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Skeletal System Pathology

Skeletal System Pathology. Congenital Pathologies. Spina Bifida “split spine” in Latin Spinous Process of the Arch of a Vertebrae does not fuse properly allowing the spinal cord to stick out (this is called myelomeningocele ). Most commonly in C-spine and L-spine

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Skeletal System Pathology

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  1. Skeletal System Pathology

  2. Congenital Pathologies • Spina Bifida “split spine” in Latin • Spinous Process of the Arch of a Vertebrae does not fuse properly allowing the spinal cord to stick out (this is called myelomeningocele). • Most commonly in C-spine and L-spine • Fixed surgically post-natal but baby will have permanent motor disabilities. • Etiology: lack of folic acid in utero • Osteopetrosis “stone bones” in Latin • Hyperproduction of osteoblasts over osteoclasts leads to overly dense/hard bones. • Medullary cavity and spongy bone is not created properly thus bone marrow is not produced leading to hematopoetic problems. • Symptoms: stunted growth, easily broken bones, fatigue • Ideopathic • Treatment is constant bone marrow and blood transfusions to balance out osteoblastic/osteoclastic imbalance. • Opposite condition is osteoporosis.

  3. Congenital Conditions • Achondroplasia • Common result of dwarfism. • Lack of GH causes cartilage growth in growth plates of bones to stop, thus new bone cannot grow. • Treatment with GH is not effective • Congenital Dysplasia of the Hip (CDH) • Acetabulum of pelvis does not fully form or is too shallow thus femoral head more prone to slipping out (subluxing). • Multiple Causes • Increased exposure to hormones in utero • Decreased amniotic fluid puts pressure on the hips • Improper swaddling of child • Breached birth • Treatment: Femoral head must be immobilized; patient placed in pelvic cast or harness.

  4. Inflammatory/Infectious Disorders • Rheumatoid Arthritis (RA) • Autoimmune disorder which affects the MCP/DIP/PIP joints of hands/feet called Synovitis. • Results in: • Increased synovial fluid in joint • Fibrous clot development in joint • Ligaments of joint become inflamed • Destruction of cartilage in joint • Ankylosis: Fusion of joint resulting in excessive pain and diminished/no movement of the joint. • Secondary complications in pleura, pericardium, sclera and other organs. • Ideopathic • Treatment: • NSAIDs and anti-inflammatory medications • Physical and Occupational Therapy

  5. Osteoarthritis (OA) • aka Degenerative Joint Disease • Not autoimmune; OA is caused by wear-and-tear and old age. • Most common in weight-bearing bones (hip/knee) and DIPs and PIPs • Cause: • Cartilage in joints wither away exposing bone to bone. • Osteophytes (bone spurs or bony peninsulas) develop in joint space causing pain. • Treatment • Weight loss • Moderate Exercise • Strength Training • Analgesics/NSAIDs

  6. Exercise-Related/Trauma Injuries • Bursitis • Bursas are synovial fluid-filled pads located in key joints to help reduce friction • Caused by repetitive motion/excessive use/or trauma. • Meniscus Tears • Each knee has two fat pads: Medial Meniscus and Lateral Meniscus • Most common knee injury • Caused by trauma or wear-and-tear. • Both conditions resolved by rest, immobilization, NSAIDs, and elevation • Osteomyelitis • Bacterial infection of the bone (osteitis) and/or bone marrow (myelitis). • In adults, affects spongy bone; in children, the medullary cavity • Most commonly caused by laceration of tissue near the bone; bacteria travels to bone. • Bacteria develop abcesses on bone; pus originates from abcesses and drips down to infects rest of bone. • Treatment: abx; if worse then osteotomy.

  7. Osteoporosis (Latin for “porous bone” is the decrease of bone density; osteoclastic activity surpasses osteoblastic leading to weaker bones • Opposite of osteopetrosis • Most commonly seen in menopausal women • Causes • Smoking, alcohol consumption, • Taking steroids (Prednisone), Calcium and Vitamin D deficiency • Sedentary Lifestyle, Excessive soda drinking. • Difficult to diagnose b/c bones look normal; first fx is first indication. • Treatment • Increased calcium and Vit D • Exercise

  8. Gout (Hyperuricemia) • Gout is acute arthritis of the 1st MTP joint of the foot • Used to be called rich man’s disease” or “King’s Disease” • Symptoms: • Nocturnal excruciating pain with redness. • It is caused by the accumulation of uric acid (urea) crystals in the joint. (Hyperurecemia) • Uric Acid is the main waste excreted by the kidneys. • Kidney is not excreting uric acid sufficiently. • Causes: • High seafood and meat consumption • High Alcohol consumption • Metabolic Syndrome: High cholesterol, Type II DM, Obesity, Hypertension • Treatment: • Ice, NSAIDs, change of diet, and use of drugs, Colchicine and Allopurinol.

  9. Benign Bone Tumors • Osteochondroma • “Tumor of the cartilage of the bone” • Most common bone neoplasm/tumor • Growth contains both cartilage and bone cells and normally occurs at the end of long bones. • No treatment necessary unless growth causes pain in the joint. • Endochondroma • Benign tumor growth in the medullary cavity of the long bones.

  10. Malignant Bone Tumors • Ewing’s Sarcoma • Cancer of the connective tissue of bones • Mostly seen in pelvis, ribs, femur, tibia • Occurs to mostly adolescent boys • Treatment • Removal of lesion if possible followed by chemo; amputation may be necessary if metastasis has not occurred. • Prognosis: 70% survival after 5 years if Stage 1 diagnosis; 15% if metastasized.

  11. Multiple Myeloma • Deadly Cancer of the bone marrow • Cancer of special WBC cells called plasma cells • Plasma cells congregate in spongy bone where it interferes with normal hematopoesis (blood cell development). • Most common in men, 2x more common in Blacks. • Death within 5 years is common.

  12. Lisfranc- fx in which one/many metatarsal bones are dislocated from tarsal bones. Jones- fx of the base of the 5th metatarsal of foot Jefferson- fx of Cervical 1 Hangman- fx of Cervical 2 Seat Belt- fx of the body of the Lumbar vertebrae; normally due to trauma Blowout- fx to the floor of the orbit (maxillary and zygoma bones) Tripod- fx to the floor and lateral aspect of the orbit Fractures

  13. Colles- • fx of distal radius with a buckle fx of distal ulna • Most common wrist fx due to hyperextension of fall. • Bennett’s- • fx of the base of the 1st metacarpal of hand • Boxers’- • fx of the 5th metacarpal of hand • Chauffeur’s- • fx to the styloid process of radius • Monteggia- • fx of the ulna with radius dislocation at elbow • Galeazzi- • fx of the radius with dislocation at distal radio/ulnar joint of the wrist • Pott’s- • fx of both medial and lateral malleoli at ankle. aka bi-malleolar fx

  14. Colles fx Bennetts fx

  15. Chauffeur Boxer

  16. Monteggia Galeazzi

  17. Potts Lisfranc

  18. Jefferson (fx of C1) Jones Hangman

  19. Tripod fx (Lateral Orbit) Blowout fx (Floor of Orbit) Seat Belt fx

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