ORTHO test 2 Flashcards
shoulder arthroscopy
diagnosis, removal of loose bodies, and rotator cuff repairs
acromioplasty
limited painful ROM impingement syndrome
bankart, putti platt, bristow
recurrent anterior dislocation of the shoulder
total shoulder arthroplasty
painful glenohumeral arthritis with significant loss of ROM or osteonecrosis
arthroscopic bankart procedure
shaver, burr, suture hook, MITEK for arthroscopic repair
why type of joint is the shoulder?
ball and socket
what bones articulate to form the joint?
scapula, humerus, glenoid
the top of the glenoid cavity is formed by the bony point on the top of the shoulder called the acromion process of the
scapula
three joints of the shoulder girdle
glenoidoclavicle, acromiclavicle, steroclavicular
which tendons are part of the rotator cuff?
supraspinatus, infraspinatus, teres minor, subscapularis
main function of the rotator cuff
shoulder movement
what landmark is used for orientation during the shoulder arthroscopy? what instrument is used?
biceps tendon
switching stick
how is the arm manipulated by the ST during exam of the shoulder?
external and internal rotation, slightly flexed position
what are the problems that may commonly be found and treated during the diagnostic shoulder arthroscopy?
rotator cuff repair, labral tear, loose bodies
what solution is commonly used for arthroscopy?
epi mixed with lactated ringer
bankart lesion
anterior part of the glenoid labrum of the shoulder
trocars used for bankart repair? why?
threaded to prevent dislodgement
what are the bony landmarks that are marked for an arthroscopic acromioplasty?
acromion, acromioclavicalar point, distal clavicle, coracoid process
most common method of reduction for a colles fracture?
close method, casted
femoral osteotomy guide
determine the point for removal of the femoral head using a saw
acetabular reamers
used to remove the articular cartilage
hohman retractors
elevate the femoral neck and head into the open wound
charnley
self retaining retractor for THA
femoral reamers
open up the IM canal
cookie cutter
box chisel used to prepare the end of the femur for rasping
femoral rasps
last one used is left in place as part of the base trial for the femoral component
cement restrictor
prevent entry into the unreamed segments of the IM canal
calcar plane
smooth the site around the femoral rasp just prior to the trial components are used
dynamic hip screw
hip fractures
trypes of hip fractures
interochanteric, subtrochanteric, femoral neck, basilar neck
what type of drape is commonly used with IV poles?
large barrier drape
what is the first step for a DHS/DCS procedure? and size?
guide pin is handed to the surgeon
38mm barrel plate and 135 degree angle barrel
what is used to prepare the site for the placement of the DHS plate and screw?
triple reamer
common reasons for a total hip arthroplasty?
osteoarthritis, trauma, over 65 years old
contamination during ortho? how to prevent?
when draping, change outer gloves
why should pt for THA include a type and cross?
blood loss could be high
3 advantages of laminar airflow in OR? spacesuits?
reduce microbial count, filtered air, air exchanges
to prevent contamination
what is placed to immobilize the joint as part of the post op care?
triangular split
irrigation during drilling or reaming through bone
cool bone-prevent necrosis
use laps when passing ronguer
remove tissue
verify sizes when passing reamers, rasps
verbalized when used
remove bits of tissue from field
prevent contamination
accept implants
no dropping
save sm piece of cement
so can check piece for hardness
what is the purpose of a lateral post during the knee arthroscopy?
placing counteraction on the knee joint to open the medial side
most common injury during arthroscopy? repair?
meniscus injury
arthroscopic partial mensciectomy or repair
which ligament of the knee is commonly injury? how?
ACL, pivot move in opposite direction
what can be used to repair a ligament?
autografts, allografts
where is graft placed for ACL? suture?
intercondylar notch
nonabsorbable suture 2 or 5
how is the graft secured in the tunnels?
staples, screws
why is it important to save all bone chips and pieces of tissue from the reaming process?
may be placed in defect
complications during allograft?
infection, disease transmission
additional instruments for amputation?
rasp, amputation knife/saw, power saw
why is the femur kept in extension during the suture of the quad muscle?
to avoid hip flexion
complication of amputations?
phantom limb pain
common reasons for amputation?
peripheral vascular disease
most common reasons for total knee arthroplasty?
relieve pain and disability
sandbag taped on the OR table for knee
allow for the knee to be optimally flexed
what precautions does the ST make to ensure the cuts are completed efficiently?
extra sterile saw blade
what should the ST be doing during trial reduction?
communicating what size prosthesis will be needed
purpose of triple arthrodesis?
relieve pain
what is used to perform the triple arthrodesis?
screws, bone graft
instrument for achilles tendon repair? position? foot? suture?
tendon pulling forceps
prone
foot is at rest
4-0 nonabsorbable
post op dressing after achilles tendon
4x4 dressing sponges
splint
most common cause of a bunion?
shoes styles worn, female most common
procedures for bunions
bunionectomy, mcbride, chevron
goal of bunion procedure?
prevent reoccurence
structures that must be preserved during bunion procedure?
metatarsal neck
what nerve is associated with carpal tunnel release?
median nerve
instrument sued to bluntly dissect under the carpal ligament for arthroscopic carpal tunnel release?
mosquito
when removing ganglion, what might be used to remove the last little core?
nibbler
three ways might a carpal or metacarpal fracture be fixated?
k wires, plate, screws
bones associated with an elbow fracture?
distal humerus, olecranon, proximal ulnar, radius
what position is ulnar nerve transposition done in?
supine, Olympic table
suture used to tack down the transposed ulnar nerve?
2-0 ethibond
4 things when placing a k wire in a finger
k wire, wire driver, pin cutter, pin cover
3 ligaments in acromioclavicular injury?
coracoclavicle, coracoacromion, acromiclavicular
mohow are most clavicular fractures treated?
immobilization
what tendon of the rotator cuff tear easier?
supraspinatus
which procedure for correction of anterior shoulder dislocation carries the most risk?
bristow
what positions may be used for acetabular fracture fixation?
lateral, supine
what is the reason for fixing hip fractures so quicly?
decrease in morbidity and mortality
what are possible complications of mismanaged femoral fractures?
immobility, bleeding, infection, atrophy
how can a patellar fracture be treated?
wire, screws, patellectomy
steps of IM rod insertion?
guide pin placement, reaming of the IM canal, rod placement, locking screw placements
why is it important to form the stump carefully in a lower extremity amputation?
allows for tie off, prosthesis fits better
what is considered in deciding if a patient is a candidate for limb or digit reattachment?
type of fracture, degree of damage to blood vessels, tissue, nerves
first step in limb/digit reattachment
foreign matter and damaged tissue removed
what pathology occurs that leads to total joint replacement?
degenerative joint diease
what type of systems are total joints that allow for differences in patient anatomy, component fit and surgeon preference
modular
what position is the patient for total hip arthroplasty?
lateral
3 components for a total hip arthroplasty
femoral head/neck, acetabulam
possible complation of total hip arthroplasty
shatter the femur, infection, immobility
who are candidiates for non cemented total joint arthroplasties?
young, healthy, no history of bone disease, strong cortical bone
where is PMMA mixed? why?
mixevac, the fumes are suctioned away since they are toxic
2 types of drains for total joint arthroplasties?
nonreinfusion, reinfusion–not normally used
position for total shoulder arthroplasty
semi fowlers
incision for total shoulder arthroplasty
deltopectoral groove
what does DJD stand for?
degenerative joint disease
when all surfaces of a joint are replaced what is it called?
total joint arthroplasty
3 types of components used for total joints
cemented, noncemented, hybrid
what is PMMA? and 2 parts
bone cement
liquid, powder
risk to you when using bone cement
respiratory tract problems, eye contact
risk to patient when using bone cement
cardiac arrest, hemorrhage
what is always done prior to cementing and why?
irrigation, opens pores of bones, better bonding
what is always done before closure of a total joint?
ROM, check functioning properly
which arthroplasty is done on the upper 1/3 of the leg with the patient in the lateral position?
total hip arthroplasty
what are the most commonly used hip systems?
modular
what does it mean to disarticulate the hip and what instrument is it done with?
dislocate hip, head from acetabulum
flex gently
what type of saw would be used to excise the femoral head?
oscillating saw
3 instruments used to ream the femur?
reamer, broaches, mallet
what could happen if the femur is reamed with a femoral broach that’s too big
shatter the femur
what type of component is slightly rough and has a textured posterior surface?
cemented
what type of componenent has a porous surface on the posterior side?
non cemented
what component costs more for cement?
noncemented
in which total joint arthroplasty is a tourniquet used?
knee, ankle, elbow, digits
3 components for total knee and what they are made out of
femoral: metal
tibial: polyethylene
patellar: polyethylene
when using cement for a total joint, what is avoided until the cement has hardened and why?
movement, may dislocate prosthesis
2 greatest problems after metacarpal arthroplasty?
progression of diseases to other joints
weak ability to pinch
what is usally mixed in with the irrigation for total joint arthroplasties?
antibiotics
what nerve is compressed in a carpal tunnel?
median nerve
2 incisions for closed carpal tunnel
wrist, middle of palm
excision of benign out pouchings of synovium which present as firm masses
excision of ganglion
where are ganglions most common?
palm of hand, wrist
treatment for fractures of the carpals?
closed reduction and immobilization
3 ways carpals are treated with an open procedure
k wires, small screws, mini plates
where is carpal fracture bone graft taken from?
head of the radius
most common wrist fracture?
colles
where is the colles fracture located?
distal end of the radius
what is the most common cause of the colles fracture and what could you used to help prevent it?
breaking fall with hand
wrist guards
what are the 3 common fractures of the elbow?
distal humerus, olecranon, proximal ulnar/radius
2 causes of ulnar nerve damage
trauma to elbow, dislocation of elbow
2 things happen when the ulnar nerve is damage?
sensory loss to hand, atrophy
where is the ulnar nerve usually found?
under the fascia flexor carpi ulnaris muscles
when an ulnar nerve transposition is done, where is the nerve placed?
deep in the brachialis flexor muscle origin
3 proximal femur fractures
intertrochanteric, femoral neck, subtrochanteric
which proximal femur fracture is most common in wisconsin?
intertrochanteric
what type of traction is used in hip fractures to decreases muscle spasm and pain?
bucks
if a femoral shaft fixation is not done correctly, what 3 things could the patient suffer from?
immobility, skin problems, pneumonia
what is the most common tx used for femoral shaft fixation?
IM rods
another name for popliteal cyst?
bakers cyst
3 anatomical sites that are affected with ankle fractures
medial, lateral, posterior
a triple arthrodesis is a fusion of what 3 ankle joints?
talocalcaneal, talonavicular, calcaneocubic
2 reasons why a triple arthrodesis is done?
inversion, eversion of the foot
OR table for acetabular fracture fixation
lateral
fracture table acetabular fracture fixation
supine
what is compartment syndrome and when does it usually occur?
pressure build up from bleeding or swelling of tissues, when blood flow is disrupted
how is compartment syndrome treated?
fasciotomy
Austin moore
replace femoral head and neck
bipolar
only femur is reamed, no acetabulum
replacement of femoral head with prothesis
modular
femoral, femoral head/neck, acetabular
adjust to the patient size
what is a bone hook used for?
disarticulate the hip
what would you hand after the bone hook?
oscilatting saw
another name for the femoral reamer
femoral broach
varus
inward angulation, bowlegged
valgus
angled outward, knock kneed
3 planes of motion for the knee
abduction, flexion, rotation
position for total knee surgery?
supine
unicompartmental implants
either medial or lateral part of knee
bicompartmental implants
tibiofemoral and patellofemoral joints
tricompartmental
femur, patella, tibia
2 saws for total knee
oscillating, reciprocating
what would you anticipate handing the surgeon when placing the pins to stabilize the alignment guides?
saw and mallet
why is the ulnar nerve transposed?
causes sensory loss and atrophy
what instrument is used to free the ulnar nerve?
freer
when would bone grafting be used in humeral shaft fixation?
if severely communited
why is cement used in the case of pathologic fractures?
healing potential is poor
why is gentle reaming of the medullary canal used when placing an IM nail?
to not cause further fracture
how do most clavicular fractures occur?
direct blow to clavicle
most common site of clavicular fracture?
middle 1/3 of bone
how are most clavicular fractures treated?
immobilization
when is an open reduction indicated for clavicular fractures?
distal fracture, nonunion
what are 2 types of fixation devices used with open reduction of the clavicle?
tubular plate, pins
what would you suppose a semitublar plate is, and why would it be used on a clavicle?
curves to bone, contours to bone
what is the most difficult part of surgery for open shoulder?
exposure
partial rotator cuff vs complete tears
partial: from use, middle age
complete: extreme force, athletes
goal of treatment of rotator cuff tears?
alleviate pain, return to normal activities
additional itmes for major tear
suretac
drill with small bit
additional items for minor tear
heavy suture, smoothing
goals for recurrent shoulder dislocation?
complications, correct the problem
what step is added to amke a bankart a putti platt?
subscalpuris tendon
disadvantage of the bristow procedure
loss of internal rotation
how do acetabular fractures usually occur?
severe trauma
safety done for lengthy procedures
cell saver, warm OR, art line, type and cross
why is internal fixation of the trochanter done?
to get pt up, little blood loss
determinants of procedural success?
degree of displacement, early reduction
why is blood loss low on hip and lower extremity
don’t enter joint capsule
what size of instruments are used on hip and lower extremity?
large
what eents can affect the blood supply to the femoral head?
swelling
fractures of the epiphyseal growth plate of the femur in a child?
slip capitol femoral epipshysis fracture
types of pins for epiphyseal growth plate fixation?
hag, holls
most cost effective prosthesis to replace the femoral head?
austin moore
when is austin moore selected?
when life expectancy is short
what condition if present would warrant a total joint arthroplasty?
major deficiency of acetabular side of joint
if femoral shaft fracture not managed appropriately
decrease in mobility, increase in morbidity
femur
largest in body, supports all body weight
possible tx methods for femur
im nails/rods
disadvantages to using plates and screws for femoral shaft fixation?
bend, break
advantages for IM fixation?
increase in load sharing, rod less likely to bend, less scarring
position, prep, drape for tibia
supine, circumferential toes to tourniquet, stockinette, towel, extrem. sheet, split sheet
most common complication of supracondylar fractures?
nonunion
when should repair to the menisci and ligaments?
same time as joint fixation
what do popliteal cysts often indicate in adults?
RA, torn meniscus
position for popliteal cysts?
prone
instruments for popliteal cysts
soft tissue instruments, ronguer
why are tibial shafts difficult to treat?
less blood supply
what tibial fractures heal better?
tortional, less damage to periosteum
when is external fixation tx of choice?
gross contamination
key to successful tx of open tibial fractures?
debride and clean out any non viable tissue
bones for ankle fracture
tibia, fibula
posterior, medial, lateral
where can bone be taken from if more is needed for the bone graft?
iliac crest
hallux valgus
bion
hammer toe
bump in less 4 toes, treated with k wires, plates, screws
prep for knee arthroplasty
toes to tourniquet
tourniquet for shoulder
no
treatment for hip fractures
ASAP
how are acetabular fractures fixed?
mesh, plates, screws
avascular necrosis
risk of femoral neck fractures
complications of avascular necrosis
skin breakdown, pneumonia, DVT
treatment for tibial fracture
IM rod
heel bone
calcaneus
femoral nailing positioner
chick table
suture for attaching tendon to bone
polyglactin 910
acromion process in the AC joint is part of which bone?
scapula
candidates for THA
over 65
what tissue does the acetabular reamer remove?
cartilage and bone
What 3 structures may need a possible resection during a total knee?
Patellar fat lad, ACL, meniscus
Total shoulder prep
Circumferential to wrist
What does a total shoulder do for the patient?
Gives support so rehab can occur
Total elbow position
Supine or semi fowlers
What nerve is avoided in a total elbow?
Ulnar nerve
What’s another name for distal humerus?
Trochlea
Another name for proximal ulnar
Olecranon process
What 2 medullary canals are teamed for a total elbow?
Humerus and ulna
Metatarsal
Toes
Metacarpals
Fingers
What is the implant for finger and toe surgeries called?
Silastic implant
What is the silastic implant supported by?
Ligaments, muscles, tendons
Why would a total shoulder be done?
Physically induced or accidental injury
Femoral shaft fixation
Closed reduction
Bones of the shoulder
Clavicle, scapula, humerus
Detractors used for shoulder surgery
Double end richardson, weitlanders, rakes
Clavicular fracture fixed with open reduction
Tubular plates
What shoulder dislocation surgery is easiest to do?
Bankart
What should dislocation normally doesn’t give good results?
Bristow
4 types of acetabular fractures
Column, t shaped, transverse, isolated posterior wall
