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Surgery finals KTB > Ortho basics > Flashcards

Ortho basics Flashcards

1
Q

Describe the structure of bone

A
  • Cortical bone on outside: hard, mechanical function
  • Cancellous bone inside: porous, holds marrow

Diaphysis (shaft)
Epiphysis (head)
Metaphysis (between growth plate + diaphysis)

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2
Q

Describe the 3 main types of fracture (in terms of aetiology) and give examples

A
  1. Traumatic eg. FOOSH, high speed RTA
  2. Stress eg. sports/running
  3. Pathological eg. osteoporosis compression #, tumours
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3
Q

Describe the imaging needing in suspected fracture

A
  • Plain radiographs
  • 2 views: AP and lateral +/- extras eg Mortise
  • Also xray of joints above + below injury
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4
Q

Describe the different patterns of fractures

A
  • Transverse
  • Oblique
  • Spiral
  • Compression
  • Greenstick
  • Avulsion
  • Comminuted
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5
Q

Describe how to report a fracture xray

A
  1. Patient details
  2. Fracture pattern: simple/comminuted, transverse, oblique, spiral
  3. Anatomical location: bone + part of bone
  4. Intra or extra articular
  5. Deformity: translation, angulation (varus, valgus)
  6. Soft tissues: open/closed, NV status
  7. Specific type eg. Colles, Smiths
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6
Q

Describe the stages of fracture healing

A
  1. Reactive phase: up to 48 hours. Haematoma formation -> inflammatory cell recruitment
  2. Reparative phase: 2 days - 2 weeks. Callus formation (proliferation of blasts) -> consolidation of woven bone
  3. Remodelling phase: 1 wk - 7 years. Remodelling of lamellar bone to cope w forces.
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7
Q

Describe fracture healing time

A 
3 weeks: child, upper limb, metaphyseal, closed
Prolonging factors (double time): adult, lower limb, diaphyseal, open
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8
Q

Describe the basics of fracture management

A

4 Rs: resus, reduction, restriction, rehab

  1. Resus: follow ATLS, assess for injuries + neurovascular status, stabilise -> imaging
  2. Reduction: for displaced fractures. Manipulation (closed reduction), traction, open reduction
  3. Restriction: eg non-rigid (slings), POP, ext/int fixation
  4. Rehab: physio, OT
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9
Q

Describe the specific management for open fractures

A

6 As:

  • Analgesia: morphine + metoclopramide
  • Assess: NV status, injuries
  • Antiseptic: irrigation, cover with betadine-soaked dressing
  • Alignment: align + splint
  • Anti-tetanus
  • Antibiotics: fluclox + penpen OR co-amox
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10
Q

Describe the complications of fractures

A 
General:
Trauma complications:
-Pain, bleeding, shock 
Complications of surgery + anaesthesia
Post-op complications: DVT, pneumonia, PE, infection

Specific:
Immediate: neurovascular damage
Early: compartment syn, infection
Late: problems with union, AVN, growth disturbance, OA

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11
Q

Describe compartment syndrome

A

A condition that occurs following fracture/trauma to a limb, in which pressure rises in a single compartment. Without treatment, this can compromise blood flow to the compartment and cause muscle death (when compartment P > capillary P)

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12
Q

Describe the presentation of compartment syndrome

A

PAIN
+/- reduced/absent pulses
-Warm, red, swollen limb

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13
Q

Describe the management of compartment syndrome

A

Conservative:

  • Elevation
  • Remove splint/bandages/POP

Medical:
-Analgesia

Surgical:
-Fasciotomy

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14
Q

What are some problems with fracture union?

A

Delayed union: ^ time to unite
Non-union: failure to unite
-Can be hypertrophic or atrophic
Malunion

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15
Q

What are some causes of delayed/non-union?

A

5 Is:

  • Ischaemia
  • Infection
  • Interfragmentary strain
  • Interposition of tissue between fragments
  • Intercurrent disease eg. malnutrition
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16
Q

Which bones are most susceptible to avascular necrosis?

A

Femoral head
Scaphoid
Talus

17
Q

Describe the presentation of osteoarthritis

A

Painful joints, typically large joints in lower limbs (knee, hip) and hands (DIPs, PIPs, 1st CMC)

  • Stiffness + pain worse on exercise/at end of day
  • Relieved by rest
  • Decreased range of movement
  • Deformities
18
Q

Describe the signs of osteoarthritis on radiograph

A

Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

19
Q

Describe the important features to ask on history in OA

A
  • Pain: when? Rest, night, exertion
  • Stiffness
  • Any sensation of locking, giving way
  • Disability: stairs, walking distance
  • Treatments
  • Other joints affected

-Previous Hx of trauma, infection

20
Q

Describe the basic management of OA

A

Conservative:
-Physio, exercise modification

Medical:

  • Analgesia: topical/systemic NSAIDs
  • Steroid injections

Surgical:
-Arthroplasty: TKR, PKR

21
Q

Describe the difference between total and partial knee replacement

A

Partial: replacement of one compartment (knee has 3). Suitable if only 1 has disease but this is small number of people. Less invasive, better recovery time

Total: replacement of all compartments. More frequently done. More invasive, longer recovery

22
Q

Describe the presentation of septic arthritis

A

Acute, painful joint. Often knee/hip

  • Hot, red, swollen, tender, decreased ROM, holding joint in position + unable to weight bear
  • Fever, systemically unwell
23
Q

Which pathogens commonly cause septic arthritis?

A

Staph aureus + Streptococci almost always

+ Neisseria gonorrhae, E coli, Salmonella, TB

24
Q

Name some risk factors for septic arthritis

A

Problems with the joint:

  • Artificial joint/previous joint replacement
  • Pre-existing joint disease: OA, RA
  • Steroid injections

Patient characteristics:

  • Immunosuppression: HIV, DM, steroids
  • IVDU
25
Q

Describe the investigations for septic arthritis

A

Any swollen acutely painful joint should be considered SA until proven otherwise:

  • After history and examination
  • Bloods: FBC, CRP, U+Es, LFTs, VBG, culture
  • Joint aspiration for MC+S
  • Imaging: Xray
26
Q

Describe the management of septic arthritis

A

If prosthetic -> refer to ortho straight
If septic: A to E approach
Otherwise:
-History, examination, investigations (joint aspiration is also therapeutic- aspirate til dry)
-Analgesia: paracetamol, NSAIDs
-IV fluids
-IV antibiotics (cont 2 weeks -> PO for 4 weeks)

Surgical if not responsive: washout, debridement

27
Q

Describe the presentation of osteomyelitis

A

May be acute or chronic presentation
Pain, swelling, warm, tender bone (sometimes no localising signs)
Fever + systemically unwell

28
Q

Describe the risk factors for osteomyelitis

A

Abnormal anatomy:

  • Previous surgeries
  • Penetrating injury

Abnormal host immune system:

  • Immunosuppresion: HIV, DM, alcohol, elderly, IVDU
  • Sickle cell
29
Q

What are the common causative organisms in osteomyelitis?

A

Staph aureus + Streptococci most common

+ E coli, Klebsiella, etc

30
Q

Describe the investigations for osteomyelitis

A
  • After history and examination
  • Wound swab (eg infected diabetic ulcer)
  • Bloods: FBC, CRP, U+Es, VBG, culture
  • Imaging: Xray, MRI
  • Bone biopsy rarely done
31
Q

Describe the management of osteomyelitis

A

Acute osteomyelitis:

  • Analgesia, IV fluids
  • IV ABx -> PO (total 6 weeks)
  • Surgical opinion re: debridement

Chronic:

  • ABx will not cure chronic once bone has become necrotic
  • Surgical management is necessary: debridement + excision, fixation etc

Surgery finals KTB (16 decks)

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