Elective surgery of upper and lower limbs Flashcards
when would you consider surgical intervention for an orthopaedic issue
appropriate surgical management and conservative management has failed
OR the surgical intervention would better control the patients conditions
what materials may be used for arthroplasty
metal-metal
ceramic-ceramic
ceramic/metal - polyethylene
what is a pseudotumour and what causes it
caused by reaction with metal in arthroplasty
leads to muscle and bone necrosis
what arthroplasty material causes osteolysis
polyethylene
what arthroplasty materal can shatter
ceramic
early local complications of arthroplasty?
DVT infection fracture dislocation instability bleeding arterial injury nerve injury leg length discrepancy
early general complications of arthroplasty
Hypovolaemia MI SIRS ARDS MODS PE acute renal failure chest infection urine infection
late local complication of arthroplasty
infection pseudotumour early loosening/failure fracture implant break
if arthroplasty infection is caught very early what management option may work
surgical washout/debridement
IV abx 6/52
if arthroplasty infection is caught >3/52 what is the likely management option
remove all implants/cements
IV abx
revision surgery once infection is controlled
what is a complication of revision surgery due to prosthetic joint infection
eventual stiffening of the joint
what is excision arthroplasty and on what joints is it used for
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
what is an arthrodesis, name a complication and what joints is it good for
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
what is an osteotomy
surgical realignment of bone used for deformity correction or redistribute load across arthritic joint
true/false - extensor mechanism of knee and achilles tendon benefit from steroid injection
false - never inject them
why would you perform synovectomy for extensor tendons in wrist of tibialis posterior
RA
preventing rupture
in what joints would a labrum repair/resection be performed
acetabulum/glenoid (hip/shoulder)
if a meniscal tear is causing pain failing to settle or mechanical symptoms what can be done\?
arthroscopic removal
what anatomical variations predispose patellar instability
shallow trochlear groove
genu valgum
femoral neck anteversion
how would instability caused by ligament laxity be managed surgically
tighten/advancement by tendon graft
arthrodesis in ehlers danlos
how would instability caused by anatomical variation be managed surgically
osteotomy to improve stability
how would spinal instability causing pain and nerve root compression be managed surgically
fusion of spinal motion segment
what surgical procedure is used to manage spinal nerve root compression due to osteophyte formation
discectomy/spinal decompression
peripheral nerve decompression surgery is performed typically for what nerves
median and ulnar nerves
orthopaedic surgical infection occurs in roughly what % of patients
1-2%
true/false - a prosthetic joint can become infected at a later date from surgery due to a haematogenous bacteria
true
complications of a deep seated prosthetic joint infection
fracture non union
chronic osteomyelitis
common organisms in prosthetic infection
staph aureus and gram -ves- typically earlier
staph epidermidis, enterobacter, beta haemolytic strep - typically later
would you manage a patient with prosthetic joint infection with surgery or abx first
surgery, abx prior to surgery interferes with culture results so following abx may be unrelaible
what types of spread may osteomyelitis have
direct inoculation
haematogenous
who is osteomyelitis more common in?
children
older patients
chronic disease
immunocompromised
how can staph aureus evade the immune system in osteomyelitis
it may infect intracellularly
with reference to OM, what is an involucrum?
area of new bone growing around an area of necrosis
acute osteomyelitis in absence of recent surgery is most common in ____?
children and the immunocompromised
why are children more likely to get osteomyelitis and where are they more likely to get it
metaphyses of long bones have long, tortuous vessels
proximal femur, proximal humerus, radial head, ankle
what is a brodies abscess
bone walls off an abscess with thin rim of sclerotic bone
in adults, where is chronic osteomyelitis more common and what typically causes it
more common in axial skeleton
pulmonary/urinary infection or infection of intervertebral disk
what disease especially has risk of osteomyelitis
TB
causative organisms of OM in newborns
staph aureus, enterobacter, group A/B strep
causative organisms of OM in children
staph aureus, GAS, haemophilus influenzae, enterobacter
causative organisms of OM in adolescents
staph aureus, GAS, haemophilus influenzae, enterobacter
causative organisms of OM in adults
staph aureus
streptococcus or enterobacter
causative organisms of OM in sickle cell
staph aureus
salmonella
what is the aim of surgery in chronic OM and what is a complication and solution
remove sequestrium, debride bone, take cultures
instability, needs internal/external fixation - external preferred as bone can be lengthened if shortened due to debridement
who is most at risk of spinal OM?
immunocompromised, PWID, poorly controlled diabetics
what are the most likely causative organisms in spinal OM
staph aureus
atypicals in immunocompromised
how is resolution of spinal OM estimated
clinical condition and serial CRP
indication for surgery in spinal OM?
inability to biopsy by CT biopsy, progressive vertebral collapse, no abx response, neurological deficit
surgical management of spinal OM?
debridement, stabilisation, and fusion of adjacent vertebrae
