Fractured Bone

> bleeding > Fracture hematoma

> Procallus (granulation tissue)

> fibro-cartilaginous callus / soft callus (cartilaginous cells)

> ossify > hardened matrix

> Bony Callus / Hard callus (spongy bone) 

Metabolic Bone Disease

Osteoporosis: v bone mass r/t demineralization of bone Ca > brittle bones > comprx fractures (thoracic) > Hypokyphosis / "humpback"

-postmenopausal women

Osteomalacia: soft bone r/t v vit D > v Ca absorption > pseudo fractures

-adults

Rickets: soft bone r/t v vit D -children

> Rachitic Rosary (multiple costochondral bumps) 

> pigeon breast or pectus carinatum

Osteitis deformans/ Paget's dx: ^ bone density

-geriatric, idiopathic

-spine, skull, pelvis

Osteotos fibrosa cystica/ Von Reckinghausen's Dx: > osteolytic lesions

Osteopetrosis: ^ bone density r/t inactivity of osteoclasts

Gout / "kings disease": defective purine metabolism

> uric acid crystals build up in joints

Podagia: UC crystals in metatarsophalangeal joint of big toe

Benign Bone tumors

Osteoid osteoma: benign tumor in neck of femur, distal end of the femur & proximal tibia

Osteoma: benign tumor of skull, facial bones, & paranasal sinus

Enchondroma: benign tumor of cartilage, hands & feet

Osteochondroma: benign tumor at distal end of the femur & prox tibia

-males < 25yo

Giant Cell tumor:  benign tumor at distal end of the femur & prox tibia

-women 20-40yo 

-"soap bubble" Xray

Malignant Bone Tumors

Osteosarcoma / Osteogenic Sarcoma: very malig bone tumor > mets lungs

-prox & distal femur, prox tibia, distal humurus

-20-40yo but any age

Chondrosarcoma: primary malig tumor of cartilage

-co-occurs in ppt w. multiple enchondromas (benign)

-vertebrae, pelvis, ribs, femur, tibia

Multiple Myeloma: malig of plasma cells > destructx bone tissue > hypercalcemia

-"punched out lesions" in axial skeleton

-50-70 yo M

Joint Diseases

Osteoarthritis / O.A. / degenerative joint disease: non-inflammatory joint disease r/t wear & rpt stress

> Osteophytes: "lipping & spurring" v joint space & bone

Heberden's nodes- osteophytes in distal interphalangeal joints

Bouchard's nodes- osteophytes in prox interphalangeal joints

s/s: pain & stiffness in AM, after awakening & after rest

-relieved by activity

Rheumatoid arthritis / RA: systemic, autoimmune, chronic inflmx arthritis

> Synovitis- edema, hyperplasia & hypertrophy of synovial joint lining

> Pannus- granultx tissue forms & erodes adjacent bone tissue

s/s: pain & swelling

-prox interphalangeal & metacarpophalancreal joints of upper & lower extremities & knees

-ulnar deviation r/t joint destructx & ligament laxity

Ankylosing spondylitis (AS): pain in large joints of the extremities

-sacroiliac joint, spine pain esp at PM

untreated > kyphosis

Reiter's syndrome: inflmx dx r/t venereal disease or intestinal dx

-urethritis, conjunctivitis, arthritis or lower extremity

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Bone Destructx Dx

Avascular Necrosis: non-neoplastic dx of bone r/t v blood supply

-r/t trauma, embolisms, sickle cell anemia

Legg-Calve-Perthes Dx-kids- femoral head necrosis > v development > shallow, flat head

Osteogenesis Imperfecta / "Brittle Bone Dx": congenital abn r/t defect of collagen productx

-infants- born w. mx fractures & soft skull

> hemorrhaging w. skull stillbirth 

-children- deaf, hearing loss r/t connective tissue buildup around the auditory ossicles of inner ear

-sclera blue

Charcot's joints: destructx of joints > v sensory proprioception r/t

1. Tertiary Neurosyphilis- r/t treponema pallidum spirochete

2. Syringomyelia- dx affect the central canal of spinal cord r/t cyst, congenital malformatx, infectx, tumor, trauma

3. diabetic neuropathy- r/t DM

Categories of Fractures

Displaced- two broken ends not aligned

Nondisplaced- two broken ends stay aligned

Closed / Simple- bones dont break skin

Open / compound- broken bone protrudes through skin

Complete- total break in bone

Incomplete- break does not go completely through the bone

Greenstick/ incomplete fracture- children

Avulsion- forceful muscle contractions > tendons or ligaments pull bone > tear away from itself

Osgood Sclatter's Dx- Avulsion in children

Common fractures of the extremities:

Colles' fracture: distal radius of the forearm

>post displacement of distal fragment

Smith's fracture: distal radius of forearm

>anterior displacement of distal fragment

Chauffer's Fracture / "backfire fracture": impacted or aculsion fracture of styloid process of radius

Vertebral Fractures

Clay shoveler's fracture / "coal miners fracture": avulsion fracture of spinous process of C6 or T1.

-r/t rpt stress or trauma

Burst fracture / "Jefferson's fracture": C1 or atlas compression frtx

> BL fractx in post & ant arches of atlas

Hangman's fractx: axis or C2 frctx

-severe hyperextension injury > traumatic spondylolisthesis (ant slip of vertebrae)

-high speed deceleration injury in car accidents & hanging

Abnormal curvatures of spine

Lordosis/ "sway back": increase in norm lumbar curve

Kyphosis / "humpback"- abn increase in normal thoracic curve

Scoliosis: lateral curvature of spine

-can begin 3-12yo  or after skeletal maturity

-progresses rapidly 12-16yo, treat early

Classification of Joints

by structure & function, degree of motion or how tightly joint fits together

Synarthrosis: non movable joints

Amphiarthrosis: joints that move slightly

Diarthrosis: move freely, have synovial space

Fibrous joints: tightly held by fibrous connective tissue

Fibrous joints

Sutures: "sawtooth" borders > strong immovable structures

-locked together ie. skull

Gomphoses: immovable, peg in socket structures

-ie. teeth

Syndesmosis: slightly movable, held together by interosseous ligaments

-btwn tibia, fibula & ulnar and radius

Cartilaginous Joints

held together by hyaline & fibrocartilage 

Synchondroses: immovable, hyaline cartilage

-epiphyseal plates (growth plates) in metaphysis of long bones

Symphyses: slightly movable fibrocartilage

-public symphysis & intervertebral joints

Synovial Joints

synovial space surrounded by joint capsule filled with synovial fluid.

Diarthroses- freely movable joints

1. Ball & socket: round surface fits into cup shaped socket

-shoulder & hip

2. Hinge: convex bone surface + concave bone surface

-elbow, knee, phalanges

3. Pivot: rotates around an axis

-head of radius & ulna, atlas-to-axial joint

4. Saddle joint: convex bone "sits in" concave bone

-carpal & metacarpal thumb joints

5. Condyloid Joint: oval bone + depression of bone

-radiocarpal wrist joint

6. Gliding joint: flat bones slide back & forth

-carpal bones of wrist & tarsal bones of ankle