Bone Diseases Flashcards by Iman Salem

Clinical Healing of bone healing

healing of pain and swelling

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Radiographic healing of bone healing

healing of 3 of 4 cortices

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What does Wolff’s law state

bone will adapt to a load/pressure

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What are the stages of bone healing and their descriptions (5)

Inflammatory stage: pain/hyperemia/edema. Induction of growth factors. Differentiation of MSC into osteoblasts and chondrocytes (immediately)
Hematoma formation: fibriblast/platelet differentiation (immediately)
Soft callus: Cartilage (4 days to 4 weeks)
Hard Callus: calcification (4 weeks to 4 months)
Remodeling: Wolff’s law (4 months- 2 years)

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2 mechanisms of bone healing

-Primary bone healing, membranous, direct healing

Secondary bone healing, spontaneous, indirect, enchondral healing

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Describe primary bone healing

1) Contact healing/Haversian remodeling: occurs when there is

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Describe secondary bone healing

formation of bone callus… followed by resorption of callus. Wide gaps are filled with cortical bone via Haversian remodeling
Motion allowed at the fracture site

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Description of woven bone

unorganized collagen fibers
mechanically weak
produced when osteoid is produced rapidly

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Description of Lamellar bone

Parallel alignment of collagen
Mechanically strong
Replaces woven bone eventually

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What are the zones of an epiphyseal growth plate(4)

Zone of proliferation/growth
Zone of maturation
Zone of transformation
Zone of provisional calcification

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What is the description and location of the zone of proliferation/growth

site of chondrocyte replication

- it is located closest to the epiphysis

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What is the description of the zone of maturation

chondrocyte hypertrophy

- Weak due to loss of intracellular matrix

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What is the description of the zone of transformation

-chondrocytes become calcified

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What is the description and location of the zone of provisional calcification

-Between growth plate and metaphysis. Closest to the shaft

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Comorbidities that result in significant nonunion of bone

Diabetes
Osteoporosis
Vitamin D deficiency
Osteogenesis imperfecta
Osteomyelitis

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Social history that results in significant nonunion of bone

smoking
poor nutritional status
poor bone quality
infection
ETOH consumption

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Medications that result in significant nonunion of bone

-Chronic steroid use

–NSAIDS

immunosuppressants
Chemotherapy

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Conservative treatments for nonunion of bone

oral calcitonin
Functional bracing
Bone stimulator

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What is the mechanism, duration and contraindication for bone simulator use

Mechanism: Electronegative charge used to stimulate bone growth at areas of growth and repair.

Duration: 3-6 months

Contraindication: not for use in synovial pseudoarthrosis, gaps >1cm or 50% of bone diameter

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4 categories of bone grafts

Bone grafts- for small defects
Intercalary graft-from fresh frozen femoral head. For defects < 5 cm
Trabecular cage
Vascularized graft- for large defects 10-40cm

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Description of cancellous graft healing (5)

revascularization occurs in 2 weeks
gain strength with growth pattern
results in a complete remodeling
Many osteocytes are present in this type of healing

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Description of cortical graft healing

revascularization occurs in 2 months
lose strength in the first 6 months with this type of growth pattern
Remodeling is incomplete with necrotic pockets with this type of remodeling.
Not as many osteocytes present in this type of healing

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What are the stages of bone graft healing (5)

Vascular ingrowth
osteogenesis: osteoblasts from the bone graft cause bone growth
osteoinduction: regular bone growth with many growth factors
osteoconduction: bone graft serves as scaffold/framework for osteoblasts to conduct and spread
Graft remodeling: according to Wolff’s law

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What osteobiologics help with osteoinduction phase

BMP: stimulates osteoblast production
MSC allograft
PRP: provides growth factors
BMA- provides MSC

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What osteobiologic helps with osteoconduction phase

- ceramic/bioactive glass: this is osteoconductive, osteoinductive and antibacterial - DBM : some osteoinduction

What are the main osteobiologics used for bone grafts

- PRP - Stem cells - Cartiform - Biocartilage - Arthroflex

What is PRP and what are the two main types

buffy coat layer (leukocyte rich) plasma based(leukocyte poor) better for OA treatment

What is Cartiform

chondral mesh of osteochondral allograft

what is biocartilage

an ECM scaffold for cells to augment microfractured defects

What is arthroflex

a soft tissue scaffold.

What are the advantages of external fixation (2)

Decreased soft tissue dissection Can be used with infection

What is Dynamization

before ex fix removal pins are loosened and patient allowed to WB. -axial load without distraction strengthens bone, induces callus formation and faster healing

What is the piezogenic effect

stress generates electric potentials in bone results in callus formation

What is the Calandruccio triangular compression device

Tri-planar compression External frame good for ankle arthrodesis One pin through tibia one through talus

What is the classification system for nonunions

Weber and Cech

What is the Weber and Cech classification system

- Hypertrophic: - --Elephant foot: best chance for healing - --Horse foot: poor callus - --oligotrophic: no callus - Avascular: - --atrophic - --comminuted - --defect - --torsion wedge

What are the main bone healing complications (4)

- Delayed union - Nonunion - Malunion - Pseudoarthrosis

What is the characteristic and treatment of delayed union

- when there is no evidence of union for 6-9 months | - Treatment consists of immobilization

What is the characteristic and treatment of nonunion

- when there is no evidence of union for > 9 months | - treatment consists of bone stimulator and bone graft

What is the characteristic of malunion

when bone is reduced and heals in an improper position

What is the characteristic and treatment of pseudoarthrosis

Fibrocartilaginous surface at bone fracture site, joint space contains synovial fluid -treatment is operation

What is osteonecrosis

ischemic death of bone and bone marrow

What is the etiology of osteonecrosis

- trauma - alcoholism - methylmethacrylate

How do you diagnose osteonecrosis

- bone scintigraphy - MRI - CT

What is Osteochondrosis

disease of growth center, epiphysis or apophysis degeneration/necrosis followed by regeneration/recalcification

What is the treatment of osteochondrosis

Treat with serial casting

What is Kohler's disease -description

Navicular -Coin sign, coin on edge, or silver dollar sign

Freiberg's infraction

of the 2nd metatarsal head

Mueller-Weiss

adult osteochondrosis of the navicular

Buschke disease

cuneiform

Severe's apophysitis

calcaneus -Pain with squeeze

Iselin's disease

5th met base

Osgood Schlatter

tibial tubercle

Blount's disease

Medial tibial plafond

Legg Calve Perthes disease

femoral head Most common of the osteochondrosis

Diaz/ Mouchet

Talus

Thiemann's

Phalanges

Lewin

Distal tibia

Ritter

proximal fibular head

Treve

fibular sesamoid

Renandier

tibial sesamoid

Lance

Cuboid

Assmann

1st met head

Etiology and clinical presentation of Freiberg's infraction

Fracture of the 2nd met head An osteochondrosis of 2nd MT head due to acute injury or repetitive micro trauma to an open physis -CP: is a young female athlete with MT pain

What is the classification for Freiberg's infraction

Smillie classification

Describe Smillie classification

0: normal radiograph 1: epiphysis fissure fracture with joint space widening 2: Central depression of the MT head 3: Lateral projections "crescent sign" 4: Fracturing of the lateral projections and loose bodies 5: Flattened MT head

What are the conservative treatment options for Freiberg's

immobilization with below knee cast orthotic with MT bar wide toe box, rigid shank, rocker bottom

What are the surgical treatment options for Freiberg's

Distal MT osteotomy, implant arthroplasty - Interpositional grafting - rotational osteotomy - OATS

Patterns of destruction seen with bone tumors... and their severity of aggression (3)

- Geographic: slow growing - Moth-eaten: more aggressive - Permeative: most aggressive

Periosteal reactions seen with bone tumors from least to most severe

- Buttressing - Lamellated/onion skin - Sunburst - Hair on end/spiculated - Codman's triangle

What are the malignant bone tumors

osteosarcoma and Ewing's sarcoma

Osteosarcoma epidimiology and CP

20-30 year old CP: Codman's triangle Most common malignant bone tumor

Ewing's sarcoma epidiomogy and what to look for

4 YO with elevated WBC and ESR permeative lytic lesion with onion skinning

Osteochondroma: -etiology - progression - age - radiograph - histology - size

etiology: disruption in development of the cortex progression: slower growing - age: adolescent - Radiograph: cancellous bone Histology: hyaline cartilage cap Size: much larger than exostosis

Subungual exostosis -etiology - progression - age - radiograph - histology - size

- etiology: trauma - progression: slow pre-puberty - age: 20-40 years old - radiograph: cortex confluent with underlying bone histology: fibrocartilage cap

Osteochondroma CP

most common of the benign bone tumors CP: commonly subungual boney outgrowth with cartilaginous cap that looks like mushroom

Osteoma where x-ray

located in skull periosteum X-ray osteochondroma with cartilgenous cap

enostosis: definition

bone island

osteoblastoma what is it known as and pathognomonic sign

AKA giant osteoid osteoma, nigh pain not relieved with aspirin

Osteoid osteoma

nigh pain is relieved by aspirin

Enchondroma: where what part fancy names

found in phalanges tumor of the hyaline cartilage Ollier's disease: multiple enchondromas Maffuci's syndrome: enchondroma associated with soft tissue hemangioma

Unicameral bone cyst What is the sign What is it

Fallen fragment sign Fluid filled in calcaneus

Aneurysmal bone cyst what is it

filled with blood

Giant cell tumor: similar to what

similar to aneurysmal bone cyst

What is an intra-osseous lipoma

calcaneal bone cyst with intra-osseous calcification

What does fibrous dysplasia look like: ground glass appearance

ground glass, more centered

ossifying fibroma: where is it found

prediliction for mandible

Where are non-ossifying fibromas found

in connective tissue at the muscle tendon insertion

What is a brown tumour indicitave of

hyperparathyroidism

What is Paget's disease associated with and what are the X-ray appearances

Paget's disease is associated with osteosarcoma, chondrosarcoma and fibrosarcoma. will find flame like lesions and appear as "blades of grass"

Melorheostosis: x-ray findings

wavy inner or outer cortex will appear as wax flowing down a candle

What is Ricket's/ osteomalacia and what are x-ray findings

Vitamin D deficiency -Xray: will see bowing, looser zone, milkman zone, mataphyseal cupping/fraying White line of Frankel: transversee line of increased density -Scurvy line: dark line

Scurvy: due to what and what are the x-ray signs

due to vitamin D deficiency - Wimburger sign- ring epiphysis - Pelken Spur: beaky outgrowth in scurvy

osteopetosis:

bone within bone appearance

Osteopoikilosis

multiple bone islands.

Bone Diseases Flashcards

(95 cards)