How to Treat MSK Conditions Tutorial Flashcards

Question

What are some possible fracture complications?

Answer 1

General (complications affecting the whole body) - can be early or late: Fat embolus - fat globules from bone marrow can enter the blood from the fracture, usually occurs within a few hours DVT (deep venous thrombosis) - blood clot in the vein, that can become a thromboembolus PE (pulmonary embolism) - fat embolus travelling to the lungs Systemic sepsis from an infection that is spreading Prolonged immoblity can increase risk of UTI, chest infection, pressure sores on the area of the body you are sitting on OR Local (complications just affecting the area around the fracture): Can be divided into urgent, less urgent and late

Answer 2

``` Local visceral injury Vascular injury Nerve injury Compartment syndrome Haemarthrosis Infection Gas gangrene - infection caused by clostridium ```

Answer 3

``` Fracture blisters Plaster sores Pressure sores Nerve entrapment Myositis ossificans - inflammation of the muscles, which causes calcium depositions on the muscles forming bone = stiff and painful muscles Ligament injury Tendon lesions Joint stiffness Algodystrophy ```

Answer 4

``` Delayed union - the bone hasnt healed in the time it normaly takes Malunion Non-union Avascular necrosis Muscle contracture Joint instability Osteoarthritis ```

Answer 5

Age Comorbidityrespiratory/cardiovascular/diabetes/cancer Preinjury mobilityindependent/shopping/walking/sports Social hx: relatives, stairs, etoh

Answer 6

Insifficiency fracture - often in older age from osteoporosis Requires trauma in younger population OR combination of both

Answer 7

``` Articular cartilage on the femoral head Femoral head attached to neck Neck attached to shaft 2 lumps - greater and lesser trochanters Inter-trochanteric line inbetween ```

Answer 8

In front or behind trochanteric line: Above the intertrochanteric line = intracapsular Below the intertrochanteric line = extracapsular

Answer 9

Based on location / displacement and age: Location = if extracapsular, usually try to fix it as there is minimal risk to the blood supply and avascular necrosis (AVN), so can be fixed using plates and screws (dynamic hip screw) If intracapsular: if undisplaced, less risk to blood supply so fix with screws, if displaced, 25-30% risk AVN so replace in older patients, and fix in younger patients (<55)

Answer 10

Total hip replacement = Walks >mile a day Independent Minimal co-morbidities Heiarthroplasty (half hip replacement) - metal rubs on socket = Lower morbidity Multiple comorbidities

Answer 11

1. Fibrous = e.g. skulls, contain sutures, syndesmosis and interroseous membranes 2. Cartilaginous = synchondroses e.g. sppone, symphyses e.g. pubic 3. Synovial = calssified in how the move: plane, hinge, condyloid, pivot, saddle, ball and socket

Answer 12

The proportions of the 3 components: Bone surface congruity Ligaments Muscles / tendons

Answer 13

2 bones encases in a capsule Synovial membrane lines the capsule - this secreted synovial fluid that nourishes and lubricates the joint Both heads of the bone have hyaline articular cartilage

Answer 14

Composed of: 1) specialized cells (chondrocytes) 2) extracellular matrix: water, collagen and proteoglycans (mainly aggrecan) Cartilage is avascular – it has no blood supply Surface = horizontal collagen arrangement with horizontal cellular arrangement

Answer 15

A proteoglycan that possesses many chondroitin sulfate and keratin sulfate chains Characterised by its ability to interact with hyaluronan (HA) to form large proteoglycan aggregates

Answer 16

Osteoarthritis (OA) = wear and tear of articular cartilage Inflammatory arthritis = inflammation of the synovial membrane Each can lead to each other

Answer 17

Articular cartilage becomes eroded and worn So the bones begin to produce more bone leading to sunchondral sclerosis and osteocytes This then creates some inflammation as a by-product

Answer 18

A long-term chronic disease characterized by the deterioration of cartilage in joints which results in bones rubbing together and creating stiffness, pain, and impaired movement

Answer 19

``` Age Excess weight / obesity Mechanical constraints (e.g. intense sport) Hereditary Female, menopause Osteonecrosis Leg bone malalignment Oestrogen deficiency Metabolic Syndrome Secondary to spondylarthritis or RA Injury e.g. to cruciate ligament, meniscectomy Metabolic diseases Infectious diseases involving the bone RA sequellae ```

Answer 20

Pain (exertional / rest / night Diability - walking distance / stairs / giving way Deformity Previous history - trauma, infection etc. Treatments given - physio, injections, operations, etc. Other joints affected

Answer 21

Look Feel Move Special tests

Answer 22

Osteophyte Loss of joint space Subchondral cysts Sclerosis

Answer 23

``` Conservative: Analgesics Physiotherapy Walking aids Avoidance of exacerbating activity Injections (steroid, viscosupplementation) ``` ``` Operative / surgical: Replace knee / hip Realign knee / hip Excise - toe Fuse - big toe Synovectomy - RA Denervate - wrist ```

Answer 24

Osteomyelitis - infection in the shaft of the bone | Septic arthrtiis - if the infection is in the joint

Answer 25

Mainly location | Can be localised / confirmed using an X-ray or an MRI

Answer 26

``` Refer to pathology lectures Acute or chronic Primary or secondary Pain/swelling/discharge Systemic signs: Fevers, sweats wt loss ```

Answer 27

Pain Joint swelling/stiffness Fevers, sweats, wt loss Usually one joint affected - a painful, red, hot, swollen joint with fever

Answer 28

Bacterial infection of a joint (usually caused by spread from the blood) - e.g. Staphylococcus aureus, Streptococci, Gonococcus

Answer 29

Immunosuppressed Pre-existing joint damage Intravenous drug use (IVDU)

Answer 30

Untreated, septic arthritis can rapidly destroy a joint

Answer 31

Joint aspiration - fluid sent out to lab for urgent gram stain and culture

Answer 32

``` Radiology: Plain films MRI scans: bony architecture/collections CT if MRI not available Bone scans: multifocal disease Labelled White cell scans ``` ``` Bloods = usually non-specific but sitll tell you if there is an infection: CRP: acute marker ESR slower response WCC TB culture/PCR ```

Answer 33

Osteomyelitis: Antibiotics: iv weeks Surgical drainage: especially collections/sequestrum Chronic: antibiotic suppression/dressings Worst case scenario: amputation ``` Septic Arthritis: Surgery: joint washout and drainage (repeated if required) Iv antibiotics (days/weeks) Immobilise joint in acute phase Physiotherapy once over acute phase ```