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BRS Phase 1b > Management of orthopaedic fractures > Flashcards

Management of orthopaedic fractures Flashcards

1
Q

What is an Osteogenic cell?

A

Bone stem cell

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2
Q

What is an osteocyte?

A

Mature bone cell

Formed when an osteoblast becomes imbedded in secretions

Sense Mechanical strain to direct osteoclast & osteoblast activity

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3
Q

What is an Osteoblast?

A

Bone forming
Secretes Osteoid
Catalyses mineralisation of osteoid

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4
Q

What is an osteoclast?

A

‘Bone breaking’
Dissolve and resorb bone by phagocytosis
Derived from bone marrow

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5
Q

What are Osteons?

A

Repeated structural units ‘Osteons’ – concentric ‘Lamellae’ around a central ‘Haversian Canal’

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6
Q

What is found in compact bone?

A

: has osteons
Few spaces
Provides protection, support and resists stresses produced by weight of movement

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7
Q

What is found in the Haversian canal?

A

contain blood vessels, nerves and lymphatics.

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8
Q

What are the Lacunae?

A

small spaces containing osteocytes.

Tiny Canaliculi radiate from lacunae filled with extracellular fluid.

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9
Q

What is Volkman’s canal?

A

– transverse perforating canals

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10
Q

What is the structure of long bones?

A

Periosteum – Connective tissue covering

Outer Cortex – compact bone

Cancellous bone

Medullary cavity - contains yellow bone marrow

Nutrient Artery

Articular cartilage: on surface of bone at a joint only

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11
Q

What are the Mechanisms of Fracture?

A

Trauma - Low/High energy

Stress - Abnormal stress on normal bone

Pathological - Normal stress on abnormal bone

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12
Q

What are the reasons for pathological fractures?

A

Osteoporosis - soft bone

Malignancy - Primary/Bone Metastases

Vitamin D Deficiency - Osteomalacia/Rickets

Osteomyelitis

Osteogenesis Imperfecta

Pagets

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13
Q

What are Fracture patterns

A 
Is the soft tissue intact?
yes - closed
no - open
Is the break complete?
yes 2 pieces - simple
yes >2 pieces - comminuted
no - greenstick

Are the bony ends aligned?
Yes - undisplaced
No - displaced

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14
Q

What is Wolff’s Law?

A

Bone Grows and Remodels in response to the forces that are placed on it

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15
Q

What are the signs of a clinical fracture?

A 
Pain 
swelling
crepitus
deformity
adjacent structural injury;
nerves, vessels, ligament, tendons
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16
Q

How would you treat an extra capsular neck of femur fracture?

A

Internal fixation

Plate & screws or nail

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17
Q

How would you treat an intracapsular displaced Neck of femur fracture?

A

Displaced - less than 55 reduce and fixation with screws.
older than 65, if fit and mobile total hip replacement. less fir hemiarthroplasty

Undisplaced - Fixation with screws

18
Q

How do we classify joints?

A

Fibrous - Sutures, Syndesmosis, Interosseous membrane

Cartilaginous - Synchondroses (spine), Symphses (pubic).

Synovial - Plane, Hinge, Condyloid, Pivot, Saddle, Ball & socket.

19
Q

How are synovial joint stabilised?

A

muscles/tendons
ligaments
Bone surface congruity

20
Q

What are the components of a synovial joint?

A

Synovium - 1-3 cell deep lining containing macrophage-like phagocytic cells (type A synoviocyte) and fibroblast-like cells that produce hyaluronic acid (type B synoviocyte)
Type I collagen

Synovial fluid - Hylauronic acid rich viscous fluid

Articular cartilage - Type 2 collagen, Proteoglycan (aggrecan)

21
Q

What is cartilage composed of?

A

1) specialized cells (chondrocytes)
2) extracellular matrix: water, collagen and proteoglycans
(mainly aggrecan)

Cartilage is avascular – it has no blood supply

22
Q

What is Aggrecan?

A
  • a proteoglycan that possesses many chondroitin sulfate and keratin sulfate chains
  • characterized by its ability to interact with hyaluronan (HA) to form large proteoglycan aggregates
23
Q

What are the 2 major types of joint disease?

A

Osteoarthritis

Inflammatory arthritis

24
Q

What are the radiological changes in rheumatoid arthritis?

A

Joint space narrowing
Osteopenia
Bony erosions

25
Q

What are the radiological changes in Osteoarthritis?

A

Joint space narrowing
Subchondral sclerosis
Osteophytes

26
Q

What is the pathophysiology of Osteoarthritis

A

Degenerative disease of chondral cartilage
Inflammation occurs late in disease cf. rheumatoid
Inflammatory mediators include proteinases, e.g., matrix metalloproteinases (MMPs) and aggrecanases, and inflammatory cytokines, including interleukin (IL)-1β and tumor necrosis factor α (TNFα), which enhance the synthesis of proteinases and other catabolic factors to degrade the articular cartilage membrane

27
Q

What is the definition for osteoarthritis?

A

long-term chronic disease characterized by the deterioration of cartilage in joints which results in bones rubbing together and creating stiffness, pain, and impaired movement.

28
Q

What are the risk factors for OA?

A 
Age
Excess weight gain/obesity
Mechanical constraints
Hereditary
Female gender
Osteonecrosis
Leg bone malalignment
Estrogen deficiency
Metabolic syndrome
Injury: cruciate ligament rupture, meniscectomy (surgical removal of meniscus
29
Q

What is the presentation of osteoarthritis?

A

Pain (exertional/rest/night)
Disability: walking distance/stairs/giving way
DeformityPain (exertional/rest/night)
Disability: walking distance/stairs/giving way
Deformity

30
Q

What are the assessments for OA?

A

Look - what’s the deformity
Feel
Move - angle of flexion
Special tests - torn ACL, Lachmanns

31
Q

What is conservative management for OA?

A 
Analgesics
Physiotherapy
Walking aids
Avoidance of exacerbating activity
Injections (steroid/viscosupplementation
32
Q

What is Operative management for OA?

A 
Replace (knee/hip)
Realign (knee/big toe)
Excise (toe)
Fuse (big toe)
Synovectomy (Rheumatoid)
Denervate (wrist
33
Q

What is a bone infection?

A 
Osteomyelitis
Acute or chronic
Primary or secondary
Pain/swelling/discharge
Systemic signs:
Fevers, sweats wt loss
34
Q

What is a joint infection?

A

septic arthritis
Pain
Joint swelling/stiffness
Fevers, sweats, weight loss

35
Q

What causes Septic arthritis?

A

Bacterial infection of a joint (usually caused by spread from the blood)

36
Q

What are the risk factors for septic arthritis?

A

immunosuppressed, pre-existing joint damage, intravenous drug use (IVDU)

37
Q

Why is septic arthritis important?

A

Septic arthritis is a medical emergency
-> Untreated, septic arthritis can rapidly destroy a joint

Usually only 1 joint is affected* (monoarthritis)

Consider septic arthritis in any patient with an acute painful, red, hot, swelling of a joint, especially if there is fever

38
Q

How do you diagnose septic arthritis?

A

joint aspiration

send sample for urgent Gram stain/culture

39
Q

What are common causes of Septic arthritis?

A

Staphylococcus aureus, Streptococci, Gonococcus*

40
Q

What is the treatment for septic arthritis?

A

surgical wash out (lavage) & IV antibiotics
Immobilise joint in acute phase
Physiotherapy

41
Q

What is the treatment for osteomyelitis?

A

Antibiotics: iv weeks
Surgical drainage: especially collections/sequestrum
Chronic: antibiotic suppression/dressings
??amputation

42
Q

What investigations can be done in joint infections

A 
Radiology;
Plain films
MRI scans: bony architecture/collections
CT if MRI not available
Bone scans: multifocal disease
Labelled White cell scans
Bloods;
CRP: acute marker
ESR slower response
WCC
TB culture/PCR

BRS Phase 1b (80 decks)

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