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ay bmsc orthopaedics > Orthopaedics (Unit 1 - Joint Conditions) > Flashcards

Orthopaedics (Unit 1 - Joint Conditions) Flashcards

1
Q

What cells are involved in acute disease?

A

Polymorphonuclear leucocyte (polymorph)

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2
Q

Why is a polymorph called a polymorph?

A

Because it’s nucleua is in many sections and it appears white

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3
Q

What cells are involved in chronic disease?

A

Lymphocytes

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4
Q

Where are lymphocytes produced

A

Bone marrow and the spleen

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5
Q

What is osteoarthritis?

A

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

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6
Q

What is a congenital cause of secondary OA?

A

Congenital dislocation of the hip

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7
Q

What are childhood causes of secondary OA?

A

Perthe’s disease

Infection

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8
Q

What is a traumatic cause of secondary OA?

A

Fracture in a joint

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9
Q

What are metabolic causes of secondary OA?

A

Gout

Crystal arthropathy

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10
Q

What is an infective cause of secondary OA?

A

TB

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11
Q

What is a chronc inflammatory cause of secondary OA?

A

Rheumatoid

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12
Q

Clinical presentation of OA

A

pain & associated loss of function
Worse with activity
Joint stiffness

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13
Q

Conservative management options for OA

A

Weight loss
Use of a stick
Rest
Physio

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14
Q

Surgical options for OA

A

Arthrodesis
Osteotomy
Arthroplasty

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15
Q

What is arthrodesis?

A

Surgical stiffening of a joint in a position of function

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16
Q

What is a good surgical option in a young person with painful OA and a limited range of movement

A

Arthrodesis

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17
Q

What is the long term disadvantage of arthrodesis?

A

Puts stress on adjacent joints

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18
Q

What can be done to try and reduce stress on other joints following arthrodesis in a young person?

A

“Unpick” and convert to arthroplasty in their 50’s

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19
Q

Which joints in particular are well suited to arthrodesis?

A

Wrist and ankle

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20
Q

What is osteotomy?

A

Surgical realignment of a joint

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21
Q

What is the aim of osteotomy?

A

To more evenly distribute the load to which the joint is subjected

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22
Q

In a young person with OA when would osteotomy be most useful and why?

A

If they have maintained a good range of movement despite the pain. If severely limited osteotomy won’t work as useful function cannot be restored

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23
Q

What is arthroplasty?

A

Surgery which creates a new joint or changes the shape of a joint

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24
Q

Why does arthroplasty not work as well for the upper limb?

A

Loads are low but need a large range of movement

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25
Q

Which is the most successful and common joint replacement?

A

Hip

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26
Q

What are specific early complications of joint replacement?

A

Dislocation
DVT
Infection

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27
Q

What are the most likely causative organisms in an early infection following joint replacement?

A

Staph Aureus

Commensals (e.g. staph albus)

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28
Q

What are specific late complications of joint replacement?

A

Infection

Loosening and wear

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29
Q

What is the likely route of infection if late after joint replacement?

A

Blood steam (bacteraemias)

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30
Q

Symptoms of RA

A

Severe pain. swelling and deformity of joints
Symmetrical small joint involvement
Stiffness worse in the morning

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31
Q

What soft tissue surgery can affect sufferers of RA?

A

Synovectomy (particularly at the wrist)

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32
Q

In what patients is synovectomy particularly valuable?

A

Young person, who retains movement, but has pain

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33
Q

What often accompanies a synovectomy for RA at the elbow & wrist?

A

Excision arthroplasty

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34
Q

What is AVN?

A

Bone tissue death through loss of blood supply

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35
Q

What are the causes of AVN?

A

Trauma

Spontaneous

36
Q

Which areas are at risk for post traumatic AVN?

A

Femoral head
Proximal part of the scaphoid in the wrist
Proximal part of the talus

37
Q

Which 2 sites does spontaneous AVN tend to occur?

A

Femoral head

Lunate

38
Q

In what individuals is AVN of the head of femur seen?

A

Chronic alcohol abuse
High dose steroid therapy
Caisson’s disease

39
Q

What is Caisson’s disease?

A

Decompression sickness in deep sea divers

40
Q

How does a patient with AVN of the femoral head present?

A

Acute severe joint pain
Made worse by movement
To some degree relieved by rest

41
Q

How can AVN be reversed?

A

If blood supply is restored naturally (however bone is soft and prone to distort)

42
Q

What is the role of surgery in the management of AVN?

A

Surgical restoration of blood supply not possible

Sometimes joint replacement

43
Q

What are crystal arthopathies?

A

Crystals of the by products of body metabolism are deposited in the joints, on the surface of articular cartilage and within synovial fluid

44
Q

Why do crystal arthropathies occur?

A

Abnormality of metabolism causing excess production or kidneys failing to eliminate them

45
Q

Which crystal is deposited in gout?

A

Urate

46
Q

What is urate?

A

A waste product of cell metabolism

47
Q

What are the causes of gout?

A

Dehydration
Chemo
Diuretic overuse

48
Q

Clinical presentation of gout

A

Hot, tender swollen joint

49
Q

Which condition can mimic gout?

A

Infection

50
Q

Where is gout most commonly seen?

A

Knee

First MTP

51
Q

How is gout diagnosed?

A

High level of uric acid in the blood or urate cystals in joint fluid

52
Q

What crystals are deposited in pseudogout?

A

Pyrophosphate

53
Q

What is the prognosis of pseudogout?

A

Symptoms can be controlled by anti-inflammatory drugs but long-term degeneration is likely

54
Q

What effect does chronic pseudogout have on joints?

A

Calcification of joint surfaces and menisci in the knee

55
Q

What is acute septic arthritis?

A

Infection caused bacteria spread to the joint via the blood from a site of trivial infection

56
Q

How does acute septic arthritis present in children?

A

Unpleasant acute illness
High temperature
Stiff hot and tender joint

57
Q

How does acute septic arthritis present in adults?

A

Less acute illness
chronically abnormal joint may give false impression of minor upset
Unwell for days before presenting with blood poisoning

58
Q

What is the most likely causative organism in a young adult with septic arthritis with little constitutional upset?

A

Gonococcus

59
Q

How is acute septic arthritis managed?

A

Surgical washing

IV antibiotics

60
Q

What is the first guess antibiotic in kids with acute septic arthritis?

A

Anti-staphylococcal agent

61
Q

What is the cause of chronic septic arthritis?

A

TB spread to joints via the blood

62
Q

How does chronic septic arthritis present?

A

Chronic ill health
Weight loss
Muscle wasting around affected joint

63
Q

What is seen on an x-ray of chronic septic arthritis?

A

Marked thinning of the bone

64
Q

How is chronic septic arthritis treated?

A

Combo of antibiotics (streptomycin, ethambutol, rifampricin)

65
Q

Symptoms of a meniscal lesion

A

Pain
Effusion
Locking and/or giving way
Generalised discomfort

66
Q

What is the main cause of meniscal lesions?

A

Twisting injury (femur twists over stationary tibia)

67
Q

Which meniscus is more frequently torn?

A

Medial

68
Q

Describe a cleavage lesion

A

Meniscus splits horizontally
Common in old age
Can act like flap valves and allow build up of synovial fluid within the meniscus (cyst)

69
Q

List 3 different types of meniscal tear

A

Bucket handle (vertical split anchored at both ends)
Parrot beak (split off one
end of the lateral meniscus)
Degenerate tear

70
Q

How are patients with a suspected meniscal tear investigated?

A

Arthroscopy

71
Q

How can peripheral meniscal tears be managed?

A

Sutures

72
Q

How should tears within the substance of the meniscus be managed?

A

Torn peripheral part should be removed

73
Q

What is the advantage of arthroscopic over open meniscectomy?

A

Patients recover quickly (within days)

74
Q

What is a loose body?

A

When fragments of cartillage and bone are sheared off in a shearing injury and knee swells up from associated bleeding into the joint

75
Q

How do loose bodies present?

A

First incident settles

Months or years later patient presents with lock, pain and giving way, often with effusion

76
Q

Describe osteochondritis dissecans

A

Adolescents
Osteochondral fragments occur spontaneously
Tends to settle spontaneously
Loose bodies may require removal

77
Q

How are cruciate ligaments injured?

A

Hyperextension or twist

78
Q

Why are cruciate ligaments not capable of spontaneous healing?

A

If torn blood supply is lost

79
Q

In what situation might cruciate ligament retain its blood supply after an injury?

A

If cruciate ligament pulled off with a fragment of bone at one end and put back within a few hours

80
Q

Clinical presentation of cruciate injury

A

Acute swelling (haemarrthrosis)
Feel a “pop”
Antero-posterior instability
Rotational instability

81
Q

Management of cruciate ligament injuries

A

Left untreated for a while
Knee muscle rehab
Only offer treatment if interfering with daily life or wanting to return to sport

82
Q

What are the surgical treatment options for cruciate ligament injuries?

A

Synthetic ligament

83
Q

Why is a prosthetic ligament more likely to fail?

A

Has no sensory receptors to indicate the brain that ligament is being overstretched (no muscle action to protect joint)

84
Q

What is dislocation of the patella usually associated with anatomically?

A

Malformation of either the patella or lateral femoral condyle

85
Q

How does dislocation of the patella usually present clinically?

A

Failure of quads to act as extensor so patient falls to the ground

86
Q

How are minor degrees of patellar dislocation treated?

A

Surgical splitting of vastus lateralis muscle insertion into th patella, allows the patella to fall back into a normal relationship with the femur

87
Q

How is recurrent and severe patellar dislocation treated?

A 
Medial tightening (plication) of the vastus medialis muscle 
In childhood patellar tendon may be re-sited more medially

ay bmsc orthopaedics (5 decks)

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