Skeletal Function Disorders (Metabolism) .

(A Project of National Medical Centre Karachi)
2/14/2019 1
 Describe the physical agents responsible for soft tissue
trauma.
 Differentiate among the three types of soft tissue
injuries.
 Compare muscle strains and ligamentous sprains
 Describe the healing process of soft tissue injuries
 Differentiate open from closed fractures
 List the signs and symptoms of a fracture
 Explain the measures used in treatment of fractures
 Describe the fracture healing process
 Differentiate the early complications of fractures from
later complications of fracture healing
 Toeing-in(Pigeon toe) and toeing-out (splay-footed).
 Bowlegs (have legs that curve outward at the knees)
 Knock-knees (the legs curve inward so that the feet are apart when
the knees are touching)
 Flatfoot
 Can start in utero, usually correct during normal

growth
 Osteogenesis imperfecta
◦ The most common hereditary bone disease
◦ Usually autosomal dominant
 Developmental dysplasia of the hip

◦ Can cause instability, subluxation, dislocation
◦ Checked on newborn exams
◦ Early diagnosis is important
◦ Treated with harnessing, traction, casting
◦ Multifactorial inheritance
 Congential club foot
◦ Multifactorial inheritance
◦ One or both feet involved
◦ Increased risk with family history and maternal
smoking
◦ Treated with manipulations, casting, surgery
 Legg- Calvé- Perthes Disease
◦ Osteonecrosis of the proximal femoral epiphysis
◦ Ages 2-13, mostly overweight boys
◦ Pain in groin, hip, thigh or knee or painless limp
◦ Treatment ranges from observation to bracing to surgery
 Osgood- Schlatter Disease

◦ Microfractures where patellar tendon inserts on tibial tubercle
◦ Pain in front of knee
◦ Worse with running, jumping, biking, stair climbing
◦ Treat with rest, braces, cold, anti-inflammatories
 Slipped Capital Femoral Epiphysis
◦ Most common disorder of the hip in adolescents
◦ Femoral epiphysis unites at 14-16 years of age and
slippage can occur before this
◦ Boys affected more than girls
◦ Children often overweight
◦ Knee pain, pain with walking, stiffness
◦ Treated with rest, traction, surgery
 Lateral deviation of the spine that can include rotation
or deformity of the vertebrae
 More common in girls Polio was once a big cause of this problem.
 Most are minor curves
Two Kinds:
 Postural scoliosis corrects with exercise 1. Postural
 Structural scoliosis is fixed and can be 2. Structural.
◦ Congenital
◦ Neuromuscular
◦ Idiopathic (adolescent is the most common type)
 Right curve most common
 Less than 10 degrees is normal variant, more than 40
degrees is severe
 Can cause shoulder height discrepancy, scapular
differences, clothes fitting differently. Pain usually only
if severe.
 Diagnosed through screening ages 10-16, x-ray, CT,
MRI
 Early age and larger curves will tend to progress
 Conservative treatment with <20 degrees
 Bracing for 30-40 degree curves and surgery if more
than 40 degrees
 Osteopenia: reduced bone mass
 Osteoporosis: loss of bone with deterioration of bone
architecture and increased fragility
 Most often due to aging
◦ Endocrine disorders of malignancy also causes
 Maximal bone mass occurs at age 30
 Increase in rate of bone loss after menopause with a
women’s lifetime risk of fracture 1 in 3
 Risks: female, white, small frame, family history,
postmenopausal, smoker, excessive alcohol or caffeine,
low calcium intake, sedentary lifestyle
 Imbalance in bone formation and resorption
◦ Decreased osteoblast activity and increased osteoclast
activity Low Blasts, High Clasts
 Estrogen deficiency
◦ Testosterone deficiency in men (not as severe) Mens also at risk.
 Secondary causes:
◦ Endocrine (hyperthyroidism, hyperparathyroidism)
◦ Cancer (multiple myeloma increases osteoclasts)
◦ Malabsorption (anorexia, cystic fibrosis) Multiple Myeloma is a type
of blood cancer that also
◦ Alcoholism affects bones, the cancer
◦ Corticosteroids increases osteoblast activity.
◦ Prolonged medication use (anti- convulsants, steroids)

 Manifested by:
◦ Thin outer cortex
◦ Loss of trabeculae
 Painless until fracture occurs
 Vertebral compression fracture
◦ Wedging and collapse of vertebrae lead to kyphosis and loss of
height
 Hip fracture
 Once a fracture has occurred, risk of a second fracture
is much greater
 Diagnosis with bone mineral density (BMD) scan
which scans hip and lumbar spine
 Prevention is important:
◦ Regular weight bearing exercise
◦ Calcium and vitamin D intake
 Treatment: both of the above and possibly
◦ Estrogen
◦ Calcitonin
◦ Bisphosphonates: most effective, inhibit osteoclast
activity
◦ Prevention of falls
 Softening of the bones without loss of bone matrix
 Causes: inadequate calcium absorption, reduced
vitamin D action
◦ Can occur in renal failure due to inability of the kidney to
activate vitamin D
 Symptoms: bone pain, fractures, muscle weakness
 Diagnosed through labs, x-rays
 Treated with correcting the underlying cause and
adequate calcium & vitamin D
 Rickets (children): dietary (non-fortified milks) and
inadequate sun exposure, can be
 Progressive disorder with excessive bone destruction
and structural changes of long bones, spine, pelvis
and skull
After Osteoporosis,
 The second most common bone disorder 2-3 %
 Mid-adulthood at onset with increased risk with
increasing age
 Cause unknown (?viral)
 Increased osteoclast activity with rapid bone
resorption and irregular bone formation resulting in
thick coarse bone with rough and pitted outer surface
 Can be mild or severe
 Many people may be asymptomatic
 Skull: headaches, tinnitus, hearing loss
 Spine: kyphosis
 Bowing of tibia and femur
 Pathologic fractures (femur, spine, pelvis)
 Cardiovascular disease is the most common cause of death
in those with advanced disease. Caused by increased blood
flow to affected tissues causing high-output cardiac failure
 Osteogenic sarcomas occur in 5-10% of severe cases
(femur, pelvis, humerus, tibia)
 Diagnosed on x-ray and through labs and
sometimes bone biopsy (if there is a concern
for malignancy)
 Treatment:
◦ Reduce pain
◦ Suppress with calcitonin, bisphosphonates (most
effective)
◦ Adequate calcium and vitamin D
 Acute or chronic bone infection
 Hematogenous: most often caused by
Staphylococcus aureus
◦ Bacteria reaches bone through bloodstream
◦ Usually have chronic infection elsewhere (urinary
tract, skin, IV drug users)
◦ Fever, chills, pain,
◦ X-ray findings may be delayed, bone scan will
show earlier
◦ Treatment based on cultures and requires IV
antibiotics at first, surgery may be required
 Contiguous Spread:
◦ Infection occurs from an adjacent site like an open wound
(puncture wound, open fracture, diabetic ulcer)
◦ Can occur in any bone
◦ Recurrent, persistent fever and poor healing
◦ Diagnosed through imaging, biopsy
◦ Treated with antibiotics and possible surgery
 Chronic osteomyelitis: when acute infection persists
beyond 6-8 weeks
◦ Dead bone separates from living bone
◦ May not have fever, chills or abnormal white blood cell count
◦ IV therapy needed for at least 6 weeks, surgery usually needed
 Tuberculosis can cause bone infection
 Death of a segment of bone
 Due to interruption of blood supply
 Causes: trauma, fracture, surgery, sickle cell
disease, alcoholism, corticosteroids (higher
risk with longer duration and higher doses)
 Treatment ranges from rest and anti-
inflammatories to joint replacement
 Porth, M. C. (2009). Pathophysiology Concepts of
altered health states (7th ed.). Lippincott Williams &
Wilkins.
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(A Project of National Medical Centre Karachi)

 Can start in utero, usually correct during normal

 Developmental dysplasia of the hip

 Osgood- Schlatter Disease

◦ Prolonged medication use (anti- convulsants, steroids)

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