Orthopaedics Flashcards
What is osteoarthritis?
Wear and tear in synovial joints
Imbalance between cartilage damage and chondrocyte response
What are the risk factors for osteoarthritis?
Obesity
Age
Occupation
Trauma
Female
FHx
Which joints are commonly affected in OA?
Hips
Knees
DIP hands
CMC thumb
Lumbar spine
Cervical spondylosis
What xray changes are seen in OA?
L- Loss of joint space
O- Osteophytes
S- Subarticular sclerosis (increased density bone along joint line)
S- Subchondral cysts (fluid filled holes in bone)
Outline presentation of OA
Joint pain and stiffness- Worse with activity and at end of day
Bulky, bony enlargement of joint
Restricted ROM
Crepitus on movement
Effusions (fluid) around joint
What are the hand signs in OA?
Heberden’s nodes (DIP)
Bouchard’s nodes (PIP)
Squaring at base of thumb
Weak grip
Reduced ROM
Outline diagnosis of OA
Clinical diagnosis if >45y, has typical pain associated with activity and no morning stiffness
Outline management of OA
Therapeutic exercise, weight loss, OT
1st line- Topical NSAIDs
Oral NSAIDs as required (with PPI)
Intra-articular steroid injections- Improve symptoms for up to 10wks
Joint replacement
What are the SEs of NSAIDs
GI- Gastritis and peptic ulcers
Renal- AKI and CKD
CV- HTN, HF, MI, stroke
Exacerbating asthma
What are the indications for joint replacement?
OA (most common)
Fractures
Septic arthritis
Osteonecrosis
Bone tumours
RA
What are the options for joint replacement?
Total- Replace both articular surfaces of joint
Hemiarthroplasty- Replace half joint
Partial joint resurfacing- Replace part of joint surface
Outline what occurs during joint replacement surgery in terms of anaesthetics and drugs
General anaesthetic
Prophylactic ABs
TXA
What guidance regarding VTE prophylaxis is given after joint replacement surgery?
LMWH:
28d hip
14d knee
Can also use aspirin, DOAC or anti-embolism stocking
What are the risk factors for prosthetic joint infection?
Prolonged operative time
Obesity
Diabetes
What are the symptoms of a prosthetic joint infection?
Fever
Pain
Swelling
Erythema
Increased warmth
Outline prosthetic joint infections
More likely to occur in revision surgery
Most common- Staph aureus
Outline diagnosis of prosthetic joint infection
Clinical findings
Xrays
Raised inflammatory markers
Cultures (blood or synovial fluid
Outline management of prosthetic joint infection
Repeat surgery- Joint irrigation/debridement/complete replacement
Prolonged ABs
What is a compound fracture?
Skin broken, broken bone exposed to air
What is a stable fracture?
Sections of bone remain in alignment
What is a pathological fracture?
Bone breaks due to abnormality within bone
What is a comminuted fracture?
Breaks into multiple fragments
What is a Salter-Harries fracture?
Growth plate fracture
Only occurs in children
What is a greenstick fracture?
Bone cracks on one side- Not all way through bone
More common in children