Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Charis & Ellie vs MSK part 2 > Elective Surgery > Flashcards

Elective Surgery Flashcards

1
Q

when is surgical management considered in MSK referrals?

A

if there is
an appropriate surgical solution
conservative measures have not controlled symptoms
surgical intervention more appropriate (e.g. tumour)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

the decision to undertake surgery is based on

A
  • the underlying condition
  • the prognosis without surgical intervention
  • degree of symptoms the patient is experiencing
  • disability caused by the condition
  • status of the patient’s health
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what needs to happen through consultation for surgery to take place?

A

appropriate consenting
explanation of risks & benefits
explanation of the alternatives to surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what conditions are common orthopaedic surgical elective procedures used to manage?

A 
arthritis 
soft tissue inflammatory problems - tendonitis, tendon rupture 
correction of deformity 
nerve decompression 
joint instability 
joint contractures 
chronic infection 
tumour diagnosis and treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is arthroplasty?

A

reshaping of a joint
general term - synonymous with joint replacement
can also be used to describe the removal of a diseased joint - excision/resection arthroplasty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is a joint replacement?

A

replacement of part of the joint - hemiarthroplasty

replacement of the whole joint - total joint replacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the most successful joint replacements?

A 
hip and knee
good function 
satisfactory pain relief
last a reasonable length of time
complication rates are low
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what other joints can be replaced other than hip and knee?

A 
shoulder (glenohumeral)
elbow 
ankle 
1st MTP joint of the great toe 
MCP joints of the hand and wrist
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are joint replacements made of?

A 
stainless steel 
cobalt chrome 
titanium ally 
polyetylene 
ceramic 
the components can be - cemented and uncemented
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is the prognosis of joint replacements?

A

no perfect joint replacement
will fail due to
- loosening (wear particles produce inflammatory response, high stresses)
- breakage of the joint replacement components
metal particles - cause an inflammatory granuloma (pseudotumour)
- muscle and bone necrosis
polyethylene particles - inflammatory response in bone with bone resorption (osteolysis) - loosening
ceramics can shatter with fatigue - due to brittleness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is a revision procedure?

A 
remove old components & insert a new replacement
much more difficult than first procedure
complication rates higher
functional outcomes poorer
patient satisfaction is less
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what kind of patient is more likely to have an early joint replacement failure?

A

younger patient

higher demand on the JR makes there a higher likelihood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are the potential complications of a joint replacement?

A 
deep infection 
recurrent dislocation 
neurovascular injury 
pulmonary embolism 
medical complications - renal failure, MI, chest infections
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is done to prevent deep infections in JR?

A

strict aseptic and aseptic precautions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what to do if a deep infection in a JR is diagnosed within 2-3 weeks?

A

surgical washout and debridement and prolonged antibiotic therapy
about 6 weeks
50% success

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what to do if a deep infection following a JR is present for longer than 3 weeks - not salvageable by washout?

A
  • bacteria adhere to foreign surfaces – Biofilm
  • prevent patient’s immune system attacking
  • remove implant & all foreign material (cement) – extensive surgery
  • without a joint for about 6 weeks
  • parenteral antibiotics
  • if infection under control = wound healed clean & dry, CRP reduced – revision replacement
  • 80-90% success
  • soft tissues scar & lose elasticity
  • joint stiffens – overall functional outcome compromised
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

early complications of a joint replacement?

A 
o	infection
o	dislocation
o	instability
o	fracture
o	leg length discrepancy
o	nerve injury
o	bleeding
o	arterial injury/ischaemia
o	bleeding 
o	DVT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

early general complications of a JR?

A 
o	hypovolaemia
o	shock
o	acute renal failure
o	MI
o	ARDS
o	PE
o	chest infection
o	urine infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

late local complications of a JR?

A 
o	infection – from hemategoneous spread
o	loosening
o	fracture
o	implant breakage
o	pseudotumuor formation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is an excision/ resection arthroplasty?

A

removal of bone and cartilage of one or both sides of a joint
disabling for longer joint - 1st surgical procedure for hip OA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

indications for a excision/ resections arthroplasty?

A

effective for smaller joint
1st carpometacarpal joint in hand
Keller’s procedure for hallux valgus
after failure of hip/ shoulder replacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is arthrodesis?

A

surgical stiffening/ fusion of a joint in a position of function
hyaline cartilage and subchondral bone removed - joint stabilized - bony union and fusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the affect of arthrodesis?

A 
alleviates pain 
function may be limited particularly in large joints 
may increase pressure in surrounding joints - OA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what are the indications for arthrodesis?

A

end stage ankle arthritis
wrist arthritis
arthritis of 1st MTP of the foot (hallux rigidus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what is an osteotomy?

A

surgical realignment of a bone

deformity correction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the purpose of osteotomy?

A

to redistribute load across an arthritic joint

  • offload diseased part of the joint
  • shift load to undiseased part
    e. g. medial compartment of the knee to the lateral compartment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what are the indications for osteotomy?

A

early arthritis in the knee

early arthritis in the hip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what are some common soft tissue problems?

A
  • Tendinopathies = tears & ruptures
  • Enthesopathies = inflammation of a tendinous origin from / insertion into bone
  • Cartilage tears
  • Labrum tears
  • Inflammatory bursitis
  • Tenosynovitis
  • Capsulitis
  • Non-infective fasciitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what can soft tissue problems be related to?

A 
degenerative processes
injuries
overuse
inflammatory conditions – RA
drugs – quinolone antibiotics, steroids
chronic disease – renal failure
idiopathic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what is the conservative treatment for soft tissue problems?

A

conservative treatment is often very effective
rest
analgesia
anti-inflammatory medications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what tendons and entheses are amenable to steroid injection around tendon?

A

rotator cuff

tennis elbow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

which tendons have a high risk of rupture so are not advised for steroid injection

A

achilles

extensor mechanism of the knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what is debridement?

A

removal of diseased tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what is decompression?

A

making more space - supraspinatus tendonitis and subacromial decompression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what is a synovectomy?

A

extensor tendons of the wrist in RA

inflammation of tibialis posterior to prevent rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Examples of major tendon tears

A

splintage – Achilles
surgical repair – quadriceps / patellar tendon (sometimes Achilles)
tendon transfer – tibialis posterior, extensor pollicis longus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what are the indications of a cartilage (meniscal) tear in the knee?

A

pain fails to settle

cause mechanical symptoms (locking or catching)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what is the management of a labral tear of the acetabulum or glenoid

A

resection/repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what is joint instability?

A

abnormal motion of a joint (rotation/translation)
resulting in:
subluxation
dislocation with pain and/or giving away

40
Q

common examples of joint instability

A
  • instability from knee ligament injuries
  • recurrent subluxation of the shoulder
  • recurrent dislocation of the shoulder
  • recurrent subluxation of the patella
  • recurrent dislocation of the patella
  • ankle instability with frequent giving away
  • spinal instability
41
Q

what causes instability?

A
  • injury
  • ligamentous laxity
  • anatomic variation predisposing:
    o shallow trochlea of distal femur
    o femoral neck anteversion
    o genu valgum in patellofemoral instability
  • underlying disease process
    o cervical spine instability in rheumatoid arthritis
    o knee hyperextension in polio
42
Q

what is the conservative treatment for joint instability?

A 
physiotherapy
- strengthen up surrounding muscles
- improve proprioception
e.g. ACL rupture, ankle & shoulder instability
splints
calipers
braces
43
Q

what are the surgical soft tissue procedures?

A

ligament tightening / advancement – e.g. ankle instability
ligament reconstruction using tendon graft – e.g. ACL reconstruction
tissue reattachment – shoulder instability
significant ligament laxity (EDS) – soft tissue procedures are highly unlikely to work

44
Q

what are the surgical bony procedures for joint instability?

A

in significant ligament laxity (EDS) where soft tissue doesn’t work – e.g. fusion
skeletal predisposition to dislocation (eg patellar instability) – osteotomy
spinal instability: pain, nerve root compression/ spinal cord compression – fusion of abnormal spinal motion segment

45
Q

what is the purpose of correcting a deformity?

A

improve function
prevent arthritis
improve cosmesis

46
Q

what causes deformity?

A

congenital – limb malformation
developmental – bow legs
acquired – post-traumatic
idiopathic – hallux valgus, claw toes

47
Q

what is the management of congenital deformity?

A

may require complex bony and soft tissue surgery
restore as much function as possible
some best served by functional amputation

48
Q

management of angular deformity of long bones of the lower limb?

A

this can lead to early arthritis of the knee/ankle
growth plate manipulation surgery
osteotomy

49
Q

management options for leg length discrepancies?

A

shortening the longer limb
lengthening the short limb
using special external fixator = llizarov technique

50
Q

management options for foot deformities?

A 
these can give rise to pressure problems with footwear 
osteotomy 
arthrodesis 
soft tissue procedures 
joint excisions
51
Q

why is surgery done for spine deformities?

A

cosmesis
improve wheelchair sitting
severe scoliosis - restrictive respiratory defect - correction to prevent this

52
Q

most common sites of peripheral nerve trapping?

A

median nerve at the wrist = carpal tunnel syndrome

ulnar nerve at the elbow = cubital tunnel syndrome

53
Q

how is peripheral nerve trapping treated?

A

nerve decompression surgery

54
Q

what causes spinal nerve compression?

A

disc material
bony osteophytes
causes radiculopathy

55
Q

how is spinal nerve compression treated?

A

spinal decompression/discectomy

56
Q

what causes joint contractures?

A 
neuromuscular disease
spasticity – eg. stroke
soft tissue imbalance
arthritis
injury
fibrosing disease (Dupuytren’s)
disease 
burns
57
Q

what is a joint contracture?

A

an inability to move a joint through its full range of motion

58
Q

what is the conservative treatment for joint contractures?

A

passively correctable & may be amenable
splintage
physiotherapy
medications – Baclofen, Botox injections – to relieve spasticity

59
Q

what is the surgical treatment options for joint contractures?

A 
fixed or resistant contractures
tendon lengthening
tendon transfer
tight soft tissue release or lengthening
bony procedures: osteotomy, arthrodesis
60
Q

what are the types of infections orthopaedics are involved in?

A

soft tissue infections e.g. infected bursitis, arm or leg abscesses, wound infections - if abscess might need surgery
bone infection
joint infection
septic arthritis - emergency

61
Q

what is osteomyelitis?

A

infection of the bone including - compact bone, spongy bone and bone marrow

62
Q

levels of ostomyelitis?

A

superficial - affecting the outer surface of bone
localized - affecting cortex and medullary
diffuse - segment of bone is infected resulting in skeletal instability - infected non-union

63
Q

what causes the infection to reach the bone?

A

direct infection - penetrating trauma or surgery

indirect infection - haematogenous spread from an infection, bacteremia at a distant site (area of cellulitis)

64
Q

what is involucrum?

A

new bone formed around the area of necrosis

65
Q

what are the factors which an infection depends on?

A

bacterial load inoculated
virulence of the organism
host’s immune defenses

66
Q

what is the pathogenesis of osteomyelitis once the bone is infected?

A

there are enzymes from the leukocytes which cause local osteolysis and pus
there is impaired local blood flow - infection is difficult to eradicate

67
Q

what makes staph aureus such a bad infection?

A

it can infect the osteocytes intracellularly - which makes it very hard for the immune system to reach

68
Q

what is a sequestrum?

A

a dead fragment of bone which normally breaks off - once there is a sequestrum present then antibiotics won’t be enough

69
Q

who gets osteomyelitis?

A

immunocompromised patients
chronic disease
elderly
young

70
Q

what bacteria cause osteomyelitis in newborns (less than 4 months)?

A

S. aureus
Enterobacter sp.
group A & B Strep

71
Q

what bacteria cause osteomyelitis in children (4 months to 4 years)?

A

S. aureus
group A strep
Haemophilus influenzae - reduced by vaccine
Enterobacter sp.

72
Q

what bacteria cause osteomyelitis in children/ adolescents (4 - adult)

A

S aureus (80%)
group A strep
H influenzae
Enterobacter sp.

73
Q

What bacteria cause osteomyelitis in adults?

A

S. aureus
and occasionally
Enterobacter or Streptococcus sp.

74
Q

what bacteria cause osteomyelitis in sickle cell patients?

A

S. aureus - most common

Salmonella species are common as well though and only really happen in sickle cell patients

75
Q

what causes acute osteomyelitis?

A

surgery

if no surgery can occur in children or immunocompromised without surgery trigger

76
Q

what is the pathogenesis of acute osteomyelitis in children?

A

metaphyses of long bones get tortuous vessels this causes sluggish flow
accumulation of bacteria
infection spreads towards the epiphysis

77
Q

what is the pathogenesis of acute osteomyelitis in neonates and infants?

A

certain metaphyses are intra-articular like the proximal femur, proximal humerus, radial head, ankle etc.
infection here can spread into the joint
co-existing septic arthritis
(infants have aa loosely applied periosteum so an abscess can extend widely along the subperiosteal space)

78
Q

What is a Brodie’s abscess?

A

subacute osteomyelitis with a more insidious onset - bone reacts with walling off the abscess with a thin rim of sclerotic bone

79
Q

How is acute osteomyelitis managed?

A 
best guess antibiotics by IV 
if abscess then surgical drainage 
If the infection fails to resolve then 
 - 2nd line antibiotics  
 - surgery - gain samples for culture, remove infected bone, washout infected area
80
Q

who gets chronic osteomyelitis?

A

untreated acute osteomyelitis
sequestrum and/or involucrum
adults in the axial skeleton because of haematogenous spread from pulmonary/urinary infection or from infection of IV disc (discitis)
peripheral skeleton - open fracture or fixation
TB - chronic osteomyelitis from haematogenous spread from the primary lung infection

81
Q

What is the pathogenesis of chronic osteomyelitis?

A

can be suppressed with antibiotics

can lay dormant for many years before reactivating

82
Q

what are the signs and symptoms of chronic osteomyelitis?

A

localized pain
inflammation
systemic upset
possible sinus formation

83
Q

how is chronic osteomyelitis managed?

A

cannot be cured by just antibiotics
active infection - can be suppressed by antibiotics
surgery
- gain deep bone tissue cultures
- remove sequestrum
- excise infected or non-viable bone = debridement
- samples from discharging sinus may not accurately reflect the organism causing deep infection
External fixation - might be needed is to lengthen the bone if debridement shortens it
local antibiotic delivery systems
bone grafting
plastic surgery - if skin and soft tissue coverage of the bone isn’t possible
IV antibiotics for several weeks following surgery

84
Q

who gets osteomyelitis of the spine?

A

poorly controlled diabetics
IV drug abusers
immunocompromised patients

85
Q

What is the pathogenesis of osteomyelitis in the spine?

A

lumbar spine is most common
can complicate spinal surgery
- if below LI: - lower motor neurone, cauda equina below
- if above LI: upper motor neurone, myelopathy
Pus may extrude - paravertebral/ epidural abscess
vertebral end plates weaken - the vertebrae might collapse
- kyphosis
- vertebra plana (flat)
- disc space may reduce

86
Q

what are the signs and symptoms of osteomyelitis of the spine?

A 
insidious onset of back pain 
constant and unremitting pain 
paraspinal muscle spasm 
spinal tenderness 
fever
systemic upset 
if severe (neurologic deficit)
 - below LI - lower motor neurone, cauda equina syndrome 
 - above LI - upper motor neurone, myelopathy 
kyphosis
87
Q

what investigations would you do for suspected osteomyelitis of the spine?

A

MRI - delineates the extent of infection and abscess formation
Blood - may indicate causative organism (S. aureus, MRSA, also atypical)
Endocarditis should be considered - clubbing splinter haemorrhages, murmur, ECHO

88
Q

how is osteomyelitis of the spine managed?

A

CT guided biopsy to obtain tissue cultures
High dose IV antibiotics - antibiotics may be for several months
Response assessed - clinically, serial CRP
50% go on to spontaneous fusion and resolution
surgery
- debridement
- stabilization
- fusion of adjacent vertebrae

89
Q

what are the indications for surgery in the treatment for osteomyelitis of the spine?

A

inability to obtain cultures by needle biopsy
no response to antibiotic therapy
progressive vertebral collapse
progressive neurological deficit

90
Q

what are some common orthopaedic implants?

A 
joint replacements - for arthritis, instability and tumour surgery 
for fracture fixation and skeletal stabilization 
pins 
wires 
plates 
screws
intramedullary nails 
external fixators
91
Q

what precautions are taken to prevent infection of orthopaedic surgical implants?

A

strict antisepsis
sterilisation of implants and instruments
special air flow theatres
perioperative antibiotics

92
Q

how common is deep infection in non-contaminated orthopaedic procedures?

A

1-2%

93
Q

how do bacteria enter to cause infection of orthopaedic surgical implants?

A

operative site at the time of surgery - patient’s own skin and bacteria deep within hair follicles and from shed skin cell from staff in theatre
wound post-operatively before it has healed - haematoma - in soft tissues, bacteria thrive on
can also infect prosthetic joint at a later stage by haematogenous spread

94
Q

what are the signs that a chronic infection has developed post prosthetic joint replacement complicating it?

A 
pain 
poor function 
recurrent sepsis
chronic discharging sinus formation 
implant loosening
95
Q

What happens when a deep infection complicates a fracture fixation or stabilization?

A

chronic osteomyelitis

non-union of the fracture

96
Q

what organisms cause an infection of orthopaedic surgical implants?

A 
staph aureus 
gram -ve bacilli - including coliforms 
more indolent - low grade, diagnosed late (2 years after surgery) requires surgery 
 - staph epidermidis 
 - enterococcus 
late onset haematogenous infection 
- staph aureus 
- beta haemolytic strep. 
- enterobacter
97
Q

how is an infection of an orthopaedic surgical implant treated?

A

usually surgical rather than antibiotics
antibiotics - not given until there’s a decision made about surgery
any antibiotics can interfere with the bacteriological tissue cultures and causative organism may not be identified from debridement

Charis & Ellie vs MSK part 2 (61 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions