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2 MSK > CORTEXT: Elective and Trauma Surgery > Flashcards

CORTEXT: Elective and Trauma Surgery Flashcards

1
Q

4 main strategies for surgical management of an arthritic joint?

A

arthroplasty
excision
arthrodesis
osteotomy

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2
Q

what is an excision arthroplasty?

A

removal of a diseased joint

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3
Q

what materials can joint replacements consist of?

A 
stainless steel
cobalt chrome
titanium alloy
polyethylene
ceramic
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4
Q

why do joint replacements fail?

A

wear particles produce an inflammatory response after time causing loosening OR breakage of the replacement components

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5
Q

what actually is a pseudotumour?

A

an inflammatory granuloma that causes muscle and bone necrosis

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6
Q

what material tends to cause pseudotumours?

A

metal

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7
Q

what material causes osteolysis?

A

polytethylene

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8
Q

what is osteolysis?

A

bone resorption which causes loosening

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9
Q

treatment for an early fulminant infection after surgery?

A

surgical washout
debridement
parenteral antibiotic therapy for 6 wks

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10
Q

what is a late presentation of a surgical complication?

A 
infection from haematogenous spread
loosening
fracture
implant breakage
pseudotumour formation
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11
Q

is excision/resection arthroplasty good for small or large joints?

A

small

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12
Q

what is an arthrodesis?

A

surgical stiffening or fusion of a joint in a position of function

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13
Q

how is arthrodesis done?

A

removal of hyaline cartilage and sunchondral bone allowing bony union

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14
Q

what conditions are good for arthrodesis?

A

end stage ankle arthritis
wrist arthritis
hallux rigidus (arthritis of 1st MTPJ)

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15
Q

conditions that should be treated with osteotomy?

A

early arthritis of hip and knee

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16
Q

mainstay of treatment for soft tissue inflammatory disorders?

A

NSAIDs
rest
analgesia

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17
Q

what conditions can have a steroid injection around the tendon?

A

rotator cuff injury

tennis elbow

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18
Q

what areas are a no-go for steroid injection and why?

A

achilles tendon
extensor mechanism of knee
as risk of tendon rupture

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19
Q

what should you do if the mainstay of treatment for soft tissue injury doesnt work?

A

surgical debridement

decompression

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20
Q

what conditions benefit from a synovectomy?

A

RA of the extensor tendons of the wrist

inflammation of the tibialis posterior

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21
Q

main surgical treatment for achilles rupture?

A

splintage

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22
Q

what conditions are best for a tendon transfer?

A

tibialis posterior

extensor pollicis longus

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23
Q

treatment for meniscal tears in the knee?

A

arthroscopic removal

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24
Q

what condition is ligament reconstruction using a tendon graft useful?

A

ACL reconstruction

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25
Q

what condition is a soft tissue reattachment useful?

A

shoulder instability

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26
Q

why is osteomyelitis so difficult to eradicate?

A

enzymes from leukocytes cause local osteolysis and then pus forms which impairs local blood flow = less wbc’s

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27
Q

most common cause of acute osteomyelitis in adults?

A

surgery

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28
Q

who gets acute osteomyelitis in absence of surgery?

A

immunocompromised

children

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29
Q

why do you get a chronic osteomyelitis?

A

untreated acute osteomyelitis

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30
Q

where does haematogenous spread come from in chronic osteomyelitis?

A

spine
pelvis
infected intervertebral disc

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31
Q

clinical presentation of chronic OM?

A

localised pain
inflam
systemic upset
sinus formation

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32
Q

microbiological causes of OM in newborns?

A

s aureus
enterobacter
group a/b strep

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33
Q

microbiological causes of OM in children and toddlers?

A

staph aureus
group a strep
haemophilus influenzae
enterobacter

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34
Q

microbiological causes of OM in children over 4 and teenagers?

A

s aureus
group a strep
enterobacter
haemophilus influenzae

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35
Q

microbiological causes of OM in adults?

A

staph aureus mainly

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36
Q

most common bacteria causing OM in sickle cell patients?

A

s aureus

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37
Q

treatment for OM?

A

antibiotics AND surgery

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38
Q

who is at risk of OM of the spine?

A

poorly controlled diabetics
IV drug users
immunocompromised patients

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39
Q

most common area of the spine to be affected by OA?

A

lumbar spine

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40
Q

clinical presentation of spine OM?

A 
insidious onset back pain which is constant and unremitting
paraspinal miuscle spasm
spinal tenderness
fever
systemic upset
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41
Q

what type of abscesses can form in spinal OM?

A

epidural abscess

paravertebral abscess

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42
Q

investigations for OM?

A

MRI for abscesses
blood cultures
CT guided biopsy

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43
Q

most common cause of OM?

A

staph aureus

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44
Q

differential diagnosis of OM?

A

endocarditis

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45
Q

surgical treatment of OM?

A

debridement
stabilisation
fusion of adjacent vertebrae

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46
Q

what is the risk from a haematoma?

A

acts like a medium for bacterial growth

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47
Q

what bacteria would you suspect in an early prosthetic infection?

A

staph aureus

gram negative bacilli

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48
Q

what bacteria would you suspect in a low grade prosthetic infection?

A

staph epidermidis

enterococcus

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49
Q

what bacteria would you suspect in a late onset prosthetic infection?

A

staph aureus
beta haemolytic strep
enterobacter

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50
Q

what conditions could have caused a death soon but not immediately after a trauma injury?

A

MODS

sepsis

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51
Q

what glasgow coma score indicates loss of airway control?

A

8 or less

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52
Q

signs of pneumothorax on ABCDE examination?

A 
deviated trachea to opposite side
respiratory distress
tachycardia
hypotension
neck veins distended
no air entry on affected side
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53
Q

minimum accepted urine output?

A

30ml/hr

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54
Q

first symptom of hypovolaemia?

A

tachycardia

55
Q

examination findings of cardiac tamponade?

A

muffled heart sounds

distended neck veins

56
Q

how to diagnose cardiac tamponade?

A

ECHO

57
Q

investigations for abdominal bleeding?

A

US scan
CT scan
diagnostic peritoneal lavage

58
Q

what are the “trauma x rays” performed after a primary trauma?

A

spine
pelvis
lateral c spine

59
Q

are fractures more often direct or indirect?

A

indirect

60
Q

what fracture gap does there need to be for a bone to heal via primary healing?

A

<1mm

61
Q

how does bone heal in primary bone healing?

A

osteoblasts bridge the gap

62
Q

how does secondary bone healing work?

A

inflammatory response with recruitment of macrophages, osteoclasts, granulation tissue, chondroblasts and remodelling

63
Q

what does granulation tissue do for a fracture?

A

forms fibroblasts and new blood vessels

64
Q

what collagen is laid down by osteoblasts in endochondral ossification?

A

type 1

65
Q

what does calcium mineralisation of bone produce?

A

woven bone (hard callus)

66
Q

how long does it take for the soft callus stage of fracture healing to start?

A

2-3 weeks

67
Q

how long does it take for the hard callus stage of fracture healing to start?

A

6-12 weeks

68
Q

causes of atrophic non union of a fracture?

A

lack of blood supply
no movement
too big a fracture gap
tissue trapped in fracture gap

69
Q

causes of hypertrophic fracture gap?

A

excessive movement at fracture site

70
Q

name the 5 main fracture patterns

A 
transverse
oblique
spiral
comminuted
segmental
71
Q

do transverse fractures of a limb cause it to shorten or rotate?

A

no shortening, but can rotate it

72
Q

what direction do oblique fractures tend do appear like on the bone?

A

diagonal

73
Q

how can you treat an oblique fracture?

A

interfragmentory screw

74
Q

do oblique fractures shorten or rotate?

A

both

75
Q

what causes a spiral fracture?

A

torsional forces

76
Q

what are comminuted fractures?

A

fractures with 3 or more fragments

77
Q

what type of injury typically causes a comminuted fracture?

A

high energy

78
Q

what other pathologies may be present on the bone in a comminuted fracture?

A

soft tissue swelling
periosteal damage
damage blood supply to fracture site

79
Q

what is a segmental fracture?

A

bone fractured in 2 places

80
Q

how to treat a segmental fracture?

A

stabilisation with long rods and plates

81
Q

what sites are used to describe a fracture of a long bone?

A

proximal, middle and distal thirds

82
Q

what does an intraarticular fracture mean?

A

fracture extends into joint

83
Q

what does an extraarticular fracture mean?

A

fracture that doesnt extend into the joint

84
Q

is a stiff fracture more likely to be intra or extra articular?

A

intra

85
Q

what does the position of a fracture depend on?

A

degree of displacement and angulation

86
Q

what does displacement of a fracture mean?

A

the direction of translation of the distal fragment; this can be ant/post/lat/sup

87
Q

what does angulation mean?

A

the direction in which the distal fragment points towards the degree of the deformity;

88
Q

how is angulation measured?

A

in degrees from the longitudinal axis of the diaphysis of a long bone

89
Q

what can a displacement or angulation cause?

A

deformity
loss of function
abnormal pressure
post traumatic OA

90
Q

clinical signs of a fracture?

A

bony tenderness
swelling
deformity
crepitus

91
Q

what should you check for on assessment of an injured limb?

A

open or closed injury
distal neurovascular status
compartment syndrome
status of skin and soft tissue

92
Q

when would an oblique x ray view be useful?

A

to see complex shaped bones like scaphoid, acetabulum etc

93
Q

which imaging is good for assessing the level of articular damage?

A

CT

94
Q

what imaging is good if you suspect a fracture but x ray is normal?

A

MRI

95
Q

when would a technetium bone scan be useful?

A

stress fractures

96
Q

someone presents to you with a suspected fracture; what do you do first?

A

assessment of limb
iv morphine
splintage/immobilisation
investigation- x ray

97
Q

what fractures require a thomas’ splint?

A

femoral shaft fractures

98
Q

what characteristics does a fracture need to have to be classed as stable?

A

minimally displaced or not at all

minimally angulated

99
Q

how would you treat a stable fracture?

A

period of splintage/immoblisation

rehabilitation

100
Q

how would you treat an unstable fracture?

A

reduction under anaesthetic
closed reduction
cast application
surgical stabilisation

101
Q

how would you treat an unstable extra articular diaphyseal fracture?

A

ORIF using plates and screws

can do external fixation but risk of infection

102
Q

how should you treat a fracture with joint involvement?

A

joint replacement

arthrodesis

103
Q

main late systemic complication of fractures?

A

PE

104
Q

what time after a fracture would a PE occur?

A

several days to weeks

can occur within a day

105
Q

why do you get muscle ischaemia in compartment syndrome?

A

pressure compresses the venous system = congestion of venous system = congestion of muscle = oxygenated arterial blood cant supply it due to congestion

106
Q

clinical signs of muscle ischaemia?

A

increased pain on passive stretching of muscle
severe pain
swollen limb

107
Q

what is volkmann’s ischaemic contracture?

A

necrosing ischaemic muscle causing fibrotic contracture

108
Q

what vessel is in danger of being injured in a knee dislocation?

A

popliteal artery

109
Q

how should you treat a haemorrhage from an arterial injury to the pelvis

A

angiographic embolisation

110
Q

what is degloving?

A

avulsion of the skin from its underlying blood vessels

111
Q

consequences of degloving?

A

skin ischaemia

necrosis

112
Q

another word for bruising?

A

contusion

113
Q

why do you get fracture blisters?

A

inflammatory exudates cause lifting of the skin epidermis

114
Q

signs and symptoms of fracture healing?

A

resolution of pain and function
absence of point tenderness
no local oedema
resolution of movement at site of fracture

115
Q

clinical signs of non-union/healing?

A

ongoing pain
ongoing oedema
movement at the fracture site

116
Q

slowest healing bones in the body?

A

tibia

femoral shaft

117
Q

do metaphyseal or cortical fractures take longer to heal?

A

cortical

118
Q

what fractures is a DVT particularly common in?

A

pelvic

major lower limb fracture

119
Q

what fractures are prone to developing AVN?

A

talus
scaphoid
femoral neck

120
Q

what bone injuries can cause post traumatic OA?

A

intraarticular fracture
ligamentous instability
fracture malunion

121
Q

what is complex regional pain syndrome (CRPS)?

A

heightened chronic pain response

122
Q

clinical presentation of CRPS?

A 
constant burning or throbbing
sensitivity to previously normal stimuli
chronic swelling
stiffness
painful movement
skin colour changes
123
Q

what is the differene between type 1 and 2 CRPS?

A

1 is a peripheral nerve injury, 2 is not

124
Q

antibiotic management of an open fracture?

A

iv broad spectrum antibiotics

fluclox for gram +ve organisms, metronidazole for anaerobes, gentamicin for gram-ves

125
Q

surgical treatment for open fractures?

A

internal/external fixation

debridement

126
Q

what should you do if you cant close a wound properly?

A

skin graft

127
Q

associated injuries with dislocations?

A

tendon tear
nerve injury
vascular injury
compartment syndrome

128
Q

what complete tendon tears can be treated conservatively?

A

achilles tendon
rotator cuff
long head of biceps brachii
distal biceps

129
Q

clinical presentation of septic arthritis?

A

acute onset of a severely red, hot, swollen, tender joint

severe pain on any movement

130
Q

most common cause of septic arthritis?

A

direct injury of an object into a joint

131
Q

1st, 2nd and 3rd bacterial causes of septic arthritis?

A

staph aureus
streptococci
haemophilus influenzae

132
Q

what should be done before antibiotics are given?

A

aspiration under aseptic technique

133
Q

what should the aspiration look like if it is septic arthritis?

A

pus

134
Q

treatment for septic arthritis?

A

open washout

surgical washout

2 MSK (61 decks)

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