Patho - Bone Disorders

A fracture is a defect in

the continuity of a bone

A fracture ranges from

small crack → complex w/ multi segments

Which of the following is not 1 of the 4 general categories of fractures?

Sufficiency

A traumatic fracture is caused by sudden impact into

something more dense than you

Stress fractures can be a partial break (________) or complete break (_______) in the bone.

reaction; fracture

Stress fractures are caused by the bone’s inability to

w/stand stress applied

in a rhythmic, repeated, microtraumatic fashion

A stress fracture occurs when a normal bone is exposed to

repeated, abnormal stress

Which of the following is not a risk factor for stress fracture?

Male

___________ factors (peak impact, active, and breaking GRF) do not predict stress factors.

biomechanical

Which populations are stress fractures commonly found in?

Military Trainees

Marathoners

Female recruits are at increased risk for stress fractures in which location?

pelvic/sacral

Stress factors does NOT usually occur in:

Metacarpal bones

What are the two types of stress fractures that can occur?

Compressive and Distractive

Compressive stress factors =

Forceful heel strike

during prolonged march or run

Distractive stress factor =

Repetitive muscle pull

What may indicate a stress factor in a patient's history?

training

Patient with a stress fracture will NOT typically present with which of the following?

DEC pain on WB

Which motion may not be painful for a stress fracture?

AROM

Insufficiency stress fracture results from

normal stress or force acting on bone

Normal stress/force acting on bone may result in an insufficiency stress fracture due to

deficient elastic resistance or

bone weakened by DEC mineralization

Bone deficiency in an insufficiency stress fracture is NOT secondary to:

Premenopausal

an insufficiency stress fracture is typically insidious or result of

minor trauma

What has been proposed to provide enough trauma to transmit a traumatic force to a compromised structure to cause an insufficiency stress fracture?

weight bearing

What is the most common osteoporosis related fragility fracture (~700,000 injuries per year)?

Vertebral Compression Fracture (insufficiency)

Only 20-25% of people who sustain a VCF seek

medial treatment

VCF often occur with ONLY

minor trauma

Which of the following is not a risk factor for a Vertebral Compression Fracture?

high levels of daily PA

A pathological stress fracture occurs in

bone rendered abnormally fragile by neoplastic or other conditions

Where does a pathological stress fracture occur?

at the site of a bone tumor

Fractures can be described based on the orientation;

Transverse, Oblique, Spiral, Comminuted

Bone mass reaches maximum size and density by

~30yrs

__________ lose bone mass sooner than _______.

Women (in late 30s)

perimenopausal / accelerating after menopause

men (in mid-late 60s)

Women lose bone mass sooner (in late 30s) due to

perimenopausal years and menopause

Which of the following is not one of the cancellous bone more susceptible to bone loss and fractures?

teeth

Most common traumatic fractures are associated with sudden impact injuries:

Assault, Abuse, Traumatic falls, MVA

Which upper extremit(ies) fractures account for the largest percentage?

radius/ulna

Which age group is most affected by upper extremity fractures ussually secondary to an accidental fall at home?

Children ages 5 to 14

What is an important risk factor for fractures?

Age

Which of the following is not associated with AGE-RELATED risk factors for fractures?

Increased bone mineral density

Rate of hip fracture increases at

age 50, doubling every 5-6 years

Women often have ______ fracture rates and ______ likely to develop osteoporosis than men

higher; more

Caucasians have _______ rates of fractures than African- American’s of the same gender.

higher

Other risks factors for fractures include all of the following except;

Muscle strength

Fracture heals in expected amount of time but in an unsatisfactory position is considered:

malunion

The fracture heals but it takes considerably longer is considered

delayed union

Fracture fails to heal is considered

Non-union

What is usually enough to confirm a fracture?

X-Ray

Which type of fracture is often missed with an x-ray alone?

stress fractures

What should be used in addition to x-ray for a stress fracture?

MRI or Radionuclide Bone Scan (Scintigraphy)

What is an imaging technique of choice is used to identify pathologic fracture?

CT Imaging

Treatment for a fracture is NOT based

Functional requirements of unaffected individual

What treatment is used for a stress fracture?

Rest

What treatment is used for a comminuted, unstable fracture?

immediate surgery

Typically, fractures will heal in _______ in children

4-6 weeks

Typically, fractures will heal in _______ in adolescents.

6-8 weeks

Typically, fractures will heal in _______ in adults.

10-18 weeks

How long does it take for full restoration of bone after a fracture?

months

(nonunion up to 10% of all)

Which structure usually have the highest rate of nonunion complications?

hip

______ more likely to die in 1 st year after hip fracture compared to same individual without a hip fracture.

4x

The risk of death due to hip fractures increases up to how long post fracture?

up to 5 years

Delay in suregery ________ mortality risks of hip fractures.

increases

What percentage of people regain full prior level of function following a hip fracture?

less than 50%

What is the strongest predictor for mortality following hip fracture?

inability to stand, sit, or walk 2 weeks after surgery

At least 1 of every __ adults >65yo will fall at least once during the next year.

4

Which of the folloiwing is not associated with falls?

Unipharmacy

Fall prevention is a large part of health and wellness directed towards

the geriatric population

Treatment of fractures is dependent on

type and surgical recs

initial period of rest for a fracture to allow for what two things

phagocytic removal of necrotic bone

& deposition of fibrocartilaginous callus

What is NOT a focus of treatment during the initial period of rehab for a fracture?

Maintain MMT of affected joints

Salter-Harris is defined as a fracture that involves

epiphyseal plate

What is the only population affected by salter harris fracture?

pediatric

1/5 types of Salter-Harris fracture (SALTER)

I –Slipped epiphysis

2/5 types of Salter-Harris fracture (SALTER)

II –Above the growth plate

3/5 types of Salter-Harris fracture (SALTER)

III – Lower than the growth plate

4/5 types of Salter-Harris fracture (SALTER)

IV – Through Everything

5/5 types of Salter-Harris fracture (SALTER)

V – Raised epiphysis (crush)

A greenstick fracture is where only ______ and ________ are interrupted on one side, while the other remains uninterrupted.

the cortex; periosteum

An immature skeleton is more _____ thus susceptible to Green-Stick Fracture.

pilable

Green-Stick Fracture is considered to be result of

“bending” of the bone

Nightstick fracture is isolated to

the ulna

What is a nightstick fracture secondary to?

a direct blow on ulna

(a defensive injury)

Nightstick fracture is typically a _______ fracture with a high rate ________.

closed; delyed or nonunion

Osteonecrosis refers to death of bone and bone marrow cellular components as a result of

loss of blood supply

Osteonecrosis aka

Avascular necrosis (AVN)

Aseptic necrosis

Which of the following is the most common site for osteonecrosis?

femoral head

What are other common sites for osteonecrosis?

Scaphoid, Talus, Prox humerus, Tibial plateau

Typically through trauma or thrombosis, blood supply during osteonecrosis needs to be cut off for

at least 2 hours

Risk factors of fatty emboli obstructing blood flow in osteonecrosis include all of the following except:

smoking

Which population is 100x more likely to develop an AVN?

individuals with HIV

Which of the following is NOT a bone that is more susceptible to AVN than others?

Limited coverage of cartilage

Patients with osteonecrosis during initial development are typically

symptom free

Which of the following is not a usual complaint of pain of patients with osteonecrosis?

Acute onset

Which od the following would not be expected with a patient that has osteoneecrosis located in the FEMUR?

P! provocation occurs w/ NWB and hip ROM (esp “FADIR”).

Diagnosis of osteonecrosis includes

– Made by plain films initially

– Bone scan, MRI, and CT can detect much more subtle bony changes.

What does treatment depend on with osteonecrosis?

lesion size, early diagnosis, bony collapse

What are the surgical options of Osteonecrosis?

Core decompression (early diagnosis)

Joint replacement (late diagnosis)

Osgood-Schlatter Disease results from

patellar tendon pulling small bits of immature bone from tibial tuberosity

Osgood-Schlatter Disease is commonly seen in

adolescent boys ages 10-15 (INC in females)

Osgood-Schlatter Disease results from

indirect trauma / Repetitive stress

Indirect trauma for Osgood-Schlatter Disease

Powerful contraction of quadriceps during an activity