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Musculoskeletal Trauma, Infection, & Disease

bone and joint trauma, alteration is bone structure, bone infections, bone tumors, diseases of skeletal muscles, other disorders
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fracture
broken bone
transverse fracture
approximately 90 degree angle to long axis of the bone
oblique fracture
across the bone at an angle
spiral fracture
results from rotational forces: "S" shaped winding fracture
complete fracture
entire thickness of the bone disrupted
incomplete fracture
cortex buckles or cracks, but continuity not completely disrupted; more common in children. Also known as greenstick fractures
simple fracture
fractures in which the bone is broken into just 2 pieces
comminuted fracture
severe fracture in which multiple bone fragments are present
open fracture
an external wound leads to the fracture; also known as a compound fracture; infections are much more likely
closed fracture
encased by tissue; not open
stress fracture
the result of repeated stresses like in sports and the military
compression fracture
a crushing of bone, common in vertebral bodies
treatment of fracture
casting, open reduction-external fixation, open reduction-internal fixation
open reduction-external fixation
placement of pins connected to an external frame
open reduction-internal fixation
screws, pins, etc. placed internal surgically; can speed up healing and early mobility
delayed union
healing slower than expected: 3-12 months
malunion
improper position of healed bone fragments
nonunion
failed to heal within 4-6 months
compartment syndrome
high pressure in a muscle compartment (an enclosed fascial space) reducing capillary pressure below what is necessary for tissue viability. (The blood can't get in.)
1- classified as acute, chronic, crush
2- 30-40 mm Hg pressure enough to compromise muscle microcirulation
3- Symptoms—pain out of proportion to the injury, paralysis, paresthesia, pallor, pulselessness (the 5 P's).
Neurovascular injury
may be due to the initial injury or the treatment
dislocation
bones displaced to extent that articulating surfaces lose contact.
subluxation
bones displaced to extent that articulating surfaces lose contact, except articulating surfaces partially lose contact.
Scoliosis
lateral curvature of the spine: S- or C- shaped deformity.
(1) 75-85% of cases idiopathic
(2) Occurs in 5% of children, with half of them requiring treatment—most of these female.
Non-structural scoliosis
resolves (disappears) when patient bends to the affected side & on forward flexion
Structural scoliosis
fails to correct itself on forced bending against the curvature or forward flexion. More serious, requires intensive therapy & probably surgery.
Osteoporosis
-the most common metabolic bone disease.
-Occurs in 1 in 2 females and 1 in 5 men older than age 60.
-65,000 women DIE of hip fractures in the US each year
-Estimated cost of osteoporosis yearly in US is $13 billion!
-The rate of bone resorption outpaces bone formation, with cancellous bone lost faster than cortical bone.
Rickets & osteomalacia
characterized by delayed mineralization of newly formed bone matrix with resulting soft osteopenic bone. All bones affected, but weight-bearing bones tend to collapse.
rickets
Vitamin D deficiency common, which prevents maintenance of normal Ca2+ and PO4- levels. Also common:
(1) Genu valgum—knock knees
(2) Genu varum—bow legs
(3) Kyphosis
Osteomalacia
due to either decreased intestinal absorption of Ca2+, increased urinary excretion , loss of Ca2+ or PO during pregnancy or lactation, malabsorption, or any combination
Paget disease (osteitis deformans
-Affects 3% of people > 50 years old in US.
-Clinical—pain & deformity of the affected bone due to excessive bone remodeling.
Osteomyelitis
-bacterial bone infection. Very difficult to treat, requiring LONG courses of IV antibiotics.
-ii) Organisms may reach bone via: Bloodstream, Adjacent tissues, Direct introduction of the organisms into bone—like in open fractures.
-Take particular care with human bites!
-In hematogenous bone infections, skin, sinuses, ear, and teeth are common primary sites. Also, GI, GU, and respiratory systems are possible.
Age-related bony involvement:
-kids—long bones
-adults—spine, pelvis, smaller bones like the feet.
Sequestrum
area of devitalized bone that can serve as a reservoir of bacteria.
Involucrum
layer of new bone formed by osteoblasts around infected bone in an effort to isolate the infection
Tuberculosis
can also infect bone, most commonly the vertebral column: Potts disease
Osteochondroma
the most common (non-metastatic) bone tumor.
-50% of all benign bone tumors
-Cartilage-forming
-Hereditary, usually in people < 30 years of age
Osteoid osteoma
painful! but benign
- Most common in cortex of tibia or femur.
- Usually in people 10-20 years of age.
Giant cell tumor
benign, but aggressive, can transform into sarcomas. Painful
Osteosarcoma (osteogenic sarcoma)
the most common primary bone malignancy. Highly malignant.
- Develops in 2 age groups: children to 30 and adults 60-70 years of age. Average age at diagnosis is 15.
- Growth typically rapid & destructive, so pain intense;
- Lungs are frequently the site of metastasis
Chondrosarcoma
cartilage-forming malignancy, usually in adults.
Ewing sarcoma
highly malignant, rapidly metastasizing bone cancer, most commonly found in children.
- Because they often appear systemically ill with fever, anemia, leukocytosis, and increased sed rate, it can be confused with osteomyelitis.
Multiple myeloma
represents about 1% of all cancers; actually a plasma cell cancer.
- Bone pain is the most common symptom—making this a really miserable disease.
- Discussed more fully in week #3
Muscular dystrophy
a group of disorders of progressive muscle degeneration.
Duchenne muscular dystrophy
the most common & severe
- X-linked recessive (so obviously only affects males)
- Muscle cells deficient in dystrophin (a muscular protein); which weakens the cell membrane, allowing extracellular fluid to leak into the cell.
- Clinical— Calf muscle enlarge as muscle fibers degenerate & fat cells infiltrate muscles. Frequent falls present by age 5-6; wheelchair by 12-14; survival > 20 rare. These kids stand up by "walking" their hands up their legs in the Gower's maneuver.
Becker muscular dystrophy
milder than Duchenne, with wheelchair requirement delayed until age 30 or so.
Fascioscapulohumeral muscular dystrophy
autosomal dominant; affects shoulder girdle & face; rare; normal lifespan possible.
Myasthenia gravis
autoimmune disorder
- Most common in women ages 20-30, but men occasionally afflicted.
- Weakness usually begins with ocular & cranial muscles, may spread to limb muscles.
- Thymectomy may be helpful.
- Treat with cholinergic medications
Acetylcholine receptor antibodies
block action of the neuromuscular junction.