Bone and Joint- Final- LCCW

__________________ is a slow progressive physiological resorption of normal bone which is replaced by fibrous tissue mixed w/ haphazardly arranged trabeculae.

Fibrous Dysplasia (FD)

growing fibrous neoplasm

The two great imitators of bone disease are ____________ and _____________.

FD; Paget's

___________ people usually get FD because it occurs during _______________.

Young (8-14); skeletal growth

males=females

FD is is located in the ___________________.

medullary cavity

What is a name sign for FD?

ground glass appearance

What happens to the cortex with FD?

endosteal scalloping -- eroded from within

normal cortex expands/deforms but DOES NOT break

What are the 3 clinical patterns of FD?

1. monostotic (one bone)

2. polystotic (multiple bones)

3. McCune Albright Syndrome

What is McCune Albright Syndrome?

Polystotic FD with endocrine abnormality

_____________ is the most common pattern of FD.

Monostotic

70-75%

75% of monostotic FD lesions occur in what four bones?

ribs, tibia, femur and skull

McCune-Albright syndrome is associated with __________________ and __________________.

skin pigmentation; very early sexual development

What is the name sign for the skin pigmentation associated w/ McCune-Albright Syndrome?

cafe au lait- coast of Maine (jagged border)

True or false?

There is a periosteal response with FD.

False

There is no periosteal response.

_____________ is a neurocutaneous congenital/inherited disorder.

Neurofibromatosis (NF)

What are two AKAs for NF?

1. Von Recklinghausen's disease

2. Elephant man disease

What are two skin findings associated with NF?

1. cafe au lait spots -- coast of California (smooth)

2. fibroma molluscum -- skin tags (show up radiographically)

__________% of NF patients have family history of the disease.

60

_____________% of pts w/ NF develop Cafe au Lait spots.

50

The most common place for tumor formation from NF is the _______________.

IVF

Name sign for Neurofibroma of spinal nerves within the IVF:

dumb-bell shaped lesions

What effect do dumb-bell shaped lesions have on vertebrae?

posterior VB scalloping

enlarge IVF

scoliosis

increased kyphosis

True or false?

NF is most common in people over 60.

False

Younger people usually get NF due to it being a congenital disease with chromosomal roots.

male=female

_____________ is a radiographic finding of decreased bone density.

Osteopenia

The __________ to __________ ratio is off if patents with Osteopenia.

osteoid; mineral

_____________ is a decreased in total bone mass greater than what is expected for a given age, race, sex, however, the bone is in normal composition.

Osteoporosis

With _______________ there is a normal osteoid to mineral ratio, but with ________________ the osteoid to mineral ratio is off.

Osteoporosis; osteopenia

Osteoporosis is most clinically significant in the _____________ skeleton.

axial

True or false?

Osteoporosis only causes the loss of cortical bone.

False

Both cortical and trabecular bone is lost.

Osteoporosis causes "_____________" cortices due to decreased mineral content.

pencil thin

What is a name sign associated with the biconcave fractures of the vertebrae of osteoporosis patients?

fish vertebrae

Osteoporosis can be referred to as _____________ and it mimics the "corduroy cloth appearance" vertical striations.

pseudohemangioma

_____________ tests for osteoporosis.

DEXA - Dual Energy X-Ray Absorptiometry

_____________ fractures involve the whole VB collapsing (front & back).

Pathologic

can occur with any pathology

_____________ fractures occur from a hyperflexion injury- the front collapsed but the back is maintained.

Simple Compression

_____________ occurs from defective osteoid mineralization.

Osteomalacia/Rickets

Osteomalacia occurs in _____________ while Rickets occurs in _____________.

adults; children

______________ deficiency is the main cause of Ricketts and Osteomalacia.

Vitamin D

Vitamin D is responsible for the deposition of calcium into bone

The growth plates of Rickets are _____________.

Name signs:

indistinct

frayed metaphysis; paint brush metaphysis

Osteomalacia shows characteristic _____________ on X-Ray.

pseudofractures

The classic location for pseudo fractures in Osteomalacia is the _____________ border of the ______________.

axillary; scapula

Rickets creates swelling at the _____________ junction.

costochondral

The swelling at the costochonral junction from Rickets is given the name sign ________________ due to the bead-like contour changes along the chest.

richitic rosary

Hyperparthyroidism results in increase in the release of _____________.

PTH (parathyroid hormone)

PTH functions to elevate _____________.

blood calcium level

Name the four mechanisms used by PTH to increase blood calcium levels.

1. increases osteoclastic resorption of bone (liberates Ca)

2. increases renal formation of calcitrol

3. increases renal tubular resorption of Calcium

4. decreases renal tubular resorption of phosphate

What does excess PTH secretion lead to?

hypercalcemia

hypophosphatemia

increased bone resorption

_________ between the ages of ______________ typically get HPTH.

females; 30-50

What are the two types of HPTH?

primary and secondary

Primary HPTH is due to parathyroid ___________.

adenoma

Secondary HPTH is due to __________.

another disease

HPTH leads to _____________ resorption.

subperiosteal

This subperiosteal resorption leads to _____________ outer cortical margins.

"lace-like"

True or false?

HPTH leads to cortex-medullary in-distinction like rickets.

true

HPTH leads to _____________ tumors.

brown

focal collection of blood

HPTH can also lead to wide _____________ joints.

Name sign:

SI

rugby-jersey pattern (due to wide stripes)

Labs for both osteomalacia/rickets and HPTH show an increase in _____________.

alkaline phosphate

bone is being destroyed and osteophytes release alkaline phosphate when they die.

_____________ in an infection of bone.

Osteomyelitis

What are the two forms of osteomyelitis?

suppurative and non suppurative (pus producing and non-pusproducing)

_____________ is the most common cause of suppurative osteomyelitis.

Staph Aureus

_____________ is the most common cause of non-suppurative osteomyelitis.

TS

aka Pott's Disease

_____________ is an infection of the joint.

Septic Arthritis

Suppurative osteomyelitis in adults causes _____________ disc destruction.

early

Suppurative osteomyletis starts in the ___________ and destroys ___________ and ______________.

spine; vertebral end plates; disc space

Name four pathways for infection to invade bone.

1. Hematogenous spread

2. Contiguous source -- ie. tooth infection

3. Direct implantation -- ie. dog bite

4. Postoperative (iatrogenic)

Suppurative osteomyelitis typically effects _____________ in children and the _____________ in adults.

extremities; spine

What is the favoured location of osteomyelitis?

medullary cavity

_____________ is the necrotic fragment of bone.

Sequestrum

dead bone

_____________ is the collar of new bone -- body attempts to wall off necrotic bone.

Involucrum

The radiographic latent period for the extremities is _________ days and for the spine is __________ days.

10; 21

_____________ is an infection of bone by Mycobacterium tuberculosi.

Tubercular Spondylitis.

What is an AKA for Tubercular Spondylitis?

Pott's Disease

The _________ lesion is the name for the hematogenous spread of primary infection from respiratory tract in Pott's disease.

gong

TS is most prevalent in the ________ three decades.

first

male=female

Pathogens of TS travel through the ________________.

bloodstream

What are four clinical presentations of Pott's disease?

1. chronic/insidious back pain

2. decreased ROM

3. focal tenderness

4. tubercular arthritis (knee and hip)

TS is most commonly located in the lower ____________ and upper _____________.

thoracic; lumbar

Pott's has a latent period of ________________.

21 days

________________ deformity is typically seen on X-Rays of Pott's patients.

Gibbus

anterior wedging

TS is non-suppurative but does produce ________________ instead of puss.

caseous necrosis

cheese like by product that creates cold abscesses

The most common location for caseous necrosis is the ________.

psoas

A ________________ is a discontinuity of bone.

fracture

An _____________ fracture penetrates the skin and is at increased risk of infection.

open

closed does not penetrate the skin

A _______________ fracture is when the bone breaks into many pieces. A ________________ fracture is when the bone breaks into 2 pieces.

comminuted; non-comminuted

A _____________ fracture is through the whole bone (cortex to cortex)

complete

A fracture that is only on one side and not through the whole bone is ________________.

incomplete

Complete fractures occur in ________________ and incomplete fractures occur in ________________.

adults; children

________________ lesions are characteristic of non suppurative osteomyelitis.

Skip

________________ fractures involve a disruption of the cortex on one side.

Name sign:

Greenstick

hickory stick

True or false?

Children under ten years old get Greenstick fractures.

True

________________ fractures involve a piece of bone being torn off by the pull of muscle or ligaments.

Avulsion

A ________________ fracture is a type of Avulsion Fracture.

chip

Avulsion fractures are most common at the ________________.

apophysis

i.e. trochanter tuberosites

________________ fractures involve a telescoping of trabecular and therefore a decrease in bone size.

Compression

________________ fractures are micro fractures due to repetitive stress.

Stress

________________ fractures are hidden and can't see them on X-Ray.

Occult

________________ fractures involve uncalcified osteoid.

Pseudofractures

________________ is a triquetrum fracture.

Fisher's

What are the 3 stages of healing for a fracture?

1. inflammatory phase

2. reparative (metabolic) phase

3. remodeling phase

Hemanotoma formation, vascular network, ingrowth of fibroblasts and callus formation happen during the ______________ phase of fracture healing.

inflammatory

Replacement of coarsely woven osteoid with more mature bone happens during the ______________ phase of fracture healing.

reparative (metabolic) phase