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Year 3 Surgery > 11 - Orthopaedic Assessment > Flashcards

11 - Orthopaedic Assessment Flashcards

1
Q

What is infection of bone + inflammatory destruction and apposite of new bone?

A

Osteomyelitis

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2
Q

What is the usual cause of osteomyelitis?

A

Bacterial infection
Commonest = staph aureus

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3
Q

What are RF for osteomyelitis?

A

<20 or >50
Chronic health conditions
IVDU
DM

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4
Q

How can osteomyelitis arise?

A

Haematogenous spread (children)
Wound / surgery
Diabetic foot infection

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5
Q

What bones are affected predominantly by osteomyelitis in children?

A

Long bones (have a lack of macrophages - and blood flow slows down around the metaphysis = good place for infection)

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6
Q

What bones are affected most by osteomyelitis in dialysis Ps?

A

Spine
Ribs

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7
Q

Which bone is most commonly affected by osteomyelitis in IVDU?

A

Clavicle

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8
Q

Which bones are most commonly affected in diabetic Ps?

A

Foot bones

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9
Q

What is the risk if a P has had osteomyelitis as a child and then in later life needs bone surgery?

A

That a biofilm of bacteria remains which can be reactivated in the joint space

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10
Q

What is a biofilm?

A

Where bacteria lie dormant (therefore not susceptible to Abx) in a matrix attached to an inert substance.

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11
Q

How is osteomyelitis classified?

A

Acute (within 2w)
Subacute (1-several months)
Chronic (after several months)

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12
Q

What are the S&S of osteomyelitis?

A
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13
Q

What are the DDs for osteomyelitis?
What should you always do when diagnosing osteomyelitis?

A

Tumor
Healing fracture

If suspect osteomyelitis - Send tissue to histology.

Similarly - if tumour suspected - send send tissue for culture.

ALWAYS rule out both - look VERY similar. Impossible to tell for sure from XRAY.

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14
Q

What would bloods show in osteomyelitis?

A

Elevated ESR and CRP - esp in chronic

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15
Q

What will histology show in osteomyelitis?

A

Acute = Ns and live osteocytes

Chronic = fibrosis, osteocytes without nuclei, lymphocytes

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16
Q

How long can it take for acute osteomyelitis to show on XR?

A

Up to 2 weeks - takes that long for cell turnover and change in calcified bone to be seen.
Bone loss has to be 50% loss before it is seen!

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17
Q

What is it called when you get new bone around necrotic bone?

A

Involucrum

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18
Q

What does chronic osteomyelitis look like on XR?

A

Lucency
Sclerotic rim
Osteopenia

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19
Q

Which investigation is good for bone?

A

CT

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20
Q

Which investigation is good at looking at soft tissue surrounding bone?

A

MRI

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21
Q

Which scan is good for diabetic feet or if MRI is not an option for bone?

A

Gallium scan

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22
Q

What is Rx for osteomyelitis?

A

Depends when the infection is identified.

Want Abx spruce to identified organism - high dose asap.

Can also give hyperbaric oxygen therapy
Surgery also an option - irrigation, debridement, poss amputation

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23
Q

What is a piece of dead bone that has become separated from the surrounding living bone as a result of an infection called?

A

Sequestrum

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24
Q

What does Rx of osteomyelitis depend on?

A

Patient status - IC? nutritional status?
Severity of injury
Location
Implant
Ischaemic tissue / Necrotic tissue?

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25
Q

Which part of the bone responds better to infection Rx?

A

Metaphysis better than diaphysis

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26
Q

How is osteomyelitis managed surgically?

A
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27
Q

What is the prognosis of both acute and chronic osteomyelitis?

A

Acute - good outcome if caught early

Chronic = 1% can turn malignant
30% can recur

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28
Q

What are the RF for OA?

A

F
Older age
Occupation
Muscle weakness
Inflammatory joint disease
Lack of osteoporosis

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29
Q

What percentage of Ps over 65 will have XR evidence of OA?

A

at least 50% - but many will be asymptomatic

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30
Q

What do you base need for surgery on when looking at OA?

A

The P’s symptoms and their QOL - if severe effect on ADL then stronger case for surgery. Dont make decision on radiological extent of disease alone.

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31
Q

What is the pathophysiology of OA?

A

Get articular damage in a synovial joint
Osteophytes -> formation of new bone
-> Secondary joint inflammation

Get changes to the chondral surface

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32
Q

Which 4 joints are particularly susceptible to OA?

A

hip, knee, shoulder, elbow - because they have capsules

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33
Q

What are the symptoms of OA?

A

Pain!
Swelling
Stiffness - loss of range of movement
Clicking joints
Functional impairment

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34
Q

What are the signs of OA?

A

Deformity
Muscle wasting
Effusion
Fixed flexion
Crepitus
Pain in active and passive motion

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35
Q

What investigations can be done for OA?

A

XR
CT if specific cause

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36
Q

How does OA appear on XR?

A

Narrow joint space
Subchondral sclerosis
Osteophyte formation
Cyst formation

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37
Q

How is OA managed in primary care?

A

Analgesia
Supports / footwear
Modification of activity
Exercise
Steroid injection - e.g. interarticular injections
Reduction of load

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38
Q

What is surgery to realign the joint and alter the forces within that joint called?

A

Osteotomy

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39
Q

What is surgery to fuse the joint to eliminate painful movement called?

A

Arthrodesis

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40
Q

What is surgery to restore function of the joint called?

A

Arthroplasty

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41
Q

What is surgery to excise and debride a joint space called?

A

Excision arthroplasty

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42
Q

What is surgery to partially replace a joint surface called?

A

Hemi-arthroplasty

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43
Q

What is surgery to replace a joint called?

A

Total arthroplasty

44
Q

What hip surgery can be done for younger Ps with active lifestyles?

A

Hip resurfacing - no acetabular replacement done.

45
Q

What surgery is often done for NOF#?

A

Hemi-arthroplasty - no acetabular replacement done

46
Q

How is a hip arthroplasty done?

A

Acetabulum and femoral shaft are both replaced

47
Q

What are the general complications of a total joint replacement?

A

Largely depends on health of P prior to surgery

Acute =
MI, CCF
Fat embolism
Pulmonary embolism
DVT (esp following knee replacement)
Neurovascular injury
Dislocation
Fracture
Infection
Bleeding

Long Term =
Implant failure / loosening of implant
Metallosis
Infection
Discloation
Failure to achieve desired outcome

48
Q

What is it called when the P has a reaction to the implant, causing tissues to become extremely inflamed with metal distribution in the tissue?

A

Metallosis

49
Q

What is infection of a joint called?

A

Septic arthritis

50
Q

What is the most common cause of septic arthritis?

A

Strep aureus
(Group B strep in neonates)

51
Q

What is the commonest joint in a child to be affected by septic arthritis?

A

Hip & knee

52
Q

What is the commonest joint in an adult to be affected by septic arthritis?

A

Knee

53
Q

What are the RF for septic arthritis?

A

> 80
RA
DM
Cirrhosis
HIV
Endocarditis
IVDU
Recent joint surgery

54
Q

How does septic arthritis spread?

A

Haematogenous spread
Penetrating wound
Adjacent osteomyelitis (rare)

55
Q

What happens in septic arthritis?

A

Articular cartilage is destroyed rapidly -> ankylosis
Is SURGICAL EMERGENCY

56
Q

What is ankylosis?

A

Ankylosis, in medicine, stiffness of a joint as the result of injury or disease. The rigidity may be complete or partial and may be due to inflammation of the tendinous or muscular structures outside the joint or of the tissues of the joint itself.

57
Q

How long can it take for damage to occur in septic arthritis?

A

Within 8 hours

58
Q

What are the S&S of septic arthritis?

A
59
Q

What are the differentials for septic arthritis?

A

More reduced range of motion with septic arthritis rather than bursitis - because the SA is in the joint - and the bursitis is more restricted to an area. SA is painful movement throughout the whole range of motion of the joint. Bursitis should respond to NSAIDs better than SA.

60
Q

When can you give Abx in septic arthritis?

A

Need to remove and culture the swelling before you start Abx.

61
Q

How can you differentiate between gout and pseudogout?

A

Gout = sodium urate, needle shaped, negatively bifringent

Psuedogout = calcium pyrophosphate, rectangular, positively bifringent crystals

62
Q

What investigations can you do for septic arthritis?

A

Bloods - WCC, ESR, CRP raised?
Aspirate synovial fluid - MC&S
XR / MRI not usually needed - clinical diagnosis

63
Q

How is septic arthritis managed?

A

IV Abx
Surgical irrigation and drainage + debridement if needed

64
Q

What complications can arise from septic arthritis?

A

Arthritis
Fibrous ankylosis
Osteomyelitis

65
Q

Which bursae most commonly get bursitis in M and F?

A

F = Pes anserinus and trochanteric bursae
M = Olecranon

66
Q

Septic bursitis is more common in which Ps?

A

IC
DM
RA
Alcoholics

67
Q

Which AI conditions can make you susceptible to bursitis?

A

SLE
RA
Scleroderma

68
Q

What is the pathophysiology of bursitis?

A

Inflammation of synovial lining of bursae -> inc inflammatory markers
inc TNF, cyclooxygenases, ILs.

69
Q

What are the S&S of bursitis?

A
70
Q

What are the two forms of bursitis?

A

Acute and chronic

71
Q

What are the DDs for bursitis?

A

Think - where is the region - what structures are next to there.

72
Q

What investigations can you do for bursitis/

A

XR if foreign body /trauma suspected
USS
MRI for deep bursae
Aspiration - if thinking septic joint or gout

73
Q

What are the risks of aspirating inflammatory bursitis?

A

Can turn it into infective bursitis if not entirely asceptic.

74
Q

How is bursitis managed?

A

Most resolve on their own - rest, ice, compression, avoid aggrevating

Can give anti-inflammatories
Abx only if infection
Rarely - steroid injection

75
Q

How can you differentiate between acute, sub-acute and chronic back pain?

A

Acute = sudden onset, days - weeks

Sub-acute = sudden or slow onset = 4-12w

Chronic = sudden or slow onset - 12w+

76
Q

What is the commonest cause of back pain in middle age?

A

OA of the spine

77
Q

What non-spinal causes of back pain are there?

A
78
Q

What infective causes of back pain are there?

A

Discitis
Vertebral osteomyelitis

79
Q

What Qs do you need to ask about back pain?

A
80
Q

What are yellow flags for back pain?

A

Signs that it might be difficult to eliminate or manage the P’s pain

81
Q

What tests should you do for back pain?

A

DRE - check anal tone!

82
Q

What are spinal causes of back pain?

A
83
Q

What investigations can you do for back pain?

A
84
Q

How should back pain be managed?

A

Avoid bed rest, modify activities
NSAIDS
Phsyio
Ice packs
Keep moving
Surgery rarely indicated

85
Q

What are complications of back surgery?

A
86
Q

What are the Red Flags for back pain?

A

<20 or >55
Weight loss
Fevers
Persistent pain NOT affected by movement
Night pain
Hx of malignancy
Progressive neurology - bowel/bladder dysfunction - saddle anaesthesia = poss cauda equina syndrome

87
Q

What does red dot mean on XR?

A

The ‘red dot’ is the name given to a system whereby the radiographer marks a radiograph that he or she believes shows an acute abnormality.

88
Q

What does AABCSS stand for?

A

Adequacy
Alignment
Bones
Cartilage/Joints
Soft tissue
Satisfaction of search

89
Q

When looking at alignment - what should you check for?

A
90
Q

When looking at bones - what should you check for?

A
91
Q

How do lytic and sclerotic areas look on XR?

A

Lytic = darker areas
Sclerotic = brighter areas

92
Q

When looking at cartilage on XR - what should you look for?

A
93
Q

When looking at soft tissue on imaging - what should you look for?

A
94
Q

What should you check at the end when looking at imaging?

A
95
Q

What type of fracture:
1 - goes across the bone
2 - goes in a corkscrew through the bone
3 - goes diagonally across the bone
4 - follows the long axis of the bone
5 - is broken into multiple pieces
6 - extends out of the skin?

A

1 - transverse
2 - spiral
3 - oblique
4 - longitudinal
5 - comminuted
6 - compound

96
Q

What is it called when you get bulging of the cortex (children’s fracture?

A

Torus or buckle fracture

97
Q

What is it called when you get a bulge in the cortex on one side and a break in the cortex on the other side?

A

Greenstick fracture

A greenstick fracture is a partial thickness fracture where only the cortex and periosteum are interrupted on one side of the bone but remain uninterrupted on the other

98
Q

What is it called when you get partial loss of articulation of a joint?

A

Subluxation

99
Q

What is it called when you have complete loss of articulation at a joint?

A

Dislocation

100
Q

How can you differentiate between paediatric and adult XR?

A

Paeds - apophysis is not yet fused

101
Q

What are the following called?
- anterior margin of the vertebral bodies
- posterior margin of the vertebral bodies
- posterior margin of the spinal canal
- tips of the spinous processes

A

Anterior vertebral line
Posterior vertebral line
Spinolaminar line
Posterior spinous line

102
Q

How many columns is the spine divided into?

A
103
Q

When is a spinal fracture deemed to be unstable?

A

If 2 or more spinal columns are affected

104
Q

What is a common fracture of the wrist?

A

Colles fracture

105
Q

What often causes a wedge/anterior compression of the T or L spine?

A

Osteoporosis

Year 3 Surgery (15 decks)

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