Question

Case Scenario: A mother drops off her 15-year-old son at soccer practice. He plays for a traveling team, and she is headed to the grocery store to do some shopping while he is occupied. While at the store, she receives a telephone call from the coach, telling her that her son was kicked just below the knee, causing him to fall to the ground. He was wearing his shin guards but complains that it hurts too much to walk. The mother turns around and heads back to the soccer field. When she arrives, her son is sitting on the bench with ice on his leg. The coach and a teammate help her get him into the car, and she drives him to the emergency department. An x-ray image shows a fracture near the knee with subluxation.

1. Question: Attempts at closed reduction are unsuccessful; consequently, the young man is taken into surgery. At the completion of the procedure, the orthopedic surgeon talks with the family. The repair was more extensive than the surgeon had initially expected. Near the site of the break, a tumor was found. Based on the young man’s age, the tumor is most likely what type? Explain why.

Case Scenario: A 75-year-old woman is in for her yearly exam. She states that sleep is challenging as she has pain in her upper back. She has been in good health other than the pain from her back. She has led an active life as a tennis player and states her activities are diminished by the pain. The doctor diagnoses osteoarthritis.

2. Question: Describe in detail the pathophysiology of osteoarthritis.

Answer 1

Ans) Pathophysiology of Osteoarthritis:

- Osteoarthritis is traditionally thought of as a 'wear and tear' disease which occurs as we age.

- The pathogenesis of OA involves a degradation of cartilage and remodelling of bone due to an active response of chondrocytes in the articular cartilage and the inflammatory cells in the surrounding tissues.

- The release of enzymes from these cells break down collagen and proteoglycans, destroying the articular cartilage. The exposure of the underlying subchondral bone results in sclerosis, followed by reactive remodelling changes that lead to the formation of osteophytes and subchondral bone cysts. The joint space is progressively lost over time.