20. Orthopedics (Robson)

Question 1

What are the two types of replacement forms that can be used?

Answer 1

Cemented

Uncemented

Question 2

What is the problem with cemented replacements?

Answer 2

Artificial

Can break and fracture - damaged and requires replacement

Question 3

How do uncemented replacements work?

Cells involved with uncemented prosthetics are?

Answer 3

Coated with calcium hydroxyapetite - involves usage of the skeleton’s own bone formed by osteoclasts to fuse the replacement into place

Osteoclasts

Question 4

What are the problems with uncemented replacements compared to cemented?

Answer 4

Uncemented - more expensive, require more skill in implanting them and require a longer recover period e.g. seven to 10 days before you can walk on it compared to next day with cemented

Question 5

For whom are cemented replacements better for?

Answer 5

Older patients
Obese patients
Osteoporosis

Question 6

For whom are uncemented replacements better for?

Answer 6

Younger patients

More active patients

Question 7

What is the component used in cemented replacements?

Answer 7

Acrylic polymer - PMMA

Question 8

What is the component used in uncemented replacements?

Answer 8

Calcium hydroxyapetite

Question 9

What is the hybrid replacement?

Answer 9

This is a replacement that is half cemented and half non-cemented

Question 10

What different mechanisms can be used to repair IV disc damage

Answer 10

IV disc prosthetic
Spinal fusion
Bone graft
Ground up dead bone

Question 11

Which is the best out of IV disc prosthetics and spinal fusion and why?

Answer 11

Spinal fusion - cheaper and safer

Very fiddly putting the prosthetic in and this can be dangerous so close to the spinal cord

Question 12

What is a common joint replacement made in RA?

Answer 12

Small joint replacement e.g. if there is subluxation of the MCP joint with ulnar deviation

Question 13

What is tendon repair?

Answer 13

Stitching the tendon back together again

Question 14

What is tendon transfer?

Answer 14

Used in cases of nerve palsy

Take a tendon with it’s muscle and transfer it to a different location - replace the damaged nerve and muscle

Question 15

Is upper limb or lower limb tendon transfer more complicated and why?

Answer 15

Upper limb because the upper limb is required to do more complicated movements

Question 16

What is tendon lengthening and when is this used?

Answer 16

Used for those with muscle imbalances e.g. one muscle group bigger and stronger compared to the antagonising ones
Lengthen the tendons of the weaker ones if necessary

Question 17

What are the two different methods used for ACL reconstruction?

Answer 17

Can use the patella, the patella ligament and the tibia to replace the patella
OR can use the hamstring tendons and plait this and use this as a replacement

Question 18

What is mal-union of fractures?

Answer 18

There has been a misalignment of the proximal and distal fragments during healing

Question 19

What is non-union of a fracture?

Answer 19

The two fragments caused by the fracture have failed to fuse to one another and there is a gap between them

Question 20

Why might non-union occur? x2

Answer 20

Lack of blood supply

Lack of stability of the two fragments

Question 21

What is osteotomy?

Answer 21

The surgical cutting of a bone to allow for realignment

Question 22

When is physiotherapy advised after bone grafting?

Answer 22

Before AND after the procedure

Question 23

Why is physiotherapy advised with bone grafting?

Answer 23

Build up the muscles around the joint to allow the joint to be mobile quicker

Question 24

Four methods of bone grafting

Answer 24

Osteogenesis
Osteoinduction
Osteoconduction
Osteopromotion

Question 25

What will be replaced in a hip replacement for OA?

Answer 25

Femoral head AND the acetabulum

Question 26

What will be replaced in a hip replacement for avascular necrosis of the femoral head?

Answer 26

Just the femoral head

Question 27

Three parts of a knee prosthesis are?

Answer 27

Tibial component
Femoral component
Patella component

Question 28

When might a K wire be used for internal fixation?

Answer 28

When fracture healing is quick

Question 29

When might plates and screws be used for internal fixation?

Answer 29

Long bones and radius and ulnar

Question 30

When might intra-medullary nails be used for internal fixation?

Answer 30

Long bones

Question 31

Osteogenesis - bone graft - involves what?

Answer 31

Formation of new bone by cells contained in the graft

Question 32

Osteoinduction - bone graft - involves what?

Answer 32

Chemical process - molecules are contained in the graft and these convert cells into bone forming osteoblasts

Question 33

Osteoconduction - bone graft - involves what?

Answer 33

Matrix of the graft forms a scaffold that favours outside cells to penetrate the graft and form new bone

Question 34

What is an autograft?

Answer 34

Bone is harvested from the same individual

Question 35

Two sites of autografts for ACL repair are?

Answer 35

Semitendinosus

Semimembranosus

Question 36

What is arthrodesis?

Answer 36

Surgical fusion of a joint

Question 37

What is ankylosis?

Answer 37

Spontaneous fusion of a joint

Question 38

Two reasons to perform arthrodesis?

Answer 38

Pain relief in a severely damaged joint

Stabilisation of a joint which has lost stability

Question 39

Indication of osteotomy in OA is?

Answer 39

To relieve pain in OA at the hip and the knee