Elective surgery of upper and lower limbs

Question 1

when would you consider surgical intervention for an orthopaedic issue

Answer 1

appropriate surgical management and conservative management has failed
OR the surgical intervention would better control the patients conditions

Question 2

what materials may be used for arthroplasty

Answer 2

metal-metal
ceramic-ceramic
ceramic/metal - polyethylene

Question 3

what is a pseudotumour and what causes it

Answer 3

caused by reaction with metal in arthroplasty

leads to muscle and bone necrosis

Question 4

what arthroplasty material causes osteolysis

Answer 4

polyethylene

Question 5

what arthroplasty materal can shatter

Answer 5

ceramic

Question 6

early local complications of arthroplasty?

Answer 6

DVT
infection 
fracture 
dislocation 
instability 
bleeding 
arterial injury 
nerve injury 
leg length discrepancy

Question 7

early general complications of arthroplasty

Answer 7

Hypovolaemia 
MI
SIRS
ARDS
MODS
PE 
acute renal failure 
chest infection 
urine infection

Question 8

late local complication of arthroplasty

Answer 8

infection 
pseudotumour 
early loosening/failure 
fracture 
implant break

Question 9

if arthroplasty infection is caught very early what management option may work

Answer 9

surgical washout/debridement

IV abx 6/52

Question 10

if arthroplasty infection is caught >3/52 what is the likely management option

Answer 10

remove all implants/cements
IV abx
revision surgery once infection is controlled

Question 11

what is a complication of revision surgery due to prosthetic joint infection

Answer 11

eventual stiffening of the joint

Question 12

what is excision arthroplasty and on what joints is it used for

Answer 12

removal of bone/cartilage at one or both sides of a joint

most effective for smaller joints but may be done after failure of revision hip/shoulder replacement

Question 13

what is an arthrodesis, name a complication and what joints is it good for

Answer 13

surgical stiffening/fusion of a joint - removal of cartilage and subchondral bone and stabilisation to cause bony union and fusion
can compromise large joint function and accelerate OA in adjacent joints due to pressure
end stage ankle/wrist OA, 1st MTPJ

Question 14

what is an osteotomy

Answer 14

surgical realignment of bone used for deformity correction or redistribute load across arthritic joint

Question 15

true/false - extensor mechanism of knee and achilles tendon benefit from steroid injection

Answer 15

false - never inject them

Question 16

why would you perform synovectomy for extensor tendons in wrist of tibialis posterior

Answer 16

RA

preventing rupture

Question 17

in what joints would a labrum repair/resection be performed

Answer 17

acetabulum/glenoid (hip/shoulder)

Question 18

if a meniscal tear is causing pain failing to settle or mechanical symptoms what can be done\?

Answer 18

arthroscopic removal

Question 19

what anatomical variations predispose patellar instability

Answer 19

shallow trochlear groove
genu valgum
femoral neck anteversion

Question 20

how would instability caused by ligament laxity be managed surgically

Answer 20

tighten/advancement by tendon graft

arthrodesis in ehlers danlos

Question 21

how would instability caused by anatomical variation be managed surgically

Answer 21

osteotomy to improve stability

Question 22

how would spinal instability causing pain and nerve root compression be managed surgically

Answer 22

fusion of spinal motion segment

Question 23

what surgical procedure is used to manage spinal nerve root compression due to osteophyte formation

Answer 23

discectomy/spinal decompression

Question 24

peripheral nerve decompression surgery is performed typically for what nerves

Answer 24

median and ulnar nerves

Question 25

orthopaedic surgical infection occurs in roughly what % of patients

Answer 25

1-2%

Question 26

true/false - a prosthetic joint can become infected at a later date from surgery due to a haematogenous bacteria

Answer 26

true

Question 27

complications of a deep seated prosthetic joint infection

Answer 27

fracture non union | chronic osteomyelitis

Question 28

common organisms in prosthetic infection

Answer 28

staph aureus and gram -ves- typically earlier | staph epidermidis, enterobacter, beta haemolytic strep - typically later

Question 29

would you manage a patient with prosthetic joint infection with surgery or abx first

Answer 29

surgery, abx prior to surgery interferes with culture results so following abx may be unrelaible

Question 30

what types of spread may osteomyelitis have

Answer 30

direct inoculation | haematogenous

Question 31

who is osteomyelitis more common in?

Answer 31

children older patients chronic disease immunocompromised

Question 32

how can staph aureus evade the immune system in osteomyelitis

Answer 32

it may infect intracellularly

Question 33

with reference to OM, what is an involucrum?

Answer 33

area of new bone growing around an area of necrosis

Question 34

acute osteomyelitis in absence of recent surgery is most common in ____?

Answer 34

children and the immunocompromised

Question 35

why are children more likely to get osteomyelitis and where are they more likely to get it

Answer 35

metaphyses of long bones have long, tortuous vessels | proximal femur, proximal humerus, radial head, ankle

Question 36

what is a brodies abscess

Answer 36

bone walls off an abscess with thin rim of sclerotic bone

Question 37

in adults, where is chronic osteomyelitis more common and what typically causes it

Answer 37

more common in axial skeleton | pulmonary/urinary infection or infection of intervertebral disk

Question 38

what disease especially has risk of osteomyelitis

Answer 38

TB

Question 39

causative organisms of OM in newborns

Answer 39

staph aureus, enterobacter, group A/B strep

Question 40

causative organisms of OM in children

Answer 40

staph aureus, GAS, haemophilus influenzae, enterobacter

Question 41

causative organisms of OM in adolescents

Answer 41

staph aureus, GAS, haemophilus influenzae, enterobacter

Question 42

causative organisms of OM in adults

Answer 42

staph aureus | streptococcus or enterobacter

Question 43

causative organisms of OM in sickle cell

Answer 43

staph aureus | salmonella

Question 44

what is the aim of surgery in chronic OM and what is a complication and solution

Answer 44

remove sequestrium, debride bone, take cultures instability, needs internal/external fixation - external preferred as bone can be lengthened if shortened due to debridement

Question 45

who is most at risk of spinal OM?

Answer 45

immunocompromised, PWID, poorly controlled diabetics

Question 46

what are the most likely causative organisms in spinal OM

Answer 46

staph aureus | atypicals in immunocompromised

Question 47

how is resolution of spinal OM estimated

Answer 47

clinical condition and serial CRP

Question 48

indication for surgery in spinal OM?

Answer 48

inability to biopsy by CT biopsy, progressive vertebral collapse, no abx response, neurological deficit

Question 49

surgical management of spinal OM?

Answer 49

debridement, stabilisation, and fusion of adjacent vertebrae