Developmental Dysplasia of the Hip Quiz
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Questions and Answers

What is the primary cause of acute bursitis, according to the provided information?

  • Bacterial infection of the skin
  • Trauma (correct)
  • Wound infection
  • Repetitive irritation
  • What is the primary factor that differentiates Legg-Calve-Perthes disease from other childhood hip conditions?

  • Age of onset
  • Pain location
  • Interrupted blood supply to the femoral head (correct)
  • Pain severity
  • Which of the following accurately describes the role of neutrophils and macrophages in the inflammatory response triggered by MSU crystals?

  • Macrophages release enzymes that damage tissue, while neutrophils activate the complement system.
  • Macrophages release IL-1β and IL-18, while neutrophils directly attack the crystals.
  • Neutrophils phagocytize the crystals, releasing enzymes that perpetuate inflammation, while macrophages contribute to tissue repair. (correct)
  • Neutrophils release cytokines, while macrophages phagocytize the crystals.
  • Which of the following is NOT a clinical manifestation of gout?

    <p>Increased serum calcium levels (B)</p> Signup and view all the answers

    Which of the following BEST describes the reason why gout is more common in men than women?

    <p>Estrogen has a protective effect against gout. (A)</p> Signup and view all the answers

    Which of the following risk factors is MOST associated with Developmental Dysplasia of the Hip (DDH)?

    <p>Metatarsus adductus (B)</p> Signup and view all the answers

    What is the MOST significant difference between a subluxated hip and a dislocated hip in DDH?

    <p>The femoral head is not in contact with the acetabulum in a dislocated hip. (A)</p> Signup and view all the answers

    Which physical finding MOST indicates a potentially developing false acetabulum in DDH?

    <p>Limb length discrepancy (C)</p> Signup and view all the answers

    Which clinical finding is indicative of a REDUCED (not dislocated) hip in DDH, as demonstrated during the physical exam?

    <p>Positive Ortolani sign (B)</p> Signup and view all the answers

    What is the clinical significance of a positive Trendelenburg gait in a patient with DDH?

    <p>It suggests weakness in the gluteal muscles. (B)</p> Signup and view all the answers

    Which of the following statements BEST describes the typical presentation of pain in DDH?

    <p>Pain is a very late finding in DDH. (A)</p> Signup and view all the answers

    What is the MOST likely outcome if the hip remains subluxed or dislocated in DDH?

    <p>Development of a false acetabulum. (B)</p> Signup and view all the answers

    Which of the following is NOT a common physical finding associated with DDH?

    <p>Limited hip flexion (C)</p> Signup and view all the answers

    Which of the following factors is LEAST likely to contribute to the development of Developmental Dysplasia of the Hip (DDH) in a newborn?

    <p>Maternal use of antibiotics during pregnancy. (C)</p> Signup and view all the answers

    Which of the following conditions is associated with DDH in a significant percentage of cases?

    <p>Metatarsus adductus (D)</p> Signup and view all the answers

    What initiates the formation of osteoclasts during the bone remodeling cycle?

    <p>A stimulus such as a hormone or physical injury (A)</p> Signup and view all the answers

    Which type of fracture involves the bone breaking into three or more pieces?

    <p>Comminuted fracture (A)</p> Signup and view all the answers

    After osteoblasts secrete matrix and become trapped, what are they called?

    <p>Osteocytes (A)</p> Signup and view all the answers

    Which of the following correctly describes the characteristics of osteoclasts?

    <p>Large, multinucleated cells formed from the fusion of stem cells (B)</p> Signup and view all the answers

    What happens during the reabsorption phase of the remodeling cycle?

    <p>Osteoclasts gradually absorb bone (C)</p> Signup and view all the answers

    Which of the following is NOT a type of fracture classification?

    <p>Transitional fracture (D)</p> Signup and view all the answers

    Which cells are responsible for the formation of osteoblasts from precursor cells?

    <p>Mesenchymal stem cells (C)</p> Signup and view all the answers

    What is the function of enzymes during the callus formation stage of bone healing?

    <p>They increase the phosphate content for mineral deposition. (A)</p> Signup and view all the answers

    Which of the following factors does NOT influence the speed of bone healing?

    <p>Type of fracture treatment applied. (C)</p> Signup and view all the answers

    What characterizes malunion in bone healing?

    <p>Healing occurs in a non-anatomic position. (A)</p> Signup and view all the answers

    What condition is described by the presence of a fluid-filled space resembling a joint in the fracture gap?

    <p>False joint (pseudarthrosis) (D)</p> Signup and view all the answers

    Which type of bone generally heals faster according to the healing practices?

    <p>Spongy bone (A)</p> Signup and view all the answers

    What is the main outcome of the remodeling stage in bone healing?

    <p>Replacement of callus with lamellar or trabecular bone. (A)</p> Signup and view all the answers

    Which growth factor is NOT specifically mentioned as aiding in the healing process?

    <p>Erythropoietin (C)</p> Signup and view all the answers

    What is the role of physical modalities in the treatment of delayed union and nonunion?

    <p>To stimulate new bone formation. (C)</p> Signup and view all the answers

    What outcome occurs due to improper reduction or immobilization of a fractured bone?

    <p>Nonunion, delayed union, or malunion. (B)</p> Signup and view all the answers

    What is the primary function of osteoblasts during callus formation?

    <p>To secrete osteoid that mineralizes into new bone (D)</p> Signup and view all the answers

    Which of the following best describes the procallus formation process?

    <p>Fibrovascular tissue replaces the clot and collagen fibers are laid down (B)</p> Signup and view all the answers

    What happens to the fracture line after four months of healing?

    <p>The fracture line is completely eliminated by new bone formation (D)</p> Signup and view all the answers

    What are the potential consequences of improper reduction or immobilization of a fracture?

    <p>Delayed union or malunion of the bone (A)</p> Signup and view all the answers

    Which of the following is NOT a manifestation of a fracture?

    <p>Increased strength (B)</p> Signup and view all the answers

    What stage follows hematoma formation in the bone healing process?

    <p>Procallus formation (B)</p> Signup and view all the answers

    Which statement about callus formation is accurate?

    <p>It begins developing at the fracture site within days (D)</p> Signup and view all the answers

    Where does callus formation initially occur after a fracture?

    <p>At the periosteum (D)</p> Signup and view all the answers

    What role do hematopoietic growth factors play in the healing of bone fractures?

    <p>They aid in the formation of a meshwork during hematoma development (A)</p> Signup and view all the answers

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    Flashcards

    Haversian systems

    Bone structures that undergo destruction and formation during remodeling.

    Bone-remodeling units (BMU)

    Groups of precursor cells that differentiate into osteoblasts and osteoclasts.

    Osteoclasts

    Large, multinucleated cells that absorb bone during remodeling.

    Osteoblasts

    Small cells that lay down new bone by secreting matrix.

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    Fracture

    A break in the continuity of a bone, causing unnatural alignment and pain.

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    Comminuted fracture

    A fracture that results in multiple pieces of bone.

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    Open fracture

    A fracture where the bone protrudes through the skin.

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    Inflammatory response

    Increased blood flow to the entire bone after injury.

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    Procallus formation

    Occurs within a few days; fibrovascular tissue replaces the clot with collagen fibers and osteoblasts.

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    Callus formation

    Develops over weeks as osteoblasts attract minerals to harden the procallus into a callus.

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    Hematoma formation

    First step in fracture healing; damaged blood vessels lead to bleeding and clot formation.

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    Callus replacement and remodeling

    Takes months to years; involves ongoing activity of osteoblasts and shaping of bone.

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    Malunion

    A fracture that heals improperly, resulting in deformity.

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    Delayed union

    Fracture healing takes longer than normal but eventually heals correctly.

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    Closed manipulation

    A non-surgical method to align fractured bones without an incision.

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    Cartilage formation

    The initial step in bone healing where cartilage acts as a precursor to bone.

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    Bone Replacement

    BMUs replace callus with lamellar bone or trabecular bone.

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    Bone Remodeling

    Gradual reshaping of bone to its original size and shape post-injury.

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    Factors affecting healing speed

    Includes severity of disruption, type of bone, blood supply, and hormones.

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    Nonunion

    Failure of the bone ends to grow together after a fracture.

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    False joint

    A fluid-filled space resembling a joint formed during nonunion.

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    Treatment modalities

    Techniques used to stimulate bone formation, including physical methods and grafts.

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    Acute bursitis

    Inflammation of a bursa, often due to trauma or repetitive irritation.

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    Septic bursitis

    Bursitis caused by an infection, often resulting from a wound or bacterial infection.

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    Legg-Calve-Perthes disease

    Childhood condition where blood supply to the femoral head is interrupted, leading to bone death.

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    Gout

    A type of arthritis characterized by high urate levels, causing painful joint inflammation.

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    Hyperuricemia

    Elevated levels of uric acid in the blood, often associated with gout.

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    Developmental Dysplasia of the Hip (DDH)

    An abnormality in the development of the proximal femur or acetabulum, often present at birth.

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    Asymmetry of gluteal or thigh folds

    Unequal skin folds on thighs or buttocks, indicating hip issues.

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    Limb length discrepancy

    Unequal length of legs, often assessed through the Galeazzi sign.

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    Barlow Maneuver

    A test to check for dislocatable hips, producing a 'clunk' when the hip is pushed toward dislocation.

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    Ortolani Maneuver

    A test that checks for a reducible dislocated hip, also producing a 'clunk' when relocating the hip.

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    Galeazzi Sign

    A clinical sign where one knee is lower than the other, indicating limb length discrepancy.

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    Trendelenburg Gait

    A gait where the pelvis dips on the side opposite to the weight-bearing leg, indicating hip muscle weakness.

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    Subluxated Hip

    A partially dislocated hip where there is some contact between the femoral head and acetabulum.

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    Dislocated Hip

    A condition where there is no contact between the femoral head and acetabulum.

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    Acetabular Dysplasia

    A condition where the acetabulum is shallow or underdeveloped, often leading to dislocations.

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    Study Notes

    Bone Remodeling Units

    • Bone remodeling units (BMUs) are bone precursor cells that differentiate into osteoblasts and osteoclasts.
    • BMUs repair microscopic injuries and maintain bone integrity.

    Bone-Remodeling Phases

    • Phase 1 (activation): A stimulus (hormone, drug, vitamin, physical stressor, injury) activates precursor cells to form osteoclasts, which leads to bone reabsorption. Apoptotic osteocytes guide osteoclast activity, signaling where to resorb damaged bone.
    • Phase 2 (resorption): Osteoclasts, large multinucleated cells, gradually absorb bone, creating a "cutting cone" resorption cavity. Lysosomal enzymes digest bone, and osteoclasts release degraded bone products into the vascular system.
    • Phase 3 (formation): Osteoblasts, small cells, lay down new secondary bone within the resorption cavity. Osteoblasts lining the cavity secrete osteoid, fostering calcium and phosphorus deposition. Subsequent layers generate a haversian canal around a blood vessel. The old haversian systems are eventually replaced by new ones. This phase takes 4-6 months in humans.

    Bone-Remodelling Units (BMU)

    • BMUs are composed of precursor cells that differentiate into osteoblasts and osteoclasts.
    • BMUs repair micrsocopic injuries and maintain bone integrity.

    Fracture Types/Descriptions

    • Fracture: a break in the continuity of a bone
    • Complete vs Incomplete fractures: Complete fractures go completely through the bone while incomplete fractures do not
    • Closed vs Open fractures: Closed (simple) fractures don't pierce the skin; open (compound) fractures do
    • Other types include: Comminuted (3+ fragments), Linear (parallel to bone axis), Oblique (slanted across bone), Spiral (twisting of bone ends), Transverse (perpendicular to bone axis), Greenstick (bending fracture that only occurs on one side; usually in children), Torus (buckling of bone), and Bowing (bending)

    Typical Complete Fractures

    • Closed: Skin over the bone is intact.
    • Open: Skin opening exists between bone and the skin
    • Comminuted: Multiple bone fragments are present
    • Linear: Fracture line is parallel to the bone's axis.

    Typical Incomplete Fractures

    • Greenstick: Fracture on one side only (common in children)
    • Torus: Buckling of the bone cortex
    • Bowing: Bending of the bone

    Fracture Healing Stages

    • Hematoma formation: Formation of blood clot within the injured area
    • Procallus formation: Formation of fibrovascular tissue and collagen fibers from fibroblasts and osteoblasts
    • Callus formation: Woven bone forms between the broken ends
    • Callus replacement: Existing callus is replaced with lamellar bone.
    • Remodeling: Bone remodeling occurs to shape and form the bone similar to its original structure.

    Osteoarthritis (OA)

    • OA is a noninflammatory joint disease.
    • Characterized by local areas of damage and loss of articular cartilage, sclerosis of bone beneath the cartilage, osteophyte formation, and variable degrees of mild synovitis and joint capsule thickening.

    Rheumatoid Arthritis (RA)

    • RA is a systemic inflammatory autoimmune disease primarily affecting the joints.
    • Characterized by inflammation in the synovial membrane of the joint, leading to cartilage and bone destruction.
    • Systemic signs of inflammation are often present (e.g., fever, leukocytosis, malaise, anorexia, and hyperfibrinogenemia).
    • Pathogenesis involves T cell activation, cytokine release, inflammatory cell recruitment, and damage to cartilage and bone.

    Gout

    • Gout is a metabolic disorder characterized by elevated serum uric acid levels.
    • The increased uric acid levels lead to the formation of monosodium urate crystals, which deposit in joints and other tissues, causing inflammation and pain.

    Legg-Calve-Perthes Disease (LCP)

    • LCP is a self-limited disease of the hip, usually affecting children between the ages of 3 and 10 years.
    • Primarily characterized by avascular necrosis (death of bone tissue due to inadequate blood supply) of the femoral head.

    Ankylosing Spondylitis (AS)

    • AS is a chronic inflammatory disease that primarily affects the spine and sacroiliac joints.
    • Causes stiffening and/or fusion of the spine.
    • Often associated with HLA-B27.
    • Early symptoms include low back pain and stiffness, typically worse after rest.

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    Test your knowledge on Developmental Dysplasia of the Hip (DDH) and conditions like acute bursitis and gout. This quiz covers various clinical manifestations, risk factors, and important physical findings related to hip conditions. Challenge yourself to see how well you understand these topics.

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