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Year 3 Surgery > T&O (General Principles) > Flashcards

T&O (General Principles) Flashcards

1
Q

State the three principles of Fracture Management

A

Reduce
Hold
Rehabilitate

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2
Q

What is Reduction?

A

Restoring the anatomical alignment of a fracture/dislocation
Normally done in a closed setting but may be open
Generally requires three people (one to reduce, one to provide countertraction, one to apply plaster)

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3
Q

What is ‘Hold’

A

Term for immobilising a fracture

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4
Q

When might traction be required with the ‘Hold’ principle

A

If muscular pull is particularly strong it may naturally displace the fracture
Commonly required for #NOF, Pelvic and Femoral Fractures

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5
Q

Give two principles of Splints/Plasters

A
  • For the first two weeks the plaster is not circumferential (allows for swelling and prevents compartment syndrome)
  • If axial instability then the plaster needs to cross the joint above and below
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6
Q

What is Rehabilitation?

A

Intensive phsiotherapy required by most patients

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7
Q

What are the X-Ray features of OA?

A

L - Loss of joint space
O - Osteophytes
S - Subchondral Cysts
S - Subchondral Sclerosis

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8
Q

How do intra-articular steroids work for OA?

A

Typically mixed with local anaesthetic which improves symptoms for a few hours
Will subsequently have a steroid flare which will worsen symptoms for a few days

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9
Q

Describe three surgical managements of OA

A

Osteotomy - Bone is cut to change its alignment
Arthrodesis - Fusing the joint to prevent movement and pain
Arthroplasty - Replacement or reconstruction of a joint

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10
Q

What is an Open Fracture?

A

When there is a direct communication between the fracture and the external environment
(Usually through the skin, pelvic ones may be through vagina/rectum)

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11
Q

State the two types of Open Fractures

A

In to Out - Broken bone has punctured and broken through the skin
Out to In - Penetrating injury also caused fracture

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12
Q

What is the Gustilo-Anderson classification of Open Fractures?

A

1 - less than 1cm wound and clean
2 - 1 to 10cm wound and clean
3a - Greater than 10cm wound and high energy
3b - Greater than 10cm wound and high energy, with significant tissue loss
3c - All injuries with vascular injury

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13
Q

Give 4 principles of management of Open Fractures

A
  • Involve the correct specialty (3a is Orthopaedics only, 3b involve plastics, 3c involve vascular)
  • Realignment and resplinting
  • Broad spectrum Abx and Tetanus
  • Photograph and dress wound
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14
Q

What is Compartment Syndrome?

A

Critical pressure increase in a non distensible fascial compartment
Causes include: High energy trauma/Crush Injury/DVT/Tight Casts

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15
Q

Describe three features of Compartment Syndrome pathophysiology

A
  • As pressure increases, veins compress increasing hydrostatic pressure, forcing fluid out further increasing pressure
  • Paraesthesia as traversing nerves are compressed
  • Ischaemia is Pressure is greater than diastolic
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16
Q

Give 4 clinical features of Compartment Syndrome

A
  • Paraesthesia
  • Severe Pain (Disproportionate to injury)
  • Affected area may feel tense
  • Arterial insufficiency stage - 6P’s
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17
Q

Compartment Syndrome is typically a clinical diagnosis, but suggest two possible investigations

A
  • Upward trending CK levels
  • Intracompartmental pressure monitor (>40mmHg diagnostic)
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18
Q

Give 3 principles of management for Compartment Syndrome

A
  • Pre Op (High Flow O2, IV Crystalloid Fluids, IV Opioid Analgesia)
  • Fasciotomy
  • Monitor Renal Function (Rhabdomyolysis, Reperfusion Syndrome)
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19
Q

Define Septic Arthritis

A

Infection of a joint (can be prosthetic or natural)
Can cause irreversible damage to articular cartilage leading to severe OA

20
Q

Describe the three modes of infection in Septic Arthritis

A

Bacteraemia (UTI, Pneumonia)
Direct Inoculation
Spreading from adjacent Osteomyelitis

21
Q

Give 4 causative organisms of Septic Arthritis

A

S.Aureus
Streptococci
N.Gonorrhoea
Salmonella

22
Q

State four risk factors of Septic Arthritis

A

Age>80
DM
IVDU
Joint Prosthesis

23
Q

How would Septic Arthritis present?

A
  • 60% have fever
  • Single swollen joint causing severe pain
  • Often joint is rigid and patient is unable to weight bear
24
Q

Give four investigations for Septic Arthritis

A
  • Routine Bloods
  • Blood Cultures (atleast 2 different samples)
  • Joint Aspiration PRE Abx
  • XRay
25
Q

How is Septic Arthritis managed?

A
  • Extensive Antibiotics (atleast 6 weeks with the first two being IV)
  • Extensive Surgical Irrigation and Debridement
26
Q

What is Osteomyelitis?

A

Infection of the bone that causes progressive inflammatory destruction and formation of new bone
Can be acute or chronic

27
Q

Describe the three mechanisms of infective spread causing Osteomyelitis

A
  • Haematogenous
  • Direct Inoculation with normal vascularity
  • Contiguous spread with poor vascularity (eg Diabetic
    Foot)
28
Q

Describe the pathophysiology of Osteomyelitis in five steps

A

1) Pathogen settles in a bone, creating a biofilm
2) Inflammation creates sub-periosteal reaction, lifting the periosteum from bone (appears like a tumour on the XRay)
3) No blood supply/nutrition from the periosteum devitalises it (AKA Periosteal Stripping)
4) Necrosis of bone results in Sequestrum formation (floating piece of bone - acts as a resevoir of infection)
5) Involucrum formation (AKA new bone)

29
Q

Describe the clinical features of Osteomyelitis

A
  • Low grade pyrexia
  • Severe Pain (may be worse at night) (except in diabetic patients)
30
Q

What is Pott’s Disease?

A

Infection of vertebral body and intervertebral discs with Mycobacterium Tuberculosis, normally affecting thoracolumbar region
Back Pain/Low Grade Fever
Investigate with MRI

31
Q

What is the definitive investigation of Osteomyelitis?

A

MRI

32
Q

How is Osteomyelitis managed?

A
  • Long term IV antibiotics (atleast 4 weeks)
  • If evidence of deterioration - curettage of affected area
33
Q

Give two complications of Osteomyleitis

A

Growth disturbances in Children due to premature epiphyseal closure
Chronic Osteomyelitis

34
Q

Name 5 common primary tumours that metastasise to bone

A

Thyroid
Lung
Breast
Kidney
Prostate

35
Q

Give 3 risk factors for Bone Tumours

A

Genetic (RB1, P53)
Previous Radiation Exposure
Benign Bone Conditions (Pagets, Fibrous Dysplasia)

36
Q

Give two presenting features of a Primary Bone Tumour

A
  • Pain (worse at night)
  • Fracture without trauma
37
Q

Name four benign Primary Bone Tumours

A

Osteoid Osteoma
Osteochondroma
Chondroma
Benign Osteoclastoma

38
Q

Where do Osteoid Osteomas and Osteochondromas normally form?

A

Metaphyses of bones

39
Q

Name three malignant Primary Bone Tumours

A

Osteosarcoma
Ewing’s Sarcoma
Chondrosarcoma

40
Q

Osteosarcoma is the most common malignant bone tumour, describe the bimodal age distribution

A
  • 10 to 14
  • > 65
41
Q

How would Osteosarcomas appear on an X-Ray?

A

Medullary and Cortical Bone Destruction

42
Q

How are Osteosarcomas managed?

A

Aggressive surgical resection and chemotherapy to prevent metastases?

43
Q

What is Ewing’s Sarcoma?

A

A paediatric malignancy of poorly differentiated neurectodermal cells commonly affecting the diaphyses of long bones

44
Q

How does Ewing’s Sarcoma present on an X-Ray?

A

Onion Skin

45
Q

What is the staging system for bone tumours?

A

Enneking

46
Q

Which one of the clinical signs is most strongly suggestive of Acute Compartment Syndrome?

A

Passive Stretch of Muscle Belly initiating pain

Year 3 Surgery (11 decks)

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