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MB2 Rheumatology and Orthopaedics > Elective surgery of upper and lower limbs > Flashcards

Elective surgery of upper and lower limbs Flashcards

1
Q

when would you consider surgical intervention for an orthopaedic issue

A

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

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2
Q

what materials may be used for arthroplasty

A

metal-metal
ceramic-ceramic
ceramic/metal - polyethylene

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3
Q

what is a pseudotumour and what causes it

A

caused by reaction with metal in arthroplasty

leads to muscle and bone necrosis

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4
Q

what arthroplasty material causes osteolysis

A

polyethylene

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5
Q

what arthroplasty materal can shatter

A

ceramic

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6
Q

early local complications of arthroplasty?

A 
DVT
infection 
fracture 
dislocation 
instability 
bleeding 
arterial injury 
nerve injury 
leg length discrepancy
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7
Q

early general complications of arthroplasty

A 
Hypovolaemia 
MI
SIRS
ARDS
MODS
PE 
acute renal failure 
chest infection 
urine infection
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8
Q

late local complication of arthroplasty

A 
infection 
pseudotumour 
early loosening/failure 
fracture 
implant break
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9
Q

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

A

surgical washout/debridement

IV abx 6/52

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10
Q

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

A

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

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11
Q

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

A

eventual stiffening of the joint

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12
Q

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

A

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

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13
Q

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

A

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

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14
Q

what is an osteotomy

A

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

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15
Q

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

A

false - never inject them

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16
Q

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

A

RA

preventing rupture

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17
Q

in what joints would a labrum repair/resection be performed

A

acetabulum/glenoid (hip/shoulder)

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18
Q

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

A

arthroscopic removal

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19
Q

what anatomical variations predispose patellar instability

A

shallow trochlear groove
genu valgum
femoral neck anteversion

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20
Q

how would instability caused by ligament laxity be managed surgically

A

tighten/advancement by tendon graft

arthrodesis in ehlers danlos

21
Q

how would instability caused by anatomical variation be managed surgically

A

osteotomy to improve stability

22
Q

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

A

fusion of spinal motion segment

23
Q

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

A

discectomy/spinal decompression

24
Q

peripheral nerve decompression surgery is performed typically for what nerves

A

median and ulnar nerves

25
Q

orthopaedic surgical infection occurs in roughly what % of patients

A

1-2%

26
Q

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

A

true

27
Q

complications of a deep seated prosthetic joint infection

A

fracture non union

chronic osteomyelitis

28
Q

common organisms in prosthetic infection

A

staph aureus and gram -ves- typically earlier

staph epidermidis, enterobacter, beta haemolytic strep - typically later

29
Q

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

A

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

30
Q

what types of spread may osteomyelitis have

A

direct inoculation

haematogenous

31
Q

who is osteomyelitis more common in?

A

children
older patients
chronic disease
immunocompromised

32
Q

how can staph aureus evade the immune system in osteomyelitis

A

it may infect intracellularly

33
Q

with reference to OM, what is an involucrum?

A

area of new bone growing around an area of necrosis

34
Q

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

A

children and the immunocompromised

35
Q

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

A

metaphyses of long bones have long, tortuous vessels

proximal femur, proximal humerus, radial head, ankle

36
Q

what is a brodies abscess

A

bone walls off an abscess with thin rim of sclerotic bone

37
Q

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

A

more common in axial skeleton

pulmonary/urinary infection or infection of intervertebral disk

38
Q

what disease especially has risk of osteomyelitis

A

TB

39
Q

causative organisms of OM in newborns

A

staph aureus, enterobacter, group A/B strep

40
Q

causative organisms of OM in children

A

staph aureus, GAS, haemophilus influenzae, enterobacter

41
Q

causative organisms of OM in adolescents

A

staph aureus, GAS, haemophilus influenzae, enterobacter

42
Q

causative organisms of OM in adults

A

staph aureus

streptococcus or enterobacter

43
Q

causative organisms of OM in sickle cell

A

staph aureus

salmonella

44
Q

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

A

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

45
Q

who is most at risk of spinal OM?

A

immunocompromised, PWID, poorly controlled diabetics

46
Q

what are the most likely causative organisms in spinal OM

A

staph aureus

atypicals in immunocompromised

47
Q

how is resolution of spinal OM estimated

A

clinical condition and serial CRP

48
Q

indication for surgery in spinal OM?

A

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

49
Q

surgical management of spinal OM?

A

debridement, stabilisation, and fusion of adjacent vertebrae

MB2 Rheumatology and Orthopaedics (22 decks)

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