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BMSc > Ortho unit 1 > Flashcards

Ortho unit 1 Flashcards

1
Q

orthopaedics

A

straight children

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2
Q

acute disease

A

strikes suddenly, production of polymorphs- leucocytes

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3
Q

chronic disease

A

takes a long time to develop, characterised by lymphocytes- produced in bone marrow and spleen

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4
Q

opening a joint

A

arthrotomy

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5
Q

removing something e.g. removing a meniscus

A

ectomyw eg menisectomy

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6
Q

what is most joint replacement surgery aimed at

A

pain relief

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7
Q

self limiting

A

temporary and will get better e.g. muscle tears and ligament sprains

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8
Q

congenital abnormalities

A

defects associated with development in the womb

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9
Q

inflammatory abnormalities

A

bacterial infection causing inflammation of joint (infective arthritis) or bone (osteomyelitis). Sometimes inflammation is unknown cause e.g. RA

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10
Q

metabolic disorders

A

gout- uric acid crystals deposited on cartilaginous surface of joints

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11
Q

degenerative disorders

A

normal structure of the joint has been disturbed through deterioration and wear- OA

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12
Q

trauma

A

msk system suffered damage

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13
Q

2 principle symptoms in orthopaedics

A

pain and stiffness

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14
Q

osteoarthritis

A

pain and limitation of movement of joints associated with excessive wear of articular cartilage resulting from the break down of balance between wear and repair processes

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15
Q

Aetiology of OA

A

known cause- secondary arthritis, unknown cause - primary OA- majority

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16
Q

secondary oa

A

congenital dislocation of hip, perches disease, infection, trauma, gout, infection-TB, chronic inflammatory- rheumatoid

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17
Q

OA clinical picture

A

can occur at any age but becomes increasingly common later in life. Pain, loss of function of joint, stiffness (nearly always secondary to pain)

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18
Q

when would a GP refer OA to secondary care

A

when the patients sleep is disturbed by pain

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19
Q

examination of OA

A

symptoms of pain and associated limitation of movement

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20
Q

management of OA

A

all aimed at pain relief
conservative- weight loss- quite modest reductions in body weight will result in significant reductions in total loads being borne by joint
walking stick- shoulder girdle can help in tilting the pelvis and so help in weight bearing. Stick reduces the work required of the weight bearing abductor muscles
Physio- controversial- balance between excessive exercising and excessive resting (both are bad)

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21
Q

surgical options for OA

A

Arthrodesis, osteotomy, arthroplasty

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22
Q

arthrodesis for OA

A

surgical stiffening og a joint in a position of function- appropriate for a young person with a painful and limited range of movement. Stiff painful bit of bone is cut out, raw bone ends held together by external splint or screws until they heal with a bony bridge

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23
Q

long term disadvantage of arthrodesis

A

puts stress on adjacent joints e.g. in hip more stress on spine or adjacent hip

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24
Q

joints that can usefully be fused

A

ankle and wrist- small joints easier to hold bone ends together

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25
Q

double op for OA

A

fuse joint until 5th decade then unpick and do arthroplasty

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26
Q

osteotomy for OA

A

surgical realignment of joint. Aim- redirect forces across a joint so that they distribute the load more evenly. Generally performed where joint has become deformed and the loads crossing it are distorted- e.g. knee- bow legged- load passes down medial side of joint instead of middle

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27
Q

principle indication for operative treatment of OA

A

pain

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28
Q

value of osteotomy

A

young who have retained good range of movement

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29
Q

arthroplasty

A

replacement of one or both surfaces of a joint

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30
Q

limitations of joint replacement

A

artificial joint begins to wear out from the moment its put in. Arthroplasty improves pain related loss of function but does relatively little for intrinsic stiffness

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31
Q

amount of flexion required by knee to get up and down stairs

A

90

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32
Q

most successful and common joint replacement

A

hip

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33
Q

3 requirements of any joint replacement

A

functional pain free movement, stability and resistance to forces wear and loosening

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34
Q

1 principle difference between requirements of an upper limb and lower limb joint replacement

A

upper limb- less load but greater range of movement required

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35
Q

important type of movements for knee

A

flexion and extension

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36
Q

important types of movements for hip

A

flexion extension and abduction

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37
Q

early complications of arthroplasty

A

dislocation- immediately post op- prosthesis won’t be supported by the surrounding tissues. Risk of dislocation reduces over time
DVT- prophylaxis eg heparin
Infection- staph aureus, staph albus- antibiotic prophylaxis

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38
Q

late complications of arthroplasty

A

infection- bacteraemia

Loosening and wear- loosening to some degree is probs inevitable

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39
Q

general complications of surgery

A

DVT, pressure sores, infection

40
Q

Rheumatoid arthritis clinical picture

A

severe pain, swelling and deformity of the joints

41
Q

principle joints affected in RA

A

small joints of hands and feet- affected symmetrically, no pattern in larger joints

42
Q

Typical RA patient

A

women more free affected than men, can occur at any age

43
Q

first symptoms of RA

A

stiffness worse in mornings, improving throughout the day

44
Q

role of surgery for RA

A

synovectomy- removal of the synovial membrane.
Excision arthroplasty may be combined with synovectomy at elbow and wrist.
Most of the surgeons role is salvage- goals are pain relief and return of function

45
Q

Avascular necrosis

A

bone tissue loss due to lack of blood supply

46
Q

Areas at risk of AVN following trauma

A

femoral head
proximal part of scaphoid
proximal part of talus

47
Q

femoral neck fractures

A

damage to capsular blood vessels puts femoral head at risk

48
Q

where is avascular necrosis of the femoral head seen

A

chronic alcohol abuse, high dose steroid therapy and in deep sea divers (caissons disease)- patient presents with acute and often severe joint pain, made worse by movement and to some degree relieved by rest.

49
Q

typical age of patient with AVN

A

many are young

50
Q

diagnosis of AVN

A

difficult- no changes to be seen on x ray. later, the bone appears dense, reflecting the absence of blood vessels

51
Q

can AVN be reversed

A

yes if a blood supply can be re established naturally- bone soft and prone to distortion in re vascularising stage with secondary arthritic changes

52
Q

management of AVN

A

treatment non specific, joint should be rested if possible, surgery is of no value in treating the underlying condition - often surgeon left to salvage the joint with joint replacement - highly problematic as patients often young

53
Q

why do crystal arthropathies occur

A

excess production or kidneys failing to eliminate

54
Q

gout

A

urate crystal deposition. rate is a waste product of cell metabolism- becomes deposited in circumstances such as dehydration and after chemo.

55
Q

what is probably the most common cause of gout

A

overuse of diuretics

56
Q

gout presentation

A

hot, tender, swollen joint

57
Q

where is gout commonly seen

A

knee, 1st MTP- important to exclude infection

58
Q

diagnosis of gout

A

detecting the presence of a high level of uric acid in the blood. more accurate- extracting joint fluid through a syringe and testing for presence of urate crystals

59
Q

gout treatment

A

anti inflammatory drugs- reduce inflammation and help kidneys to eliminate

60
Q

pseudo gout

A

less acute presentation than gout. Deposition of calcium pyrophosphate crystals

61
Q

what does chronic pseudo gout cause

A

calcification of joint surfaces and the menisci in the knee

62
Q

treatment of pseudo gout

A

symptoms may be controlled with anti- inflammatory drugs but long term degradation is likely

63
Q

possible long term complication of crystal arthroplasty

A

secondary arthritis

64
Q

two types of AVN

A

post traumatic, caissons disease

65
Q

acute septic arthritis

A

infection caused by bacteria- spread to joint via the blood from site of trivial infection. rarely occurs from direct penetration of the jointly a sharp object

66
Q

clinical presentation of acute septic arthritis

A

children- acute illness during which the child is unwell with a high temp- affected joint is stiff, hot sonf tender
Adults- less acute illness. Patient remains unwell for several days before presenting with blood poisoning- many patients die because of the delay in recognising the condition

67
Q

Most likely cause of young adult with septic arthritis

A

gonococcus- venereal disease

68
Q

management of acute septic arthritis

A

surgery and IV antibiotics- joint should be opened and washed. First guess antibiotic- anti staphylococcal agent in children

69
Q

risks of septic arthritis if treatment inadequate

A

septicaemia, disintegration of articular cartilage leading to fibrous or even bony fusion of the joint

70
Q

chronic septic arthritis

A

joint TB - aids patients particularly prone. TB bacteria spread to joints via blood, kidney and joint TB often found together

71
Q

clinical presentation of chronic septic arthritis

A

chronic ill health, weight loss and considerable muscle wasting around the affected joint. X rays show marked thinning of the bone

72
Q

management of chronic septic arthritis

A

antibiotics for tb - RIPE

73
Q

mechanical knee problems key symptoms

A

swelling, locking, giving way, pain

74
Q

meniscal knee lesions

A

more common in men, can rarely occur in adolescents and occasionally children are born with an abnormal lateral meniscus

75
Q

symptoms of meniscal lesions

A

pain, joint effusion, sometimes locking and giving way. abnormality is poorly localised on examination

76
Q

principle cause of meniscal lesions

A

twisting injury

77
Q

which meniscus is more frequently torn

A

medial - can be torn at its peripheral attachment or actually within its substance

78
Q

cleavage lesion

A

meniscus split horizontally- common in old age. Occasionally cleavage lesions act like flap valves and allow a build up of synovial fluid within the meniscus, forming a cyst

79
Q

bucket handle tear

A

vertical split, anchored at each end

80
Q

parrot beak tear

A

split off one end of the lateral meniscus

81
Q

degenerate tear

A

tear due to degeneration

82
Q

consequence of a meniscal tear

A

torn part becomes jammed in the joint, stopping it extending

83
Q

management of meniscal lesions

A

meniscus is important and should be preserved as much as possible during surgery. Peripheral tears can be reattached with sutures. Tears within the substance have no capacity to repair and the torn peripheral part should be removed

84
Q

examination of meniscal lesions

A

arthroscopy- small optical instrument introduced into the knee koint- most meniscal lesions can now be removed by the arthroscope (arthroscopic meniscectomy)- some require a small opening made into the joint (arthrotomy)

85
Q

arthroscopic meniscectomy vs open meniscectomy

A

patients recover quickly from arthroscopic

86
Q

Loose bodies

A

osteochondral fragments may be sheared off in an injury- knee subsequently swells up due to haemarthrosis. Osteochondral fragment is called a loose body and is often not resorbed but lives floating free in the synovial fluid

87
Q

clinical presentation of loose body

A

may settle in the first incidence buy months or years later the patient can present with locking, pain and giving way, often with effusion

88
Q

management of loose body

A

removal with arthroscope

89
Q

osteochondritis dissecans

A

osteochondral fragments occurring spontaneously in adolescents. Tends to settle spontaneously but loose bodies may require removal

90
Q

why do soft tissues to collateral ligaments heal spontaneously and cruciate tears don’t

A

collateral ligaments have an excellent blood supply. Cruciate ligaments aren’t capable of spontaneous healing because the blood supply is lost when torn

91
Q

How is cruciate ligament injured

A

hyperextension or twist, often associated with foot being anchored by a studded boot or ski

92
Q

clinical presentation of cruciate ligament injury

A

swelling- indicating haemarthrosis, patient can feel a pop, swelling resolves over a few weeks, loss of AP stability, particularly in flexion and loss of rotary stability when twisting or turning

93
Q

management of cruciate injury

A

ligament should be left untreated for a while and the knee muscles rehabbed. Treatment should only be offered if symptoms interfere with daily life. Treatment- replacing torn ligament with artificial one- artificial ligament more likely to fail because it has no sensory receptors in it to let the brain know if the ligament is being over stretched

94
Q

dislocation of the patella

A

usually associated with malformation of the patella or the lateral femoral condyle- leads to patella moving abrasively over the femur (malt racking) which is painful due to the associated muscle spasm

95
Q

clinical presentation- dislocation of the patella

A

spontaneous dislocation of patella and failure of quads group to act as an extensor, so the person falls to the ground

96
Q

management of dislocation of the patella

A

minor degrees of mal tracking- dealt with by surgical splitting of the vests laterals muscle insertion into the patella, allowing the patella to fall back into a normal relationship to the femur. If its recurrent and severe- medial tightening (plication) of vests medals muscle may be required. In adulthood- the patellar tendon may be rested more medially

97
Q

define plication

A

medial tightening of the vests medals muscle

BMSc (9 decks)

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