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Sub-Acute Exam > Orthopaedic > Flashcards

Orthopaedic Flashcards

1
Q

DR Referral - Red Flags

A

Fever
New or worsening numbness, tingling, or weakness in limbs.
Bladder/bowel dysfunction
Redness, warmth, swelling, or
increased pain at the surgical site.
Cold, pale, or bluish limbs.
Swelling, warmth, and pain in the calf
(indicative of DVT).
Unexplained weight loss (>5kg in 2
weeks)

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2
Q

How to treat degenerative tear for Meniscus

A

Conservative treatment is usually the first line and surgery is recommended if it fails (also for older people)

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3
Q

How to treat Traumatic tear for Meniscus

A

Surgery is often necessary inner-two thirds especially as no vascularisation

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4
Q

Achilles tendon treatment surgery

A

When >5 days
Increased risk of infection
re-rupture rate 2/100
high cost

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5
Q

Achillies tendon treatment conservative

A

Reduce re-rupture rate 4/100
Reduce the risk of infection
<5 days can start with a conservative (benefits from bleeding of the tear)

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6
Q

TKR and THR Treatment

A

GLAD protocol recommends conservative management as 1st line treatment (education, exercise and weight loss)

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7
Q

Types of ACL surgery

A
  • Autografts – tissue from patients’ own body.
  • Allografts = tissue from donor (revision surgery)
  • Hamstring graft = might have some weakness in hamstrings, this graft is a lot looser and more lax
  • Patella graft = stronger, trouble with extension and PFPS
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8
Q

Types of THR surgery

A

Posterior - glute max fibres dissection (hip extension) –> high dislocation rate
Anterior - TFL and sartorius muscles
Anterolateral - TFL and glute med –> can have limp (medium dislocation rate)
Lateral - splits TFL to get through to glute med –> Trendelenburg, nerve damage = hip abductor weakness (lowest dislocation rate)

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9
Q

Laminectomy for LSF

A

Removal of Lamina to enlarge the spinal canal

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10
Q

Foraminotomy

A

widening the space where the nerves leave the spine

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11
Q

When is a Open RC Repair used and when would arthroscopic performed

A

Large or complex tears where the tear is completely retracted off the bone or needs greater access to the torn tendons.
Arthroscopic is smaller procedures and tears –> can even be to just have a look but is become more popular for all RC tears

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12
Q

Indications for THR

A

Debilitating pain highly impacting function
- Avascular necrosis
- End stage symptomatic hip OA
- Congenital hip disorders including hip dysplasia, and inflammatory arthritic conditions
- Pain
- Osteoarthritis (~85% of all THR)
- Rheumatoid arthritis
- Post-traumatic arthritis
- Developmental abnormalities of the hip
- Limited success with conservative Mx
- Trauma (e.g. fall)

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13
Q

Indications for LSF

A

● Similar to indications for ACDF
● Severe pain
● Unstable #’s
● Progressive spondylolisthesis

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14
Q

Indication for RC Surgery

A

Failure of 3–6-month conservative plan OR
An acute full-thickness tear in active patient < 50 y/o (Difficult to determine without imaging) Conservative plan failure is defined as:
- Persistent symptoms
- Failure to tolerate therapy due to pain
- Plateau of initial improvement with persistent symptoms
Acute trauma with full-thickness tears associated with significant RC weakness

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15
Q

Indications for Shoulder Reconstruction

A

High pain (+ night pain) and disability
- Advanced OA
- RC Arthropathy
- Serious pathology, e.g. avascular necrosis with glenoid involvement, some proximal humerus #’s
- Revision surgery

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16
Q

Worse outcomes for THR

A

Prior hip surgery
Elderly age (older than 70 years)
Component malpositioning: Excessive anteversion results in anterior dislocation and
excessive retroversion results in posterior dislocation
○ Neuromuscular conditions/disorders (for example, Parkinson disease)
○ Drug/alcohol abuse

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17
Q

Worse outcomes for RC tear

A

●Surgery due to rheumatoid arthritis or trauma
● Severe loss of PROM
● Increased number of comorbidities
● Radiographic evidence of humeral head subluxation
● Loss of posterior glenoid bone
● Significant rotator cuff pathology
● Increased fatty degeneration of the infraspinatus, subscapularis

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18
Q

Better outcomes for RC Tear

A

● No previous surgery
● Higher level of preoperative function
● Minimal rotator cuff pathology
● Overall well-being of the patient before surgery
● Surgery because of primary osteoarthritis

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19
Q

Non-Modifiable risks for ACL Injury

A

Gender
Variations in bone morphology
Neuromuscular control
Genetics - CC genotype variant in COL541
Hormones
Previous ACLR

20
Q

Modifiable risks for ACL injury

A

Young playing age
Weather
Friction (number of cleats)
Earlier, more intense and more frequent participation in sport

21
Q

KANON Trial

A

I found no difference between the knee being surgically reconstructed earlier or late there is just risk that patient will need surgery later down track and will take longer for recovery

22
Q

SNAPP

A

Better 18month outcome with those that had early recon compared to delay –> due to recovery time I assume

23
Q

3 types of ACL treatments

A
  1. ACLR followed by rehab
  2. Rehab first line of treatment and then surgery if patient develops functional instability
  3. Preop rehab and ACLR (not to be used with meniscal tears)
24
Q

What is the Weber Classification

A

Weber A - #’s inferior to syndesmosis, usually stable and able to do conservative Mx

Weber B - #’s at the level of syndesmosis can be stable or unstable depending if Medial Malleolus # or deltoid ligament injury or syndesmosis intact or not, may need ORIF

Weber C - #’s above syndesmosis, syndesmosis is not intact, Medial and deltoid injury, ORIF required due to unstable

25
Q

WEBER B Mx

A

Traditional cast compared to foot orthosis is just as effective for ankle function and fracture healing as the conventional 6 week immobilisation in a cast –> shorter immobilisation could be viable option for patients (short term is close enough in effectiveness to the long term)

26
Q

Precautions after THR

A

No twisting of the leg
Leg to not cross the midline of the body
No hip flexion past 90º
No hip extension past netural
PWB
no excessive hip ABD
Avoid reaching across
Must get in and out of bed on the operated side
–> 6 weeks usually

27
Q

Progression of Assistive Aid

A

FASF
2WF
Pick up frame
Crutches
stick

28
Q

Difference between WB post THR or ORIF

A

THR - WBAT from day 1
ORIF - NWB (6-8/52)
- PWB (8-10/52)
- FWB (10-12/52)

29
Q

Evidence for traction

A

NICE and AAOS guidelines do not recommend traction as pre-surgery Tx due to lack of efficacy and surgeons can now get more stability in the Sx itself

30
Q

ACDF Surgery precautions and instructions

A

Must:
Log roll
Wear cervical collar if told for 2/52
Wear Philadelphia collar or soft collar 48hrs unless an exception
Sleep on the firm pillow to support the neck
Change positions regularly
See a Dr if red flags become present

DO NOT:
Get the surgical site wet
lift arms above 90º
Do not lift anything heavier than 1.5kg
Do not bend, twist, lift
Do not sleep with arms overhead
Do not spend all your time in bed
Do not drive until cleared
Do not perform strenuous activities

31
Q

Evidence for Cervical Spine Surgery

A

At the 2-year mark, there is no significant difference between arm pain and function in the conservative group. Surgery has massive improvements in pain and neck disability index in the first year but evens out by year 2.
Surgery = speed recovery and reduce pain faster (comes with complications)

32
Q

Standard precautions following LSF

A

Do Not Do:
No bending, lifting or twisting
No lifting more than 5kg
No driving unless cleared
No over extending
No prolonged sitting for >30-60mins

Must:
Incorporate log rolling
Gradual Ambulation
Stabilisation exercises for breathing and relaxation (extensor spinal muscle)

33
Q

Referral - Pseudoarthrosis

A

Inadequate unloading to allow healing to occur in the fusion site or because of a delay in diagnosis. Interrupts the bones ability to heal, creating a scar tissue to form in between like a fibrous joint.
- can have axial radicular pain
- widespread pain around the abdomen
- strange and persistent neurological pain

34
Q

Referral - DVT

A

Blood clot that forms within the deep veins due to immobilisation 9can travel proximally
- Odema
- red and hot skin with a dilated vein
tenderness
- Wells scoring ≥2

35
Q

Referral - Infection

A

Pain (insidious 1 month post-op
swelling or erythema at the incision
wound dehiscence and purulent drainage from wound

36
Q

Referral - Cauda Equina Syndrome (L1-L5)

A

Spinal cord is so compressed –> lower region (lumbar spine)
- urinary retention
- radicular pain down the back of legs
- Reduced anal sphincter tone
severe low back pain
- Sensory loss
- Sexual dysfunction

37
Q

Sx VS Cx for lumbar spine fusion

A

Surgery is preferred as it provides faster pain relief, improved QOL, and functional improvement and is essential for those with severe conditions.
Conservative treatment can be used for low severity patients
–> will clinically see more improvement with fusion.

38
Q

RCT Surgery Precautions 0-4/52

A

No pushing, pulling or lifting
No shoulder extension, abduction or IR
No overhead movements
No excessive stretching or sudden movements
Sling must be worn 24/7 for the first 6 weeks
No sleeping on the affected side
Wound Mx
keep the incision dry/ use shower sling
No BW through arms or hands or leaning on both elbows
No muscle activation for 6-8/52

39
Q

Subacromial Shoulder Pain - arthroscopic Subacromial decompression

A

Surgery group had better outcomes in terms of functionality, pain compared with no treatment but was not clinically significant–> surgery is a quick fix at the end of the day
Either surgery does the job and neither are superior of each other.

40
Q

Physiotherapy Repetitive Exercise compared with best practice

A

PRE was not sueprior
Corticosteroid injections had no long term benefit

41
Q

Non-traumatic RC tear

A

Conservative treatment is a reasonable option for the primary initial treatment for isolated, symptomatic, non-traumatic, supraspinatus tears in older patients. –> There was no clinical difference between the three interventions

42
Q

Definition: Mean Difference

A

The bigger the mean difference the better = will depend on what the clinically significant number is

43
Q

Definition: clinical worthwhile effect

A

Determine how much of a change is needed

44
Q

Definition: Confidence Interval 95%

A

The smaller the confidence interval, the better, as it means there is a smaller chance the researchers have got it wrong for which outcome is better

45
Q

12 factors that affect Rehab after RC repair –> may give in relation to other joint

A
  1. Surgical approach
  2. Size of tear
  3. tissue quality
  4. fixation method
  5. location of tear
  6. type of tear
  7. mechanism of failure
  8. timing of surgery
  9. characteristics of the patient
  10. RC tissue quality anterior and posterior of tear site
  11. Access to care
  12. Physiotherapy philosophical approach
46
Q

Achilles Tendon Rehab

A

Wear Cam boot 24/7 for 2 weeks
2cm heel lift for 6-8 weeks, reducing the height.
Cam boot must be worn for 3 months total

47
Q

RC Tear Rehab

A

On for 24/7 for the first 6 weeks
Can remove sling when resting or sitting with the arm by side
Remove arm from the sling 3-4x/day to bend and straighten your elbow → arm needs to be supported
however throughout

Sub-Acute Exam (4 decks)

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