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MUSCULOSKELETAL > 1b Management of Orthopaedic Conditions > Flashcards

1b Management of Orthopaedic Conditions Flashcards

1
Q

What are osteoblast cells?

A

Bone forming
Secrete Osteoid
Catalyse mineralisation of osteoid

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2
Q

what is an osteocyte cell?

A

Mature bone cell

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3
Q

How are osteocytes formed?

A

Formed when an osteoblast becomes imbedded in its secretions

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4
Q

What do osteocyte cells sense?

A

Mechanical strain to direct osteoclast and osteoblast activity

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5
Q

What is an osteoclast?

A

Bone breaking - dissolves and reabsorbed bone by phagocytosis

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6
Q

What investiagtions should be done to look for a fracture?

A

Radiograph
CT Scan
Bone Scan
MRI Scan

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7
Q

What should you include when describing a fracture?

A

Location: which bone and which part of bone?

Pieces: simple/multifragmentary?

Pattern: transverse/oblique/spiral

Displaced/undisplaced?

Translated/angulated?
X/Y/Z plane

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8
Q

What are the two ways a fracture might be displaced?

A

Translation
Angulation

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9
Q

Why is childrens bone more elastic than adults?

A

Children’s bone can bend – more elastic than adult
Increased density of haversian canals

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10
Q

What are the clinical signs of a fracture?

A

Pain
Swelling
Crepitus
Deformity
Adjacent structural injury:
Nerves/vessels/ligament/tendons

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11
Q

Describe the stages of fracture healing?

A

Step 1: Bleeding/Haematoma – prostaglandins/cytokines released; growth factors increase local blood flow – Periosteal supply takes over

Step 2: Granulation Tissue/connective tissue/Fibrous tissue laid down / Soft Callus

Step3: Once fracture is bridged with soft callus- hard callus is formed ( laying down of Osteoid/ bone)

Step4 : Bone is remodelled via endochondral ossification lamellar bone in its place.

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12
Q

What is Wolff’s Law?

A

Bone grows and remodels in response to the forces that are placed on it

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13
Q

What is used to describe the soft tissue integity of a fracture?

A

Open / Closed

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14
Q

What is used to describe the number of bony fragments of a fracture?

A

Green stick
Simple
Multifragmentary

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15
Q

What is used to describe the movement of a fracture?

A

Displaced / undisplaced

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16
Q

What are the general principles of managing a fracture?

A

reduce
Hold
Rehabilitate

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17
Q

What are the causes of a fractured neck of femur?

A

Osteoporosis (older)
Trauma (younger)
Combination

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18
Q

What treatment would you use for an extracapsular fracture?

A

Minimal risk to blood supply and risk of AVN (avascular necrosis) is low: fix with plate and screws

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19
Q

How would you treat an intracapsular fracture is undisplaced?

A

Fix with screws as there is less risk to the blood supply

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20
Q

How would you treat an intracapsular fracture if displaced?

A

25-30% risk AVN: replace in older patients; fix if young

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21
Q

How would you treat an intracapsular, displaced fracture in patients over 65?

A

Fit and mobile - total hip replacement
Less fit = hemiarthroplasty

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22
Q

what are the types of fibrous joints?

A

Sutures
Syndesmosis
Interosseous membrane

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23
Q

What are the types of cartilaginous joints?

A

Synchondroses
Symphyses

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24
Q

What are the types of synovial joints?

A

Plane
hinge
Condyloid
Pivot
Saddle
Ball and Socket

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25
Q

How are synovial joints stabilised?

A

muscles / tendons
ligaments
bone surface congruity

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26
Q

What are the components of a synovial joint?

A

Synovium
Synovial Fluid
Articular cartilage

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27
Q

What does the articular cartilage consist of?

A

Type 2 Collagen
Proteoglycan (Aggrecan)

28
Q

What is the synovial fluid?

A

Hyaluronic rich viscous fluid

29
Q

What is the synovium?

A

1-3 cell deep lining containing macrophage-like phagocytic cells (type A synoviocyte) and fibroblast-like cells that produce hyaluronic acid (type B synoviocyte), with type 1 collagen

30
Q

What is cartilage composed of?

A

Cartilage is composed of:
1) specialized cells (chondrocytes)
2) extracellular matrix: water, collagen and proteoglycans
(mainly aggrecan)

31
Q

What is aggrecan?

A

Aggrecan is:
-a proteoglycan that possesses many chondroitin sulfate and keratin sulfate chains
-characterized by its ability to interact with hyaluronan (HA) to form large proteoglycan aggregates

32
Q

What are the two major divisions of arthritis?

A

Osteoarthritis and Inflammatory arthritis

33
Q

What is OA?

A

Degenerative arthritis

34
Q

What is joint space narrowing?

A

joint space narrowing indicates articular cartilage loss. This can occur in osteoarthritis (primary abnormality) and in Rheumatoid Arthritis (secondary damage due to synovitis)

35
Q

What radiographic changes will you see in a patient with RA?

A

joint space narrowing
osteopenia
bony erosions

36
Q

What type of osteopenia is a common radiographic sign of inflammatory arthritis?

A

juxta-articular osteopenia

37
Q

Where do bony erosions occur in RA?

A

erosions occur initially at the margins of the joint where the synovium is in direct contact with bone (the ‘bare’ area; see rheumatoid arthritis lecture)

38
Q

What features might you see in a radiograph of patients with OA?

A

Joint space narrowing
Subchondral cysts
Sclerosis
Osteophytes

39
Q

What is OA?

A

deterioration of chondral cartilage in joints which results in bones rubbing together and creating stiffness, pain, and impaired movement.

40
Q

What are the inflammatory mediators of RA?

A

Inflammatory mediators include proteinases, e.g., matrix metalloproteinases (MMPs) and aggrecanases, and inflammatory cytokines, including interleukin (IL)-1β and tumor necrosis factor α (TNFα), which enhance the synthesis of proteinases and other catabolic factors to degrade the articular cartilage membrane

41
Q

What are the signs and symptoms of OA?

A

Pain (exertional/rest/night)
Disability: walking distance/stairs/giving way
Deformity

42
Q

what deformity might occur in OA?

A

Valgus deformity

43
Q

Which procedure can be done for ACL injury?

A

Lachmann’s

44
Q

Which test suggests ACL injury?

A

Anterior draw

45
Q

what are the risk factors for OA?

A

Age
Weight
Menopause as less oestrogen
Injury
Overuse

46
Q

What are the conservative principles of OA management?

A

Analgesics
Physiotherapy
Walking aids
Avoidance of exacerbating activity
Injections (steroid/viscosupplementation)

47
Q

What are the operative management principles of OA?

A

Replace (knee/hip)
Realign (knee/big toe)
Excise (toe)
Fuse (big toe)
Synovectomy (Rheumatoid)
Denervate (wrist)

48
Q

What is infection of the bone called?

A

Osteomyelitis

49
Q

What is septic arthritis?

A

Infection of the joint resulting in swelling, stiffness, fevers and weight loss

50
Q

What causes septic arthritis?

A

Bacterial infection of a joint (usually caused by spread from the blood)

51
Q

Why is septic arthritis important?

A

Medical emergency

52
Q

How many joints are effected in septic arthritis?

A

usually one

53
Q

Why is gonococcal septic arthritis an exception?

A

Affects multiple joints, and less likely to cause joint destruction so do not need to aspirate the joint

54
Q

What are the signs and symptoms of a septic arthritis?

A

Consider septic arthritis in any patient with an acute painful, red, hot, swelling of a joint, especially if there is fever

55
Q

How is septic arthritis diagnosed?

A

by joint aspiration. Send sample for urgent Gram stain and culture

56
Q

what is the treatment of septic arthritis?

A

Treatment is with surgical wash-out (‘lavage’) and intravenous antibiotics

57
Q

What bloods are done for septic arthritis?

A

CRP: acute marker
ESR slower response
WCC
TB culture/PCR

58
Q

What are the treatments for osteomyelitis?

A

Antibiotics: iv weeks
Surgical drainage: especially collections/sequestrum
Chronic: antibiotic suppression/dressings
??amputation

59
Q

What are the treatments for septic arthritis?

A

Surgery: joint washout and drainage (repeated if required)
Iv antibiotics (days/weeks)
Immobilise joint in acute phase
Physiotherapy once over acute phase

60
Q

Describe the organisation of compact bone?

A

Repeated structural units ‘Osteons’ – concentric ‘Lamellae’ around a central ‘Haversian Canal’

61
Q

What is a haversian canal?

A

‘Haversian Canal’ – contain blood vessels, nerves and lymphatics.

62
Q

What are Volkmans canals?

A

transverse perforating canals

63
Q

What are lacunae?

A

small spaces containing osteocytes

64
Q

What does the medullary cavity contain?

A

Yellow bone marrow

65
Q

What is the difference between a stress and pathological fracture?

A

Stress = Abnormal stresses on normal bone
Pathological = Normal stresses on abnormal bone

MUSCULOSKELETAL (13 decks)

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