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This Concept Map, created with IHMC CmapTools, has information related to: Bone, It's Bone Infections OSTEOMYELITIS TUBERCULOUS OSTEOMYELITIS -1-3% of pulm TB pts -usually hematogenous -or direct or lymph -can fester for years -mostly solitary, mult in AIDS -SPINE>knees>hips -more destructive than PYOGENIC -spreads thru medulla->necrosis POTT DZ-in spine-thru vert discs to next vert body, abscesses in soft tissue CLINICAL-pain on motion, fevers, chills, wt loss -inguinal mass -scoliosis, kyphosis, neuro defects -can->amyloid, TB arthritis, sinus tract formation, It's Bone Developmental Abnormalities MALFORMATIONS -homeobox gene alterations Absence of bone- phalanx, rib, clavicle Supernumerary ribs, digits Syndactyly Arachnodactylism Craniorachischisis-skull, spinal column don't close -meningomyelocele or meningoencephalocele Dysplasias-muts in genes of skel organogenesis, It's Bone OSTEONECROSIS (AVASCULAR NECROSIS)-10% jt replacements -all result from ischemia -infarction is pretty common Via. fracture, steroids, embolism, vessel injury (radiation, vasculitis), inc'd intraoss. pressure, venous HTN -corticoster-high-dose short term, low dose long term or intraarticular MORPH- Medullary infarcts-spotty necrosis, NL cortex -stay pretty stable over time Subchondral-wedge-shaped ->creeping substitution too slow to work ->eventual collapse -collapse more than medullary CLINICAL-chronic pain, It's Bone Fractures Healing Stages: Thru wk 1: hematoma organizes -fibroblasts, cytokines ->remodel ends of Fx bone ->procallus-some anchorage -no weight bearing Wk1-2 or 3 :osteoprogenitors->trabeculae -perpendic to cortical axis -can have cartilage component -repair tissue at max girth-bony callus -controlled weight-bearing Maturation-part of callus resorbs if not needed for wt-bearing -medullary cavity reformed If nonunion->too much motion, can ->cystic degeneration of callus center -can ->false joint w/ synovial-like cells, It's Bone Osteoclast Dysfunction PAGET DISEASE (OSTEITIS DEFORMANS) -collage of matrix madness -furious resorption->hectic formation ->gain bone mass (osteosclerosis) -(woven bone->weak->breaks) ->osteosclerosis -mid-adulthood->progressive -Whites N. Europe, Aus, US -mostly (-)Sx-but in 5-11% of pop'n -rare in Asia, Scandinavia, Africa Cause-PARAMYXOVIRUS->inflammation ->makes osteoblasts->IL-6->'clasts MORPH-focal process-mosaic pattern -LARGE 'clasts in 'clastic phase (20 nuc) -fibrovasc CT in marrow space in mixed ->resorbs to NL marrow ->thick trabec, soft cortices->deform,Fx CLINICAL-PAIN in affected bone -mostly long bones, vert, skull -not fibula, ribs, small hand/foot bones -can compress sp. nn, CNs -leotiasis ossea-big, heavy head->deaf -2NDARY OSTEOARTHRITIS-femur heads -chalkstick-type Fx -hypervascular bone-warm skin, HF -usually benign, just need CALCITONIN, BISPHOSPHONATES, Pamidronate ->Tumors: giant cell, EMH -OSTEOSARCOMA-5-10%-dreaded, It's Bone Infections OSTEOMYELITIS SKELETAL SYPHILIS Congenital-begin at 5th mo gest -fully developed at birth -spirochetes in active ossification Acq'd-2-5yrs after infx-TERTIARY zones, periosteum -nose, palate, skull, limbs (tibia) -SABER SHIN-massive bone dep MORPH-edematous gran tissue w/ plasma cells, necrotic bone -acq'd dz-also have GUMMATA -silver stains, It's Bone Fractures Complete vs Incomplete Closed/Simple vs Compound Comminuted (splintered) -delays healing -can->nonunion Displaced (ends not aligned) Pathologic(Insuff) Fx vs Stress Fx Salter Fx-thru growth plate-physis, It's Bone Abnormal Matrix OTHER COLLAGEN ABNORMALITIES Types 2, 10, 11 coll in hyaline coll -some fatal, some w/ jt destruction, It's Bone Bone-Forming Tumors OSTEOID OSTEOMA ɚcm - mostly limbs (50% LEGS) -Teens, 20s - 75% are ញ yo MEN>women 2:1 50% in femur or tibia, 10% vert arch -mostly CORTEX -pain via PGE2-RELIEVE by ASA -WORSE AT NIGHT -reactive, SCLEROTIC bone formation encircles nidus-LUCENCY MORPH (also OB) -round-oval, well circum'd -loose CT around nidus w/ caps Tx: excise entirely, but get ALL of it XRT PROMOTES MALIGNANCY -RELIEVE BY ASPIRIN, It's Bone Abnormal Matrix MUCOPOLYSACCHARIDOSES-AR -def enzs that degrade dermatan, haparan, karatan sulfate -affects chondrocytes ->short bones, ABNL chest wall, It's Bone Infections OSTEOMYELITIS PYOGENIC OSTEOMYELITIS -mostly bacterial-S. aureus 80-90% -hematogenous spread>extension> direct implantation -mostly long bones or vert bodies -epiphysis, subchondral in adults -UTI or IVDA-E. coli, Pseudomonas, Klebsiella -mixed infx if surgical or open Fx -neonates- H. influenzae, GBS -metaphysis and epiphysis -can->joint destruction-arthritis -kids-metaphysis -Sickle cell-Salmonella MORPH -big subperiosteal abscesses in kids -rupture->draining sinus -sequestered, dead bone=sequestrum -acute->chronic after 1st wk ->'clastic resorption, reactive bone in periph -involucrum-living bone around dead Brodie Abscess-intraoss, often in cortex Sclerosing OM of Garre-in jaw CLINICAL-acute systemic illness -throbbing pain -Dx via Xray-lytic inside sclerosis -can have acute flare-ups after yrs Tx: ABX, surgical drainage, It's Bone Abnormal Matrix OSTEOPOROSIS-COMMON -disuse OP of limb -metabolic bone dz -senile & postmenopausal-common ->Fx -senile-older 'blasts less effective -thinned cortex-wide Haversian ᢈyo F-40% w/ Fx experience -hormonal-estrogen def ->more IL-1, 6, TNFa->'clasts -esp vertebrae-thinned trabec -post-puberty-resorption>building -0.7% loss/yr, more w/ phosphorus -M=F, WHITE>blacks, smokers, EtOH -F w/ early hysterectomy at risk -diff vit D receptors-polymorphism -insuff Ca in diet (esp teen girls) -glucocorticoids, anticonvulsant Rx -caffeine, hyperthyroid, tachycardic MORPH-THIN spicules-quicker than cortex CLINICAL-detected via X-ray w/ 30-40% loss -Ca, phos, AlkPhos levels not Dx -use BONE DENSITY scans Tx-ESTROGENS, controlled exercise Prevent: Ca++,Vit D, Exer, Falls, Gain wt Stop smoking, It's Bone Bone-Forming Tumors OSTEOMA -inside skull or facial bones -solitary, in MIDDLE-AGED Gardner Syndrome-multiple MORPH-woven and lamellar -cortical pattern-Haversian -some w/ trabec and marrow -slow-growing -problems when impinge on face -NO TRANSFORMATION TO -SARCOMA, It's Bone Bone-Forming Tumors OSTEOBLASTOMA -like OO, but SPINE -DULL, ACHY pain -unresponsive to ASA -no marked bony rxn MORPH-like OO, It's Bone Osteoclast Dysfunction OSTEOPETROSIS-RARE =marble bone dz, Albers-Schonberg -diffuse, symm, sclerosis -stonelike, brittle -due to osteoclast dysfcn: -eg carbonic anhydrase II def -Mediterranean, Arab - chrom 8q22 ->acidic blood, cranial Ca++ -no medullary canal, little marrow -woven bone persists (no remodel) ->infx, blindness, deafness, strokes AR-malignant-in utero->die post partum, or infx (few WBCs) -CN deficits, hep'splen'meg-EMH AD-benign-discovered later, many Fx -CN deficits, anemia Tx-Bone marrow xplant-'clasts derived from monos stem cells, It's Bone Abnormal Matrix OSTEOGENESIS IMPERFECTA-AD -"brittle bone dz-too little bone -can have persistent woven bone Type 1 coll dz-alpha1, alpha2 chains -some mild w/ just less coll, some severe w/ malformed coll OI I-IV - most AD I-acq'd mutation-NL lifespan/stature -NL collagen, but not enough BUT more childhood Fx, blue sclerae, hearing loss, dental problems, lax joints, II-uniformly fatal in utero, perinatal -resp problems III-intermediate-improper collagen -Fx at/before birth IV-intermed b/w I and III-NL sclerae Tx-"rodding" thru long bones, -low impact EXERCISE, healthy wt -NO steroids, NO smoking, It's Bone Developmental Abnormalities THANATOPHORIC DWARFISM -most common lethal dwarfism -FGFR3 missennse or pt mutation -diff from achodroplasia -bell-shaped abd, short limbs, frontal bossing, big head ->resp insuff->death at birth, OSTEOPOROSIS-COMMON -disuse OP of limb -metabolic bone dz -senile & postmenopausal-common ->Fx -senile-older 'blasts less effective -thinned cortex-wide Haversian ᢈyo F-40% w/ Fx experience -hormonal-estrogen def ->more IL-1, 6, TNFa->'clasts -esp vertebrae-thinned trabec -post-puberty-resorption>building -0.7% loss/yr, more w/ phosphorus -M=F, WHITE>blacks, smokers, EtOH -F w/ early hysterectomy at risk -diff vit D receptors-polymorphism -insuff Ca in diet (esp teen girls) -glucocorticoids, anticonvulsant Rx -caffeine, hyperthyroid, tachycardic MORPH-THIN spicules-quicker than cortex CLINICAL-detected via X-ray w/ 30-40% loss -Ca, phos, AlkPhos levels not Dx -use BONE DENSITY scans Tx-ESTROGENS, controlled exercise Prevent: Ca++,Vit D, Exer, Falls, Gain wt Stop smoking 2ndary OP Marrow Dzs-myeloma, etc. Renal insuff Severe COPD Depression Rheumatologic dzs Organ Xplant Cushing Syndrome Acidosis Rx: loop diuretics, MTX, anti-neoplastic, GNRH agonists, It's Bone Developmental Abnormalities ACHONDROPLASIA-AD trait -most common growth plate dz ->DWARFIS -defect in cell signaling -reduced chondrocytes in GP -point mutation in FGFR3 gene ->constant activation ->shortened prox extremities -NL trunk, enlarged head, bulging forehead, depressed root of nose -NL intelligence, sex, lifespan MORPH-narrowed zones of prolif, hypertrophy -clusters of large chondrocytes -premature bone struts at GP base ->seals growth plate -NL appositional intermemb formation ->NL cortical thickness, It's Bone Abnormal Minerals HYPERPARATHYROIDISM Primary or 2ndary (not as bad) -PTH->'blasts->stim 'clasts ->unabated resorption diffusely MORPH-cortical bone most affected->Fx -X-ray is diagnostic -'clasts bore along haversian canal -Dissecting Osteitis-railroad-like trabec ->osteopenia, decreased density -fibrotic marrow ->osteitis fibrosa cystica rare w/ early Dx (von Recklinghausen dz of bone)= Brown Tumor-microFx+hemorrh -after microfracture ->ingrowth of reactive fibrous tissue ->can become cystic -brown due to hemosiderin +Peritrabecular fibrosis +Increased bone cell activity