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BMSc SB > Orthopaedics Unit 1 > Flashcards

Orthopaedics Unit 1 Flashcards

1
Q

what is acute disease characterised by

A

polymurphonuclear leucocyte or polymorph

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2
Q

what is chronic disease characterised by

A

lymphocytes produced by bone marrow and the spleen

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3
Q

when is “…..octomy” and “….ectomy” used in surgery

A

otomy - when surgeons operate and open something up

ectomy - when something is removed in operation

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4
Q

what is most joint replacement surgery aimed at

A

pain relief

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5
Q

what is gout caused by

A

uric acid crystal deposited on the cartilaginous surface of the joints

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6
Q

what are the 2 principles symptoms of orthopaedics

A

pain

stiffness

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7
Q

what is OA and what causes this

A

wear and tear of the joints leading to degeneration

breakdown of the balance between wear and repair processes in the joint

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8
Q

what are causes of secondary OA

A

congenital - CDH

childhood - Perthe’s disease, infection

trauma - fracture into a joint

metabolic - gout

infection - TB

chronic inflammatory - rheumatoid

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9
Q

Sx of OA

A

Pain
Stiffness
Loss of function
Limitation of movement

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10
Q

when is secondary care sought in OA

A

when sleep is disturbed

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11
Q

what is important to remember about OA in regards to limitation of movement

A

better ROM when under anaesthetic (patient not feeling pain)

successful surgeries are related to adequacy of pain relief rather than improving mobility of joint

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12
Q

what are conservative Tx for OA

A

weight loss
- modest reduction in weight can have significant reduction in total loads

use of a stick

  • used in opposite hand, means shoulder girdle can help in tilting the pelvis
  • reduces work of abductor muscles and reduces load on the hip

rest
physio

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13
Q

what joints are particularly affect by obesity

A

lower limb joints
- e.g. hip joint = joint loading during the stance phase of walking can reach 3x body weight and during activities of greater hip muscle exertion joint loading can reach 5x body weight

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14
Q

why is physiotherapy controversial in Tx for OA

A

Over-exercise issues

some exercise does relieve stiffness and muscle spasm and therefore pain.

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15
Q

what should young and old be told in relation to physio

A

Young - should be advised against excessive activity

Elderly - Total rest is however equally counterproductive, maintenance of the activities of daily living is essential.

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16
Q

surgical Tx for OA

A

Nothing
Arthrodesis
Osteotomy
Arthroplasty

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17
Q

why is nothing an option for Tx of OA

A

if risks outweigh the benefits

patient needs to be allowed to decided for themselves

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18
Q

what is arthrodesis

A

surgical stiffening of a joint in a position of function

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19
Q

when is arthrodesis an appropriate operation

A

for a young person with a painful and limited ROM

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20
Q

what is done in arthrodesis

A

stiff and painful joint is cut out and the remaining raw bone ends are held together either by an external splint or screws until they heal with a bony bridge

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21
Q

what is the position the hip joint is fused in and who dislike this position

A

30 degrees in flexion and some adduction

disliked in females as it can interfere with sexual activity

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22
Q

what is the recovery period of arthrodesis

A

6 months

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23
Q

what are the disadv of arthrodesis

A

puts stress of adjacent joints

e.g. in the hip, it causes extra stress on the lumbar spine

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24
Q

what procedure can be done on the hip joint to avoid the disadv of arthrodesis

A

fuse the joint until the fifth decade and then performing a second operation to “unpick” the arthrodesis and convert it to an arthroplasty

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25
Q

what joints can undergo arthrodesis with good response

A

ankle

wrist

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26
Q

what is osteotomy and what is the aim of the operation

A

surgical alignment of a joint

redirect forces across a joint so that they more evenly distribute the load to which the joint is subjected.

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27
Q

when is osteotomy normally used

A

joint is deformed and the loads crossing it are distorted by the deformity

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28
Q

what is the disadv of osteotomy

A

seen as a temporary measure lasting from 1 to 2 years to around 10

rarely tackles underlying cause

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29
Q

when is osteotomy used in arthritis

A

young patient who have maintained a good ROM, despite the pain and preservation of articular cartilage

which is typical of the early stages of osteoarthritis

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30
Q

what joints are suitable for osteotomy and how is the operation carried out

A

hip
knee

performed on the femoral side by altering the angle of the femoral neck to change the attitude of the femoral head relative to the acetabulum.

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31
Q

what is arthroplasty

A

surgery that creates a new joint or changes the shape of a joint

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32
Q

what is the aim of arthroplasty

A

reduce pain and the restricted ROM pain brings

not likely to alleviate disability due to stiffness

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33
Q

what is important to remember about the artificial joints

A

From the moment it is put in, it begins to wear out, whereas a natural joint has the capacity to regenerate.

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34
Q

for the knee and hip joint, what is the current success rates

A

knee joint - very successful

hip joint - more successful in the elderly

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35
Q

why has there been difficulty in joint replacements in the arm

A

loads involved are low but the ROM of the elbow and shoulder required are quire large

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36
Q

why does arthroplasty improve pain related Loss of function but does less for intrinsic stiffness

A

due to soft tissue distortion of the capsule and ligaments remaining even after replacing articular surfaces

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37
Q

what angle must the elbow be able to flex to to permit eating

A

90 degrees

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38
Q

what is the functional range of hip motion required

A

30-50 degrees flexion
10-15 degrees extension

few degrees of abduction and rotation

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39
Q

what is the functional range of knee motion required

A

90 degrees flexion

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40
Q

what is essential for the surgeon to ensure in a knee joint replacement and how is this achieved

A

stability in extension so that we can support the full weight of the body on a single straight leg

accurate soft tissue balance

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41
Q

how does the surgeon achieve accurate soft tissue balance

A

must balance the collateral ligaments

ensure the medial and lateral collateral ligaments are under equal tension

surgeon cuts ligaments and puts in artificial surface replacements of sufficient thickness to re-tighten the ligament

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42
Q

what are 3 requirements for any joint replacement

A

functional and pain-free range of movement

stability and resistance to forces

wear and loosening

43
Q

what are general complications post surgery

A

chest infection
UTI
DVT
PE

44
Q

what are specific early complications of joint replacement surgery

A

dislocation
DVT
infection

45
Q

why is the hip at a period of risk of dislocation after surgery

[when is the period of risk]

A

prosthesis will not be fully supported by the surrounding soft tissues.

muscles and proprioceptors out of action due to surgery and pain inhibition

[before the effects of anaesthesia wears off]

46
Q

what movement of the leg can particularly cause a hip dislocation

A

twisting the leg into extreme flexion with adduction and internal rotation

47
Q

what are prophylaxis of DVT

A

heparin

stockings [prevent blood pooling in the legs]

48
Q

what organisms most commonly infect the hip joint

A

staph aureus

commensals - staph albus [found on the skin]

49
Q

what measures are taken to try prevent infection

A

antibiotic prophylaxis

ultra-clean air operating environment

50
Q

when does late specific surgical complications occur

what are the late specific surgical complications

A

may occur as late as 10 years post surgery

infection
loosening and wear

51
Q

what are the ways an artificial joint can become infected

A

bacteria being introduced at the time of insertion

blood borne (bacteraemia) i.e. after tooth extraction

52
Q

what Sx of RA

A

severe pain
swelling
deformity of the joints

F > M

53
Q

what are the principal joints affected in RA

A

small joints of hands and feet that are affected symmetrically

54
Q

how does RA differ from OA Sx

A

RA - first notice stiffness, worse in the morning and improves during the day

OA - stiffness worse after activities

55
Q

what are operations that can be done to tackle RA

A

soft tissue surgery
- synovectomy = helps with damage to tendon sheath and tendons.

joint surgery
- excision arthroplasty

56
Q

what synovectomy surgery is successful in RA and what can it relieve

A

at the wrist
- clears up damage around extensor tendons

can reduce pain and stiffness
- good for younger patents who retains movement, but who has pain

57
Q

what is the adv and disadv of excision arthroplasty

A

relieves pain

but as part of joint has been removed, there can never be full return of function

58
Q

what is the surgeons role in RA

A

salvage joint
pain relief
return of function

59
Q

what is AVN

A

bone tissue death through loss of blood supply

can be caused by trauma or be spontaneous

60
Q

what areas are at risk of AVN after trauma

A

femoral head
proximal part of the scaphoid
proximal part of the talus

61
Q

what areas are at risk of AVN spontaneously

A

lunate of the wrist

femoral head

62
Q

when is AVN of the femoral head seen

A

chronic alcohol abuse

high dose steroid therapy

deep sea divers [Caisson’s disease]

63
Q

Sx of AVN

A

acute, severe joint pain

worse on movement

relieved a little by rest

patients tend to be younger

over time becomes indistinguishable from OA

64
Q

why is AVN difficult to diagnose

A

no changes are seen on an x-ray

65
Q

Mx of AVN

A

may be reversed if blood supple is re-established naturally

Tx underlying cause

joint replacement if needed

66
Q

what causes gout

A

urate crystal

- urate = waste product of cell metabolism normally passed in the urine

67
Q

causes of gout

A

dehydration [i.e. post-op]

after chemo

overuse of diuretics

68
Q

Sx of gout

A

hot, tender, swollen joint

seen in 1st metatarsophalangeal joint and knee joint

69
Q

Ix of gout

A

high level of uric acid in the blood

extract joint fluid and test for the presence of urate crystals

70
Q

Mx of gout

A

NSAID

71
Q

what is the cause of pseudogout

A

calcium pyrophosphate crystals on the articular surface of the joint

causes calcification of joint surfaces and menisci of the knee

72
Q

what is the consequences of pseudo gout and gout

A

long term degeneration

73
Q

what causes acute septic arthritis

A

infection which has spread to the joint via the blood

74
Q

Sx of acute septic arthritis

A

in children

  • acute illness
  • high temperature
  • joint is stiff, hot and tender

in adults

  • can have less acute illness
  • present with blood poisoning
  • can be easy to miss septic arthritis
75
Q

if a young adult presents with acute septic arthritis, what is the likely organism

A

gonococcus

76
Q

Mx of acute septic arthritis

A

surgery - open and wash the joint

IV antibiotics
- first guess IV anti-staphylococcal agent in children [most likely organism]

77
Q

what is the consequences of septic arthritis if not managed adequately

A

septicaemia

articular cartilage may disintegrate, may cause fibrous or bony fusion of the joint

78
Q

what causes chronic septic arthritis

A

TB

- chronic SA seen commonly in AIDS patients

79
Q

if there is TB in the joints, where else is it likely to be

A

Kidneys

80
Q

Sx of chronic septic arthritis

A

chronic ill health

weight loss

muscle wasting around the joint

thinning of the bone

81
Q

Mx of chronic septic arthritis

A

streptomycin, ethambutol and rifampicin

82
Q

what are the Sx of mechanical knee problems

A

swelling
locking
giving way
pain

83
Q

Sx of meniscal lesions

A

M > F

pain
effusion
locking
giving way

abnormality poorly localised O/E

84
Q

MOI of meniscal lesions

A

twisting injury

  • foot gets stuck on the ground, femur twists over stationary tibia cause a wrench to the meniscus
  • may be torn or pulled off the bone
  • seen in football, skiing
85
Q

what menisci is more likely to be injury

A

medial more than lateral

86
Q

what are the different types of meniscal lesions

A

cleavage lesion

  • meniscus splits horizontally
  • common in old age
  • can cause the formation of a cyst due to build up of synovial fluid

bucket handle tear
- vertical split, which is anchored at both ends

parrot beak tear
- split off ones end of the lateral meniscus

degenerate tear
- tear due to generation

87
Q

consequence of meniscal tear

A

torn part can become jammed in the joint

- stops the joint extending

88
Q

why is your menisci important

A

shock absorber

helps distribute loads between femur and tibia

89
Q

Mx of menisci tear

A

peripheral tears

  • reattached with sutures
  • have ability to heal due to good blood supply

tears within centre of menisci

  • no ability to heal
  • should be removed by arthroscopic meniscectomy
  • patients recover quicker with arthroscopic
90
Q

Ix of menisci tear

A

arthroscopy

91
Q

what are osteochondral fragments

A

small fragments of cartilage and bone sheared off in injury a.k.a loose body

causes haemarthrosis (bleeding into the joint) and swelling

92
Q

why can osteocondral fragments be difficult to diagnoses

A

invisible on x-ray

93
Q

Sx of osteocondral fragments

A

after first incident may settle

months/years later

  • locking
  • pain
  • giving way
  • effusion
94
Q

Mx of osteocondral fragments

A

removed with arthroscope

95
Q

what is osteochondritis dissecans.

A

osteochondral fragments occurring spontaneously in adolescents

can settle spontaneously

96
Q

why do collateral ligaments of the knee injuries heal by themselves but injuries to the cruciate do not

A

collateral ligaments have an excellent blood supply

when cruciate ligament is torn, blood supply is lost

97
Q

how is the cruciate ligament commonly injured

A

by hyperextension or twist, often with the foot being anchored

98
Q

Sx of ACL rupture

A

haemarthrosis

  • knee swells quickly
  • caused by bleeding from artery in cruciate

loss of antero-posterior stability
- particular flexion

loss of rotatory stability
- when twisting and turning

patients may report feeling a “pop”

99
Q

what activities will cause the patient to experience Sx in ACL rupture

A

descending stairs

twisting or turning

100
Q

Mx of ACL rupture

A

Tx offered when Sx interfere with daily life or if patients wishes to return to sport

replace torn ligament with synthetic one

101
Q

why are synthetic ligaments more likely to fail compared to a natural ligament

A

it has no sensory receptors to let the brain know if the ligament is being overstretched

The brain is therefore unable to initiate muscle action to protect the joint.


102
Q

what is patella dislocations associated with and what is the clinical presentation

A

malformation of the patella or lateral femoral condyle

  • leads to patella moving on the femur (mal-tracking)
  • painful and associated muscle spasm present
  • spontaneous dislocation
  • failure of quads to act as an extensor = person falls to the ground
103
Q

Mx of patella dislocation

A

minor mal-tracking

  • surgical splitting of the vastus laterals muscle insertion into the patella
  • allows patella to fall back into a normal

recurrent/severe mal-tracking
- medial tightening (PLICATION) of the vastus medialis muscle

104
Q

what can patella dislocation be confused with

A

anterior knee pain often seen in adolescent girls

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