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Huang's Orthopaedic Surgery > Basic Science > Flashcards

Basic Science Flashcards

0
Q

Give an example of an osteoconductive, osteoinductive and osteogenic bone graft:

A

Osteoconductive: demineralized bone matrix
Osteoinductive: bone morphogenetic protein
Osteogenic: fresh autograft, bone marrow aspirate

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1
Q

What are the properties of bone graft?

A
  • Osteoconductive: provides scaffolding for bone growth
  • Osteoinductive: provides factors that stimulate osteogenesis and induction of stem cells down a bone forming lineage
  • Osteogenic: directly osteogenic. Material directly provides cells that will produce bone including primitive mesenchymal stem cells, osteoblasts, and
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2
Q

What are the different types of bone graft? Give an example of each type:

A

Autograft: cancellous, cortical, vascularized bone graft
Allograft: fresh, fresh frozen, freeze dried (croutons)
Demineralized bone matrix:
Synthetics: silicate, calcium sulfate/phosphate, corraline
Bone growth factor: BMP, TGF-B, IGF-2, PDGF

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3
Q

What is the only bone graft with osteoinductive, osteoconductive and osteogenic properties?

A

Autologous bone graft

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4
Q

What are the major risks of iliac crest bone grafting? Which approach has a higher complication rate?

A

2% to 36% complication rate: anterior > posterior for complications

  • Blood loss and hematoma
  • Nerve injury: lateral femoral cutaneous or cluneal nerves
  • Hernia formation
  • Infection
  • Fracture
  • Cosmetic defect
  • Chronic pain
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5
Q

Name the different types of necrotizing soft tissue infections:

A

Necrotizing cellulitis, myositis and fasciitis

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6
Q

What are the different microbiological types of necrotizing soft tissue infections?

A

Type 1: Polymicrobial
- At least 1 anaerobic species (Bacteroides, clostridium or peptostreptococcus) in combination with one or more facultative anaerobic streptococci (other than GAS), and members of enterobacteriaceae (E.coli, enterobacter, klebsiella or proteus)
Type 2: GAS or B-hemolytic strep aka hemolytic streptococcal gangrene
- GAS or other beta-emolytic streptococci are isolated alone or in combination with other species, most commonly staph aureus

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7
Q

Name 5 risk factors for necrotizing fasciitis:

A 
Diabetes
Drug use (IVDU)
Obesity
Immunosuppression
Recent surgery
Traumatic wounds
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8
Q

What is the pathological difference between necrotizing cellulitis, fasciitis and myositis?

A

Cellulitis: infection of superficial soft tissue, sparing the fascia and deep muscles
Fasciitis: deep infection of subcutaneous tissue with destruction of fascia and fat
Myositis: aggressive infection of skeletal muscle

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9
Q

Describe clinical signs of necrotizing cellulitis?

A
  • Thin, dark wound drainage and gas formation in the skin.
  • Gradual onset, but may later progress rapidly
  • Pain, swelling and systemic toxicity NOT prominent features
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10
Q

Describe the clinical signs of necrotizing fasciitis?

A
  • Erythematous area without sharp margins
  • Swollen, warm, shiny and very tender
  • Rapidly progressive over days
  • Skin changes from red-purple to blue-grey
  • May have bullae with skin breakdown
  • Frank cutaneous gangrene may be present in 3-5 days
  • High fever and systemic toxicity in advanced infection
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11
Q

Describe the clinical signs of necrotizing myositis?

A
  • Fever, exquisite pain, swelling of muscle with induration
  • Erythema, warmth, petechiae, bullae, and vesicles may develop over skin
  • However, may be uninvolved initially
  • Systemic toxicity may develop, with Streptococcal TSS
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12
Q

What is the diagnosis of necrotizing soft tissue infections?

A

Clinical/Surgical diagnosis

- Can only be truly diagnosed through surgery by seeing what planes it involves

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13
Q

When type of necrotizing soft tissue infections causes gas in the soft tissue?

A

Type 1 necrotizing fasciitis or gas gangrene caused by clostridia

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14
Q

What is the best way to radiographically detect gas in the soft tissue?

A

Non-contrast CT scan

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15
Q

What type of necrotizing soft tissue infection does the presence of anasthesia and skin necrosis suggest?

A

Necrotizing fasciitis (as opposed to cellulitis or myositis)

16
Q

What is the definitive management of necrotizing infection?

A

Surgical debridement (antibiotics alone has a mortality rate of almost 100%)

17
Q

When is surgery indicated in necrotizing infection?

A

Progressive soft tissue infection, severe pain, toxicity, fever, elevated serum CK

18
Q

What are goals of initial debridement of necrotizing infections/

A
  • Debride tissue until viable (bleeding) tissue is reached
  • Send tissue for gram stain and culture
  • Do not close definitively as will need repeat in 24hrs
19
Q

What is the antibiotic therapy of choice in necrotizing infections?

A

Coverage of G+, G-, anaerobic species.
- Regimen: carbapenem or beta/lactam/lactamase inhibitor + clindamycin (for its antitoxin effects) + Vancomycin/daptomycin or linezolid (for MRSA)

IVIG may be used for GAS infection

Hyperbaric oxygen

20
Q

When does C-Reactive Protein (CRP) levels start and peak?

A

Start at 6hrs and peak 2-3 days. Comes down 5-21 days

So POD 5, CRP should be coming down, if not, then it’s a sign of infection/continuing inflammation

21
Q

When does Erythrocyte sedimentation rate (ESR) levels start and peak?

A

Peak 4-11 days

23
Q

What is the most sensitive measurement of post-op infection or inflammation?

A

CRP

24
Q

What are the characteristic lab findings of renal osteodystrophy?

A 
Bone mineralization deficiency b/c of lack of minerals:
Decreased Ca
Increased serum Phosphate
Increased alkaline phosphate
Increased PTH
 - Secondary hyperparathyroidism
25
Q

COL5A1/COL5A2 mutation

A

Ehloer-Danlos

26
Q

Abnormal hemoglobin S alleles

A

Sickle cell

27
Q

What is the most common osteomyelitis infection in sickle cell patients?

A

Staph aureus

- Salmonella (the classic infection) is increased but still not as common as staph

28
Q

Females with COL5A1 genotype have a decreased risk of what?

A

COL5A1 = Ehlers-Danlos

- These female patients have a decreased risk of ACL tear

29
Q

Carbonic anhydrase II gene mutation:

A

osteopetrosis

30
Q

What is the underlying pathology of osteopetrosis?

A

Defective osteoclastic resorption of immature bone

31
Q

Urinary N-telopeptide

A

Indicator of type 1 collagen breakdown

32
Q

Name 3 markers of high bone turnover

A

Serum alkaline phosphatase
Urinary N-telopeptide
Hydroxylproline
Deoxypyridinoline

33
Q

What happens with an FGFR3 mutation?

A

Achondroplasia

34
Q

What happens with a mutated FBN1 gene?

A

Marfan’s Syndrome

35
Q

What are the different types of CRPS?

A

Type 1: no definable nerve lesion. Previous RSD. 90% of cases

Type 2: definable nerve lesion. Previously causalgia

Huang's Orthopaedic Surgery (15 decks)

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