CORTEXT: Elective and Trauma Surgery Flashcards
(134 cards)
1
Q
4 main strategies for surgical management of an arthritic joint?
A
arthroplasty
excision
arthrodesis
osteotomy
2
Q
what is an excision arthroplasty?
A
removal of a diseased joint
3
Q
what materials can joint replacements consist of?
A
stainless steel cobalt chrome titanium alloy polyethylene ceramic
4
Q
why do joint replacements fail?
A
wear particles produce an inflammatory response after time causing loosening OR breakage of the replacement components
5
Q
what actually is a pseudotumour?
A
an inflammatory granuloma that causes muscle and bone necrosis
6
Q
what material tends to cause pseudotumours?
A
metal
7
Q
what material causes osteolysis?
A
polytethylene
8
Q
what is osteolysis?
A
bone resorption which causes loosening
9
Q
treatment for an early fulminant infection after surgery?
A
surgical washout
debridement
parenteral antibiotic therapy for 6 wks
10
Q
what is a late presentation of a surgical complication?
A
infection from haematogenous spread loosening fracture implant breakage pseudotumour formation
11
Q
is excision/resection arthroplasty good for small or large joints?
A
small
12
Q
what is an arthrodesis?
A
surgical stiffening or fusion of a joint in a position of function
13
Q
how is arthrodesis done?
A
removal of hyaline cartilage and sunchondral bone allowing bony union
14
Q
what conditions are good for arthrodesis?
A
end stage ankle arthritis
wrist arthritis
hallux rigidus (arthritis of 1st MTPJ)
15
Q
conditions that should be treated with osteotomy?
A
early arthritis of hip and knee
16
Q
mainstay of treatment for soft tissue inflammatory disorders?
A
NSAIDs
rest
analgesia
17
Q
what conditions can have a steroid injection around the tendon?
A
rotator cuff injury
tennis elbow
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
19
Q
what should you do if the mainstay of treatment for soft tissue injury doesnt work?
A
surgical debridement
decompression
20
Q
what conditions benefit from a synovectomy?
A
RA of the extensor tendons of the wrist
inflammation of the tibialis posterior
21
Q
main surgical treatment for achilles rupture?
A
splintage
22
Q
what conditions are best for a tendon transfer?
A
tibialis posterior
extensor pollicis longus
23
Q
treatment for meniscal tears in the knee?
A
arthroscopic removal
24
Q
what condition is ligament reconstruction using a tendon graft useful?
A
ACL reconstruction
25
what condition is a soft tissue reattachment useful?
shoulder instability
26
why is osteomyelitis so difficult to eradicate?
enzymes from leukocytes cause local osteolysis and then pus forms which impairs local blood flow = less wbc's
27
most common cause of acute osteomyelitis in adults?
surgery
28
who gets acute osteomyelitis in absence of surgery?
immunocompromised
| children
29
why do you get a chronic osteomyelitis?
untreated acute osteomyelitis
30
where does haematogenous spread come from in chronic osteomyelitis?
spine
pelvis
infected intervertebral disc
31
clinical presentation of chronic OM?
localised pain
inflam
systemic upset
sinus formation
32
microbiological causes of OM in newborns?
s aureus
enterobacter
group a/b strep
33
microbiological causes of OM in children and toddlers?
staph aureus
group a strep
haemophilus influenzae
enterobacter
34
microbiological causes of OM in children over 4 and teenagers?
s aureus
group a strep
enterobacter
haemophilus influenzae
35
microbiological causes of OM in adults?
staph aureus mainly
36
most common bacteria causing OM in sickle cell patients?
s aureus
37
treatment for OM?
antibiotics AND surgery
38
who is at risk of OM of the spine?
poorly controlled diabetics
IV drug users
immunocompromised patients
39
most common area of the spine to be affected by OA?
lumbar spine
40
clinical presentation of spine OM?
```
insidious onset back pain which is constant and unremitting
paraspinal miuscle spasm
spinal tenderness
fever
systemic upset
```
41
what type of abscesses can form in spinal OM?
epidural abscess
| paravertebral abscess
42
investigations for OM?
MRI for abscesses
blood cultures
CT guided biopsy
43
most common cause of OM?
staph aureus
44
differential diagnosis of OM?
endocarditis
45
surgical treatment of OM?
debridement
stabilisation
fusion of adjacent vertebrae
46
what is the risk from a haematoma?
acts like a medium for bacterial growth
47
what bacteria would you suspect in an early prosthetic infection?
staph aureus
| gram negative bacilli
48
what bacteria would you suspect in a low grade prosthetic infection?
staph epidermidis
| enterococcus
49
what bacteria would you suspect in a late onset prosthetic infection?
staph aureus
beta haemolytic strep
enterobacter
50
what conditions could have caused a death soon but not immediately after a trauma injury?
MODS
| sepsis
51
what glasgow coma score indicates loss of airway control?
8 or less
52
signs of pneumothorax on ABCDE examination?
```
deviated trachea to opposite side
respiratory distress
tachycardia
hypotension
neck veins distended
no air entry on affected side
```
53
minimum accepted urine output?
30ml/hr
54
first symptom of hypovolaemia?
tachycardia
55
examination findings of cardiac tamponade?
muffled heart sounds
| distended neck veins
56
how to diagnose cardiac tamponade?
ECHO
57
investigations for abdominal bleeding?
US scan
CT scan
diagnostic peritoneal lavage
58
what are the "trauma x rays" performed after a primary trauma?
spine
pelvis
lateral c spine
59
are fractures more often direct or indirect?
indirect
60
what fracture gap does there need to be for a bone to heal via primary healing?
<1mm
61
how does bone heal in primary bone healing?
osteoblasts bridge the gap
62
how does secondary bone healing work?
inflammatory response with recruitment of macrophages, osteoclasts, granulation tissue, chondroblasts and remodelling
63
what does granulation tissue do for a fracture?
forms fibroblasts and new blood vessels
64
what collagen is laid down by osteoblasts in endochondral ossification?
type 1
65
what does calcium mineralisation of bone produce?
woven bone (hard callus)
66
how long does it take for the soft callus stage of fracture healing to start?
2-3 weeks
67
how long does it take for the hard callus stage of fracture healing to start?
6-12 weeks
68
causes of atrophic non union of a fracture?
lack of blood supply
no movement
too big a fracture gap
tissue trapped in fracture gap
69
causes of hypertrophic fracture gap?
excessive movement at fracture site
70
name the 5 main fracture patterns
```
transverse
oblique
spiral
comminuted
segmental
```
71
do transverse fractures of a limb cause it to shorten or rotate?
no shortening, but can rotate it
72
what direction do oblique fractures tend do appear like on the bone?
diagonal
73
how can you treat an oblique fracture?
interfragmentory screw
74
do oblique fractures shorten or rotate?
both
75
what causes a spiral fracture?
torsional forces
76
what are comminuted fractures?
fractures with 3 or more fragments
77
what type of injury typically causes a comminuted fracture?
high energy
78
what other pathologies may be present on the bone in a comminuted fracture?
soft tissue swelling
periosteal damage
damage blood supply to fracture site
79
what is a segmental fracture?
bone fractured in 2 places
80
how to treat a segmental fracture?
stabilisation with long rods and plates
81
what sites are used to describe a fracture of a long bone?
proximal, middle and distal thirds
82
what does an intraarticular fracture mean?
fracture extends into joint
83
what does an extraarticular fracture mean?
fracture that doesnt extend into the joint
84
is a stiff fracture more likely to be intra or extra articular?
intra
85
what does the position of a fracture depend on?
degree of displacement and angulation
86
what does displacement of a fracture mean?
the direction of translation of the distal fragment; this can be ant/post/lat/sup
87
what does angulation mean?
the direction in which the distal fragment points towards the degree of the deformity;
88
how is angulation measured?
in degrees from the longitudinal axis of the diaphysis of a long bone
89
what can a displacement or angulation cause?
deformity
loss of function
abnormal pressure
post traumatic OA
90
clinical signs of a fracture?
bony tenderness
swelling
deformity
crepitus
91
what should you check for on assessment of an injured limb?
open or closed injury
distal neurovascular status
compartment syndrome
status of skin and soft tissue
92
when would an oblique x ray view be useful?
to see complex shaped bones like scaphoid, acetabulum etc
93
which imaging is good for assessing the level of articular damage?
CT
94
what imaging is good if you suspect a fracture but x ray is normal?
MRI
95
when would a technetium bone scan be useful?
stress fractures
96
someone presents to you with a suspected fracture; what do you do first?
assessment of limb
iv morphine
splintage/immobilisation
investigation- x ray
97
what fractures require a thomas' splint?
femoral shaft fractures
98
what characteristics does a fracture need to have to be classed as stable?
minimally displaced or not at all
| minimally angulated
99
how would you treat a stable fracture?
period of splintage/immoblisation
| rehabilitation
100
how would you treat an unstable fracture?
reduction under anaesthetic
closed reduction
cast application
surgical stabilisation
101
how would you treat an unstable extra articular diaphyseal fracture?
ORIF using plates and screws
| can do external fixation but risk of infection
102
how should you treat a fracture with joint involvement?
joint replacement
| arthrodesis
103
main late systemic complication of fractures?
PE
104
what time after a fracture would a PE occur?
several days to weeks
| can occur within a day
105
why do you get muscle ischaemia in compartment syndrome?
pressure compresses the venous system = congestion of venous system = congestion of muscle = oxygenated arterial blood cant supply it due to congestion
106
clinical signs of muscle ischaemia?
increased pain on passive stretching of muscle
severe pain
swollen limb
107
what is volkmann's ischaemic contracture?
necrosing ischaemic muscle causing fibrotic contracture
108
what vessel is in danger of being injured in a knee dislocation?
popliteal artery
109
how should you treat a haemorrhage from an arterial injury to the pelvis
angiographic embolisation
110
what is degloving?
avulsion of the skin from its underlying blood vessels
111
consequences of degloving?
skin ischaemia
| necrosis
112
another word for bruising?
contusion
113
why do you get fracture blisters?
inflammatory exudates cause lifting of the skin epidermis
114
signs and symptoms of fracture healing?
resolution of pain and function
absence of point tenderness
no local oedema
resolution of movement at site of fracture
115
clinical signs of non-union/healing?
ongoing pain
ongoing oedema
movement at the fracture site
116
slowest healing bones in the body?
tibia
| femoral shaft
117
do metaphyseal or cortical fractures take longer to heal?
cortical
118
what fractures is a DVT particularly common in?
pelvic
| major lower limb fracture
119
what fractures are prone to developing AVN?
talus
scaphoid
femoral neck
120
what bone injuries can cause post traumatic OA?
intraarticular fracture
ligamentous instability
fracture malunion
121
what is complex regional pain syndrome (CRPS)?
heightened chronic pain response
122
clinical presentation of CRPS?
```
constant burning or throbbing
sensitivity to previously normal stimuli
chronic swelling
stiffness
painful movement
skin colour changes
```
123
what is the differene between type 1 and 2 CRPS?
1 is a peripheral nerve injury, 2 is not
124
antibiotic management of an open fracture?
iv broad spectrum antibiotics
| fluclox for gram +ve organisms, metronidazole for anaerobes, gentamicin for gram-ves
125
surgical treatment for open fractures?
internal/external fixation
| debridement
126
what should you do if you cant close a wound properly?
skin graft
127
associated injuries with dislocations?
tendon tear
nerve injury
vascular injury
compartment syndrome
128
what complete tendon tears can be treated conservatively?
achilles tendon
rotator cuff
long head of biceps brachii
distal biceps
129
clinical presentation of septic arthritis?
acute onset of a severely red, hot, swollen, tender joint
| severe pain on any movement
130
most common cause of septic arthritis?
direct injury of an object into a joint
131
1st, 2nd and 3rd bacterial causes of septic arthritis?
staph aureus
streptococci
haemophilus influenzae
132
what should be done before antibiotics are given?
aspiration under aseptic technique
133
what should the aspiration look like if it is septic arthritis?
pus
134
treatment for septic arthritis?
open washout
| surgical washout
