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Y5 - T+O > fracture healing / infection > Flashcards

fracture healing / infection Flashcards

1
Q

most common organisms is osteomyelitis

A

staph aureus

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2
Q

imaging modality of choice for avascular necrosis

A

MRI

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3
Q

Salter haris classification of paeds fractures

A

LOOK THIS UP

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4
Q

what is a Salter Harris fracture (paeds)

A

one that involves the growth plate

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5
Q

what is the significance of the salter harris gradings

A

worse the fracture grading (5 is worse and indicated a crush injury), then the more likely it s that growth will be disturbed

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6
Q

what is a greenstick fracture

A

unilateral cortical breach only

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7
Q

most common organism in septic arthritis is

A

staph aureus

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8
Q

key symptoms of septic arthritis

A

red, hot, swollen joint, reduced ROM and systemic signs

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9
Q

IX for septic arthritis

A

FBC, U+E, CRP, blood cultures, joint aspiration and MC+S

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10
Q

Abx for septic arthritis

A

IV flucloxacillin

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11
Q

Complications of septic arthritis

A

sepsis, osteomyelitis, joint destruction

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12
Q

first stage of fracture healing

A

haeamtoma formation and inflammation where bleeding stops and dead tissue removed (weeks 0-2)

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13
Q

whats the second stage of fracture healing

A

soft callus formation (2-3 weeks)–>angiogenesis and granulation tissue makes a cartilaginous network

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14
Q

what is the third stage of fracture healing

A

hard callus formation (3-6 weeks) where the cartilaginous network undergoes ossification

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15
Q

how long does remodelling occur for in bone healing

A

8 weeks to 2 years

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16
Q

what is second healing in bone

A

when there is the formation of a callus (This occurs when there is some movement at the fracture site)

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17
Q

what is primary bone healing

A

where there is reestablishment of the cortex without formation of a callus (occurs when there is complete stability - screws/plates)

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18
Q

what causes non union in bone healing

A

when there is inadequate stability or inadequate blood flow

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19
Q

RF for non union in bone healing

A

smoking, age, DM

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20
Q

what are the options in helping union of a bone

A

dietary supplements, bone stimulators (US waves which stimulate growth factors) or bone grafts

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21
Q

what are BMPs

A

bone morphogenetic proteins which induce formation of bone and cartilage

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22
Q

what are kanavels 4 signs of a tendon sheath infection

A

1) finger held in slight flexion
2) fusiform swelling
3) tenderness along the sheath
4) pain on passive extension

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23
Q

what is a flexor tendon sheath infection

A

the flexor sheath where the finger tendons run get infected - can be proceeded by a penetrative injury. Emergency as causes a raised pressure with the sheath with compromises the finger

24
Q

Mx of a flexor tendon sheath infection

A

if presenting early can do hand immobilisation and IV abx but normally requires surgery with a flexor tendon sheath washout

25
Complications of a tendon sheath infection
necrotising fasciitis
26
how might avascular necrosis appear on xray
sclerosis and flattening of the femoral head
27
things to comment on in a MSK xray
name, age, gender of patient what the xray is imaging (this is an xray of the Left hip) Comment on projection (AP) Type of fracture eg oblique / transverse and whether it is displaced or not displaced
28
definition of a comminuted fracture
>2 fragments
29
what is spondylodiscitis
infection of the disc and vertebrae normally with staph aureus
30
Ix for spondylodiscitis
blood cultures as can get a bacteraemia and MRI
31
Mx for spondylodiscitis
Abx for 6 weeks, spinal surgery input, immobilisation
32
what is cervical spondylosis
age related wear and tear of the discs which causes pain and stiffness, may also cause radicular symptoms if the nerve roots become compressed
33
RF of cervical spondylosis
neck trauma, age, congenital bony abnormalities
34
what is cervical spondylosis a good differential for
PMR
35
what is spondylolisthesis
where the proximal vertebrae displaces forward (due to fracture in the pars interarticularis)
36
symptoms of spondylolisthesis
lower back pain that is worse on movement, tight hamstrings, pain in the legs that may extend down the thighs
37
red flags of back pain
thoracic tenderness, pain that is not relieved by lying down, history of malignancy, systemic signs, <20 or >55,
38
pathophysiology of compartment syndrome
raised intracompartmental pressure (due to bleeding, oedema, inflammation), veins compressed first and then arterial blood supply compromised
39
presentation of lumbar stenosis
pain and claudication like pain but this is better going up hill
40
Mx of lumbar stenosis
conservative --> weight loss / physio laminectomy
41
Signs of psoas abscess
fever, back pain, limb, pain on passive extension of the hip
42
RF for psoas abscess
crohns, UTI, diverticultiis, IVDU
43
imaging of choice for a psoas abscess
CT abdomen
44
what is firstline for back pain
NSAID (and stay physically active) + physio -need routine secondary care referral if no improvement after 4-6 weeks
45
what is a segmental fracture?
more than one fracture alone a bone
46
what happens in brown sequard syndrome
hemisection of spinal cord injured. -get ipsilateral paralysis and ipsilateral loss of dorsal column -contralateral loss of spinothalamic
47
what is priority in open fractures
debridement first, need soft tissues to recover before definitive Mx
48
what are the nerve roots in the sciatic nerve
L4 to S1
49
causes of sciatica
1) lumbar disc herniation (most common) 2) spondylolisthesis 3) spinal stenosis
50
RF of sciatic
smoking, lifting heavy loads, obesity, whole body vibration
51
what screening tool can be used to assess for longer term disability with back pain
the start back tool
52
if NSAID is contraindicated for back pain, what can be used next?
codeine (paracetamol alone is ineffective)
53
advise for MX sciatica
-stay active -apply local heat -simply pain - NSAID -codeine if NSAID doesn't work -consider CBT and physical exercise programme if this does not work -more specialist mx --> epidural ICS
54
indications for lumbar spine Xray
back pain for > 6 weeks <20 or > 50 ank spond suspected osteoporotic fracture
55
limb threatening immediate complications in trauma
1) acute limb ischaemia 2) compartment syndrome
56

Y5 - T+O (11 decks)

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