritis?

Answer 31

appears in 50's - 60's pain in joints pain, stiffness, swelling, joint deformity limited range of motion creaking/grating sounds with movement

Question 32

What is inflammatory joint disease?

Answer 32

inflammatory damage in synovial membrane or cartilage by systemic signs of inflammation

Question 33

Describe the differences between infectious and non-infectious joint disease.

Answer 33

Inf: Caused by pathogens through wound or blood Non: most common caused by immune reactions or crystal deposition

Question 34

Describe rheumatoid arthritis and its causes

Answer 34

chronic, systemic, inflammatory autoimmune disease known for joint swelling, tenderness, and destruction of synovial joints Causes unknown, possibly genetic with inflammatory problems.

Question 35

What body parts/tissues are affected by Rheum. Arthritis?

Answer 35

fingers, wrists, elbows, feet, ankles, and knees first tissue us synovial membrane, then articular cartilage, joint capsule, and surrounding tissue

Question 36

What factors are involved in Rheum. arthritis?

Answer 36

involves "rheumatoid factors" which are antibodies that react to host antibodies present in the synovial membrane.

Question 37

What has to happen to start producing RF's?

Answer 37

An unknown antigen must be found in the synovial tissue and an immune response is triggered

Question 38

What are the clinical manifestations of Rheum. arthritis?

Answer 38

General inflammation: fever, fatigue, weakness painful, tender, stiff joints for 1 hour loss of range, possible deformities loss of mobility -> atrophy of surrounding muscle

Question 39

What is ankylosing spondylitis? Where does it start?

Answer 39

chronic, systemic inflammatory disease of joints in vertebral column starts at sacroiliac joints and works up to smaller spinal joints

Question 40

Who does A. Spondylitis affect? What are the manifestations?

Answer 40

Mostly affects men aged 15-40 pain, progressive stiffness and fusion of spinal column

Question 41

What are the stages of disease progression?

Answer 41

1. fibrocartilage in vertebral joints are inflamed 2. damage occurs from macrophages and lymphocytes 3. Fibroblasts repair damage, secrete collagen which ossifies 4. Joints fuse together

Question 42

Describe club foot. What are causes and corrections?

Answer 42

one or both feet are turn in and down in babies can be positional, idiopathic, or from another syndrome Can be corrected by manipulation and casts

Question 43

Describe developmental dysplasia of the hips

Answer 43

Imperfect development of hip joint, ranging from loose to dislocation Correctable in 1st month after birth, otherwise surgery is required