Elective surgery and General trauma Flashcards
surgical strategies to manage an arthritic joint
arthoplasty/replacement, excision/resection, arthrodesis, osteotomy
replacing one half of a joint is known as?
hemiarthroplasty
materials which can be used to replace a joint
stainless steel, cobalt chrome, titanium alloy, polyethylene and ceramic
best procedures for smaller joints
excision or resection arthroplasty
when is arthrodesis a good treatment option
end stage ankle arthritis, wrist arthritis, hallux rigidus
what does osetomyelitis effect
the bone, including compact and spongy bone. bone marrow as well
what makes infection in bone hard to eradicate
leucocytes cause local osteolysis and pus forms, this impairs local blood flow.
what is a dead fragment of bone called
sequestrum
new bone forming around an area of necrosis is called
involucrum
what bacteria can infect osteocytes intra cellularly
staph aureus
who is more likely to suffer from acute osteomyelitis
children, immunocompromised adults, recent surgery
what part of the skeleton is chronic osteomyelitis more likely to develop in
axial skeleton
osteomyelitis: infecting organismS NEWBORNS (4months)
S.aureus, enterobacter, group A/B strep
osteomyelitis: infecting organism CHILDREN
s.aureus, A strep, H.influenza, enterobacter
osteomyelitis: infecting organism 4 YEARS TO ADULT
s.aureus, A strep, H.influenza, enterobacter
osteomyelitis: infecting organism ADULT
s.aureus, rarely enterobacter or Strep
osteomyelitis: infecting organism SICKLE CELL PATIENTS
S.aureus, salmonella
classification of osteomyelitis
superficial, medullary, localised, diffuse
what is the primary survey
ABCDE
what score on the GCS would indicate loss of airway control
8 or less
what is the maximum GCS score
15
minimum GCS score
3
describe secondary bone healing
1 fracture occurs,
2 haematoma and inflammation,
3 macrophages and osteoclasts remove debris and reabsorb bone ends,
4 granulation tissue forms from fibroblasts,
5 chondroblasts from cartillage (soft callus)
6 osteoblasts lay bone the matrix (collagen type 1)
7 calcium mineralisation produces woven bone (hard callus)
8 remodelling
how long does it take the soft callus to form
2-3 weeks
how long does it take the hard callus to form
6-12 weeks
what are the five basic fracture patterns
transverse, oblique, spiral, comminuted, segmental
describe a transverse fracture
pure bending force (cortex on one side fails in compression and the other side in tension) might not shorten (unless totally displaced) may angulate
describe an oblique fracture
shearing force, can shorten and angulate
describe a spiral fracture
torsional force, unstable to rotational force
describe a comminuted fracture
2 or more fragments, high energy injury, very unstable
describe a segmental fracture
fractured in two separate places
what is displacement
describes the direction of translation of the distal fragment
what is angulation
describes the direction in which the distal fragment points towards the degree of deformity
assessment of an injured limb must include
open/closed?, distal neurovascular status, compartment syndrome? status of skin and soft tissue envelope
what nerve injuries are associated with a fracture
neurapraxia or axonotmesis
what is neurapraxia
temporary conduction defect
what is axonetmesis
sustained compression of a nerve. nerves die past the point of injury
what is a neurotmesis
complete transection of a nerve, rare in closed injuries
most common cause of septic arthritis
staph aureus
second most common cause of septic arthritis
streptococci
