Fractures and Dislocations Quiz

Alterations of Musculoskeletal Function

• Disorders discussed include bone fractures, support structure disorders, bone disorders, joint disorders, secondary muscular dysfunctions, fibromyalgia, chronic fatigue syndrome, bone tumors, and muscle tumors.

Fractures

• A fracture is a break in the continuity of a bone.
• Fractures can be classified as complete or incomplete, closed or open, comminuted, linear, oblique, spiral, transverse, greenstick, torus, or bowing. They can also be pathologic, stress, fatigue, or transchondral.
• Healing can be direct (primary) or indirect (secondary).
  • Direct healing happens when surgical fixation is used and involves intramembranous bone formation.
  • Indirect healing happens when a cast is used and involves both intramembranous and endochondral bone formation, as well as callus formation and remodeling.

Healing

• Direct (primary) healing often follows surgical fixation
• Indirect (secondary) healing typically occurs with casting and involves a cascade of bone formation steps.

Manifestations (Symptoms)

• Symptoms of fractures include unnatural alignment, swelling, muscle spasm, tenderness, pain, impaired sensation, decreased mobility, and often transient numbness due to nerve trauma.

Treatment (of fractures)

• Treatment options include immobilization, closed manipulation with traction, open reduction, internal or external fixation.
• Improper reduction or immobilization can lead to nonunion, delayed union, or malunion.

Dislocations and Subluxations

• Dislocation involves the complete displacement of bones in a joint, with loss of contact between articular cartilage.
• Subluxation involves partial loss of contact between articular surfaces.

Question 1 - Bone fracture splinter

• The correct answer is D – Greenstick fracture.

Support Structures

• Strain: Tearing or stretching of a tendon or muscle.
• Sprain: Tearing or injury to a ligament.
• Avulsion: Complete separation of a tendon or ligament from its bony attachment site.
• Tendinopathy: Inflammation of a tendon.
• Epicondylopathy: Inflammation of a tendon where it attaches to a bone (Commonly called tennis or golfer's elbow).
• Bursitis: Inflammation of a bursa. (A fluid-filled sac that reduces friction in joints).

Rhabdomyolysis

• Rapid breakdown of muscle.
• Release of intracellular contents, including myoglobin, into the extracellular space.
• Can lead to acute renal failure and electrolyte imbalances.
• Characterized by muscle pain, weakness, and dark urine.

Compartment Syndrome

• Increased pressure within a muscle compartment.
• Caused by conditions disrupting vascular supply.
• Leads to muscle ischemia, edema, rising compartment pressure, and tamponade.
• Typically involves muscle infarction and nerve injury.
• "6 Ps" are used for diagnosis.

Disorders of Bones

• Metabolic bone diseases: Osteoporosis, osteomalacia, and Paget disease of bone.
• Infectious bone diseases: Osteomyelitis.

Bone Remodeling Cycle

• Osteoclasts resorb bone (break down).
• Osteoblasts form new bone (build up).

Osteoporosis

• Characteristics: Poorly mineralized bone, increased risk of fractures (due to alterations in bone microarchitecture). Old bone is resorbed faster than new bone is made, leading to loss of bone mass.
• Potential Causes: Endocrine dysfunction (parathyroid, cortisol, thyroid, GH), medications, vitamin D deficiency, underlying diseases, low physical activity, and abnormal BMI.
• Manifestations: Often pain, bone deformity, lower back pain, and/or hunchback (kyphosis).

Osteomalacia

• Inadequate or delayed mineralization of osteoid.
• Remodeling cycles occur but calcification does not, leading to soft bones, resulting from vitamin D deficiency.
• Symptoms might include pain, bone fractures, vertebral collapse, and bone malformation.
• Treatment varies by etiology.

Paget's Disease of Bone

• Chronic, accelerated bone remodeling.
• Disorganized bone deposition.
• Often enlarges and softens bones.
• Frequently affects vertebrae, skull, sacrum, sternum, pelvis, and femur.
• May be asymptomatic (without symptoms).
• Often diagnosed through radiographic findings.

Osteomyelitis

• Bone infection, often caused by bacteria such as Staphylococcus aureus.
• Hematogenous: Pathogens carried through bloodstream.
• Can be either contiguous (infections spread to adjacent bones) or via direct inoculation (open fractures, surgical procedures).
• Treated with antibiotics, débridement (cleaning), surgery, and hyperbaric oxygen therapy.

Disorders of Joints

• Osteoarthritis: Characterized by loss and damage of cartilage, inflammation, new bone formation, subchondral bone changes, variable degrees of synovitis, and thickening of the joint capsule. Prevalence increases with age.
• Risk factors: Age, joint trauma/mechanical stress, and obesity.
• Characteristics: Local areas of cartilage damage, new bone formation (bone spurs), subchondral bone changes, and variable degrees of mild synovitis and thickening of the joint capsule.
• Manifestations: pain, stiffness (which diminishes with activity), swelling, and joint enlargement (e.g., Heberden and Bouchard nodes).

Rheumatoid Arthritis

• Inflammatory, autoimmune disease.
• Systemic damage to connective tissue, primarily synovial membrane in joints.
• Symptoms often include pain, tenderness, stiffness (especially in the morning), and joint deformities.
• The onset is insidious, and other symptoms can include fatigue, malaise, fever, and weight loss.
• Often involves significant joint deformities (boutonniere, swan-neck, ulnar deviation) and sometimes rheumatoid nodules, and related syndrome "Caplan syndrome."

Ankylosing Spondylitis

• Inflammatory arthropathy.
• Affects spine and sacroiliac joints.
• Characteristically leads to stiffening and fusion of the joints.
• Is a systemic disease, commonly associated with HLA-B27 antigen and inflammatory process at the entheses (where ligaments and tendons attach to bones).
• Diagnosed principally by imaging (identifying sacroiliitis, the presence of inflammation on the sacroiliac joints).

Gout

• Inflammatory response from excessive uric acid levels.
• Characterized by elevated levels in blood and synovial fluid, resulting in the formation of monosodium urate crystals in joints causing acute, painful inflammation (gouty arthritis).
• Risk factors include male sex, increasing age, high intake of alcohol, red meat, and fructose.
• Diagnostic criteria include acute attacks of pain, especially at night, tenderness and redness of a single joint (usually the base of the big toe), signs of systemic inflammation (elevated ESR or CRP), and tophi (uric acid crystal deposits in and around joints).
• Symptoms include severe pain at night, and swelling; redness and warmth in affected joint.

Secondary Muscular Dysfunction

• Contractures: Lack of full passive range of motion due to muscle and soft tissue limitations.
• Can be physiologic (muscle fiber shortening), or pathologic (caused by muscle spasm or weakness).

Chronic Fatigue Syndrome

• Also called myalgic encephalomyelitis.
• Characterized by profound fatigue, musculoskeletal pain, cognitive impairment, and unrefreshing sleep, often worsened by activities.
• Related to central sensitization within the CNS, potentially related to dysfunction in the reticular activating system and autonomic nervous system.

Fibromyalgia

• Chronic widespread diffuse pain and muscle pain/tender points causing fatigue; potentially marked by increased sensitivity to touch and other sensory abnormalities.
• Symptoms include fatigue, tender points, nonrestorative sleep, and possible anxiety/depression.
• Potentially influenced by underlying genetic alterations in serotonin, catecholamines, and dopamine.

Bone Tumors

• May originate from bone cells (e.g., osteogenic, osteosarcoma), cartilage (e.g., chondrogenic, chondrosarcoma), fibrous tissue (e.g., collagenic, fibrosarcoma), or marrow/blood cell precursors.
• Can be classified based on originating cell type.
• Criteria including nuclear/cytoplasmic ratio, borders, chromatin density, prominently displayed nucleolus, and mitotic rate (growth rate) are evaluated to distinguish benign from malignant tumors.
• May appear as geographic, moth-eaten, or permeative patterns of bone destruction on X-rays.

Muscle Tumors

• Two major types of muscle tumors: benign rhabdomyoma, and malignant rhabdomyosarcoma, both affecting striated muscle (generally voluntary muscle) but with different qualities.
• Rhabdomyosarcoma is generally highly malignant with rapid metastasis, and typically originates from head, neck, and genitourinary tracts.