1. Chapter 57 Disorders of Musculoskeletal Function: Trauma, Infection, and Neoplasms

2. Causes of Musculoskeletal Injuries
Blunt tissue trauma
Disruption of tendons and ligaments
Fractures of bony structures

3. Athletic Injuries Acute injuries Caused by sudden trauma
Include injuries to soft tissues (contusion, strains, and sprains) and to bone (fractures)
Overuse injuries
Chronic injuries
Include stress fractures that result from constant, high levels of physiologic stress without sufficient recovery time

4. Types of Soft Tissue Injuries
Contusion
An injury to soft tissue that results from direct trauma and is usually caused by striking a body part against a hard object
Hematoma
A large area of local hemorrhage
Laceration
An injury in which the skin is torn or its continuity is disrupted

5. Types of Joint Injuries
Strain
A stretching injury to a muscle or a musculotendinous unit caused by mechanical overloading
Sprain
Involves the ligamentous structures surrounding the joint; pain and swelling subside more slowly than in a strain
Caused by abnormal or excessive movement of the joint

6. Types of Joint Injuries (cont.)
Dislocation
Displacement or separation of the bone ends of a joint with loss of articulation
Loose bodies
Small pieces of bone or cartilage within a joint space

7. Healing Process in Soft Tissue
Repair is accomplished by fibroblasts from the inner tendon sheath
Capillaries infiltrate the injured area during the initial healing process
Formation of the long collagen bundles

8. Question
Joint damage limited to ligamentous attachment occurs in which condition?
Strain
Sprain
Dislocation
Loose bodies

9. Answer
Strain
Sprain: Sprain involves the ligamentous structures surrounding the joint; pain and swelling subside slowly.
Dislocation
Loose bodies

10. Classifications of Fractures
By cause
Sudden injury
Stress fractures
Pathologic fractures
Location
Proximal, midshaft, distal
Types
Open or closed
Pattern of fracture line
Comminuted, compression, greenstick

12. Signs and Symptoms of a Fracture
Pain
Tenderness at the site of bone disruption
Swelling
Loss of function
Deformity of the affected part
Abnormal mobility

13. Bone Healing Three objectives for treatment of fractures:
Reduction of the fracture
Closed manipulation or surgical reduction
Immobilization
Immobilization through the use of external devices
Preservation and restoration of the function
Therapy

14. Five Stages of Bone Healing
Hematoma formation
Cellular proliferation
Callus formation
Ossification
Remodeling

15. Fracture healing

16. Fracture healing

17. Factors Delaying Bone Healing
Patient’s age
Current medications
Debilitating diseases
Local stress around the fracture site
Circulatory problems
Coagulation disorders
Poor nutrition

18. Complications of Fractures
Loss of skeletal continuity
Injury from bone fragments
Pressure from swelling and hemorrhage
Fracture blisters, compartment syndrome
Involvement of nerve fibers
Reflex sympathetic dystrophy and causalgia
Development of fat emboli

19. Origin of Bone Infections
Microorganisms introduced during injury
Microorganisms introduced during operative procedures
Microorganisms from the bloodstream

20. Actions of Microorganisms Localized in Bone
Proliferation
Cause cell death
Spread within the bone shaft
Incite a chronic inflammatory response with further destruction of bone

21. Question
Which of the following complications of healing may lead to osteonecrosis?
Loss of skeletal continuity
Injury from bone fragments
Involvement of nerve fibers
Development of fat emboli

22. Answer Loss of skeletal continuity Injury from bone fragments
Involvement of nerve fibers
Development of fat emboli: Fat emboli potentially will cause an infarct, resulting in tissue anoxia and necrosis.

23. Types of Osteomyelitis
Hematogenous osteomyelitis
Originates with infectious organisms that reach the bone through the bloodstream
Contiguous spread osteomyelitis
Secondary to a contiguous focus of infection
Direct inoculation from an exogenous source or from an adjacent extraskeletal site
Chronic osteomyelitis
Occurs secondary to an open wound

24. Hematogenous osteomyelitis

25. Spread of Tuberculosis
Tuberculosis can spread from one part of the body to the bones and joints.
When this happens, it is called extrapulmonary or miliary tuberculosis.
Caused by Mycobacterium tuberculosis
The disease is localized and progressively destructive but not as contagious as primary pulmonary tuberculosis.

26. Osteonecrosis Causes Mechanical disruption of blood vessels
Thrombosis and embolism
Vessel injury
Increased intraosseous pressure
Blood flow
Interconnecting plexus
Outer cortex receives supply from surrounding blood vessels.
Some sites have limited collateral circulation; interruption of flow affects significant amount of bone tissue.

28. Symptoms of Bone Tumors
Pain
Presence of a mass
Impairment of function

29. Characteristics of Benign Tumors
Limited to the confines of the bone
Well-demarcated edges
Surrounded by a thin rim of sclerotic bone

30. Types of Benign Bone Tumors
Osteoma
Chondroma
Osteochondroma
Giant cell tumor

31. Characteristics of Malignant Bone Tumors
Tend to be ill defined
Lack sharp borders
Extend beyond the confines of the bone

32. Types of Malignant Bone Tumors
Osteosarcoma
Aggressive and highly malignant
Ewing sarcoma
Peripheral primitive neuroectodermal tumor
Chondrosarcoma
Malignant tumor of cartilage

33. Osteocarcinoma

34. Metastatic Bone Disease
Metastatic lesions are seen most often in the spine, femur, pelvis, ribs, sternum, proximal humerus, and skull.
Tumors that frequently spread to the skeletal system are those of the breast, lung, prostate, kidney, and thyroid.

35. Treatment Goals for Metastatic Bone Disease
Preventing pathologic fractures
Promoting survival with maximum functioning
Allowing the person to maintain as much mobility and pain control as possible

36. Treatment Methods for Metastatic Bone Disease
Chemotherapy
Irradiation
Surgical stabilization

37. Question
Which of the following tumor types would most likely metastasize?
Osteoma
Chondroma
Osteochondroma
Osteosarcoma

38. Answer Osteoma Chondroma Osteochondroma
Osteosarcoma: Osteosarcoma is the most aggressive type of malignant bone tumor.