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Applied Orthopaedic Technology BMSc > Semester 1: Orthopaedic Medicine > Flashcards

Semester 1: Orthopaedic Medicine Flashcards

1
Q

How has the field of orthopaedics changed over time?

A

Historically deals with musculoskeletal abnormalities occurring at birth or in children. Far less common now due to better nutrition, health of pregnant women, use of antibiotics, immunisation programmes, decreased incidence of TB and Polio.

Nowadays, the field has grown to encompass a whole range of musculoskeletal conditions.

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2
Q

Define acute

A

Strikes the patient suddenly. Characterised by polymorphonuclear leukocytes (Neutrophils, Eosinophils and Basophils)

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3
Q

Define chronic

A

Takes a long time to develop and may last a long time. Characterised by lymphocytes (T and B Cells)

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4
Q

What is the difference between the suffix “…-otomy” and “…-ectomy”?

A

“…-otomy” - opening something up i.e. Arthrotomy is opening up a joint
“…-ectomy” - removing something i.e. Meniscectomy is removal of a meniscus

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5
Q

List the professionals that make up the orthopaedic management team

A

Orthopaedic surgeon, theatre nurses, porters, orthopaedic nurses, GPs, anaesthetists, rheumatologists, general surgeons, physiotherapists, occupational therapists, technicians

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6
Q

What is the goal of treating musculoskeletal disorders?

A

Symptom relief i.e. relieve pain or stiffness

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7
Q

What are the causes of congenital abnormalities?

A

Familial
Genetic
Insult to child within the womb

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8
Q

What is Osteoarthritis?

A

A condition of pain and limitation of movement of joints associated with excessive wear of articular cartilage resulting from a breakdown of the balance between the wear and repair processes in the joint.

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9
Q

What is the difference between primary and secondary osteoarthritis?

A

Primary - unknown aetiology (more common)

Secondary - known aetiology

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10
Q

Give an example of a Congenital cause of secondary osteoarthritis

A

Congenital dislocation of the hip

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11
Q

Give an example of a Childhood cause of secondary osteoarthritis

A

Perthe’s disease, Infection

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12
Q

Give an example of a Traumatic cause of secondary osteoarthritis

A

Fracture especially intra-articular

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13
Q

Give an example of a Metabolic cause of secondary osteoarthritis

A

Gout or other crystal arthropathies

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14
Q

Give an example of an infective cause of secondary osteoarthritis

A

TB

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15
Q

Give an example of a Chronic Inflammatory cause of secondary osteoarthritis

A

Rheumatoid

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16
Q

What are the conservative management options for Osteoarthritis?

A

Weight loss, Use of walking aids, Rest and Physiotherapy

Use of Analgesia in parallel with these measures

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17
Q

During normal walking when the weight is on the right leg which muscle groups are activated to tilt the pelvis

A

Right gluteal abductors

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18
Q

How do walking aids help reduce pain in hip osteoarthritis?

A

When a stick is held in the opposite hand it reduces the work required of the weight bearing abductor muscles

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19
Q

What are the 4 surgical options available to arthritis patients ?

A

Nothing
Arthrodesis
Osteotomy
Arthroplasty

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20
Q

What is the goal in an osteotomy procedure?

A

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

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21
Q

Which knee compartment is under excessive stress in a Genu Varum presentation?

A

Medial

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22
Q

Which knee compartment is under excessive stress in a Genu Valgum presentation?

A

Lateral

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23
Q

In which surgeries are people particularly at risk of Deep Vein Thrombosis and Pulmonary Embolism?

A

Hip and Knee Surgery. Also any surgery in and around the pelvis.

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24
Q

List general complications of surgery

A 
Chest Infection 
Urinary Complications 
Pressure Sores 
Deep Vein Thrombosis 
Pulmonary Embolism
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25
Q

What is the difference between early and late specific surgical complications?

A

Early - complications specific to the operation that arise soon after the operation
Late - complications specific to the operation that arise months to years later

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26
Q

List some specific early complications of joint replacement surgery

A

Dislocation
Deep Vein Thrombosis
Infection

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27
Q

List some specific late complications of joint replacement surgery

A

Infection

Loosening and wear

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28
Q

Why is dislocation a common early complication following arthroplasty?

A

Prosthesis will not be fully supported by the surrounding soft tissues. Muscles and their proprioceptors may be temporarily out of action i.e. through surgical trauma and pain inhibition. A capsule of scar tissue will not yet have formed around the prosthesis.

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29
Q

What measures can be taken to protect against deep vein thrombosis?

A

Heparin

Stockings

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30
Q

Symptoms of Rheumatoid Arthritis

A

Severe pain, swelling and deformity of the joint

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31
Q

What are the principle joints affected in Rheumatoid Arthritis?

A

Small joints of the hands and feet

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32
Q

Describe the clinical picture as seen in Rheumatoid Arthritis

A

Severe pain, swelling and deformity of the smaller joints particularly in the hands and feet in an often symmetrical pattern. Morning stiffness in affected joints which improve throughout the day. Affects females more than males.

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33
Q

Which surgical procedure may be offered to someone with Rheumatoid Arthritis?

A

Synovectomy - removal of the synovial membrane

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34
Q

Define avascular necrosis

A

Bone tissue death through loss of blood supply

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35
Q

Which areas are at particular risk of avascular necrosis following trauma and why?

A

Femoral head - supplied by a single end artery (Artery to head of Femur)
Proximal part of Scaphoid - retrograde arterial supply
Proximal part of Talus - retrograde arterial supply

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36
Q

Causes of non-traumatic avascular necrosis of the head of Femur

A

Chronic Alcohol abuse
High dose steroid therapy
Caisson’s Disease - following a quick ascent after scuba diving

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37
Q

Signs of avascular necrosis of the femoral head on X-ray

A

Initially - nothing

Later - dense crescent-shaped bone, reflecting the absence of blood vessels

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38
Q

What causes Gout?

A

Urate crystal deposition

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39
Q

What is the most common cause of Gout in the west?

A

Overuse of diuretics

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40
Q

Which serious condition may mimic the gout presentation?

A

Septic Arthritis - also presents with a hot, tender and swollen joint

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41
Q

How is Gout diagnosed?

A

High levels of uric acid in the blood

Gold Standard - joint aspiration and microscopy

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42
Q

What is the difference between the presentation of Gout and Pseudogout?

A

Pseudogout tends to be less acute

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43
Q

What crystals are deposited in a joint with Pseudogout?

A

Pyrophosphate

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44
Q

What happens to menisci in knees affected by pseudogout?

A

Calcification

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45
Q

What is Acute Septic Arthritis?

A

An infection caused by bacteria, which have spread to the joint via the blood from a site of trivial infection. Rarely occurring from direct penetration of the joint by a sharp object.

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46
Q

Presentation of Acute Septic Arthritis in children

A

Pyrexia, joint stiffness, joint erythema and joint tenderness

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47
Q

What is the most common infective organism responsible for Septic Arthritis in young adults with little constitutional upset?

A

Gonococcus

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48
Q

Treatment of Septic Arthritis

A

Surgical wash and debridement

Antibiotic therapy - “first-guess” will be an anti-staphylococcal agent

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49
Q

Who are at particular risk of joint Tuberculosis?

A

AIDS patients

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50
Q

Clinical presentation of Chronic Septic Arthritis

A

Chronic ill health (weight loss and muscle wasting - particularly around the affected joint)
Radiography will show marked thinning of affected bone surfaces

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51
Q

Symptoms of Meniscal lesions

A

Pain, joint effusion and sometimes locking and/or giving way

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52
Q

What is the mechanism of injury most commonly associated with meniscal tears?

A

Twisting injuries - particularly where the foot is planted in the ground and the Femur twists over the stationary Tibia

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53
Q

Which meniscus is most commonly torn?

A

Medial

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54
Q

Which two types of meniscal injury are common in old age?

A 
Cleavage lesion (Horizontal tear)
Degenerative tear
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55
Q

What is the role of the meniscus?

A

Help distribute the load between the femur and tibia

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56
Q

What is the benefit of an arthroscopic meniscectomy over an arthrotomy to perform an open meniscectomy?

A

Arthroscopic meniscectomy - quicker recovery

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57
Q

How are osteochondral fragments in the synovial fluid often managed?

A

Removal via arthroscopy

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58
Q

Which adolescent condition is characterised by spontaneous osteochondral fragmentation?

A

Osteochondritis dissecans

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59
Q

What is the mechanism of injury most commonly associated with cruciate ligament tears?

A

Hyperextension or Twisting

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60
Q

What are the possible causes of patella dislocation?

A

Malformation of the patella or lateral femoral condyles

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61
Q

What are the possible surgical options for recurrent patella dislocation?

A

Surgical splitting of the vastus lateralis muscle insertion into the patella +/- medial tightening (plication) of the vastus medialis muscle

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62
Q

What term is used for non-nervous tissues in the spine?

A

Spondylitides

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63
Q

What are localising signs of nerve root pain?

A

Loss of sensation or muscle weakness

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64
Q

What structures are located in front of and behind the nerve root?

A

Intervertebral disc infront

Facet joint behind

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65
Q

What is spondylosis?

A

Degeneration of the intervertebral disc leading to increased loading of the facet joints, which then develop secondary osteoarthritis

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66
Q

Define spondylolisthesis

A

Slippage of one vertebra relative to the one below, commonly seen in the lumbar spine

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67
Q

What does a fatigue fracture of the pars interarticularis (spondylolysis) predispose to?

A

Spondylolisthesis (slippage)

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68
Q

Which surgical option is available for severe cases of spondylolisthesis?

A

Spinal fusion

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69
Q

How does the pain in a prolapsed intervertebral disc differ from referred backache?

A

Pain from a prolapsed intervertebral disc is felt down the back of the thigh, leg and foot
Referred backache rarely extends beyond the knee or upper calf

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70
Q

What type of imaging is used to localise the site of an intervertebral disc prolapse prior to surgery?

A

Myelography - radio-opaque material injected into spinal fluid, X-ray is then captured and the location is identified as the fluid will not be able to flow past the site of the prolapse

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71
Q

Describe the difference between the likely sufferers of disc prolapse compared with bony root entrapment

A

Disc prolapse - under forty, more common in men, may follow a single event of straining/lifting or occur spontaneously
Bony root entrapment - over forty with history of previous mechanical backache, that have recently developed pain radiating to the legs and feet, which worsens with exercise

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72
Q

Define spinal claudication

A

Backache that radiates down the leg, usually made worse by exercise

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73
Q

By what age does the average child normally sit?

A

9 months

74
Q

By what age does the average child normally stand?

A

12 months

75
Q

By what age does the average child normally walk?

A

20 months

76
Q

What is the normal alignment of the knees?

A

Valgus

77
Q

By which age should children have developed normal knee alignment?

A

7 years

78
Q

When is In-toeing exaggerated?

A

Whilst running

79
Q

What is the wear pattern seen on the soles of shoes worn by children with in-toeing?

A

Worn down quick at the heels

80
Q

What are the three main causes of in-toeing?

A

Femoral neck anteversion
Tibial Torsion
Abnormal Forefeet

81
Q

By which age does femoral neck anteversion normally correct itself?

A

10 years

82
Q

Is tibial torsion a normal variation that should be ignored?

A

Yes

83
Q

What are the two types of flat feet?

A

Rigid and Mobile

84
Q

At which age does the arch in feet form?

A

May not form until aged 7

85
Q

In which sex is pain around the knee more common?

A

Female

86
Q

Define Osgood Schlatter’s disease

A

Inflammation of the attachment of the patellar tendon to the growing tibial epiphysis caused by excess traction by the quadriceps

87
Q

Who is at particular risk of Osgood Schlatter’s disease?

A

Active children

88
Q

Is the pain from Osgood Schlatter’s disease better or worse following exercise?

A

Worse

89
Q

When does Osgood Schlatter’s disease become asymptomatic?

A

Middle adolescence when the epiphysis fuses

90
Q

What is Chondromalacia patellae?

A

Erosion of the patellar cartilage seen arthroscopically in some cases of adolescent knee pain

91
Q

How common is Congenital Dislocation of the Hip?

A

1-2/1000 live births

92
Q

When are children screened for Congenital Dysplasia of the Hip?

A

Birth
3 months
6 months
12 months

93
Q

What are the clinical signs of Congenital Dysplasia of the Hip?

A

Shortening of the limb, asymmetrical skin creases, limited abduction and a limp

94
Q

Early diagnosed management of Congenital Dysplasia of the Hip

A

Splintage

95
Q

Late but before weight bearing diagnosed management of Congenital Dysplasia of the Hip

A

Period of gentle traction followed by open or closed manipulation. It is then splinted in plaster for three months.

96
Q

Very late diagnosed Congenital Dysplasia of the Hip management

A

Major surgery - usually involving deepening the acetabulum and re-angulation of the femoral neck

97
Q

What are the two types of Talipes Equino Varus?

A

Postural - mild (associated with breech position)

Fixed - severe (associated with developmental abnormalities of the nerves and muscles)

98
Q

What is the initial treatment of Talipes Equino Varus?

A

Gentle stretching to correct the hindfoot equinus followed by the correction of the mid and forefoot varus

99
Q

What is the treatment of mild Talipes Equino Varus?

A

Stretching and strapping in place for 6 weeks

100
Q

What is the treatment severe Talipes Equino Varus?

A

Initial stretching and strapping (6 weeks) followed by surgery if unsuccessful

101
Q

At which age do children’s feet stop growing?

A

14 years

102
Q

What are the long-term risks of Talipes Equino Varus?

A

Affected foot may be significantly smaller

103
Q

What are the two types of Spina bifida?

A

occulta and cystica

104
Q

What percentage of the population are affected by Spina bifida occulta?

A

2%

105
Q

What is the main symptom of Spina bifida occulta?

A

Mechanical back pain

106
Q

What is diastamatomyelia?

A

Tethering of the spinal cord to the higher lumbar vertebrae during growth

107
Q

What are the two types of Spina bifida cystica?

A

Meningocele and Meningomyelocele

108
Q

What is the difference between Meningocele and Meningomyelocele ?

A

Meningocele - Nervous tissue covered by a cyst

Meningomyelocele - Nervous tissue incorporated in the cyst wall

109
Q

What is common comorbidity of children with spina bifida cystica?

A

Hydrocephalus

110
Q

Define Cerebral Palsy

A

Abnormality of the brain often caused by damage during birth

111
Q

Are spinal reflexes affected in Cerebral palsy?

A

No

112
Q

Define Hemiparesis Cerebral palsy

A

One arm and one leg on the same side affected

113
Q

Define Paraparesis Cerebral palsy

A

Both legs affected

114
Q

Define Quadparesis Cerebral palsy

A

All four limbs affected

115
Q

What is toe-walking in adolescence a sign of?

A

Minor spasticity

116
Q

Which condition in children is characterised by osteochondritis of the femoral head epiphysis?

A

Perthe’s disease

117
Q

Why may pain from the hip joint radiate to the knee?

A

The sensory distribution follows the path of the obturator nerve

118
Q

What is an enthesopathy of the origin of the forearm flexors called?

A

Golfer’s Elbow

119
Q

What is an enthesopathy of the origin of the forearm extensors called?

A

Tennis Elbow

120
Q

Is the common extensor origin located on the medial or lateral side of the forearm?

A

Lateral

121
Q

Is the common flexor origin located on the medial or lateral side of the forearm?

A

Medial

122
Q

What two options are available to speed up the recovery of an enthesopathy?

A

Course of anti-inflammatory agents

Local steroid injections

123
Q

Define neuropraxia

A

Nerve injury caused by compression or stretching

124
Q

What are the common sites of nerve entrapments?

A

Median nerve at the wrist
Ulnar nerve at the elbow and the wrist
Posterior tibial nerve at the ankle

125
Q

Which condition is known as housemaid’s knee?

A

Pre-patellar bursitis

126
Q

Define Hallux valgus

A

Turning away of the phalanges of the big toe from the mid-line, usually because of a deformity at the joint line

127
Q

Define Hallux rigidus

A

Osteoarthritis of the first metatarsophalangeal joint

128
Q

What is the main cause of hallux rigidus in adolescents?

A

Osteochondral fracture

129
Q

What is the management of mild hallux rigidus?

A

Surgical removal of the osteophytes with an osteotomy of the proximal phalanx

130
Q

What is the Keller’s procedure?

A

Excision of the metatarsophalangeal joint

131
Q

What is a common cause of claw foot?

A

Weak or denervated small muscles of the feet, often associated with minor spinal abnormalities i.e. Spina bifida occulta

132
Q

What is the surgical management of hammer toes?

A

Fusion of the interphalangeal joints in a straight position

133
Q

What is a Morton’s Neuroma?

A

Trapped cutaneous nerves to the toes become irritated between the metatarsal heads giving rise to a neuroma

134
Q

What is the plantar fascia?

A

Tough fibrous layer which runs from the os calcis to each toe base

135
Q

Describe the pattern of pain felt in plantar fasciitis

A

Soreness of the instep, often worse first thing in the morning and after sitting for a few hours
Symptoms may be relieved slightly by walking

136
Q

What is the main cause of Achilles tendinitis and rupture in middle age?

A

Degeneration thought to be caused by a poor blood supply to lower part of tendon which is considered a point of weakness

137
Q

Why must steroids injections never be used in Achilles tendinitis?

A

May lead to rupture

138
Q

How is Achilles rupture treated?

A

Equinus plaster for a minimum of 8 weeks

Some opt for surgical suturing

139
Q

Which two conditions is tenderness under active movement within a painful arc suggestive of?

A

Supraspinatus tendon inflammation

Subacromial bursitis

140
Q

Why should repetitive shoulder steroid injections be avoided?

A

May cause degeneration of rotator cuff

141
Q

What determines the positions of the proximal and distal bone fragments after a fracture?

A

Proximal - determined by muscles

Distal - determined by gravity

142
Q

What can be done initially to reduce swelling after injury?

A

Elevate injured part

143
Q

How can the colour of bruising help diagnose age of injury?

A

Initial dark bruises occur due to deoxygenated blood loss into soft tissues, then as haemoglobin begins to breakdown the colour changes to green and then to yellow

144
Q

Which cells carry haemoglobin degradation products from the site of bruises to the liver?

A

Scavenger Cells

145
Q

Describe the technique used in radioisotope scanning

A

Small quantity of radioactive substance is injected into the blood. The substance attaches to phosphate molecules which is actively taken up by bone. An Xray plate is then exposed under the affected body part and a very sensitive radiograph is obtained.

146
Q

Which of Spiral, Oblique and Transverse fractures are associated with low energy mode of injury?

A

Spiral - low energy twisting mechanism of injury

147
Q

Describe the displacement of a fracture

A

Position of the distal fragment described relative to the proximal one

148
Q

Which three terms are used when describing the position of the distal fragment of a fracture?

A

Displacement
Angulation
Rotation

149
Q

How much blood is expected to be lost into soft tissues following a femoral fracture?

A

2-3 units

150
Q

How much blood is expected to be lost into soft tissues following a tibial fracture?

A

Around 1 unit

151
Q

What management is acceptable if there is any doubt whether a wound created from an open fracture can be closed without any skin tension?

A

Wounds are better left open and closed as a secondary procedure after a few days. Patients meanwhile should receive broad spectrum antibiotics and tetanus protection

152
Q

How much blood is expected to be lost into soft tissues following a pelvic fracture?

A

Around 6 units

153
Q

Restoration of a bone after fracture to normal position is achieved by the process of…

A

Reduction

154
Q

Describe the difference between unity and consolidation of a fracture site during stages of healing

A

United - bone has become strong enough to support itself

Consolidation - bone has become strong enough to bear some load

155
Q

Give an example of an internal fixator that works via apposition

A

K-wires

156
Q

Give an example of an internal fixator that works via interfragmentary compression

A

Screws or Tension band wires

157
Q

Give an example of an internal fixator that works via an onlay device

A

Plate and screws

158
Q

Give an example of an internal fixator that works via an inlay device

A

Intramedullary nail

159
Q

What is the difference between traction used to reduce a fracture and traction used to hold a reduced fracture?

A

Traction may be used to hold a reduced fracture by exerting a small weight to the limb. Which exerts a pull along the axis of the broken limb, causing muscles to contract thus holding the fracture site.

Traction may be used to achieve reduction by using a relatively large force to overcome muscle resistance to achieve alignment.

160
Q

Give an example of a static traction device

A

Thomas splint

161
Q

What is the difference between static traction and balanced traction?

A

Static - pull achieved against another part of the body

Balanced - pull against a body part os balanced with a counterweight at the other side

162
Q

How is dynamic traction achieved?

A

Joints are still permitted to move but by means of pulleys and a pull along the fracture site is maintained throughout movement

163
Q

What is the difference between early primary and early secondary complications of fractures?

A

Early primary - as a consequence of injury

Early secondary - as a consequence of treatment

164
Q

Give examples of early primary fracture complications

A 
Blood loss
Infection for open fractures
Fat embolism 
Renal failure 
Soft tissue injury 
Compartment syndrome
165
Q

Give examples of early secondary fracture complications

A 
Plaster disease
Renal stones 
Immobility 
Infection 
Compartment syndrome
166
Q

What is the difference between Late primary and early secondary complications of fractures?

A

Late primary - as a consequence of injury

Late secondary - as a consequence of treatment

167
Q

Give examples of Late primary fracture complications

A 
Non-union
Delayed union
Mal-union
Growth arrest
Arthritis
168
Q

Give examples of Late secondary fracture complications

A

Mal-union

Infection

169
Q

What is the treatment of an infected unstable open fracture?

A

Stabilisation via external fixation followed by surgical wound cleansing and later bone grafting

170
Q

How might a fat embolism present post-fracture?

A

Usually in younger men under twenty years old, 2-5 days post-injury present with tachypnoea and mild confusion

171
Q

What is the main symptom presentation in compartment syndrome?

A

Disproportional pain to the injury

172
Q

What is a useful diagnostic test for compartment syndrome?

A

Stretch the muscles in the affected compartment, this should precipitate extreme pain

173
Q

What complications may arise from late mobilisation?

A 
Osteoporosis
Renal stone formation
Stiffness
Muscle wasting
Skin sores
174
Q

What percentage of fractures go on to non-union?

A

2%

175
Q

What is the most common site of fracture non-union?

A

Tibia

176
Q

List the potential causes of non-union

A

Excessive movement
Too little movement - as a result of rigid internal fixation
Soft tissue interposition (between bone ends)
Poor blood supply
Infection
Excessive traction - bones too far apart
Intact adjacent bone

177
Q

When are upper limb fractures considered to be non-union?

A

At 10 weeks

178
Q

When are lower limb fractures considered to be non-union?

A

At 20 weeks

179
Q

Define mal-union

A

Fracture has been allowed to heal in a position that precludes normal function

180
Q

How are mal-unions treated?

A

Open reduction - internal fixation

Applied Orthopaedic Technology BMSc (2 decks)

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