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Musculoskeletal > Elective Surgery/General Trauma > Flashcards

Elective Surgery/General Trauma Flashcards

1
Q

Describe conservative management for most conditions?

A

Rest

Physiotherapy

NSAIDs

Analgesia

Splints/Braces

Mobility Aids

Injections

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2
Q

Describe the surgerys available for arthritis?

A
  • Arthroplasty/Joint replacement
  • Excision or resection arthroplasty
  • Arthrodesis (Fusion)
  • Osteotomy
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3
Q

What is a hemiarthroplasty?

A

Surgical procedure to replace one half of the joint (Eg: The Hip)

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4
Q

Describe revision procedures?

A

These are done once a joint replacement has failed

These are harder to do, have a higher rate of complication and have worse prognosis

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5
Q

Describe treatment if a deep surgical infection has been present in a joint:
- < 3 weeks

  • > 3 Weeks
A

Less than 3 weeks = Washout, debridement, antibiotics

Over 3 weeks = Biofilm has formed, needs joint removed, IV antibiotics for 6 weeks (while person has no joint) then new joint put in

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6
Q

Describe excision or removal arthroplasty?

When is this used?

A

This is removing bone or cartilage one either one or both sides of a joint

Can be quite disabling in large joints but is useful in small joints (Eg: Hallux Valgus, first carpometacarpal in hands)

Can be used following failed hip or shoulder replacement

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7
Q

What is arthrodesis?

Pros?

Cons?

What may it predispose to?

Give an example when it would be used?

A

Surgical fusion of a joint into a position

The remaining cartilage is removed to result in bony union (a bit like fracture healing)

Good for relieving pain

Bad for limiting function

May predispose to arthritis

Good for end stage arthritis

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8
Q

What is osteotomy?

Give an example when this would be used?

A

Surgical realignment of a bone

Can be used to correct deformity or to redistribute joint load(Eg: Across an arthritic joint)

Early arthritis of the hip or knee

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9
Q

How are the vast majority of soft tissue problems resolved?

A

Rest

NSAIDs

Analgesia

Physiotherapy

Steroid Injection - NOT IN WEIGHT BEARING ONES (EG: ACHILLES TENDON OR EXTENSOR MECHANISM OF KNEE) DUE TO RUPTURE RISK

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10
Q

Describe surgical decompression?

Give two examples where it would be used?

A

This making more space in a joint

Shoulder Impingement (Subacromial decompression in supraspinatus tendonitis)

Carpal or cubital tunnel

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11
Q

Describe how you treat tendon tears?

A

Splintage

Surgical Repair

Tendon Transfer

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12
Q

How do you manage joint instability?

A

Physiotherapy - strengthens surronding muscles

Splints/Callipers/Braces

Ligament Tightening (Ankles)

Ligament Reconstruction (ACL)

Soft Tissue Reattchemnt (Shoulder)

Arthrodesis (Ehler Danos, Spinal)

Ostetomy (Patellar)

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13
Q

How do you correct deformity?

A
  • Osteotomy (Angular Deformity)
  • Limb Lengthening (Limb Length Deformity)
  • Foot Problems (Osteotomy, Arthrodesis, Joint Excision)
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14
Q

What is nerve decompression?

When is this done?

A

Decompression of sites where peripheral nerves are trapped

  • Cubital Tunnel
  • Carpal Tunnel
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15
Q

How do you correct joint contractures?

A

Splints

Physiotherapy

Medications (Botox Injections)

Surgical release

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16
Q

What is osteomyelitis?

A

Infection of bone (both compact and spongy) as well as bone marrow

Usually bacterial

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17
Q

How do people get osteomyelitis?

Describe the pathophysiology?

A

Can be caused by penetrating trauma (including surgery) or indrecitly by haemtaogenous spread

Once infected, enzymes from leucoytes cause osteolysis and pus forms - this limits blood flow making infection difficult to eradicate

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18
Q

What is a Sequestrum?

Describe the treatment if one is present?

A

A piece of dead bone that has broken off due to necrosis

Complication of osteomyelitis

If a sequestrum is present, antibiotics alone will not treat osteomyelitis and surgical debridement is indicated

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19
Q

What are the two types of osteomyelitis?

A

Acute = Usually following surgery. Can be seen in children or immunocompromised adults NOT after surgery. Presents as fever, bone pain, swelling, redness, warmth

Chronic = Follows untreated acute osteomyelitis

Often seen in spine or pelvis. Can lay dormant for years

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20
Q

What is the most common causative agent of ostoemyelitis?

A

Staph Aureus

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21
Q

Treatment of osteomyelitis?

(Acute and Chronic)

A

Acute = Best guess IV antibiotics

Surgical washout for abscess

Chronic = Surgical debridement, antibiotics, stabilization

ANTIBIOTICS = FLUCLOXACILLIN

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22
Q

Who gets spine osteomyelitis?

Symptoms?

Treatment?

A

Diabetes, IVDU, Immunocompromised

Causes constant unremitting back pain

Treatment is high dose IV antibiotics

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23
Q

What is a Brodie’s Abscess?

What is this seen in?

A

Abscess with a thin wall of sclerotic bone

Seen in children with osteomyelitis

24
Q

What is polytrauma?

A

Where more than one major bone is invovled or where a major fracture is associated with significant chest or abdominal trauma

25
Q

Describe primary bone healing?

A

There is a minimal fracture gap (<1mm)

The bone simply bridges the gap with new osteoblasts

26
Q

Describe secondary bone healing?

A

This occurs in the majority of fractures

There is a gap between the fracture (>1mm) that is filled temporarily

  1. Haematoma and inflammatory infilitrate
  2. Soft Callus (from chondrocytes)
  3. Hard Callus (Osteoblasts)
  4. Remodelling (Osteoblasts, calcification)
27
Q

What can impair secondary fracture healing?

A

Too big a fracture gap

Lack of blood supply

Smoking

No movement

Tissue trapped in gap

Malnutrition

Chronic Ill Health

28
Q

Name these fracture patterns?

A

1 = Segmental

2 = Comminuted

3= Oblique

4 = Spiral

5 = Transverse

29
Q

Describe this fracture?

A
  • Femur
  • Middle
  • Shaft
  • Medial Displacement
  • No angulation
30
Q

Describe this fracture?

A
  • Femur
  • Middle
  • Shaft
  • No displacement
  • Varus angulation
31
Q

Describe how you describe a fracture?

A
  • Name the bone - Eg: Humerus
  • Which part of bone affected - Eg: Proximal
  • Joint Involvement - Eg: Intra-articular, extra-articular (extending into the joint)
  • Displacement Eg: Anterior
  • Angulation: Eg: Varus (Which way the distal fragment points)
32
Q

What are the clinical signs of a fracture?

A

Localised tenderness, severe

Swelling

Deformity

Crepitus

33
Q

Describe imaging of fractures?

A

X-Ray (AP and lateral(

CT
MRI

Bone Scans (Stress Fractures)

34
Q

Treatment of a long bone fracture?

A

Analgesia - IV Morphine

Splintage and Immobilization

Surgery:

  • Closed Reduction (with casts)
  • Surgical Stabilization
  • Open Reduction
  • Internal Fixation
35
Q

What is Compartment syndrome?

A

This is rising pressure within a confined space/compartment

Often caused by fracture and injury which causes bleeding/swelling (increases pressure)

36
Q

Signs and symptoms of compartment syndrome?

A

Severe pain outwith the expected severity in the clinical context

Worse on stretching

Swollen limb

Tender muscle

37
Q

Treatment of Compartment syndrome?

A

Remove any tight bandages

Emergency Fasciotomy

Leave wounds open for a few days - secondary closure - although may require skin grafting

38
Q

What is Volkmann’s ischaemic contracture?

A

Direct result of undiagnosed compartment syndrome

Causes permanent flexion contracture at the wrist

Claw like deformity of wrist and fingers

39
Q

Describe nerve injury when associated with fracture?

A

Fractures can cause nerve injury

  • Neurapraxia is a temporary conduction defect, resolves over time
40
Q

Describe the nerve injury seen with:

  • Colle’s fracture?
  • Anterior shoulder dislocation?
  • Humeral shaft fracture?
A

Colle’s fracture = Median nerve compression/carpal tunnel

Anterior shoulder dislocation = Axillary nerve damage

Humeral Shaft fracture = Radial nerve damage

41
Q

Describe the nerve injury seen with:

  • Supracondylar fracture of elbow?
  • Posterior dislocation to hip?
  • Bumper injury to lateral knee?
A

Supracondylar fracture of elbow = Median nerve

Posterior dislcoation of hip = Sciatic Nerve

Bumper injury to lateral knee = Common peroneal nerve injury

42
Q

Describe the vascular complications of fracture?

Specifically:

  • Knee?
  • Shoulder?
  • Elbow?
A

Can cause ischaemia of distal limbs leading to amputation

Haemorrhage can cause hypovolaemic shock

Knee = Popliteal Artery risk

Shoulder = Axillary Artery Risk

Elbow = Brachial Artery Risk

43
Q

Describe what is happening here?

Describe treatment?

  • Tenting of skin
  • Blanching of skin
  • Following fracture
A

Excess pressure on skin

Fracture needs emergency reduction to avoid necrosis

44
Q

Describe a degloving injury?

A

Caused by shearing force

Skin can avulse from underlying structures

  • Non blanching
  • Insensate
45
Q

Describe hypertrophic non union?

A

This can occur due to excess movement at the fracture site or instability

46
Q

Describe atrophic non union?

A

Caused by rigid fixation with a fracture gap

Poor blood supply

Chronic disease

Soft tissue trapped in gap

47
Q

Give some clincial signs of non union?

A

Ongoing Pain

Ongoing Oedema

Movement

48
Q

What is fracture disease?

A

This is stiffness and weakness due to the fracture and ongoing casts

Most cases resolve in time

May be helped by physiotherapy

49
Q

Describe Complex Regional Pain Syndrome?

A

Poorly understood heighted pain response after injury

Includes contast throbbing, burning, sensitivity to normally innoculus stimuli,

50
Q

Treatment of complex regional pain syndrome?

A

Analgesia

Antidepressants - Amitryptyline

Anti-convulsants: Gabapentin

Steroids

All may help

51
Q

The principle late systemic complication, especially after lower limb or pelvis fracture is..?

A

PULMONARY EMBOLISM

52
Q

Treatment of open fractures?

A

Prompt Surgery

Prevent infection

Early Debridement

53
Q

Septic arthritis causative agents:

  • Adults?
  • 2nd most common cause in adults?
  • Elderly, immunocompromised, IVDU?
  • Children with no vaccinations?
A

Adults = Staphylococcus Aureus

2nd = Streptococci

Elderly/immunocompromised/IVDU = E.coli

Non vaccinated Children = Haemophilus Influenzae

54
Q

Describe the presentation of septic arthritis?

A

Acute Onset

Hot

Swollen

Red

Tender

Joint

Severe pain on movement

55
Q

What history is there normally in septic arthritis?

A

Some form of penetration

  • ‘Fight bite’ wound from punching
  • Penetrating of tooth
  • Penetration of rose thron
56
Q
A

Musculoskeletal (23 decks)

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