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Bone 2

Terms in this set (62)

Skeletal disease with increased activity of osteoblasts and osteoclasts
Paget Disease of bone
What are the 3 phases of Paget Disease of Bone?
- osteolytic (OC win)
- mixed (balanced)
- osteosclerotic (OB win)
what part of body does Paget Disease of Bone mainly affect?
axial skeleton and large bones
Thick trabeculae and cortex with a disorganized "mosaic" lamellar bone histological pattern is indicative of what disease?
Paget Disease of Bone
What viral family may play a role in Paget Disease of Bone?
paramyxovirus
Which bones of the body commonly are bowed in Paget Disease of Bone?
tibia and femur (weight bearing bones)
what bone disease can present with patient complaining of "increased hat size"?
Paget Disease of Bone
Serum marker increased in Paget Disease of Bone
alkaline phosphatase
List 2 treatments with Paget Disease of Bone
- bisphosphonates (inhibit osteoclasts)
- calcitonin
Worst complication of Paget Disease of Bone
osteosarcoma
2 diseases characterized by defect in matrix mineralization that results in unmineralized bone matrix
rickets + osteomalacia
MCC of rickets/osteomalacia
lack of vitamin D
What is the difference in manifestation of Rickets or Osteomalacia?
rickets presents with deformities (bowed legs) due to abnormal bone growth; osteomalacia presents with fracture
Sign associated with Rickets
trumpet sign

-- wide, flared metaphyses
MCC of secondary hyperparathyroidism
chronic renal failure
Lesion of bone associated with hyperparathyroidism
brown tumor
What is the cause of the brown appearance of brown tumors in hyperparathyroidism?
hemorrhage/hemosiderin
Anatomic changes of severe hyperparathyroidism
osteitis fibrosa cystica

-- this is osteoporosis/penia + brown tumors

aka von Recklinghausen disease of bone
hyperparathyroidism affects what portion of bone most?
cortical
how is hyperparathyroidism treated?
surgery (adenoma/carcinoma) or improved renal function
Term that refers to all of the skeletal changes associated with CRF
renal osteodystrophy

-- combo of osteoporosis and osteomalacia
What 3 changes in CRF result in renal osteodystrophy?
- hypocalcemia = increase PTH
- low vitamin D
- acidosis = demineralization of bone
Incomplete, or greenstick, fractures are more common in _______
children (more flexible bones)
Fracture site communicates with skin surface
compound fracture
Splintered fracture
comminuted
Fracture with ends of bone not aligned
displaced
Fracture caused by bone alterations from a disease process
pathologic fracture
Fracture caused by repetitive loads and accumulation of microfractures
stress fracture
A soft-tissue callus or procallus forms after ____ weeks
1
The procallus is converted into a ______
fibrocartilagenous callus
At 2-3 weeks, a _____ callus has formed
bony callus
Callus that bridges and stabilizes the fractured ends of bone
bony callus
What leads to remodeling of the bony callus back into the normal shape of the bone? When can this begin?
weight-bearing; usually around 6 weeks
Complication of fracture healing due to poor alignment
deformity
Complication of fracture healing due to poor immobilization
non-union
Center of callus undergoes cystic degeneration and becomes lined with synovium
pseudoarthrosis (false joint)
Infection is most common with what kind of fracture?
compound fracture
Which portion of the bone is subject to osteonecrosis?
trabecular bone (medullary cavity)
Why is cortical bone spared from osteonecrosis infarcts?
collateral blood flow
Why is articular cartilage spared from osteonecrosis infarcts?
it receives nourishment from synovial fluid
What are 2 common causes of avascular necrosis of bone?
- fracture
- corticosteroids
Sx of avascular necrosis are usually only seen with ____ infarcts
subchondral

-- joint surface becomes deformed and causes degenerative arthritis
How is dead bone recognized on x-ray?
flattened, sclerotic appearance with loss of joint spaces
How is dead bone recognized histologically?
loss of osteocytes (empty lacunae) and fat necrosis of marrow
Form of repair in which new bone is deposited on dead trabeculae
creeping substitution

note: process is too slow to prevent collapse of necrotic bone and subsequent degenerative joint disease
Inflammation of the bone and marrow
osteomyelitis
3 ways that organisms can reach bone and cause osteomyelitis
- hematogenous
- extension from soft tissue (e.g. DM or PVD ulcer)
- direct implantation (surgery or compound Fx)
MC overall cause of osteomyelitis
S aureus
Mixed bacterial organisms cause osteomyelitis following _____
open fractures and surgery
3 microbes that cause osteomyelitis in Pt with GU infections and IV drug users
- E Coli
- Klebsiella
- Pseudomonas
2 microbes that cause osteomyelitis in neonates
- H influenzae
- Group B strep
MCC of osteomyelitis in Pt with sickle cell disease
Salmonella
X Ray appearance of osteomyelitis
lytic focus with zone of sclerosis
Tx for osteomyelitis
surgical drainage + antibiotics
A segment of dead bone
sequestrum
The spread of osteomyelitis into the joint space to cause destructive septic arthritis is most common in ______
infants
Where is the most common site of spread of osteomyelitis in adults?
intervertebral discs or adjacent vertebra
How long does it take for chronic inflammation to predominate with osteomyelitis? What is stimulated at this point?
1 week; osteoclasts are stimulated
Newly deposited subperiosteal bone that encases dead infected bone
involucrum

-- feature of chronic osteomyelitis
Small abscess in bone that has been walled off by reactive bone
Brodie abscess

-- feature of osteomyelitis
how does TB spread to bone?
hematogenously
Spinal involvement of TB
Pott disease

-- complication can include spinal cord compression
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