Anatomy Practical 2 Flashcards
What is the most common cause of degeneration of the hip joint?
- osteoarthritis (wear and tear arthritis)
- then avascular necrosis of the femoral head so dies from lack of blood supply
What has avascular necrosis of the femoral head been linked to?
- alcoholism
- fractures
- dislocations of the hip
- LT cortisone treatment
What are some symptoms of osteoarthritis?
- pain whilst bearing
- reduction in range of motion
- develop bony spurs which can limit movement
- pain may be present all the time as condition develops affecting sleep
How is osteoarthritis diagnosed?
- complete history and physical exam
- x-rays determine extent of degenerative process and suggest a cause
- MRI may be necessary to determine whether avascular necrosis is cause of hip condition
- blood tests to rule out systemic arthritis or infection in hip
What are the 2 major hip replacement types?
- cemented prosthesis
- uncemented prosthesis
(choice made by surgeon based on age/lifestyle/personal preferences)
What is each prosthesis made up of?
- acetabular component
- femoral component (may be femoral stem and head joined or separate)
What is the prosthesis made of?
Femoral - metal
Acetabular - metal shell with plastic inner socket liner acting like a bearing
(plastic is tough, smooth and slick)
What are the components of a knee prosthesis?
- tibial component (replacing top of tibia)
- femoral component (replaces 2 femoral condyles and patella groove)
- patellar component (replaces joint surface on bottom of patella rubbing against femur)
What is the knee prosthesis made up of?
- femoral component = metal
- tibial component = metal tray attached to bone and plastic spacer between replacing menisci
What is traction?
- rarely used for fracture/dislocation management
- skeletal = pin placed through bone distal to fracture and apply weights to pin and place patient in apparatus
- common in femur fractures = pin in distal femur or proximal tibia posterior to tibial tuberosity
What is plaster of Paris used for?
- treatment of bone fracture, soft tissue injuries and immobilisation
- being replaced by newer fibreglass based casts which are lighter, more water resistant and more colours
What is external fixation?
- frame used with pins passing through skin and sometimes muscles to connect external fixator to bone
- 2 or more pins placed on either side of broken bone to hold in place and to anchor fixor
- external fixator used to place broken bone in correct position and alignment until bone healing occurs
- 6 weeks approx. for simple fracture
- up to 1 year for more complicated
What is internal fixation?
- bone fragments fixed with K-wires, screws, transfixing pins or nails, metal plate held by screws, long intramedullary nail, circumferential bands
What are K-wires?
- hold fracture fragments together
- used where fracture healing is predictably quick
- external splintage (cast) applied as supplementary support
What are plates and screws?
- for treating metaphyseal fractures of long bones and diaphyseal fractures of the radius and ulna
What are intra-medullary nails?
- IM nails suitable for long bones
- nail inserted into medullary canal to splint the fracture
- rotational forces resisted by introducing locking screws
Define arthrodesis?
- surgical fusion of a joint
- by clearing articular cartilage and bringing bone together and holding it in place until fusion occurs OR extra articular where fusion by-passes joint
Define ankylosis?
- spontaneous fusion of a joint
Why is arthrodesis performed?
- pain relief in severely damaged joint
- stabilisation of a joint which has lost stability from ligamentous damage or paralysis
What is arthroscopy?
- looking inside joint
- diagnostic and therapeutic purposes
- most useful in knee, shoulder, wrist, ankle and hip
- rigid telescope fitted with fibreoptic illumination
What is osteotomy?
Dividing a bone by open reduction
- corrects a bone deformity and joint contracture
- unite with external plaster fixation or by internal fixation
- used to relieve pain in OA of hip and knee
What is kyphoplasty?
- restores height of compression fractures
- improves angle of kyphosis
- vertebral body inflated with balloon then injected with bone filler
- benefits patients with spinal fractures
- ## alternative is vertebroplasty
What is vertebroplasty?
- cement directly injected into vertebral body with no prior balloon inflation
- mainly ineffective as prevents any further collapse of vertebra not restoring original height
What is congenital dysplasia of the hip?
- dislocated at birth
- developmental dysplasia similar
- check soon after birth for evidence of instability and categorise into 5 groups on basis of Barlow test
- more common in girls
- common after a breach delivery and in first-born
- genetic component
How is CDH managed?
- newborn: splintage in abduction
- 6 to 18 months: closed reduction (traction, splintage), open reduction and splintage
Why should you nose force a reduction in children who are detected late?
- may cause AVN of femoral head
- if close reduction not possible, open reduction through anterolateral approach carried out maintaining reduction using hip spica
What is SUFE?
- slipped upper femoral epiphysis
- cause of limp in early adolescence rather than childhood
- spontaneous posterior slippage of the femoral head
- femoral neck rotated externally off head
- changes in hormonal levels and secondary sexual development may impact
- boys more prone and develop slightly earlier 11-12 years
- presents with limp and pain referred to knee
- xray diagnosis
- shortening of leg and deformity restricting movement
- OA develop earlier
- reversing slip = risk of AVN to femoral head
