Question

- mechanism of bone healing and repair, treatment options, and complications 

- dislocation/luxation vs subluxation: description, clinical manifestations 

- osteomyelitis: description, etiology, clinical manifestations scoliosis vs kyphosis vs lordosis: description, complications 

- osteoporosis: description, etiology, clinical manifestations 

- rickets vs osteomalacia: description, age group affected, etiology, clinical manifestations osteosarcoma: description, age group affected, locations, clinical manifestations 

- multiple myeloma: review from week 2! 

- Duchenne muscular dystrophy, myasthenia gravis, fibromyalgia: description, etiology, clinical manifestations

Answer 1

1.mechanism of bone healing

bone union for healing is the process that occurs after the integrity of bone is interrupted

Stages:

1) the formation of hematoma at the break- the fracture causes soft tissue edema and bleeding because of the vascularity of the bone this blood soledefies into hematoma over 48- 72 hours

2) formation of fibrocartilaginous callus-dead cells promote migration to host your bloods and fibroblast to the area and healing starts with the formation of fibrocartilage

3) formation of Bony callus.-bon union begins as callus form with vascular and cellular proliferation surrounding the fracture site this loose fibrous tissue or changes into bone over next 3 to 6 months.

4) remodeling and addition of compact bone-remodeling occurs as bone tissue of the callus is resorbs as time passes and weight bearing activities are gradually increased.

Treatment options; for fractures

a) Reduction- Reduction restores born to proper alignment.

* Closed reduction is non surgical intervention performed by manual manipulation. Is performed under general or local anaesthesia a cast may be applied following reduction

*Open Reduction- involves a surgical intervention the fracture may be treated with internal fixation devices.

b) Fixation

*Internal fixation follows an open reduction.It involves application of screws ,plates pins ,for intramedullary rods to hold the fragments in alignment.

Internal fixation , involve the removal of damaged bone and replacement with prosthesis. Internal fixation provides immediate bone strength.

*External fixation is the use of external frame to stabilize fracture by attaching skeletal pins through bone fragments two rigid external support.

C) Traction- traction is the solution of pulling force applied in two directions to reduce and immobilize fracture. Traction provides proper born alignment and reduces muscle spasm

*Skeletal traction-traction applied mechanical to bone with pins wires and tongs. Typical wait for skeletal traction 25 to 40lb. Examples are cervical tongs and halo fixation device

*Skin traction-skin traction is applied by using elastic bandages for adhesive form boot, or slings.

Cervical skin traction relieves muscle spasm and compression in the upper extremities and neck.it uses a head halter and chin pad to attach traction.

Buck skin traction used to alleviate muscle spasm and immobilize lower limb by maintaining stright pull on Limbwith use of weight.

Complications of fractures

a) fat embolism-fat embolism originate in the bone marrow and occurs after the fracture when fat global is released into the bloodstream

B) compartment syndrome- occurs when pressure increase in with one or more compartments leading to decreased blood flow tissue ischemia and neurovascular impairment.

C) instruction and osteomyelitis- infection and osteomyelitis can be caused by introduction of organism in two bones leading to localised bone infection.

2). a)Bone dislocation - dislocation is an injury to a joint a place where two or more bones come together in which ends of the bones are forced from their normal positions. Dislocation is most common in shoulders and fingers.

b) subluxation -subluxation is an incomplete or partial dislocation of joint or organ.

*Clinical manifestations-weakness numbness or tingling near the injury, tenderness processing muscle spasm and stiffening or swelling. Loss of ability to move joint.

3. Osteomyelitis -osteomyelitis is inflammation and destruction of borne caused by bacteria mycobacteria or fungi.

*Etiology-osteomyelitis is caused by,

- continuous spread from infected tissue or an infected prosthetic joint

- backbone organisms -hematogenous osteomyelitis

-open wound from contaminated open fractures for bone surgery.

-trauma and foreign bodies predispose osteomyelitis

*Clinical features

-patient with acute osteomyelitis of peripheral bonds usually experience weight loss fatigue fever and localised swelling erythema and tenderness.

-vertebral osteomyelitis course localised back pain and tenderness with paravertebral muscle spasm.

-chronic osteomyelitis course intermittent bond pain tenderness and draining sinuses.

4.a) scoliosis -lateral curvature of spine

b) kyphosis-is normal outward curvature of the spine specially at the thoracic region

C)lordosis-refers to normal inward curvature of spine at the cervical and lumbar region.

Complications-

Spine infection osteoporosis,arthritis

Poor posture or slouching

5) osteoporosis- osteoporosis is metabolic disease characterized by bone de mineralization with loss of calcium and phosphorus salt leading to fragile bonds and subsequent risk for fractures.

Etiology-

A) primary osteoporosis-most often occurs in postmenopausal women occurs in men with low testosterone levels

B) secondary osteoporosis-courses include prolonged therapy with corticosteroids thyroid detecting medications aluminium containing antacids or anticonvulsants

C) osteoporosis associated with immobility ,alcoholism, malnutrition or malabsorption.

Clinical features

-possibly asymptomatic

-back pain occurs after lifting bending or stooping.

-pelvic for hip pain especially with weight bearing.

-problems with balance

-decline in height from vertebral compression

-kyphosis of dorsal spine also known as dowagers hump

-degeneration of lower thorax and Lambar vertebrae on radiographic studies.

6) Rickets vs osteomalacia

Rickets-in children prior to epiphysial fusion,vitamin d deficiency results in growth retardation associated with the expansion of growth plate known as rickets

Osteomalacia- Adults, the hypocalcemia and hypophosphatemia that accompany with vitamin D deficiency result in impaired mineralization of bone Matrix proteins called osteomalacia

Causes of rickets

Lack of vitamin d or calcium is the most common cause of rickets.

Vitamin d largely comes from exposing the skin to sunlight, it also found in some foods such as only fish and eggs. Vitamin d is essential for formation of strong and healthy bones in children.

Clinical features

_pain-the bones affected by rickets can be saw and painful so the child may be reluctant to walk on may tire easily.(waddling)

-skeletal deformities-thickening of ankles a,wrists, soft knees,bowed legs,skull bones and rarely bending of spine.

-dental problems-including week tooth enamel delay in teeth coming through and increased risk of cavities

-poor growth and development

-fragile bonds

Osteomalacia-

Signs and symptoms-

Diffuse joint and bone pain especially spine pelvis and legs

Muscle weakness

Difficulty walking of an with wadding gait

Hypocalcemia

Compressed vertebrae and diminished stature

7) osteosarcoma

Osteosarcoma is a type of cancer that produces immature bone. Tution found in the end of long bones of around knees.

-in children and young adults osteosarcoma usually starts in areas where born is growing quickly such as near ensaf leg or arm bones

- tumors develop in the bones around the knee area in the distal femur or in the proximal tibia

-the upper arm bone close to the shoulder

*most osteosarcoma occur in children and young adults.teens are the most commonly affected age group but osteosarcoma can develop at any age.

Signs and symptoms

-signs and symptoms include swelling near the bone, bone or joint pain b,injury or bonr break for clear reason.

8) multiple myeloma-

Multiple myeloma is multiple myeloma is a malignant proliferation of plasma cells within the bone.

-an excessive number of economic plasma cells inward the bone marrow and ultimately destroy the bone.

-multiple myeloma causes decreased production of immunoglobulin and antibodies and increase the level of uric acid and calcium with can lead to renal failure

-the disease typically develops slowly and causes is in known.

-assessment;

*Bond paint specially in the ribs spine and pelvis

*Weakness and fatigue

*Recurrent infections

*Anaemia

*Thrombocytopenia and leukopenia

*Spinal cord compression and paraplegia

*Osteoporosis

*Elevated calcium and uric acid levels

Duchenne muscular dystrophy

A inherited disorder of progressive muscular weakness,typically in boys.

symptoms- frequent falla,trouble getting up or running,waddling gait,big calves and learning dissabilities

myasthenia gravis;

is a neuromuscular disease characterized by considerable  weakness and abnormal fatigue of the voluntary muscle.

etiology-insufficient secretion of acetylcholine,excessive secretion of cholinesterase and un responsiveness of muscle fibers to acetylcholine

signs and symptoms;

Weakness and fatigue

difficulty in chewing dysphagia

ptosis

diplopia

weak horse voice

difficulty in breathing

diminished breath sounds

Fibromyalgia;

Fibromyalgia is a dissorder charecterised by wide spread musculoskelital pain accompanied by fatigue,memory and mood issues.

cause-exact cause is unknown, its a problem withbeain and spinal cord process pain signals

symptoms

• Wide spread pain - muscle pain,burning,twitching,tightness. cosistant dull ache lasted for at least 3 months
• fatigue,insomnia
• cognitive difficulties- impaires ability to focus ,pay attention and concentrate mental task