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#2 BOARDS > Miscellaneous 2 > Flashcards

Miscellaneous 2 Flashcards

1
Q

4 stages of bone healing

A
  • Inflammation
  • Soft callus
  • Hard callus
  • Remodeling
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2
Q

Inflammation

A
  • Peaks at 48 hours, subsides at 1 week
  • Inflammation acts as an immoblizer by causing pain and edema

4 days

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3
Q

Soft callus

A
  • Begins several days after injury and persists for 1-2 months
  • Fibrous and cartilagenous tissue develops at each end of the fracture
  • If the soft callus fails to unite, the two sides of the fracture will cease to grow and will be resorbed

4 weeks

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4
Q

Hard callus

A

If a soft callus is successful in connecting the fracture, it begins to ossify
- This occurs at 2-4 months

4 weeks

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5
Q

Remodeling

A
  • Lasts for several years
  • Excessive callus is resorbed
  • Final bone morphology is determined by Wolff’s law

4-ever

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6
Q

How long does it take for osteomyelitis to show up on x-ray?

A

2 weeks

Osteomyelitis takes about 2 weeks to show up on x-ray after there has been a 50% loss of bone

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7
Q

Sequestrum

A

A piece of necrotic bone separated from living bone by granulation tissue, radiographically evident as a highly opaque, smooth island of bone that is usually surrounded by areas of decreased bone density

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8
Q

Involucrum

A

A layer of living bone that has formed around the dead (infected) bone

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9
Q

Cloaca

A

An opening in the involucrum that may form a sinus and drain

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10
Q

Brodie’s abscess

A

A chronic abscess in bone surrounded by dense fibrous tissue and sclerotic bone, most commonly found in the metaphysis

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11
Q

Phases of wound healing

A
  • Inflammatory phase
  • Proliferative phase
  • Remodeling phase
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12
Q

Inflammatory phase

A
  • 1-7 days
  • Influx of platelets and leukocytes
  • Release of cytokines and mediators
  • Coagulation
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13
Q

Proliferative phase

A
  • 5-20 days
  • Collagen fibers are produced and lend strength to wound
  • Re-epithelialization (some authors describe epithelialization as a separate phase between proliferation and remodeling)
  • Angiogenesis
  • Fibroplasia
  • Wound contraction
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14
Q

Remodeling phase

A

AKA maturation

  • 3 weeks to 2 years
  • Deposition of matrix materials
  • Collagen deposition/remodeling
  • Return to preinjury state
  • As long as the scar or past ulcer site is erythematous, remodeling is occurring
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15
Q

Stages of Charcot

A
  • Stage 0: Pre-Charcot
  • Stage 1: Fragmentation/developmental
  • Stage 2: Coalescence
  • Stage 3: Remodeling/reconstruction
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16
Q

Stage 0

A

Pre-Charcot

  • Warmth, dull pain, swelling and joint instability, with normal appearing bone and joints on radiographs
  • Acute sprain or fracture in the presence of neuropathy
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17
Q

Stage 1

A

Fragmentation or developmental

  • Clinical signs and symptoms of inflammation (warmth, erythema and edema)
  • X-ray: bone debris formation at the articular margins, fragmentation of the subchondral bone, subluxation, dislocation and capsular distention
  • Dissolution, fragmentation, dislocation
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18
Q

Stage 2

A

Coalesence

  • Beginning of the reparative process
  • Edema, warmth and redness diminish
  • X-ray: absorption of fine debris and fusion of large fragments to adjacent bones, bone ends become sclerotic
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19
Q

Stage 3

A

Remodeling/reconstruction

  • Bony consolidation and healing
  • Residual bony deformity is common, most notably collapse of the longitudinal arch resulting in the classic “rocker-bottom” foot
  • Rounding of the bone ends with a decrease in sclerosis
  • Bony protuberences are clinically important because they may develop sites for future neuropathic pressure ulcers
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20
Q

HBO therapy

A
  • Increases oxygen concentration in the blood
  • Angiogenesis and fibroblast production occurs, which helps with collagen synthesis and epithelial closure
  • During HBO treatment and for 3-4 HOURS AFTER the O2 is dissolved in the plasma and helps oxygenate the hypoxic area
  • Speeds healing time for ulcerations
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21
Q

Baxter’s neuritis

A
  • Entrapment neuropathy of the 1st branch of the lateral plantar nerve (AKA nerve to abductor digiti minimi muscle)
  • Pain after activity rather than pain first thing in the morning as with plantar fasciitis
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22
Q

Pigmented villonodular synovitis

A
  • Symptoms: pain, joint effusion, hemarthrosis (thus hemosiderin pigment), limited ROM
  • The syovium will appear red-brown in color due to the hemosiderin found in the tissue
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23
Q

Post op note

A

SAPPPPA HEMI CG

S = Surgeion 
A = Assistant 
P = Pre-op diagnosis 
P = Post-op diagnosis 
P = Procedure 
P = Pathology 
A = Anesthesia 
H = Hemostasis
E = EBL
M = Materials 
I = Injectables 
C = Complications 
G = General statement about how the patient is doing
24
Q

Admit orders

A

ADC VANDILMAX

A = Admit to service 
D = Diagnosis 
C = Condition (stable, fair, poor) 
V = Vitals q8 hrs 
A = Activities 
N = Nursing orders 
D = Diet 
I/O = Ins and outs 
L = Labs 
M = Meds 
A = Ancillary services 
X = X-ray
25
Q

Microcytic anemia

A
  • Iron deficiency
  • Thalassemia
  • Blood loss
  • Lead poisoning
26
Q

Normocytic anemia

A
  • Chronic disease
  • Bone marrow failure
  • Hemolysis
27
Q

Macrocytic anemia

A
  • Folate acid deficiency
  • Vitamin B12 deficiency
  • Liver disease
  • Drugs (phenytoin, cytotoxic meds)
28
Q

Normal INR

A

3-4

Therapeutic INR = 2-3

29
Q

ANA (antinuclear antibody)

A

Normal: negative

Conditions with positive ANA:

  • Lupus
  • Scleroderma
  • RA
  • Sjogren’s
  • Dermatomyositis
  • Polyarteritis
30
Q

RA factor (rheumatoid factor)

A

Absence of RA factor does not exclude diagnosis of RA

Positive in:

  • Rheumatoid arthritis
  • Systemic lupus erythematosus
  • Scleroderma
  • Dermatomyositis
  • Sjogren’s syndrome
  • Syphilis
  • Sarcoidosis
  • Liver disease
31
Q

HLA-B27

A

Human leukocyte antigens (HLA) are a major histocompatibility antigen found on all nucleated cells, play a major role in histocompatibility between donors/recipients

Positive in: 
A = ankylosing spondylitis 
R = reactive arthritis (Reiter's) 
P = psoriatic arthritis 
E = enteric colitis (ulcerative colitis, regional enteritis)
32
Q

ASA classification

A 
I = healthy patient 
II = mild systemic disease 
III = severe systemic disease that limits activity 
IV = severe systemic disease with constant threat to life 
V = not expected to survive with or without surgery 
VI = brain dead, organ donation surgery
33
Q

Pituitary adrenal suppression

A

Patients on 7.5 mg of corticosteroids/day should be tested for cortisol suppression

If regular dose <5 mg…
Continue regular dose with no supplementation
If regular dose >5mg…
Continue regular dose PLUS 25 mg supplementation prior to surgery

34
Q

Tourniquet rules

A
  • Inflate tourniquet to 100-120 over systolic
  • Max for ankle = 250
  • Max for thigh = 500
  • Max time = 2 hours, must be deflated for 15-20 minutes before reinflating
35
Q

Patients on anti-coagulants before surgery

A
  • Discontinue 3-6 days prior to surgery and resume 24 hrs after surgery
  • If anticoagulant cannot be stopped, discontinue coumadin 3 days prior and start heparin drip, DC heparin drip 2-4 hours prior to surgery
36
Q

Pre-op rheumatoid patient

A
  • Cervical spine x-ray due to predisposition for atlas/axis dislocation
  • More prone to infection due to immunosuppressive medications
37
Q

Sickle cell disease

A
  • Mutationin beta chain gene that results in amino acid change from glutamic acid to valine
  • Hemoglobin S becomes insoluble and aggregates into long strands in “sickle” shape
  • Sickle cell can no longer deform in shape to fit through small capillaries and they can clog small vessels and result in ischemia
  • Anemia due to spleen destroying all abnormal RBCs, resulting in splenomegaly
  • Signs/sympoms: long bone pain, hand/foot pain, arthritis with fever, avascular necrosis of femoral head, chronic punched out lesions of ankles, abdominal pain with vomiting
38
Q

Surgical considerations in sickle cell disease

A
  • High index of suspicion for sepsis post-op
  • Salmonella is most common organism from sickle cell patients with osteomyelitis
  • Prone to hypoxia
  • Local anesthesia preferred to prevent hypoxia
  • Avoid tourniquet
  • Increased post-op complications
  • If using general, extra precautions must be taken to avoid volume depletion and hypoxia
39
Q

Operative considerations for cardiac patients

A
  • Delay elective surgery for 6 months after an MI
  • Endocarditis prophylaxis for patients with valve disease, rheumatic murmur, prosthetic valves (IV PCN or ancef, clinda if PCN allergic)
  • Patients on diuretics need K+ checked
  • HTN (diastolic pressure of 110) increases intra op risk of MI or stroke
  • Most heart medications should be continued up to and through the day of surgery
40
Q

Post-op fever

A
  • Wind: atelectasis (first 24-48 hours)
  • Water: UTI (after day 3)
  • Wound: infection (after day 5)
  • Walking: DVT, PE (day 7-10)
  • Wonder: anesthesia, drugs, other
41
Q

Weakest point in a screw

A

Run out

Point where shank (non-threaded part) meets the threaded part

42
Q

Pitch

A

Distance between threads

Cortical screws have smaller pitch than cancellous screws

43
Q

Rake angle

A

Thread to axis of screw angle

44
Q

Core diameter

A

Diameter of screw between the threads (not including threads)

45
Q

Thread diameter

A

This value is used to describe the screw size (i.e. a 2.7 mm screw has a 2.7 mm thread diameter)

46
Q

Tip angle

A

Tip to axis of screw angle

47
Q

Mini frag set

A

1.5 and 2.0 cortical screws

48
Q

Small frag set

A

2.7 and 3.5 cortical screws, 4.0 cancellous screws (partially or fully threaded)

49
Q

Standard or large frag set

A

4.5 cortical screws, 4.5 malleolar screws and 6.5 cancellous screws

50
Q

Lag by technique

A
  • Drill thread hole (2.0 mm drill bit, drill through near and far cortex) - over drill
  • Drill glide hole (2.7 mm drill bit, drill through near cortex only) - under drill
  • Countersink
  • Measure
  • Tap (2.7 mm tap)
  • Flush
  • Insert 2.7 mm screw (to two finger tightness)
51
Q

Tension band wiring

A
  • Used when there is eccentric distraction of fracture/osteotomy site due to muscle/ligament pull
  • Converts distractive forces into compressive forces
  • Cerclage wire placed on tension side of osteotomy prevents distraction and cause compression on opposite side
  • Common uses: patellar, malleolar and styloid process fractures
52
Q

Dynamic compressive plate

A

Allows compression across a fracture/osteotomy site as screws are tightened due to plate screw hole shape

53
Q

Neutralization plate

A

Allows stress to be transmitted through the plate so as to avoid the fracture/osteotomy site

54
Q

Buttressing plate

A

Used to maintain separation of bone to protect a bone graft from being crushed

55
Q

Tension band plate

A
  • As with tension band wiring, it takes advantage of asymmetrical biomechanical forces across a fracture/osteotomy site
  • The plate is placed on teh tension side of a fracture/osteotomy to prevent distraction on that side, causing corresponding compression on the other side
56
Q

Ilizarov

A

A technique to heal non-unions involving an external fixation device

Through variations of this technique, the bone can also be elongated by as much as 1 mm/day through slow distraction

57
Q

Primary pathogen that infects implants

A

Staphylococcus epidermis

#2 BOARDS (14 decks)

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