Orthopaedics - SAQ questions Flashcards
Define a chronic disease.
A chronic disease is a disease which takes a long time to develop and may last a long time. It is characterised by the bodies immune reaction producing lymphocytes in response to development of the disease.
Name the two principal symptoms in orthopaedics.
The two principle symptoms in orthopaedics are pain and stiffness (loss of normal function of joints).
What does the term ‘orthopaedics’ mean
Literally “orthopaedics ”means “straight children” but today it means the field of medicine concerned with diseases of the musculoskeletal system.
Define osteoarthritis.
OA is a condition which results in excessive breakdown of articular cartilage due to an imbalance in the wear and repair of the joint, this results in pain and limitation of movement (stiffness) of the associated joint
What is the principal difference between primary and secondary arthritis?
The principle difference is that primary OA is OA which has arisen due to an unknown cause, secondary OA is OA which has arisen due to an identifiable cause
Which is more significant in arthritis - pain or stiffness?
Pain is the most significant feature in OA, stiffness is secondary
Name the three conservative measures for treating osteoarthritis.
Conservative measures for treating osteoarthritis are weight loss, use of a stick, rest and physiotherapy.
What is the principal indication for operative treatment in arthritis?
Pain is the principal indication for operative treatment.
Name four treatment options for OA
Four treatment options would be doing nothing, arthrodesis, osteotomy and arthroplasty.
Which is the most successful and common joint replacement?
Hip replacement
Name three requirements of any joint replacement.
- Functional and pain-free range of movement
- Stability
- Resistance to forces, wear and loosening
These are the 3 requirements for any joint replacement.
Name one principal difference between the requirements for an upper limb and a lower limb joint replacement.
An upper limb joint replacement must be capable of a larger range of movement than a lower limb joint replacement, but it does not require to withstand such large forces.
Name the important types of movement of: (i) the knee and (ii) the hip.
i) Flexion and extension are the important types of movement of the knee.
ii) Flexion, extension and abduction are the important types of movement of the hip.
Name 2 early specific complications of arthroplasty
- Dislocation
- DVT ==> PE
- Infection
Define a bacteraemia.
This is the presence of bacteria in the blood stream
Describe 3 general complications of surgery.
- Chest and urinary tract infections
- DVT ==> PE formation
- Pressure sores
Which late complication is possibly almost inevitable?
Loosening and wear
Define rheumatoid arthritis.
RA is a chronic inflammatory disorder of many systems of the body, the cause of which is unknown. It manifests itself as joint pain and can result in deformities in the joints as the disease progresses.
Which joints are most commonly affected in RA?
The fingers, wrists, feet and ankles
unlike in OA in which larger joints are more commonly affected e.g. knees and hips
What is a synovectomy?
This is the surgical removal of the synovium (synovial membrane) from a joint
Outline the role of surgery in rheumatoid arthritis.
The role is to reduce pain and retain as much function to the joint as possible
The deposition of which crystal causes gout?
Deposition of urate crystals
What is the possible long-term consequence of crystal arthroplasty?
They can cause a chronic degenerative change in the joint and be a secondary cause of arthritis
Name two types of avascular necrosis.
Two types of avascular necrosis are post traumatic and Caisson’s disease.
Find out if ans would also be spontaneous/unknown cause?
What role has the surgeon in the treatment of avascular necrosis?
The surgeon has NO role in the treatment of avascular necrosis until the joint requires replacement
Again I think this is incorrect as there is surgical decompression and drilling ?
What happens to menisci in knees affected by pseudogout?
In knees affected by pseudogout the menisci become calcified.
What kind of cells would you expect the immune defence system of the body to produce in response to tuberculosis?
As it is a chronic disease you would expect the immune system to produce lymphocytes in response to TB e.g. B & T lmyphocytes and also NK cells
Which organism may cause septic arthritis in young adults?
Gonoccocus
Name two important elements in the management of acute septic arthritis
Surgery and IV antibiotics are two important elements in the management of acute septic arthritis.
What is the important difference between treating tuberculosis and acute septic arthritis?
The important difference between treating TB and acute septic arthritis is that surgery is rarely necessary in the treatment of TB.
Name the four cardinal symptoms of knee disorders.
The four main symptoms of knee disorders are:
- swelling
- locking
- giving way
- pain
Define an effusion.
An effusion is excess fluid in the joint
List the most common types of meniscal lesion
Bucket handle tear and Parrot beak tear are the two most common
What is a loose body?
A fragmeant of cartilage or bone which has broken off and is free floating within the synovial fluid in a joint
Why do cruciate ligaments not heal spontaneously?
When a cruciate ligament is torn it loses its blood supply and therefore cannot heal spontaneously.
Define plication.
Plication is a medial tightening of the vastus medialis muscle (one of the quadriceps muscle group).
Give two possible aetiologies of dislocation of the patella.
Malformation of the patella or the lateral femoral condyle are two possible aetiologies of dislocation of the patella.
Why are prosthetic knee ligaments liable to fail?
Prosthetic knee ligaments are liable to fail as they have no sensory receptors and so may be overstretched without the brain “knowing”. The brain is therefore unable to initiate protective muscle action.
Define spondylitis.
Spondylitis is pain occuring due to disease of the discs, bones, muscles, joints or ligaments in the spine.
List three types of pain experienced in spinal disorders.
- Local
- referred
- nerve root pain
How is referred pain in the leg distinguished from sciatica?
Referred pain - down leg and buttock and always above knee.
Nerve root pain - down leg to foot, can also have localising signs (loss of sensation & weakness)
List the main categories of back disorders (i) related to spondylitides (ii) related to nervous tissue.
i) Related to spondylitides - aches and sprains, mechanical back pain, spondylolisthesis.
ii) Related to nervous tissue - disc prolapse, bony root entrapment.
What is spondylosis?
Spondylosis is degeneration of intervertebral discs and associated wear and arthritis of facet joints in the motion segment.
What is (i) the difference and (ii) the similarity between spondylolysis and spondylolisthesis?
i) Spondylolysis is a condition in which there is a defect or stress fracture in the pars interarticularis of the vertebrae whereas spondylolisthesis implies slipping of one vertebra relative to another, due to spondylolysis
ii) Spondylosis and spondylolisthesis both cause pain.
In two sentences, compare and contrast bony root entrapment and disc prolapse.
Bony root entrapment occurs in older people with degenerative disc disorders whereas disc prolapse occurs in young people where the disc material is abnormal and the disc collapses.
Define a spinal claudication.
A spinal claudication is nerve root pain brought on by exercise
To which other parts of the body may neck pain be referred?
Neck pain can be referred to the arm and shoulder.
Do disc prolapses in the cervical spine usually need surgery?
Disc prolapses in the cervical spine do not usually require surgery.
Define cervical spondylosis.
Cervical spondylosis is a degenerative disease of the cervical discs leading to secondary arthritic changes in the adjacent facet joints.
List four minor childhood disorders resulting in walking/posture problems
- Knock knees/bow legs
- In-toeing
- Flat feet
- Curly toes
List the causes of in-toeing.
- Femoral neck angle variation - mainly femoral neck anteversion
- Tibial torsion
- abnormal forefeet - mainly forefoot adduction
What are the two types of flat feet?
The two types of flat feet are mobile and rigid.
What is the frequency of occurrence of CDH?
The frequency of occurrence of CDH is one/two live births per thousand.
List the ages at which children should be screened for this condition.
Children should be screened for CDH at birth, three months, six months and twelve months
How do we treat early CDH?
Early CDH is treated by splintage.
What are the long term consequences if the diagnosis is missed?
OA and limp are the long term consequences if diagnosis of CDH is missed.
What are the two stages of manipulative treatment of the talipes?
The first phase corrects the hindfoot equinus and the second phase corrects the mid and forefoot varus.
What are the long-term risks of talipes?
Difficulties in shoe fitting (because the affected foot is always smaller than the normal foot), and sores are both long-term risks of talipes
Why is the condition called “club foot”?
“Club foot” is so-called as the foot resembles a golf club.
Describe two causes of talipes.
Posture in the womb (breech birth) and defects of nerves and muscles are two causes of talipes.
What are the different types of spina bifida?
The two types of spina bifida are cystica and occulta.
Define cerebral palsy.
Cerebral palsy is an abnormality of the brain usually associated with musculoskeletal abnormalities.
Describe hydrocephalus.
Hydrocephalus is an abnormally large amount of fluid in the brain.
What is meant by (i) a hemiparesis and (ii) a quadraparesis?
i) A hemiparesis is paralysis of one arm and one leg on the same side.
ii) A quadraparesis is paralysis affecting all four limbs.
What are the possible causes of a limp in childhood?
CDH, infection, Perthe’s disease and slipped upper femoral epiphysis (SUFE) are all possible causes of a limp in childhood.
At which age is SUFE more common (i) in boys, and (ii) in girls?
(i) SUFE is more common in boys aged 12.
(ii) SUFE is more common in girls aged 14.
Define scoliosis.
Scoliosis is an abnormal curvature of the spine.
Which type of scoliosis is most common?
Idiopathic scoliosis is the most common type.
List three common sites of nerve entrapment.
The median nerve at the wrist, the ulnar nerve at the wrist or elbow and the posterior tibial nerve at the ankle are three common sites of nerve entrapment.
Describe the sites of the two common enthesopathies.
Elbow - common flexor and extensor origins are the sites of the two common enthesopathies.
Define tenosynovitis and what is its cause?
Tenosynovitis is inflammation of tendons and their sheaths and its cause is unknown.
What is an enthesis?
An enthesis is the ligamentous origin of a muscle
What is a bunion?
A bunion is a fluid filled bursa, which is found around a bony prominence
What is the relationship between a corn and a bunion?
Both corns and bunions are formed as a reaction to higher than normal applied pressure.
What is a sensory neuropathy?
A sensory neuropathy is a loss of sensation caused by disease or injury to sensory peripheral nerves.
Define hallux rigidus.
Hallux rigidus is osteoarthritis of the first metatarsophalangeal joint.
What characterises a self-limiting disorder?
It gets better spontaneously.
Give two possible aetiologies of frozen shoulder
Unaccustomed activity e.g. DIY or a recent minor pull are both aetiologies of frozen shoulder
Name four structures often involved in shoulder disorders.
- Subacromial bursa
- Supraspinatus tendon
- Acromioclavicular joint
- biceps tendon and rotator cuff are four structures often involved in shoulder disorders
Give two reasons for taking a history after trauma.
History taking after trauma is important for both clinical (diagnosis and management) and medico-legal reasons.
What five questions should be asked about an accident?
- What happened?
- How did it happen?
- Where and when?
- What was the injured person’s health like before the incident?
- What are the social circumstances of the person?
List six signs which could indicate the existence of a fractured bone
Pain, deformity, tenderness, swelling, discolouration/bruising and loss of function are all signs that indicate the existence of a fractured bone.
Name four other tissues, other than bone, often involved in injuries to the limbs.
Other tissues, other than bone, often involved in limb injuries include skin, fat, muscle, blood vessels and nerves.
Name three techniques for investigating a fracture.
X-ray, tomography, computer-aided tomography and radioisotope scanning are all techniques for the investigation of fractures.
List 8 features necessary to describe a fracture.
- Which bone is broken?
- Which side?
- Open or closed?
- Where on the bone is the fracture?
- What shape is the fracture?
- How many fragments?
- The position of distal fragment.
- Is it pathological?
Which fragment of a fractured bone is assumed to be stationary?
The proximal fragment of a fractured bone is assumed to be stationary.
In which directions may the distal fragment of a broken bone be displaced?
The distal fragment of a broken bone may be displaced anteriorly or posteriorly and medially or laterally.
Name two ways in which pain can be relieved following a fracture.
Following a fracture pain can be relieved by the use of pain killign drugs and splintage.
Why should special care be taken with open fractures?
Special care should be taken with open fractures as contamination is inevitable and may lead to infection.
How much blood may be lost from:
- (i) a pelvic fracture?
- (ii) a femoral fracture?
- (i) a pelvic fracture? - 6 units may be lost
- (ii) a femoral fracture? - 2-3 untis may be lost
What are the two stages of treating a fracture?
The two stages of treating a fracture are reduction and holding.
Name four ways in which a fractured bone may be held in the correct position for healing.
Casting, traction, internal fixation and external fixation are ways of holding a fractured bone in the correct position for healing.
In which circumstances would external fixation be used?
External fixation would be used where there is gross soft tissue injury.
Describe four ways that fractures may be fixed internally.
Fractures may be fixed internally by apposition, interfragmentary compression, onlay device and inlay device.
Name the three types of traction.
- Fixed using a Thomas splint.
- Balanced using a counterweight to take pressure off the skin.
- Dynamic to permit joint motion.
Movement in which direction stimulates healing in a broken bone?
Movement along the long axis of the bone - very small (micro) movement - stimulates healing in a broken bone.
Does rigid fixation speed up or slow down healing?
Rigid fixation slows down healing.
What tissue forms to heal a fractured bone?
Bone tissue forms to heal a fractured bone. (remember bone is a special tissue which can regenerate)
Which method is commonly used to treat fracture around joints?
Internal fixation is commonly used to treat fracture around joints.
Why are fractures in the elderly commonly held using internal fixation techniques?
Using internal fixation techniques for fractures in the elderly are commonly used to permit early mobilisation and thus a return to normal function as soon as possible
Name three ways in which low energy fractures may be managed.
Plaster cast, internal fixation and traction are all used to manage lowenergy fractures.
Name six early complications that may arise from an injury which has caused a fracture.
- Blood loss.
- Infection.
- Fat embolism.
- Renal failure.
- Soft-tissue injury.
- Compartment syndrome
Name five early complications that may arise from the treatment of a fractur
- Plaster disease
- Renal stones.
- Immobility.
- Infection.
- Compartment syndrome.
