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LOCO2 > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

Name 6 indications for elective adult joint replacement [6]

A
  • Degenerative disease (e.g. osteoarthritis)
  • Inflammatory disease (e.g. rheumatoid arthritis)
  • Trauma (e.g. fracture neck of femur / fracture neck of humerus)
  • Tumour (metastatic / osteosarcoma)
  • Vascular disease (e.g. Avascular necrosis)
  • Revision of previously failed / worn out joint replacement
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2
Q

Name three main types of total hip replacement (THR)

A

Cemented
Hybrid: cemented stem; cementles cup
Uncemented - more expensive but more common

Lots of designs: UK: 2010 at least 123 acetabular cups; 146 stems

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3
Q

Cemented fixations use which material to create fixation? [1]

What is the role of cement in the fixation?

A

Cemented fixation uses an acrylic polymer: Poly(methyl methacrylate) (PMMA)

Cement simply acts as a filler between the bone and the implant

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4
Q

What physiological response occurs as a result of cement fixation insertion? [1]

A

Highly exothermic response: can burn tissue

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5
Q

Cemented THR are more suitable for which patients? [3]
Uncemented THR are more suitable for which patients? [1]

A

Cemented:
* obese patients
* dysplastic hips
* patients with osteoporosis

Uncemented:
* Younger & active patients

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6
Q

Describe the surfarce of uncemented fixation [1]

What complication is more common in uncementated fixation? [1]

A

Uncemented have rough surface covered with porous or hydroxyapatite covering

Can create intraoperative fractures; hole needed in COME BACK

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7
Q

Whats the difference between how long can weight bear between cemented v uncemented? [2]

A

Cemented can weight bear immediately

Uncemented: wait 4-6 weeks before weigh bearing

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8
Q

State 5 newbiomaterials used for replacements [5]

A

Ceramic on ceramic
Metal on metal
Ceramic in cross-linked polyethylene
Oxinium in cross-linked polyethylene
Metal in cross-linked polyethylene

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9
Q

Which type of material causes least infections / best wear rate?

Ceramic on ceramic
Metal on metal
Ceramic in cross-linked polyethylene
Oxinium in cross-linked polyethylene
Metal in cross-linked polyethylene

A

Ceramic on ceramic

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10
Q

Which of the following has the worst wear / break down?

Ceramic on ceramic
Metal on metal
Ceramic in cross-linked polyethylene
Oxinium in cross-linked polyethylene
Metal in cross-linked polyethylene

A

Metal on metal

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11
Q

The sockets are colour coded.
What are each of these made from? [3]

A
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12
Q

The sockets are colour coded.
What are each of these made from? [3]

A
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13
Q

What is a major problem with THR? [1]

A

Can wear down

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14
Q

What is this? [1]

Which joint does it replace [1]

A

Speedspiral: tightly rolled acellular human collagen: encourages fibroblast to move in

Replaces carpometacarpal phalangeal joint

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15
Q

Four reasons why may need spinal decompression surgery? [4]

A

Spinal stenosis
Damaged IV disc
Fractured vertebrae
Tumours

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16
Q

What is spinal fusion? [1]

A

Where 2 or more vertebrae are joined together with a section of bone to stabilise and strengthen the vertebral column

17
Q

What is a spinal bone graft? [1]

A

fuse together painful or unstable bones in the spine so that they heal into a single, solid bone.

18
Q

State and describe this process

A

Vertebroplasty: the injection of bone cement into the vertebral body in order to relieve pain and / or stabilise the fractured vertebra

19
Q

foot drop x

A
20
Q

Tendon transfer upper limb

A
21
Q

Describe why may undergo tendon lengthening for the Achilles [1]

What are they two methods? [2]

A

Plantar flexors are more powerful than dorsiflexors; can get hypertonia of plantar flexors

Surgery can lengthen the achilles:
- Cut a V into the achilles and lengthen
OR
- Cut a Z into achilles and lengthen

22
Q

What are the two methods for ACL reconstruction?

A

Patella - ligament - tibia

Hamstring: semitendinous and or gracilis tendons

23
Q

What is a free muscle transfer? [1]

A

Take whole muscle (& overlying skin) and place elsewhere in body

24
Q

Which muscle is commonly used for free muscle transfer? [1]

Expl

A

Rectus femoris
Place femoral nerve that have detached and link to tibial nerve

25
Q

What are the three types of poor fracture healing? [3]

A

Delayed
Malunion
Non-union

26
Q

Explain the different types of poor fracture healing [3]

A

Delayed
Failure to consolidate within 1.5x the normal expected time

Malunion:
Misalignment of proximal and distal fragments leading to biomechanical deformity:
* Rotation
* Angulation
* Shortening
* Translation

Non-union
* Failure to consolidate within 2x the normal expected time
Can be Atrophic / Hypertrophic depending on blood supply and degree of stability

27
Q

What is the difference between atrophic and hypertrophic blood supply in non-union fracture healing? [2]

A

Hypertrophic – there is a blood supply that causes bone growth on either side of the fracture but if there is adequate insecure fixation the fracture moves and forms a callus that may continually break and reform.

Atrophic – no blood supply

28
Q

What are osteotomy [1] and distraction osteogenesis? [1]

A

Distraction osteogenesis (i.e. bone lengthening procedures)
* Progressive correction with use of an external fixator (e.g. Ilizarov technique)

Osteotomy
* Re-alignment osteotomy

29
Q

Explain the four different types of bone grafts

A

Osteogenesis
* Formation or development of new bone cells contained in graft
* The cells are the “seeds”

Osteoconduction
* Physical effect by which the matrix of the graft forms a scaffold that favours outside cells to penetrate the graft and form new bone
* The scaffolds are the “trellis”

Osteoinduction
* Chemical process by which molecules contained in the graft convert the neighbouring cells into osteoblast
* Growth factors are the “fertilizer”

Osteopromotion
* When the grafted material enhances osteoinduction
* Trellis and fertilizer, or trellis and seeds

30
Q
A
31
Q

Describe the process of aseptic loosening

A
32
Q

Difference between hybrid and reverse hybrid fixations? [2]

A

Hybrid fixation
Femoral component inserted without cement while acetabular is

Reverse hybrid fixation
Acetabular component inserted with cement while femoral isn’t

33
Q

Difference between hybrid and reverse hybrid fixations? [2]

A

Hybrid fixation
Femoral component inserted without cement while acetabular is

Reverse hybrid fixation
Acetabular component inserted with cement while femoral isn’t

34
Q

Tendon transfer for wrist extension (radial nerve palsy)? [2]

A

PT (pronator teres) to ECRB (extensor carpi radialis brevis)

35
Q

Tendon transfer for finger MCP extension? (radial nerve palsy)? [2]

A

FCU to EDC (extensor digitorum communis)

36
Q

Tendon transfer for thumb extension? [2]

A

PL (palmaris longus) to rerouted EPL (extensor pollicis longus)

LOCO2 (58 decks)

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