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MSK - Cortex > Week 5 > Flashcards

Week 5 Flashcards

1
Q

what is arthroplasty also known as

A

joint replacement

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2
Q

what is replacing one half of the joint known as

A

hemiarthroplasty

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3
Q

when can excision of a joint be useful

A

in smaller joints

e.g. CMC jt

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4
Q

what is arthrodesis and when is it used

A

surgical stiffening or fusion of a
joint in a position of function

used for end stage ankle arthritis, wrist arthritis and arthritis of the first MTP jt of the foot (hallux rigidus)

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5
Q

what is osteotomy and when is it used

A

surgical realignment of a bone

used for deformity correction or to redistribute load across an arthritic joint

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6
Q

what type of soft tissues would benefit from decompression

A

supraspinatus tendonitis

subacromial decompression

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7
Q

what can be performed in the extensor tendons of the wrist in RA to prevent rupture

A

synovectomy

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8
Q

Mx of joint instability

A

physio - strengthen surrounding muscles
splints

Surgery

  • ligament tightening/advancement (e.g. ankle instability)
  • ligament reconstruction using tendon graft (e.g. ACL reconstruction)
  • soft tissue reattachment (e.g. shoulder instability)
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9
Q

conditions that cause significant ligamentous laxity

A

Ehlers-Danlos

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10
Q

why would spinal instability need to be fused

A

may cause pain, nerve root compression or spinal cord compression

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11
Q

what is osteomyelitis

A

infection of bone

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12
Q

pathogenesis of osteomyelitis

A
  • bone infected
  • enzymes from leucocytes cause local osteolysis
  • pus forms which impairs blood flow
  • infection difficult to eradicate
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13
Q

what is sequestrum

A

dead fragment of bone which has broken off

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14
Q

with the presence of sequestrum, osteomyelitis can be cured by antibiotics - true or false

A

false

antibiotics will not cure the infection alone

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15
Q

what is involucrum

A

new bone forming around the area of necrosis

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16
Q

who gets acute osteomyelitis

A

children + immunocompromised

in absence of recent surgery

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17
Q

chronic osteomyelitis

A

evelops from an untreated acute osteomyelitis and may be associated with a sequestrum and/or involucrum

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18
Q

where does the infection tend to be in chronic osteomyelitis in adults

A

axial skeleton (spine or pelvis) with haematogenous spread from pulmonary or urinary infections, or from infection of the intervertebral disc (discitis)

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19
Q

what can suppress chronic OM and what can this cause

A

antibiotics
lay dormant for many years before reactivating causing localized pain, inflammation, systemic upset and possible sinus formation

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20
Q

what disease can cause chronic OM

A

TB

particularly in the spine through haematogenous spread from primary lung infection

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21
Q

what organisms cause OM in newborn

A

s.aureus
enterobacter sp
group A & B strep

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22
Q

what organisms cause OM in children (up to 4y/o)

A

s.aureus
group A strep
H.influenzae
Enterobacter sp

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23
Q

what organisms cause OM in children/adolescents)

A

s.aureus
group A strep
H.influenzae
Enterobacter sp

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24
Q

what organisms cause OM in adults

A

S. aureus

occasionally enterobacter or streptococcus sp

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25
Q

what organisms cause OM in sickle cell anaemia patients

A

s. aureus

salmonella

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26
Q

acute OM Tx

A

best guess antibiotic IV
surgical drainage of pus
remove infected bone
washout area

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27
Q

chronic OM Tx

A 
antibiotics IV
Surgery - debridement
- to gain deep bone tissue cultures,
- remove any sequestrum 
- excise any infected or non‐ viable bone
28
Q

what happens if the bone becomes unstable after removing infected bone in OM

A

internal or external fixation

29
Q

adv of external over internal fixation in treatment of chronic

A

bone can be subsequently lengthened if it has been shortened as a result of the debridement

30
Q

who is at risk of OM of the spine

A

Poorly controlled diabetics
intravenous drug abusers
immunocompromised patients

31
Q

Sx of OM of the spine

A

insidious onset of back pain which is constant and unremitting.
paraspinal muscle spasm
spinal tenderness
fever and/or systemic upset. neurologic deficit
paravertebral or epidural abscess

32
Q

Ix for OM of the spine

A

MRI

Blood cultures

33
Q

Tx for OM of the spine

A

high dose IV antibiotics

CT guided biopsy to obtain tissue culture

34
Q

Indications for surgery of OM of the spine and the surgery

A

inability to obtain cultures by needle biopsy,
no response to antibiotic therapy progressive vertebral collapse progressive neurological deficit.

surgery

  • debridement,
  • stabilisation
  • fusion of vertebrae
35
Q

what is the concern when a deep infection complicates a prosthetic joint replacement

A

development of chronic infection with pain, poor function, recurrent sepsis, chronic discharging sinus formation and implant loosening

36
Q

what is there a risk of with deep infections

A

chronic OM

non-union fracture

37
Q

what is primary bone healing

A

1st intention healing

minimal fracture gap (less than 1mm). Bone bridges the gap with new bone from osteoblasts. Occurs for healing of hairline fracture and when # are fixed with compression screws and plates

38
Q

what is secondary bone healing

A

2nd intention - used in majority of fractures

Gap at # needs filed temporarily to act as a scaffold for new bone. Involved inflammatory response.

39
Q

fracture process of secondary bone healing

A

Fracture occurs
Haematoma occurs with inflammation from damaged tissues
Macrophages and osteoclasts remove debris and resorb the bone ends
Granulation tissue forms from fibroblasts and new blood vessels
Chondroblasts form cartilage (soft callus)
Osteoblasts lay down bone matrix (collagen type 1)– Enchondral ossification
Calcium mineralisation produces immature woven bone (hard callus)
Remodelling occurs with organization along lines of stress into lamellar bone

40
Q

when does soft and hard callus formed

A

soft - 2nd to 3rd week

hard - 6-12 weeks

41
Q

what is required for secondary healing

A

good blood supply for oxygen, nutrients and stem cells and also requires a little movement or stress

42
Q

what can causes atrophic non union

A

Lack of blood supply, no movement (internal fixation with fracture gap), too big a fracture gap or tissue trapped in the fracture

43
Q

what can impair healing of fracture

A

smoking
vascular disease
chronic ill health
malnutrition

44
Q

what type of fractures have greater risk of stiffness, pain or OA

A

intra-articular

45
Q

Ix of #

A

AP and lateral X-ray
Bone scans for stress fractures
MRI - when clinical suspicion but normal X-ray
CT - assess + determine degree of damage (e.g. polytrauma)

46
Q

initial Mx of long bone fracture

A

Analgesia e.g. IV morphine
Splintage/immobilisation
Ix

47
Q

what splint is used in femoral shaft fractures

A

Thomas splint

48
Q

Tx for stable, undisplaced, minimally displaced and minimally angulated fractures

A

non-operatively
period of splint age or immobilisation
rehab

49
Q

Tx for Displaced or angulated fractures where the position is deemed unacceptable

A

reduction under anaesthetic

Closed reduction and cast application

50
Q

Tx for unstable injuries

A

surgical stabilisation
small percutaneous pins (K‐wires) for small fragments, cerclage wires, screws, plates & screws, intramedullary nails or external fixation.

51
Q

Tx for Unstable extra‐articular diaphyseal fractures

A

Open reduction and Internal Fixation (ORIF) using plates and screws
goal - anatomic reduction and rigid fixation leading to primary bone healing

52
Q

when might ORIF be avoided

A

soft tissues too swollen
blood supply to the fracture site is tenuous (high energy),
ORIF may cause extensive blood loss (eg femoral shaft)

53
Q

if ORIF cannot be used what can be done

A

closed reduction and indirect internal fixation with an intramedullary nail with dissection distant to the fracture site

54
Q

Tx for intra-articular fractures

A

ORIF using wires, screws and plates

Poor outcome predicted then Joint replacement or arthrodesis

55
Q

why are elderly more likely to be treated non-operatively

A

co-morbities
osteoporosis
dementia
lower functional demand

56
Q

signs of compartment syndrome

A

1 - increased pain on passive stretching of the involved muscle
2 -severe pain outwith the anticipated severity in the clinical context
3 - limb very swollen and tender to touch

57
Q

what artery is at risk with knee dislocations

A

popliteal artery

58
Q

what is at risk in paediatric supracondylar fracture of the elbow

A

brachial artery

59
Q

what artery is at risk with shoulder trauma

A

axillary artery

60
Q

Signs/Symptoms of non-union

A

ongoing pain and oedema

movement at fracture site

61
Q

what fractures have delayed union

A

tibia fracture - slowest healing fracture, 16 weeks

femoral shaft fracture - 3-4 months

62
Q

what causes hypertrophic and atrophic non-union

A

hypertrophic - instability and excessive motion
atrophic - rigid fixation with a fracture gap, lack of blood supply to the fracture site, chronic disease or soft tissue interposition.

63
Q

what fractures are prone to poor healing

A

scaphoid wrist fractures
fractures of the distal clavicle
subtrochanteric fractures of femur
Jones fracture of 5th metatarsal

64
Q

what fractures are prone to AVN

A

femoral neck
scaphoid
talus

65
Q

Initial management of open fractures

A

IV broad spectrum antibiotics

66
Q

what are the 3 grades of ligament ruptures

A

grade 1 - sprain
grade 2 - partial tear
grade 3 - complete tear

67
Q

Mx of soft tissues injuries

A

RICE

MSK - Cortex (5 decks)

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