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Year 2 MSK > Surgery > Flashcards

Surgery Flashcards

1
Q

Arthroplasty

A

Reshaping/replacement of the joint

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2
Q

Hemiarthroplasty

A

Replacement of only one side of the joint

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3
Q

What are the five common materials for joint replacements.

A 
Stainless Steel
Cobalt chrome
Titanium alloy
Polyethylene
Ceramic
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4
Q

What is the issue with metal components?

A

They can trigger an inflammatory response resulting in a inflammatory granuloma (pseudo tumour)

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5
Q

What are the issues with a pseudotumour

A

It can trigger bone and muscle necrosis

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6
Q

What is the issue with polyethylene?

A

Can trigger an inflammatory response in bone resulting in osteolysis.

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7
Q

What is the issue with ceramics?

A

They can shatter

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8
Q

If infection of replacement caught within 3 weeks what is the treatment?

A

Surgical washout
Debridement
Parenteral antibiotics 6 weeks
50% success

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9
Q

If infection of replacement presents after 3 weeks what is the treatment?

A

Removal of infected implant and all foreign material.
Parenteral antibiotics until infection is under control.
Revision is performed.

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10
Q

Why does post three weeks require a more severe treatment?

A

As by this point a biofilm will have formed which prevent the immune system from attacking.

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11
Q

Early local surgical complications

A 
Infection
Dislocation
Instability
Fracture
Nerve Injury
Bleeding 
DVT
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12
Q

Early General Complications

A 
Hypovolaemia
Shock
Acute Renal Failure
MI
PE
0.2% fatality in hip or knee replacement
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13
Q

Late Local complications

A 
Infection - haematogenous spread easy to colonies metal objects
Loosening
Fracture
Breakage
Pseudotumour formation
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14
Q

Arthrodesis

A

Surgical stiffening or fusion of a joint in a functional position.
Usually for endstage pain relief

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15
Q

Osteotomy

A

Surgical realignment of a bone often by the removal of wedges.
Used to redistribute the load

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16
Q

Osteomyelitis

A

Infection of the bone

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17
Q

Causes of osteomyelitis

A

Penetrating trauma or surgery (inoculation)

Haematogenous spread

18
Q

Why are young children more susceptible to osteomyelitis from haematogenous spread?

A

Young children have long tortuous vessels in their metaphysis with sluggish flow allowing bacteria to colonise.

19
Q

When are antibiotics no longer effective in osteomyelitis ?

A

When a sequestrum forms and breaks off.

20
Q

What is a sequestrum?

A

A dead fragment of bone.

21
Q

What is a involucrum?

A

New bone forming around the area of infection in order to try and contain the spread and necrosis.

22
Q

What is a Brodies abscess

A

A thin wall of sclerotic bone forms around the abscess.

23
Q

Who present with Brodies abscess?

A

Children with subacute osteomyelitis.

24
Q

Why in children do the abscesses often spread along the bone?

A

The have a loosely applied periosteum so it forms between it and the bone.

25
Q

Acute osteomyelitis

A

In absence of surgery - Young children or immunocompromised adults

26
Q

Chronic osteomyelitis

A

Develops from untreated acute

Associated with sequestrum and or involucrum

27
Q

Where does chronic osteomyelitis usually present?

A

Axial skeleton
Usually haematogenous spread for UTI.
Peripheral
From open fracture or internal fixation.

28
Q

Skeletal tuberculosis

A

Spread from primary lung infection.

29
Q

What is a gibbus deformity?

A

Sharp angular change in the back as a result of destructive TB granuloma.

30
Q

In kids what receptors should be checked?

A

IFN-gamma

IL-12

31
Q

Osteomyelitis infective organisms.

Newborns under 4 months

A

S.aureus
Enterobacter sp.
Group A and B Strep

32
Q

Osteomyelitis infective organisms.

4 months to 4 years

A

S.aureus
Group A strep
H.influenzaa
Enterobacter

33
Q

Osteomyelitis infective organisms.

4 years to Adult

A

S.aureus 80%
Group A strep
H.influenzae
Enterobacter sp

34
Q

Osteomyelitis infective organisms.

Adult

A

S.aureus

Occasionally enterobacter or streptococcus sp

35
Q

Osteomyelitis infective organism

Sickle cell anaemia patients

A

S.aureus

Salmonella is unique

36
Q

What is correct procedure regarding antibiotics in osteomyelitis.

A

Avoid empiric, chronic won’t kill you wait for lab results then use targeted antibiotics.

37
Q

When are antibiotics used before lab results in osteomyelitis.

A

Septic arthritis

Soft tissue syndrome

38
Q

What is surgical treatment for osteomyelitis.

A

Debridement and removal or all infected or unviable tissue.

39
Q

Which groups are at risk of osteomyelitis of the spine?

A

Poorly controlled diabetics
Intravenous drug users
Immunocompromised

40
Q

Where is most common location for osteomyelitis within the spine?

A

Lumbar region

41
Q

How does osteomyelitis of the spine present?

A

Insidious onset back pain, unremitting and constant.
Paraspinal muscle spasm.
Fever and or systemic upset.
Severe may have neurological deficit.

Year 2 MSK (19 decks)

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