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Locomotor 2 > Anatomy Practical 2 > Flashcards

Anatomy Practical 2 Flashcards

1
Q

what is the most common condition that requires hip replacement

A

osteoarthritis

In the majority of cases of (OA) there is no previous history of injury to the hip joint - the hip simply “wears out”.

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2
Q

what is osteoarthritis commonly referred to

A

wear and tear arhritis

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3
Q

Is there a genetic tendency in OA

A

There may be a genetic tendency in some people that increases their chances of developing OA

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4
Q

what happens in avascular necrosis

A

Another cause of degeneration of the hip joint is avascular necrosis of the femoral head , which loses a portion of its blood supply and actually dies

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5
Q

what is avascular necrosis linked to

A

Avascular necrosis (AVN) has been linked to alcoholism, fractures and dislocations of the hip, and long term cortisone treatment for other diseases.

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6
Q

Why are the hip and knee joint most commonly affected by OA?

A

bear the most weight

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7
Q

What features of OA can be recognised in an X-ray?

A
  • narrowing of the space between the bones where the cartilage wears away
  • cysts and fluid filled cavities caused by the bones rubbing against each other
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8
Q

what arteries supply the femoral head

A

medial femoral circumflex artery
lateral femoral circumflex artery
branch of the obturator artery

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9
Q

What is the main symptom of a degenerating hip joint

A

pain whilst weight bearing

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10
Q

what does degeneration lead to

A

The degeneration leads to a reduction in the range of motion of the affected hip

Bony spurs will usually develop which may limit how far the hip is able to move

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11
Q

How do you diagnose hip degeneration

A
  • history
  • physical
  • x rays - determine the extent of the degenerative process and suggest a cause for the degeneration
  • MRI - scanning may be necessary to determine whether avascular necrosis is causing the hip condition
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12
Q

what are the two major types of artificial hip replacements

A
  • Cemented prosthesis

- Uncemented prosthesis

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13
Q

What is the choice of the type of artificial hip replacement based of of

A

The choice is usually made by the surgeon based on the age of the patient and their lifestyle, as well as the surgeon’s experience and personal preferences.

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14
Q

What is the prosthesis made up of

A

an acetabular component and a femoral component

The femoral component may come as a complete unit with the femoral stem and the femoral head joined together, or the femoral stem and the femoral head may come separately.

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15
Q

What is the femoral component of the prosthesis made out of

A

The femoral component is made of metal (some actually have a ceramic ball attached to the metal stem)

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16
Q

What is the acetabular compoenent made up of

A

The acetabular component is made of a metal shell with a plastic inner socket liner that acts like a bearing. The plastic used is very tough and very smooth and slick - (slick = slippery).

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17
Q

What are the advantages and disadvantages of a cemented

A

cemented
Advantages
- Bone cement allows a surgeon to affix prosthetic joint components to a bone that is slightly porous from osteoporosis.
- A small amount of antibiotic material can be added to the bone cement, helping to decrease the risk of post-surgical infection.
- The bone cement dries within 10 minutes of application, so the surgeon and patient can be confident the prosthetic is firmly in place

Disadvantages

  • The drawback to using bone cement is that it may degrade over time and bits of cement can break off, potentially causing problems:
  • A breakdown of the cement can cause the artificial joint to come loose, which may prompt the need for another joint replacement surgery (revision surgery).
  • The cement debris can irritate the surrounding soft tissue and cause inflammation.
  • While rare, the cement can enter the bloodstream and end up in the lungs, a condition that can be life-threatening. This risk is greatest for people who undergo spinal surgeries.
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18
Q

What are the advantages and disadvantages of an uncemented hip joint

A

A number of surgeons prefer cementless components because:

  • They believe cementless components offer a better long-term bond between the prostheses and bones.
  • Cementless components eliminate worry about the potential breakdown of cement.

The downsides to cementless prostheses are that:

  • Press-fit prostheses require healthy bones. Patients with low bone density due to osteoporosis may not be eligible for these components.
  • It can take up to three months for bone material to grow into a new joint component.1,2
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19
Q

What ligament is removed during a total hip arthroplasty?

A

x

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20
Q

what is the most common cause for patients to undergo knee replacement surgery

A

Osteoarthritis

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21
Q

What is the prosthesis for the knee joint made up of

A

1 The tibial component (bottom portion) replaces the top of the tibia (remember that the fibula plays no part in the knee joint.

2 The femoral component (top portion) replaces the two femoral condyles and the groove where the patella runs.

3 The patellar component (kneecap portion) replaces the joint surface on the bottom of the patella that rubs against the femur in the femoral groove

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22
Q

what is the femoral component of a knee joint made up of

A
  • made of metal
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23
Q

what is the tibial component of a knee joint made up of

A

a metal tray that is attached directly to the bone and a plastic spacer that provides the bearing surface which replaces the menisci

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24
Q

What is hip joint made up of

A

As for the hip the plastic used is very tough and very slick.

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25
what happens in a skeletal traction
In skeletal traction, a pin (eg, Steinmann pin) is placed through a bone distal to the fracture. Weights are applied to this pin, and the patient is placed in an apparatus to facilitate traction and nursing care.
26
When is traction most commonly used
Skeletal traction is most commonly used in femur fractures: A pin is placed in the distal femur (see image below) or proximal tibia 1-2 cm posterior to the tibial tuberosity. Once the pin is placed, a Thomas splint is used to achieve balanced suspension.
27
What is external fixation
External fixation is a surgical treatment wherein rods are screwed into bone and exit the body to be attached to a stabilizing structure on the outside of the body
28
When is plaster of paris used
Plaster of Paris is used for the treatment of bone fracture, soft tissue injuries and for immobilisation where required
29
What is now replacing plaster of paris
Newer fibreglass based casts are now replacing plaster of Paris and are lighter and slightly more water resistant than the older casts.
30
What are the advantages and disadvantages of plaster casting
x
31
What are some of the complications of plaster casting
x
32
what is used for a more complex external fixation
a frame is used with pins that pass through the skin and sometimes muscles to connect the external fixator to the bone two or more pins are placed on either side of the broken bone to hold the bond in place and to anchor the fixator securely - sometimes wires are used with pins or instead of pins to secure the bone pieces - the surgery uses the external fixator to place the broken bone in its correct position and alignment until bone healing occurs
33
How long can bone healing take
This may take approximately six weeks for a simple fracture, and up to one year or longer for a more complicated procedure.
34
What happens when the fixation is internal
When the fixation is internal, bone fragments may be fixed with Kirschner wires (K-wires) screws, transfixing pins or nails, a metal plate held by screws, a long intramedullary nail (with or without locking screws), circumferential bands, or a combination of these methods.
35
What do K wires do
K-wires (often inserted percutaneously without exposing the fracture) can hold fracture fragments together. Some form of external splintage (usually a cast) is applied as supplementary support.
36
When are K wires used
They are used in situations where fracture healing is predictably quick.
37
What are plates and screws used for
This form of fixation is useful for treating metaphyseal fractures of long bones and diaphyseal fractures of the radius and ulna.
38
what are intramedullary nails useful for
IM nails are suitable for long bones. A nail (or long rod) is inserted into the medually canal to splint the fracture. Rotational forces are resisted by introducing locking screws which transfix the bone cortices and the nail proximal and distal to the fracture.
39
define autograft
x
40
define allograft
x
41
define xenograft
x
42
define isograft
x
43
Define alloplast
x
44
what are the three characteristics of an ideal bone graft
- osteogenesis - Osteoinduction - Osteoconduction
45
What is the idea bone graft
Autogenous grafts are the ideal bone grafts because they possess all three of these characteristics.
46
where does autogenous grafts be harvested
- from our own bone | The bone is typically harvested from the chin, jaw, lower leg bone, hip, or the skull
47
What is the most reliable way of re-establishing knee stability
- knee ligament reconstruction using tendon grafts | - particularly after disruption of the anterior cruciate ligament
48
what is the most common knee ligament replacement graft used
Autogenous tendons are most commonly used | - Allograft tendons have also been employed
49
When are allograft tendons are used in knee ligament replacement
- both as a means of reducing donor site morbidity when multiple or revision ligament reconstructions are performed, - and when host tissue is inadequate or unavailable.
50
What is arthrodesis
This is defined as the surgical fusion of a joint (ankylosis is the spontaneous fusion of a join
51
what is the word for spontaneous fusion of a joint
Ankylosis
52
When is arthrodesis done
1) Pain relief in a joint severely damaged | 2) Stabilisation of a joint which has lost stability from ligamentous damage or paralysis.
53
How does arthrodesis work
The joint may be fused by either clearing the articular cartilage and bringing the bone together and holding it in place until fusion occurs, or extra articular where fusion by-passes the joint.
54
What is arthroscopy and what is it performed for
Arthroscopy (looking inside a joint) is performed for both diagnostic and therapeutic purposes
55
When is arthroscopy mostly used for
- Knee - Shoulder - Wrist - Ankle - Hip
56
What is an arthroscope
An arthroscope is basically a rigid telescope fitted with fibreoptic illumination.
57
What is osteotomy
This is defined as dividing a bone by open reduction
58
What is osteotomy used for
It is used to correct a bone deformity and occasionally joint contracture. The osteotomy is allowed to unite either with external plaster fixation or by internal fixation. Osteotomy has also been used to relieve pain in osteoarthritis of the hip and knee.
59
What is kyphoplasty
Aims to restore the height of compression fractures and also improve the angle of kyphosis.
60
How does kyphoplasty used
During this process, the vertebral body is inflated with a balloon then injected with bone filler material. Clinical studies have shown that this balloon kyphoplasty is of benefit for patients with spinal fractures
61
What happens in vertebroplasty
The alternative is vertebroplasty where the cement is injected directly into the vertebral body with no prior balloon inflation,
62
Why is vertebroplasty ineffective
this has been shown to be mainly ineffective as it merely prevents any further collapse of the vertebra and does not restore the original height.
63
Why are children referred to paediatric orthopaedics
Children are often referred as a result of parental anxiety about when, or how they walk.
64
What can limit diagnosis in children
- the age of the child can limit the diagnosis in children
65
What is a true congenital dislocation of the hip
True congenital dislocation of the hip is a hip that is dislocated at birth (rare),
66
How are babies hips categorize for congenital dislocation/dysplasia of the hip
hip. All babies can be categorized at birth into one of 5 groups on the basis of the Barlow test
67
what is currently recommended for congenital dislocation/dysplasia of the hip
currently recommended that all newborn babies should be examined soon after birth for evidence of instability
68
what is congenital dislocation/dysplasia more common in
- more common in girls - common after a breach delivery - first born children - might be a genetic component as it can run in families
69
What is Barlows categories of CDH
x
70
What groups on Barlows cartiegories of CHD is the usual definition of CHD
groups 2, 3 and 4
71
What is hilgenreiners line
Hilgenreiner's Line: is a horizontal line along inferior aspect of triradiate
72
What is the acetabular index line
Acetabular index Line: is drawn along the lower border of the acetabulum
73
The angle is measured between Hilgenreiner’s line and the acetabular index line should...
The angle is measured between Hilgenreiner’s line and the acetabular index line. The acetabular angle should decrease with age: 0 - 1 year old < 34 1 > 4 year old < 28 > 4 year old < 25
74
an angle of less that 45 between Hilgenreiner’s line and the acetabular index line ... and an angle of greater than 60 Hilgenreiner’s line and the acetabular index line ..
An angle of <45 deg will spontaneously correct with splintage, whereas angle of > 60 deg will usually require surgery.
75
Explain why the epiphyseal growth plate does not appear on an x-ray?
Because growth plates are made of cartilage, they don't show up clearly on an X-ray and instead appear as an empty space between the middle section of a bone and the end.
76
How do you manage CHD (Congenital hip dysplasia/dislocation)
• Newborn o Splintage in abduction (Pavlik harness, Von Rosen splint) • 6 - 18 months o Closed reduction – Traction, Splintage o Open reduction and Splintage
77
What happens if there is late detection of Congenital hip dysplasia/dislocation
In children who are detected late it is unwise to force a reduction as this may cause AVN of the femoral head
78
What do you do if a closed reduction in Congenital hip dysplasia/dislocation is not possible
If close reduction is not possible then an open reduction through an anterolateral approach is carried out with maintenance of the reduction using a hip spica (a cast or splint that immobilises the hip or shoulder).
79
What is a hip spica
a cast or splint that immobilises the hip or shoulder
80
What is perthe's disease
Perthes disease is a rare childhood condition that affects the hip. It occurs when the blood supply to the rounded head of the femur (thighbone) is temporarily disrupted. Without an adequate blood supply, the bone cells die, a process called avascular necrosis.
81
When does Perthe's disease present
- The condition usually presents at age 7-8 years up to 11 or 12 years. - The entire course of the disease can take 1.5 to 3 years. - Boys are more commonly affected and 15% of cases are bilateral.
82
What are the radiological features of Perthe's disease
x
83
What is a cause of a limp in early adolescence rather than childhood
Slipped upper femoral epiphysis (SUFE) is a cause of a limp in early adolescence rather than childhood.
84
What happens in a slipped upper femoral epiphysis
sing the convention of describing deformities in terms of displacement of the distal portion, it is the femoral neck that has rotated externally off the head
85
what is the aertiology of slipped upper femoral epiphysis
The aetiology of SUFE is unknown but there is circumstantial evidence that strongly supports changes in hormonal levels and secondary sexual development.
86
What is the onset of slipped upper femoral epiphysis
- boys more prone - boys tend to have it at 11-12 years - females tend to develop it t around 12-15 years
87
How does slipped upper femoral epiphysis present
SUFE presents with a limp and pain that is sometimes referred to the knee.
88
How is slipped upper femoral epiphysis diagnosed
Most cases of SUFE can be diagnosed on x-rays.
89
How do you manage slipped upper femoral epiphysis
Procedures used to treat SCFE include: In situ fixation. This is the procedure used most often for patients with stable or mild SCFE. The doctor makes a small incision near the hip, then inserts a metal screw across the growth plate to maintain the position of the femoral head and prevent any further slippage. A risk of reversing the slip is that the femoral head can become avascular.
90
What can develop earlier in patients with slipped upper femoral epiphysis
Osteoarthritis can develop earlier in individuals who have had SUFE
91
what is clubfoot
Clubfoot is a deformity of the foot that makes the foot look like a golf club
92
What can cause club foot
Clubfoot is relatively common (1:1000) and probably related to intra-uterine posture. More severe cases can be associated with the maldevelopment of the nerves and muscles of the legs.

Locomotor 2 (30 decks)

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