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ortopedie > orto > Flashcards

orto Flashcards

1
Q

Sediul fracturii mai frecv la copil

A

epifizar

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2
Q

Sediul fracturii mai frecv la batrani

A

metafizar

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3
Q

Sediul fracturii care evolueaza ulterior spre ARTROZA POSTTRAUMATICA PRECOCE

A

articular- cu traiect ce deplaseaza S articulare

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4
Q

fr “in lemn verde”

A

fara deplasare
la copil (copiii au periostul f gros, rezistent)

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5
Q

O fr fara deplasare e de suspicionat intr-un traumatism cu

A

echimoza tardiva
dureri in punct fix
impotenta functionala

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6
Q

Cea mai grava deplasare

A

axiala (rotatie)

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7
Q

Traiect cominutiv al fr

A

=fr cu >2 fragmente
(un focar de fr, mai multe fragmente)

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8
Q

Traiect segmentar al fr

A

cu 1-2-3 fragmente bine definite, etaje
(segm osoase intacte intre focare de fr)

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9
Q

Pseudartroza

A

focar de fractura neconsolidat dupa un anumit timp

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10
Q

Cand mecanismul de producere este direct, fr este de ob

A

transversa/ cominutiva
de ob deschisa

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11
Q

Cand mecanismul de producere este indirect, fr este de ob

A

oblica/ spiroida etc

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12
Q

Mecanism indirect al fr, fr se produc prin

A

FLEXIE
EXTENSIE FORTATA (cu smulgeri epifizare)
COMPRESIUNE (fr epifiz, calcaneu, corppi vertebrali)
TORSIUNE

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13
Q

Semne de certitudine in fracturi

A

-mobilitate anormala
-crepitatii osoase
-intreruperea continuitatii osoase
-netransmisibilitatea miscarilor
-Rx

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14
Q

Clasificarea fr deschise

A

GUSTILO-ANDERSON
Pt I si II-> osteosinteza

I - <=1 cm
-fara contaminare evidenta
dupa traumatisme de E mica

II - >1cm
-ts moi NU sunt smulse de pe os
-contaminare medie
-dupa traumatisme de E medie

III A -larga, dar CU ACOPERIRE ADECV a ts moi
-contaminare intensa
-dupa traumatisme E inalta

III B -larga CU SMULGERE PERIOSTALA (os expus)

III C- larga, cu lez grave ale axului arterial pp
-lez vasc
-lez nervoase

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15
Q

Ischemia intinsa =>

A

retractie musculara (sdr VORKMANN)
gangrenare=> amputatie

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16
Q

sdr Volkmann

A

ischemie intinsa=> retractie musculara

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17
Q

Complicatii locale tardive fr

A

calus vicios= reduceri neanatomice
pseudartroza (hipertrofica/hipotrofica)
tulb de crestere in fr cu decolarea cart crest
necroza osoasa (proteza/artrodeza)
artroza posttraumatica tardiva (tratam: artroplastie)
redoare articulara
sdr sudeck
scurtare segm
pseudartroza infectata
osteita postfracturara (inf unui focar de fr)

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18
Q

se protezeaza (sol de vindecare)

A

umar
cot
sold
genunchi

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19
Q

artrodeza

A

=anchilozarea articulatiei in scop functional pt a disparea durerea

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20
Q

sdr sudeck

A

complicatie locala tardiva a fr
dupa perioade lungi de imobilizare=> tulb VASC, cu durere, edeme
se dau vasodilatatoare + kinetoterapie

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21
Q

Nu se ef reducerea fr in

A

-fr-luxatii severe genunchi (risc lezare a poplitee)
-fr deschise

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22
Q

Prevenire tumefatie mb traumatizat

A

pozitie procliva

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23
Q

Se poate opera fractura cand

A

-bolnavul e echilibrat hemodinamic si resp
-traumatism GCS >=8 (+neurochirurg)

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24
Q

Osteosinteza

A

-cu focar inchis
-cu focar deschis
-cu fixator ext

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25
Q

Etape vindecare fr

A

hematom
calus moale
calus dur
remodelare osoasa

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26
Q

Colul femural= zona

A

de minima rezistenta la niv trigonului WARD

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27
Q

Vasc extrem prox femurala

A

(CROCK)
-cerc arterial extracapsular ( rr din a femurala circumflexa lat si med, rr din aa gluteale

-ram cervicale ascendente (art retinaculare WEITBRECHT care pot fi lezate in fr col femural)
grupul de aa laterale hranesc in cea mai mare parte colul si capul femural si formeaza CERCUL ARTERIAL SUBSINOVIAL INTRAARTICULAR care aj la CAPUL fem se trans in aa EPIFIZARE

-aa ligamentului rotund (rr din a obturatorie/ a circumflexa femurala mediala)

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28
Q

aa care hranesc in cea mai mare parte colul si capul femural

A

grupul de aa laterale si form CERCUL ARTERIAL SUBSINOVIAL INTRAARTICULAR care ajunse la CAPUL fem se transf in aa EPIFIZARE

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29
Q

Clasificari folosite pt fr col femural

A

Pauwels
Garden
AO/OTA

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30
Q

Claisf Pauwels

A

pt fr de col femural
in functie de unghi
tip I 30 grd
tip II 50 grd
tip III 70 grd

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31
Q

Clasif Garden

A

-in fr de col femural
Garden I
-fr incompleta
-impactare in VALGUS
-RETROVERSIE
-corticala inferioara a colului INTACTA

Garden II
-completa, fara deplasare
-travee intrerupte dar in continuare (cele din cap cu cele din col)

Garden III
-cu deplasare mica
-angularea traveelor in VARUS
-fara translarea proximala mare a diafizei femurale

Garden IV
-cu deplasare proximala a diafizei femurale
-travee intrerupte
-mare scurtare

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31
Q

Simptomatologie fr col femural

A

-durere sold/inghinal
-mb in rotatie externa, abductie, usoara scurtare

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32
Q

Tratament fr col femural

A

-conservator: doar in CI clara de operatie
-CHIRUGICAL! (orice fr de col fem trb operata atunci cand e posibil)
1. osteosinteza cu suruburi de SPONGIE (canulate 2-3 buc/ paralele/ in triunghi inversat) in primele 24h de la prod fract- atitudine ideala

  1. osteosinteza cu suruburi GLISANTE (DHS) si surub ANTIROTATOR
  2. HEMIARTROPLASTIA cu proteza tip AUSTIN-MOORE (necimentata)
  3. HEMIARTROPLASTIA cu proteza tip THOMPSON (cimentata)
  4. HEMIARTROPLASTIA UNIPOLARA modulara
  5. HEMIARTROPLASTIA BIPOLARA modulara
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33
Q

Complicatii fr de col femural

A

precoce:
- tromboza venoasa profunda si embolie pulmonara
- escare
- inf urinare si resp

tardive
-pseudartroza: la 20-30% din pac la >6 luni de la fr
-NACF
-osificari heterotopice
-dureri locale CRONICE- frecv dupa hemiartroplastie

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34
Q

Clasif fol pt fr trohanteriene

A

-decoulx si lavarde
-kyle
-seinsheimer

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35
Q

clasif Decoulx si Lavarde

A

pt fr trohanteriene
-cervicotr.
-pertr. simple/complexe
-intertr.
-subtr.
-trohanterodiafizare

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36
Q

clasif KYLE

A

-pt fr trohnateriene (intertr)

I
-stabile
-fara deplasare
-fara cominutie

II
-stabile
-cu deplasare
-minima cominutie

III
-instabile
-cu deplasare
-cominutie POST-MED

IV
-instabile
-cu deplasare
-cominutie POST-MED
-comp subtrohanteriana

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37
Q

clasif Seinsheimer

A

pt fr trohanteriene

I
-fr subtrohanteriene fara deplasare sau cu depl max 2 mm

II
fr cu 2 fragmente
II A trnsversala
IIB spiroida, micul trohanter atasat de fragm proximal
IIC spiroida, micul trohanter atasat de fragm distal

III
fr cu 3 fragm
IIIA fr spiroida cu micul trohanter=al 3lea fragm
IIIB fr spiroida cu al 3lea fragm in “aripa de fluture”

IV
fr cominutive cu min 4 fragm

V
fr subtrohanteriene si intertrohanteriene

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38
Q

Simptomatologie fr trohanteriana

A

-durere accentuata
-impotenta functionala totala
-tumefactie
-atitudine vicioasa: adductie, rotatie ext, scurtare

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39
Q

Tratament fr trohanteriene

A

chirurgical
-tije ender
-DHS
-Gamma nail

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40
Q

Clasif fol pt fr diafiza femurala

A

WINQUIST

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41
Q

Clasif Winquist

A

pt fr diafiza femurala
tip I
cu fragm in fluture <25% latime os

tip II
cu fragm in fluture <50% latime os

tip III
cu fragm in fluture >50% latime os

tip IV
cominutie severa

tip V
cominutie cu lipsa os

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42
Q

Simptomatologie fr diafiza femurala

A

-durere
-impotenta functionala totala
-deformare: crosa cu convex ant-ext

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43
Q

tratament fr diafiza femurala

A

in urgenta: atela cu mb lezat legat de cel sanatos

in spital:
-tractiune transosoasa (doar ca preg preop)
-OSTEOSINTEZA CENTROMEDULARA pe focar INCHIS cu tije NEALEZATE, zavorate static/dinamic
-FIXATOR EXTERN

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44
Q

complicatii fr diafiza femurala

A

imediate
-generale: soc traumatic, hemoragic
-locare: fr deschisa, lezare pachet vasc femural, lez n sciatic

precoce
-soc traumatic, hemoragic
-embolia grasoasa
-embolie pulmonara

tardive
-generale: escare, inf urinare, resp
-locale: REDOARE de genunchi, PSEUDARTROZA, CALUS VICIOS

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45
Q

Clasif AO a fr supracondiliene

A

TIP A - EXTRAARTICULARA
A1- avulsia epicondilului lat/med
A2- fr supracondiliana simpla
A3- fr supracondiliana cominutiva

TIB B - UNICONDILIANA
B1- condil med/lat
B2- fr condilian cu extensie diafizara
B3- fr post de condil

TIP C- BICONDILIANA
C1- intercondiliana
C2- intercondiliana cu cominutie supracondiliana
C3- fr bicondiliana cominutiva

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46
Q

simptomatologie fr extrem distala femur

A

-tumefactie acc a genunchiului prin HEMARTROZA
-deformare segm
-scurtare variabila mb inf
-durere

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47
Q

complicatii fr extrem distala femur

A

-lez pachet vasc popliteu=> gangrena
-pseudartroza
-calus vicios
-artroza de genunchi
-redoare de genunchi

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48
Q

Tratament fr extrem distala femur

A

urgenta: imobilizare
spital:
-tractiune continua
-chir: refacere S articulare si ax mb pelvin: TIJE ZAVORATE, LAMA PLACA+SURUBURI, DCS (dynamic condylar screw)

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49
Q

Poz picior in fr ambelor oase gamba

A

equin

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50
Q

Tratament fr ambe oase gamba

A

ortopedic: in fr fara deplasare gips FEMURO-PODAL

chir:
-osteosinteza centromedulara cu TIJE KUNTSCHER (clasica)- doar la fr stabile

-osteosinteza centromedulara cu TIJE ZAVORATE KUNTSCHER- pe focar INCHIS cu/fara alezaj

-osteosinteza cu PLACI CU SURUBURI (in fr 1/3 proximala si distala tibie)- din ce in ce mai rar folosita

-FIXATOR EXT in fr deschise tip IIIB/IIIC

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51
Q

complicatii fr ambe oase gamba

A

imediate
-fr deschisa
-lez vasc, nervoase
-sdr de compartiment

tardive
-consolidare intarziata
-pseudartroza
-calus vicios

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52
Q

Fr maleolare- mec de producere

A

indirect
EVERSIUNE= abductie+rotatie ext
INVERSIUNE=adductie+rotatie int

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53
Q

Clasif fr maleolare

A

-monomaleolare
-bimaleolare
-trimaleolare= bimaleolara+ fr pilon tibial post

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54
Q

clasif folosite pt fr maleolare

A

AO
LAUGE-HANSEN

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55
Q

Clasif Ao fr maleolare

A

elem pp e sediul fr fibulare- cu cat e mai inalt, cu atat e mai grav deficitul gleznei

tip A: fr fibulei sub sindesmoza tibio-peroniera (INFRASINDESMOZICA)
A1- izolata
A2- cu fr maleolei mediale
A3- cu fr posteromediala

tip B: fr fibulei la niv sindesmozei (TRANSsindesmozica)
B1- izolata
B2- cu lez de maleola/ ligam medial
B3- cu lez mediala si fr posterolat tibie

tip C: fr fibulei deasupra sindesmozei (SUPRAsindesmozica)
C1- simpla a diafizei fibulare
C2- complexa a diafizei fibulare
C3- proximala a fibulei

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56
Q

Simptomatologie fr ambe oase gamba

A

fr fara deplasare: semne clinice contuzii/entorse

fr cu deplasare: se asoc depl post-lat/ post-med a piciorului

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57
Q

complicatii fr maleolare

A

imediate
-fr deschisa
-lez vasc-nerv
-ireductibilitate prin interpunere parti moi

tardive
-atroza
-persistenta unor subluxatii

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58
Q

tratament fr ambe oase gamba

A

ortopedic in fr maleolare fara deplasare
chirurgical
-maleola EXT: suruburi, placa cu suruburi
-maleola INT: surub maleola+- BROSA K
-diastazis tibio-peronier: surub de diastazis

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59
Q

Clasif astragal

A

clasif HAWKINS

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60
Q

Astragalul intra in componenta articulatiilor

A

tibiotalica
subastragaliana
taloscafoida

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61
Q

AA deteriorate in fr de astragal

A

aa trec prin SINUS TARSI si CANAL TARSAL- IN FR SUNT DETERIORATE=> NECROZA ISCHEMICA AVASC

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62
Q

CLASIF HAWKINS

A

in fr de astragal (se ref la fr de col astragalian)

TIP I
-fr verticale, fara deplasare
-dureri pe partea ant a gleznei la palpare si mobilizare
-imposib sprijin pe picior
-tumefactie ant
-prognostic fav FARA necroza/pseudartroza
-tratam: gips GAMBIER, fara sprijin 8 sapt

TIP II
-fr cu subluxatie/luxatie subastragaliana
-deformarea gleznei si piciorului
-prg: NECROZA AVASC 40% cazuri

TIP III
-fr cu luxatie subastragaliana si in articulatia gleznei
-deformare glezna, picior
-!uneori astrgalul sparge tegumentul post
-prog: PSEUDARTROZA (11% cazuri) NAV (91%

Tratament: tip II si III chirurgical, cu reducere sangeranda a fracturii si OSTEOSINTEZA CU SURUBURI

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63
Q

Calcaneu- unghi tuberoarticular Bohler normal

A

23-40 grade

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64
Q

Simtomatologie fr calcaneu

A

-calcai tumefiat, largit, scurtat
-pierderea reliefului bimaleolar si ahilian
-bolta longitudinala stearsa
-echimoza NUMULARA MONDOR
-dureri sub si retromaleolare
-misc in articulatia subtalara f dureroase

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65
Q

Clasif fol in fr calcaneu

A

bohler
essex-lopresti
sanders-diPasquale

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66
Q

Clasif Bohler

A

fr calcaneu
tip I unghi<30 grd
tip II unghi in jur de 0 grd
tip III unghi <0 grd

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67
Q

clasif essex-lopresti

A

fr calcaneu

-extrarticulara (25-30% fr calcaneu)
tuberozitate ant
sustentaculum tali
corp calcanean

-intraarticulara (70-75% fr calcaneu)
fr cu infundare articulara
fr “in limba” subtalara

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68
Q

complicatii fr calcaneu

A

calus vicios
sdr sudeck
artroza subtalica

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69
Q

Tratament fr calcaneu

A

fr extraart cu minima deplasare” gips Graffin

fr intraart <50 ani: reconstructie chir
>50 ani: tratam functional

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70
Q

fr clavicula- deplasare segmente

A

fragm int: tractionat in sus de m SCM
fragm ext: depl INF sub actiune m DELTOID, PECTORAL MARE, GREUTATE

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71
Q

complicatii fr clavicula

A

imediate
-fr deschisa
-lez a si v subclavii
-lez plex brahial
-inteparea domului pleural-> emfizem subcutanat

tardive
-pseudartroza
-calus vicios
-osteita postfracturara

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72
Q

Tratam fr clavicula

A

urgenta
-reducere si bandaj WATSON-JONES (in 8)
-orteze in forma de bandaj in 8
-manevra OMBREDANNE la copii: mana la spate, fasa peste brat
-manevra COUTAUD (politraumatizati)- brat si antebrat atarnand la marg pat

chirurgical: OSTEOSINTEZA CU PLACI MULATE, BROSE K

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73
Q

fr extrem prox humerus- clinic

A

echimoza brahio-cefalica HENNEQUIN
zona de depresiune subdeltoidiana (“lovitura de topor”)
!DD cu luxatie scapulo-humerala

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74
Q

DD fr col chirurgical humerus vs luxatie scapulo-humerala

A

fr col chirurgical
-“lovitura de topor”-depresiune subdeltoid
-ABDUCTIE REDUCTIBILA
-cap humeral in cav glenoida

luxatie scapulo-humerala
-umar in EPOLET
-ABDUCTIE NEREDUCTIBILA
-cap humeral in AXILA

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75
Q

Complicatii fr extrem prox humerus

A

imediate
-vasc (a axilara)
-neurologice
-ireductibilitate

tardive
-pseudartroza
-calus vicios
-redoare de umar
-osificari periarticulare

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76
Q

tratament fr extrem prox humerus

A

urgenta
-imobilizare
-reducere BOHLER (in fr prin abductie) si imobilizare in bandaj dessault

chir
OSTEOSINTEZA CU PLACI IN T
HOBANAJ

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77
Q

fr diafiza humerala deplasare

A

fragm prox depl in abductie si rotatie ext
fragm distal depl in adductie si rotatie int

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78
Q

complicatii fr diafizara humerala

A

paralizie n radial: in fr 1/3 medie si inf ->imposib extensie si abductie police
ireductibilitate fr prin interpoz musc
fr deschisa

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79
Q

tratament fr diafizara humerala

A

ortopedic
-gips atarnare Caldwell
-gips toraco-brahial la copii

chir (politrauma, fr deschise, alte fr)
osteosinteza centromed NEALEZATA ZAVORATA STATIC

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80
Q

fr de paleta humerala

A

-supracondiliene frcv la copii
-supra si intercondiliene la adulti

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81
Q

fr paleta humerala SUPRACONDILIENE

A

-cele 3 pct de reper ale cotului (olecran, condil lat, condil med) NU isi pierd raporturile (triunghi Nelaton)

-complicatii:
compresie a brahiala prin deplasare fragm= sdr VOLKMANN;
calus vicios in var/valg

-tratam OSTEOSINTEZA CU 2 BROSE K IN X sub ecran tv

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82
Q

Fr paleta humerala supra si intercondiliene

A

aspect T, V, Y
cot tumefiat, dureros
brat scurtat, paleta humerala largita

-complicatii
pseudartroza
calus vicios
osif periarticulare
redoare de cot

-tratam
urgenta: imobil brahio-antebrahio-palmara
ortoped: tractiune transolecraniana
chir OSTEOSINTEZA CU PLACI CU SURUBURI

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83
Q

Tratament fr olecran

A

urgenta: atela brahio-antebrahio-palmara
ortop:
-in fr fara deplasasre: ap gipsat brahio-antebrahio-palmar cu cotul in flexie 90-130 grd 3 sapt

chi in fr cu deplasare: reducere si osteosinteza (hobanaj)

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84
Q

fr ambe oase antebrat deplasare

A

incalecare
lat
angulare, convex POST-EXT
cu decalaj (rotatie fragm)

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85
Q

tratam fr ambe oase antebrat

A

urgenta: atela brahio-antebrahio-palmara
ortopedic la copii: reducere+gutera gips 4-6 sapt
chir in fr cu deplasare
-adulti osteosinteza radius cu PLACA CU SURUBURI, osteosinteza cubitus cu PLACA/BROSE K
-copii osteosinteza cu BROSE K

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86
Q

Fr Monteggia-Stanciulescu

A

fr diafiza cubitala
+
luxatie cap radial

hiperextensie=> luxatie ant cap radial
flexia cubitus=> luxatie post cap radial

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87
Q

tratam fr Monteggia stanciulescu

A

=fr diafiza cubitala+ luxatie cap radial
-osteosinteza cubitus cu PLACI/BROSE K=>reducere spontana luxatie cap radial
-in fr vechi, capul radial isi pierde dreptul la domiciliu->REZECTIE cap radial

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88
Q

fr Pouteau Colles

A

-fr extrem distala radius “in dos de furculita”
-cea mai frecv, prin cadere pe mana in hiperextensie
-fragm inf se deplaseaza CRANIAL, RADIAL (lat), POST

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89
Q

complicatii fr Pouteau Colles

A

fr extrem distala radius

imd: fr deschisa
tardive
-osteoporoza de imobil
-redori art
-calus vicios
-artroza radio-carpiana
- sdr sudeck
-pseudartroza f rara

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90
Q

tratament fr Pouteau Colles

A

ortopedic
-reducere prin tractiune degete II, III, IV, depl fragm in sens invers producerii + imobilizare in gutiera antebrahio-palmara 4 sapt (fr fara del), 6 sapt (fr cu depl)

chir OSTEOSINTEZA CU 2 BROSE K

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91
Q

fr de scafoid carpian complicatii

A

-pseudartroza (risc mare in traiect VERTICAL si catre pol proimal)
-necroza ischemica

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92
Q

fr de scafoid carpian tratament

A

ortopedic: ap gipsat antebrahio-palmar, prinzand si FALANGA PROX A POLICELUI, cu policele in abductie 6-8 sapt

chir OSTEOSINTEZA CU SURUBURI HERBERT

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93
Q

Tratam entorsa pumn (radio-carpiana)

A

imobilizare gipsata 10-14 zile / fasa elastica

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94
Q

Triada nefasta O’Donoghue

A

(int)
entorsa de genunchi
LCM (lig colat medial)
MM (menisc medial)
LIA (lig incrucisat ant)
+calota POST-INT

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95
Q

Pentada nefasta Trillat

A

cea mai grava entorsa de genunchi
triada int/ext
ambele LI (lig incrucisate)
dezinsertii musc (biceps in ext, laba de gasca in int)
dezinsertii capsulare extensive

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95
Q

Puncte dureroase ligament colateral medial

A

fata cutanata a condilului femural intern
fata interna a extrem prox tibie

teste de stres in valg

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96
Q

Puncte dureroase ligament colateral extern

A

fata cutanata a condilului femural extern
capul peroneului

teste de stres in var

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97
Q

Testare instabilitate ligamente incrucisate

A

test Lachmann (sertar ant/post)
pivot shift

98
Q

lez meniscale- genunchi blocat in semiflexie

A

subluxatie intercondiliana a fragm meniscal

99
Q

punct dureros menisc
teste clinice menisc

A

interliniu articular
teste clinice:
-appley
-McMurrau
-tipatul meniscului “Oudard”
-Payr etc

100
Q

Tratament entorse usoare genunchi (genunchi stabil)

A

-fasa elastica/orteza
-evitare efort
-gheata local
-antiinflamatoare
-infiltratii
etc

101
Q

Tratament entorse moderate genunchi

A

-evacuarea hemartozei prin punctie articulara
-imobiliz in burlan gipsat/orteza 10-14 zile

102
Q

Tratament entorse grave genunchi

A

-imobilizare 4-6 sapt/ tratam chir/artroscopic:
-menisectomie
-suturi meniscale (MM, ME)
-ligamentoplastie (LIA, LIP)
-ligamentorafie (LCM, LCE)
-reinsertii osoase

!fiziokinetoterapie

103
Q

Art subastragaliana- misc de

A

supinatie-pronatie

104
Q

art mediotarsiana misc de

A

adductie-abductie

104
Q

Puncte dureroase entorsa glezna prin inversiune/eversiune

A

inversiune:
-marg ant si vf maleola ext
-art tibio-peroniera inf

eversiune
-inf de maleola tibiala

105
Q

entorsa de glezna prin EVERSIUNE

A

(pronatie-abductie
lez lig tibio-astragalian (lig deltoid)
entorsa mai rara
se asoc cu fr maleolei peroniere=> echivalenta de fr bimaleolara

106
Q

Comp cu fr, la entorsa de glezna, impotenta functionala

A

instalata relativ tardiv

107
Q

tratament entose de glezna

A

USOARE
-fasa elastica
-gheata local
-antiinflam

MODERATE
-imobilizare in ap gipsat 3-6 sapt
-poz procliva etc

GRAVE
-chir ligamentorafie, ligamentoplastie, osteosinteza etc

fiziokinetoterapie

108
Q

Luxatii
in cazul DIARTRO-AMFIARTROZELOR

A

SIMFIZA PUBIANA
ART ACROMIO-CLAVICULARA
s n
DISJUNCTIE

109
Q

Luxatii
in cazul SINDESMOZELOR

A

ART TIBIO PERONIERA INF
sn
DIASTAZIS

110
Q

Varietati luxatie scapulo-humerala

A

-ANTERO INTERNA (95%)
-posterioara (4%)
-antero-inf

111
Q

clinica luxatie scapulo-humerala antero-interna

A

durere
umar in epolet
scurtare brat
abductie (semnul abductiei elestice Berger dd cu fr col chir humerus)
lipsa cap humeral in cav glenoida la palpare (e in axila)
lez asociate (plex brahial, fr col chir humerus)

112
Q

Reducere luxatie scapulo humerala

A

Von Arlt (pe scaun)
Hipocrate
Mothes
Kocher
Djanelidze

+imobilizare in bandaj Dessault 10-21 zile
fiziokinetoterapie

113
Q

Indicatii chirurgicale in luxatie scapulo-humerala

A

ireductibilitate
instab cronica
lez asoc (fr col chirurgical, trohiter humeral, fr col scapula)

=>reducere sangeranda a luxatiei
osteosinteza
ablatie cap humeral
artroplastie de umar
op BANKART
capsular shift

114
Q

Luxatii de cot cele mai frecv in f de deplasare

A

in f de deplasarea antebratului fata de humerus cele mai frecv sunt cele POST

115
Q

La luxatiile de cot

A

se inverseaza triunghiul Nelaton!
!lez asoc- pachet neurovasc: a brahiala, n median, cubital
-fr olecran, coronoida, paleta humerala, cap radial

116
Q

tratament luxatii cot

A

reducere orop in urgenta
imobilizare inflexie 90 grf 14 zile
tratam chir in lez asoc: suturi vasc, osteosinteza, neuroliza etc

117
Q

luxatie degete

A

l metacarpo falang II-V: rara
( falanga prox lux dorsal)
l metacarpo falangiana a policelui- deformare in Z cu I falanga oblica pe MC si a IIa flectata pe I (capul Mc palp pe fata palmara)
-reducere ortopedica+ imobil cu policele in flexie 45 grd 21 zile)

l interfalangiana- red ortopedica+ imobilz 10 zile

118
Q

Str stabilizatoare ale soldului

A

lig ilio-femural Bertin
lig pubo-femural
lig ischio-femural
caps art
lig rotund

119
Q

complicatii luxatii sold

A

imediate
-lez nervoase: elongatie n sciatic, crural
-lez vasc: comprimare vase femurale
-osoase: fr cotiloidiene

tardive
-NACF
-COXARTROZA
-osif heterotopice

120
Q

cele mai frecv luxatii de genunchi

A

varietati anterioare (complicatii nervoase frecv ; in cele post sunt compl vasc)

121
Q

tratam luxatii genunchi

A

reducere in urg
imobiliz ap gipsat circular 15-20 grd de flexie 2-3 sapt
chir pt lez asoc

122
Q

tratam luxatii glezna

A

red ortopedica in urg (lez tegument necrotice rapid instalate)
osteosinteza in cazul fr asoc, suturi ligament etc

123
Q

tratam luxatii subastragaliene

A

reducere
imobiliz ap gipsat de mers cu picior unghi drept 4-6 sapt
eventual fixare brose K

124
Q

tratam luxatie mediotarsiana

A

la niv interliniei lui Chopart
red de reg sub anestezie
ag 4-6 sapt
ev fixare cu brose K

125
Q

tratam luxatie tarso-metatarsiana

A

in art Lisfranc
reducere si fix brose K/ ag 4 sapt

126
Q

tratament fracturi de bazin

A

hemoragia- urgenta=> fixator ext la camera de garda

ortopedic: hamac, tractiune osoasa CONTINUA pt fracturi tip A si unele tip B

127
Q

tratam chir fr de aripa iliaca

A

reduceri si osteosinteza cu SURUBURI SPECIALE

128
Q

tratam chir fr arc ant inel pelvin

A

(disjunctie pubiana, fr ilio-ischio-pubiene)
reducere si osteosinteza cu PLACA si SURUBURI sau FIXATOARE EXT

129
Q

tratam chir fr cu deplasare si instabile de inel pelvin post

A

fr de sacrum, disjunctii sacro-iliace, fr-dislocatie a art sacro-iliace)
reducere si osteosinteza pe FOCAR DESCHIS

130
Q

Clasif fol in fr de acetabul

A

letournel-judet

131
Q

fr de acetabul- incidente Rx

A

de fata
oblica alara
obturatorie
iliaca

132
Q

complicatii fr de acetabul

A

coxartroza posttraumatica precoce (<=incongruentei articulare)
paralizie n sciatic
osificari heterotopice: se trat cu Indometacin 3 cp/zi 8 sapt +radioterapie

133
Q

tratament chirurgical fr de acetabul

A

-fr de acetabul, fr asociate de mb pelvin, pac politraumatizat, coxartroza posttraumatica (proteza totala de sold)

aborduri:
-POSTERIOR: pt fr post: PLACI DE RECONSTRUCTIE, SURUBURI
-ILIO-INGHINAL si ILIO-FEMURAL LARGIT (se abordeaza ambele coloane

134
Q

osteomielita

A

infectia osului cu germeni ajunsi pe cale hematogena (cel mai frecv stafilococ auriu-90%)

135
Q

osteita

A

inf osului prin inoculare directa cu stafilococ (in fr) sau iatrogena sau cu germeni specifici (osteita sifilitica, tbc, parazitara)

136
Q

localizarea cea mai frecv osteomielita acuta a perioadei de crestere

A

oasele lungi, la niv metafizelor
-femur si tibie (extrem fertile, apropiate de genunchi)
-humerus (7%)
-oase antebrat (5%)
-peroneu (1%)

137
Q

in osteomielita ac perioada de stare se manifesta prin

A

-atinge maxim la 2-3zile de la debut
-durerea domina tabloul clinic
-zona afectata: infiltrata, edematiata, tegumente rosii, calde si circulatie venoasa aparenta
-NU exista adenopatie
-dupa in 2-3 zile: ABCES SUBPERIOSTIC simtit la palpare ca o fluctuenta/renitenta profunda

138
Q

in evolutia osteomielitei acute, dupa o scurta perioada de ameliorare, cand temp creste din nou, indica:

A

-extinderea infectiei la diafiza
-aparitia unui alt focar in alt os
-complicatie articulara/viscerala

139
Q

dupa drenarea spontana sau chirurgicala a puroiului, osteomielita acuta

A

se poate vindeca
mai frecv se cronicizeaza

140
Q

examen radiologic osteomielita acuta

A

-la debut nu exista modif radiol
-dupa 5-6 zile: abces subperiostic si tumefactie ca semn cutanat
-14-16 zile: rarefiere in zona metafizo-diafizara (mici pete neregulate “aspect baltit”)
-18-20 zile: osul subperiostic nou format poate sa apara ca o dedublare a corticalei
-mai tarziu: sechestre osoase (mai opace, inconjurate de sp clar)
-in cursul ev, osul nou format- asp mai regulat, mai dens, sub forma unor ingrosari diafizare (hiperostoza)

141
Q

forme clinice osteomielita acuta

A

-toxica
-septico-pioemica
-a sugarului
-abcese si flegmoane ale partilor moi, de origine osoasa

142
Q

complicatii osteomielita acuta

A

-artrita
-fractura pe os patologic
-luxatie patologica
-tulb de osteogeneza

143
Q

DD osteomielita acuta

A

-boli contagioase ale copilariei
-traumatisme
-RAA- febra scazuta, manif pluriarticulare, migratorii, af cardiaca etc
-artrita supurata de alta etiologie decat cele secundare osteomielitei
-sarcom EWING (localizare diafizara, pusee febrile, reactie cortico-periostala cu aspect fusiform)
-flegmon simplu

144
Q

osteomielita acuta dd cu sarcomul

A

ewing
-loc diafizara
-pusee febrile
-reactie cortico-periostala cu aspect fusiform

145
Q

Osteomielita cronica

A

primara: inf hematogena cu germeni mai putin virulenti
secundara: urm unei osteomielite acute

146
Q

forme osteomielita cronica primara

A

-hiperostozanta si necrozanta
-sclerozanta
-abces central osos BRODIE
-osteomielita albuminoasa OLLIER

147
Q

Osteomielita cronica primara- forma hiperostozanta si necrozanta

A

-loc frecv femur si tibie
-dureri surde, profunde
-osul devine dur, ingrosat, dar slab calitativ
-RX: hiperostoza, din cauza condensarii osoase sechestrele mici nu se vad

148
Q

osteomielita cronica primara- forma sclerozanta

A

-la niv diafizei oaselor lungi (femur, tibie)
-RX: ingrosarea corticalei in zona metadiafizara, astfel incat nu se mai obs str trabeculara a osului

149
Q

Osteomielita cronica primara- abces central Brodie

A

-cav relativ mica, rotunda/ovalara, cu continut PURULENT
-in metafiza/diafiza oaselor lungi
-in jurul cavitatii exista o mica reactie hiperostozanta
-primitiv sau sec unei inf osteomielitice
-clinic: durere nevralgica, ce poate avea aspect OSTEOCOP
-ev de lunga durata
-trtam chirugical= excizie

DD:
-chist osos
-tumora cu mieloplaxe
-osteita fibroasa TBC
-sifilis
-osteosarcom

150
Q

Osteomielita cronica primara- osteomielita albuminoasa ollier

A

-rara
-cauza: stafilococ cu virulenta scazuta
-colectie de lichid vascos, incolor
-RX: reactie periostala
-DD cu sarcom Ewing (biopsie)
-tratam chir+antibiotic

151
Q

in osteomielita cronica secundara, perioada de acalmie dureaza

A

-cat timp drenajul este suficient
-cand fistula se inchide/ nu mai dreneaza suficient: durere, inflamatie, subfebrilitate

152
Q

osteomielita cronica sec- tratam chir

A

fistulectomie
sechestrectomie
excizie pana in ts sanatos
PLOMBAJ cu PEDICUL MUSCULAR

153
Q

osteomielita cronica sec- tratam adjuvant

A

PLOMBAJ
perle cu AB
AUTOGRAFON SPONGIOS dupa sterilizarea focarului infectios

154
Q

Anchiloza spontana, ca modalitate de vindecare a unei tuberculoze osteoarticulare, se produce mai frecv

A

la niv coloanei vertebrale (67%) fata de membre (20%)

155
Q

vindecarea previzorie in TOA este

A

claustrarea= procesul prin care bacilul viu determina formarea granulomului

156
Q

TOA
-leziuni
-evolutie

A

leziuni osoase si sinoviale
ev in 3 faze anatomice: debut, evolutie, separare

157
Q

medulohaversita proliferativa/infiltrativa
osteita cu foliculi tbc
caverna
invazie articulara

A

faza de debut TOA
lez osoase

158
Q

Granulatii
clinic-revarsat articular

A

faza de debut TOA
lez sinoviale

159
Q

secheste tbc in TOA faza

A

de evolutie, lez osoase

160
Q

ulceratia compresiva LANNELONGUE

A

TOA faza de evolutie, lez osoase
osteoporoza vecina cavernelor, uneori deformare epifizara prin contractie musculara

161
Q

sinovita fungoasa

A

TOA faza de evolutie, lez sinoviale
exudat serofibrinos->sinovita serofibrinoasa->sinovita fungoasa (muguri carnosi) cu asp pseudotumoral= TUMORA ALBA A GENUNCHIULUI

162
Q

TOA puroi granjos galbui

A

=ABCES ARTROFLUENT
din fungozitatile cazeificate si exudatul articular

162
Q

abcesele reci TOA

A

faza de evolutie
osifluente/artrofluente
ies prin brese articulare la ext prin piele sau la distanta de locul de plecare
cu exc TOA umar= geode inconjurate de scleroza

163
Q

Faza de reparare TOA la copil

A

anchiloza osoasa

164
Q

Faza de reparare TOA la adult

A

anchiloza fibroasa

165
Q

Adenopatie teritoriu supraiacent, satelita nedureroasa

A

TOA faza de stare

165
Q

Plica Alexandros in

A

TOA faza de stare

166
Q

In stadiu tardiv TOA, articulatia superficiala este

A

mult tumefiata, contrastand cu atrofia musculara din vecinatate
piele albicioasa (tumora alba), uneori brazdata de vene dilatate
-uneori in vecinatate se palpeaza tumefactia unui abces

167
Q

semne RX distructie cartilaginoasa TOA

A

-faza de stare
-PENSAREA INTERLINIULUI ARTICULAR

168
Q

semne RX distructie osoasa TOA

A

-faza de stare
-eroziuni si ancose rau delim de contururi osoase
-imagini subcondrale deschise in articulatie (carie osoasa) sau aparent inchise, cel mai adesea rau delim si neconturate de osteoscleroza

169
Q

Pt diag poza TOA se efectueaza

A

biopsia sinoviala prin punctie/artroscopie

170
Q

Stadiu clinic- semne sugestive pt TOA

A

-tumefactie locala izolata
-abces rece
-fistula
-adenopatie
-diformitate (cifoza-morb Pott, redoare in flexie)

171
Q

Stadiile lezionale Martini in TOA

A

1-loc SINOVIALA a bolii
-nu exis lez osoase, osteoporoza locala, largirea sp art

2-loc OSOASA
-cavitati/eroziuni in osul juxtacortical
-ingustarea sp articular

3-interesarea INTREGII ARTICULATII
-dar isi pastreaza arhitectura
-ingrosare pe ambii versanti articulari
-sp articular mult ingrosat/disparut
-demineralizare imo
-pierderea transparentei normale a ts moi

4-se acc stadiul 3+ modificari arhitectura articulara

!!in std 3 si 4 apar false imagini de “RX prost facuta” datorita suprapunerii OSTEOPOROZEI DIFUZE cu INGROSAREA PARTILOR MOI

172
Q

In TOA predomina bacilii cu metabolism

A

redus si dormanzi

173
Q

O mare valoare diag pt TOA o are foliculul

A

MOALE
cel dur poate aparea si in alte afectiuni: lepra, coccidiomicoza, granuloame de contaminare cu zirconiu, beriliu, corpi straini, chist hidatic, sarcoidoza, boala Crohn

174
Q

Chimioterapia antituberculoasa- eficace asupra germenilor dormanzi

A

PIRAZINAMIDA

175
Q

pp medicamente antituberculoase

A

-hidrazida
-rifampicina
-pirazinamida
-streptomicina
-etambutol

176
Q

tuberculostatice de rezerva- in cazuri de multirezistenta, fiind mult mai toxice

A

etionamida
cicloserina
ranamicina
capreomicina
acid paraminosalicilic

177
Q

medicamente noi, active mai ales in inf cu mycobacterii atipice (avis) sunt

A

ciprofloxacina si ofloxacina (fluorochinolone)
clofazimina
amikacina

178
Q

TOA GENUNCHI faza distructiva- genunchi mobil dar instabil

A

artroplastie prin interpozitie de fascia lata

178
Q

TOA GENUNCHI faza initiala

A

debridare articulara

179
Q

TOA GENUNCHI faza distructiva- genunchi mobil si stabil

A

artroplastie cu proteza totala

180
Q

TOA sold- sold indolor, mobil dar INSTABIL

A

artroplastie excizionala

181
Q

TOA sold- sold stabil, de forta, “neutralitate mecanica”, se pierde definitiv mobilitatea

A

artrodeza

182
Q

TOA sold- de electie pt ca satisface cele 3 deziderate- sold indolor, stabil si mobil

A

artroplastie cu proteza totala

183
Q

Coxartroze sec
unghi normal cervicocefalic si modificarea lui in coxa vara si coxa valga

A

malformatii coxo-femurale congenitale
unghi N 135 grade
in coxa vara e mai mic
in coxa valga e mai mare

184
Q

Epifizioliza esentiala este cauza a

A

Coxartrozei secundare
=alunecarea (bascularea) epifizei pe cartilajul de crestere la copii

185
Q

Osteocondrita juvenila (Legg-Perthes-Calve) este cauza a

A

coxartrozei secundare
=necroza idiopatica de cap femural la copil

186
Q

simptomatologie durata de stare coxartroza

A

-durere la niv soldului
-poz vicioasa mb inf
-inegalitate de mb pelvine
-redoare a art coxo-femurale

187
Q

RX coxartroza

A

-cap femural turtit cu OSTEOFITOZA
-oblicizare cotil
-ingustare sp dintre cap femural si cotil=PENSARE
-cotil cu fund dublu, cu osteofite
-modif de str osoasa: geode in oglinda, condesari (osteofite)
-subluxatii prin cant cresc de osteofite, displazie luxanta congenitala

188
Q

tratament coxartroza

A

-de debut: antialgic, antiinflam, balneologic
-per de stare: osteotomie (nu se mai fac), artroplastie totala de sold cu proteza cimentata/necimentata

189
Q

gonartroza- 4 stadii Collins

A

1
-in zona de max pres cartilaj galben
-fara luciu
-eroziuni tangentiale

2
-distuctie accentuata a cartilajului
-hiperplazie marginala

3
-cartilajul dispare in zonele de maxima presiune
-osteofitoza marginala

4
-cartilaj distrus pe S intinse
-osteofitoza marginala accentuata
-degenerescenta meniscului
-ingrosarea capsulei
-proliferarea sinovialei

190
Q

etiopatogenie gonartroza

A

cauze intraarticulare
-traumatisme
-osteocondroza disecanta
-condrodistrofii

cauze extraartculare
-genunchi in varul/valgum
-genu flexum
-instabilitate laterala rotula
-supraincarcare statica si dinamica genunchi

191
Q

simptomatologie gonartroza

A

-debut de ob progresiv, cu durere; rar brutal, cu hidartoza sau blocaj
-durere pe fata INTERNA a genunchiului, sp popliteu, subrotulian. cu iradiere in gamba; durerea se acc la efort si diminua in repaus
-cracmente
-senzatie de instabilitate, mers schiopatat

192
Q

examen obiectiv gonartroza

A

tumefactie
soc rotulian
amiotrofie de cvadriceps
genu valgum sau VARUM
limitarea flexiei/extensiei
crepitatii si durere la mobilizarea laterala a rotulei

193
Q

RX gonartroza

A

deviere axiala
pensarea sp articular
osteofitoza
osteoscleroza
corpi straini intraarticular
calcifieri meniscale

194
Q

DD gonartroza

A

-dureri din coxalgie/coxartroza proiectate la genunchi
-osteocondromatoza genunchiului
-artropatia tabetica, gutoasa, hemofilica
-osteocondroza disecanta Konig
-artrite infectioase
-poliartrita reumatoida
-spondilita anchilopoietica
-tumori osoase sau sinoviale

195
Q

osteocondroza disecanta konig dd cu

A

gonartroza

196
Q

tratament chirurgical gonartroza

A

emondaj articular
osteotomii de corectie
artroplastie

197
Q

necroza idiopatica de cap femural clasificare

A

clasif FICAT- ARLET (radiologica)

std 0
-RX normal, fara simptome

std 1
-RX normal, simptome moderate
-apar modificari histologice

std 2
-modif RX ale DENSITATII OSOASE
2A: scleroza/chisturi, interliniu articular si contur al capului femural NORMALE
2B:modificari de forma cap femural (turtire)

std 3
-pierderea sfericitatii capului femural, prabusirea acestuia

std 4
-ingustare sp articular, modificari acetabulare

198
Q

Tratament necroza idiopatica de cap femural

A

-foraje trohantero-capitale
-osteotomie de degajare
-artroplastie totala de sold necimentata
-proteza bipolara cand capul femural are conturul pastrat si nu exista leziuni de cartilaj

199
Q

adenopatia regionala apare

A

doar la sarcomul EWING

200
Q

Semiologie tumori

A

durere
tumefactie
adenopatia regionala doar la sarcom Ewing
compresiune vasculonervoasa
fr spontana

201
Q

tumora cu cel gigante mai frecv

A

la femei
epifizar

202
Q

in tumori este obligatorie

A

BIOPSIA OSOASA
examenul histopatologic este cel care pune diagnosticul pozitiv

203
Q

Osteomul osteoid

A

-t benigna, la adolescenti si tineri, in special gen masc
-loc cea mai frecv oasele lungi ale mb inf (75%), extremitati (15%), arc post vertebre (10%)
-clinic durere- la inceput intermitenta, apoi permanenta, necalmata de repaus, cu paroxisme nocturne, calmata la inceput de aspirina ; tumefactie mai rar

204
Q

Osteom osteoid RX

A

3 sedii: cortical, intraspongios, periostal

-cortical (pe diafiza)
NIDUS=mica lacuna in mijlocul unei reactii corticale condensate “imagine in cocarda”

-intraspongios
preponderent pe col femural, oasele mainii si picioarelor

CT util in localizari intraarticulare sau in canal medular

205
Q

nidusul- imagine in cocarda este specific

A

osteomului osteoid- localizare corticala (pe diafiza)

206
Q

Osteom osteoid DD cu

A

-osteomielita sclerozanta sau abcesul Brodie
-hemangiom cortical
-osteosarcom intracortical
-miozita osifianta
-boala Paget localizata
-tumora cu cel gigante

207
Q

abces Brodie dd cu

A

osteom osteoid

207
Q

boala Paget localizata dd cu

A

osteom osteoid

208
Q

tratament osteom osteoid

A

-chirurgical: rezectie+osteoplastie
!obligatoriu ablatia nidusului pt a preveni recidiva
-se fol GREFA OSOASA fixata sau nu cu material de osteosinteza

209
Q

Condrom

A

-tumora benigna cu potential de malignizare
-central (ENcondrom) sau periferic (ECCondrom)
-poate aparea sub forme multiple (boala OLLIER); se asoc cu angioame stelate (sdr MAFFUCCI)
-cel solitar este meta sau metadiafizar
-clinic durere si tumefactie
-descoperit intmplator la fr spontana pe os patologic
-ENcondromatoa det deform ale mainilor, antebratului sau genunchilor

210
Q

boala Ollier

A

condrom forma multipla
se asoc cu angioame cutanate=sdr Maffucci

211
Q

condrom RX

A

condrom solitar
-geoda clara omogena
-margini neregulate
-limite nete
-corticala suflata

condrom periferic
-excrescenta opaca, neomogena
-baza larga pe corticala osoasa, ce form un SEPT- semn imp rx de dd cu EXOSTOZA

212
Q

CONDROM periferic-semn imp RX de dd cu exostoza

A

baza larga pe corticala osoasa, ce form un SEPT

213
Q

Tratament condrom

A

condrom CENTRAL: chiuretaj +-plombaj+-osteosinteza

condrom PERIFERIC: exereza

cele degenerate MALIGN: tratament complex oncologic (rezectie-reconstructie chirurgicala, chimio si radio terapie)

214
Q

Chist osos

A

-tumora benigna cu CONTINUT LICHIDIAN
-frecv baieti a 2a decada
-metafiza proximala humerus
-rar durere moderata si tumefactie
-fr spontana pe os patologic (6 din 10 cazuri)
-descop intamplator la RX

215
Q

chist osos RX

A

-metafiza
-forma ovalara/rotunda
-FARA REACTIE PERIOSTALA
-imagine neomogena, uneori fragm osoase plutesc in continut

216
Q

chist osos dd

A

encondrom
displazie fibroasa monostica
chist anevrismal
tumora bruna din hiperparatirodism

217
Q

tratament chist osos

A

-15% cazuri fr se vindeca spontann
-CHIURETAJ+PLOMBAJ
-punctie-evacuare+ injectare de maduva osoasa hematogena recoltata extemporaneu

218
Q

dd chist anevrismal

A

chist osos
tumora cu cel gigante

219
Q

dd tumora bruna din hiperparatiroidism

A

chist osos
tumora cu cel gigante

220
Q

tumora cu cel gigante

A

-borderline
-primitiva, bogat vascularizata, OSTEOLITICA
-cel gigante multinucleate de tip OSTEOCLASTIC
-CEL GIGANTE STROMALE MONONUCLEARE DAU AGRESIVITATEA
-20-40 ani in sp femei (50-60%)
localizare:
-iubeste genunchiul in zona epifizara
-epifiza distala radius
clinic
-durere localizata, creste progresiv
-tumefactia semn tardiv
-fr revelatoare pe os patologic (10%)
-paraclinic nimic patologic

221
Q

ce cel dau agresivitatea in tumora cu cel gigante

A

cel gigante stromale mononucleare

222
Q

tumora cu cel gigante rx

A

localizare epifizara cu aspect osteolitic
“subtiaza si sufla corticala”

223
Q

tumora cu cel gigante anatomopat

A

-M: ts tumoral rosu-brun, moale, friabil
-m: cel mononucleate, stromale fibroblastice, gigante mononucleate
-tumorile agresive G2 metastazeaza in 10-15%cazuri

224
Q

tumora cu cel gigante dd

A

-tumora bruna din hiperparatiroidism
-chist anevrismal
-sarcom osteogenic cu cel gigante
-condroblastom
-fibrom neosifiant

225
Q

tratament in tumora cu cel gigante dep de

A

localizare
starea articulatiei invecinate
tratam ant in cazul recidivelor
grad de agresivitate histopat
metastaze

226
Q

tratament tumora cu cel gigante

A

grd I si II: chiuretaj+plombaj (ciment acrilic)+-grefa osoasa

grd III: rezectie+reconstructie

cazuri exceptionale- amputatie/dezarticulatie
radioterapie (tumori profunde/adjuvanta chimioterapiei)
chimioterapie pt tumori agresive

227
Q

Osteosarcom

A

tumora primitiva, maligna
80%la copii si adolescenti
-durere OSTEOCOPA in vecinatatea articulatiei
-tumefactia (std avansate), tegum cald, circ colat
-poz vicioase (genu FLEXUM)
-fr pe os patologic

paraclinic: fosfataze alcaline crescute in forme osteolitice

228
Q

osteosarcom RX

A

in forme avansate
-zone de osteoliza in zona metafizara
-reactie periostala lamelara (triunghiul lui CODMAN)
-aspect de “iarba de foc” cu osificari in partile moi
-efractia corticalei

forme osteolitice- prognostic sever
forme osteocondensate- mai blande
forme mixte

229
Q

apare reactia periostala lamelara- triunghiul lui codman in

A

osteosarcom forme avansate

230
Q

apare aspect de “iarba de foc” cu osificari in parile moi in

A

osteosarcom forme avansate

231
Q

osteosarcom localizare

A

centrala- debut in cav medulara
periferica/periostala

232
Q

dd osteosarcom

A

af inflam (osteomielite)
tumori benigne/borderline
tumori maligne ce apar in primele 2 decade

233
Q

tratament osteosarcom

A

chimioterapie urmata de tratam chir la 10-12 sapt
chimioterapie postop la tumori gigente suprainfectate

chirurgical
-radical: amputatii, dezarticulatii (tumori gigante suprainfectate/recidive)
-conservator-reconstructiv (tendinta actuala)

postop se cont chimioterapia
supraveghere din 3 in 3 luni primii 2 ani, apoi din 6 in 6 luni pana la 5 ani
evaluarea se face clinic, radiologic si scintigrafic

234
Q

Condrosarcom

A

tumora maligna primitiva
dupa a 3a decada de viata, mai frecv la B
mai frecv la niv trunchiului si oaselor lungi

clinic
durere, tumefactie
ferm aderenta de os
FARA ADENOPATIE
la pac cu boala OLLIER (25%)
fr pe os patologic
compresiune (localizare pe bazin)

235
Q

25%pac cu boala Ollier apare

A

condrosarcom

236
Q

condrosarcom RX

A

3 forme
-CENTRAL
geode de talie variabila cu contur neregulat
care perforeaza corticala

-PERIFERIC
creste densitatea partilor moi
disconcordanta intre volumul perceput clinic si cel RX

-CU CELULE CLARE
osteoliza epifizara
fara intreruperea corticalei (se confunda cu tum cu cel gig sau condroblastom)

237
Q

!in condrosarcom- arteriografia:

A

vasc peritumorala nespecif
tumora este AVASCULARA

238
Q

Condrosarcom dd

A

infarct osos
calus postfracturar
tumori begine: exostoze, condroame periferice, condroblastom, fibrom condromixoid, tum cu cel gig
tumori maligne: osteosarcom forma condroblastica, osteosarcom juxtacortical

239
Q

tratament condrosarcom

A

chirurgical: rezectii oncologice (ridicarea tumorii in bloc, pana in ts sanatos fara a fi vazuta)

reconstructie f dificila- artrodeze, grefe sau proteze modulate

condrosarcom si metastazele sale sunt RADIO si CHIMIO REZISTENTE

dg precoce cheia succesului

ortopedie (1 decks)

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