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BRS 5 Musculoskeletal > 1b Management of Orthopaedic Conditions > Flashcards

1b Management of Orthopaedic Conditions Flashcards

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1
Q

What are osteoblast cells?

A

Bone forming
Secrete Osteoid
Catalyse mineralisation of osteoid

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2
Q

what is an osteocyte cell?

A

Mature bone cell

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3
Q

What are osteocytes formed?

A

Formed when an osteoblast becomes imbedded in its secretions

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4
Q

What do osteocyyte cells sense?

A

Mechanical strain to direct osteoclast and osteoblast activity

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5
Q

What is an osteoclast?

A

Bone breaking - dissolves and reabsorbed bone by phagocytosis

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6
Q

What investiagtions should be done to look for a fracture?

A

Radiograph
CT Scan
Bone Scan
MRI Scan

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7
Q

What should you include when describing a fracture?

A

Location: which bone and which part of bone?

Pieces: simple/multifragmentary?

Pattern: transverse/oblique/spiral

Displaced/undisplaced?

Translated/angulated?
X/Y/Z plane

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8
Q

What are the two ways a fracture might be displaced?

A

Translation
Angulation

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9
Q

Why is childrens bone more elastic than adults?

A

Children’s bone can bend – more elastic than adult
Increased density of haversian canals

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10
Q

What are the clinical signs of a fracture?

A

Pain
Swelling
Crepitus
Deformity
Adjacent structural injury:
Nerves/vessels/ligament/tendons

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11
Q

Describe the stages of fracture healing?

A

Step 1: Bleeding/Haematoma – prostaglandins/cytokines released; growth factors increase local blood flow – Periosteal supply takes over

Step 2: Granulation Tissue/connective tissue/Fibrous tissue laid down / Soft Callus

Step3: Once fracture is bridged with soft callus- hard callus is formed ( laying down of Osteoid/ bone)

Step4 : Bone is remodelled via endochondral ossification lamellar bone in its place.

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12
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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13
Q

What is used to describe the soft tissue integity of a fracture?

A

Open / Closed

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14
Q

What is used to describe the number of bony fragments of a fracture?

A

Green stick
Simple
Multifragmentary

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15
Q

What is used to describe the movement of a fracture?

A

Displaced / undisplaced

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16
Q

What are the general principles of managing a fracture?

A

reduce
Hold
Rehabilitate

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17
Q

What are the causes of a fractured neck of femur?

A

Osteoporosis (older)
Trauma (younger)
Combination

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18
Q

What treatment would you use for an extracapsular fracture?

A

Minimal risk to blood supply and AVN: fix with plate and screws

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19
Q

How would you treat an intracapsular fracture is undisplaced?

A

Fix with screws as there is less risk to the blood supply

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20
Q

How would you treat an intracapsular fracture if displaced?

A

25-30% risk AVN: replace in older patients; fix if young

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21
Q

How would you treat an intracapsular, displaced fracture in patients over 65?

A

Fit and mobile - total hip replacement
Less fit = hemiarthroplasty

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22
Q

what are the types of fibrous joints?

A

Sutures
Syndesmosis
Interosseous membrane

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23
Q

What are the types of cartilaginous joints?

A

Synchondroses
Symphyses

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24
Q

What are the types of synovial joints?

A

Plane
hinge
Condyloid
Pivot
Saddle
Ball and Socket

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25
How are synovial joints stabilised?
muscles / tendons ligaments bone surface congruity
26
What are the components of a synovial joint?
Synovium Synovial Fluid Articular cartilage
27
What does the articular cartilage consist of?
Type 2 Collagen Proteoglycan (Aggrecan)
28
What is the synovial fluid?
Hyaluronic rich viscous fluid
29
What is the 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), with type 1 collagen
30
What is cartilage composed of?
Cartilage is composed of: 1) specialized cells (chondrocytes) 2) extracellular matrix: water, collagen and proteoglycans (mainly aggrecan)
31
What is aggrecan?
Aggrecan is: -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
32
What are the two major divisions of arthritis?
Osteoarthritis and Inflammatory arthritis
33
What is OA?
Degenerative arthritis
34
What is joint space narrowing?
joint space narrowing indicates articular cartilage loss. This can occur in osteoarthritis (primary abnormality) and in Rheumatoid Arthritis (secondary damage due to synovitis)
35
What radiographic changes will you see in a patient with RA?
joint space narrowing osteopenia bony erosions
36
What type of osteopenia is a common radiographic sign of inflammatory arthritis?
juxta-articular osteopenia
37
Where do bony erosions occur in RA?
erosions occur initially at the margins of the joint where the synovium is in direct contact with bone (the ‘bare’ area; see rheumatoid arthritis lecture)
38
What features might you see in a radiograph of patients with OA?
Joint space narrowing Subchondral cysts Sclerosis Osteophytes
39
What is OA?
deterioration of chondral cartilage in joints which results in bones rubbing together and creating stiffness, pain, and impaired movement.
40
What are the inflammatory mediators of RA?
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
41
What are the signs and symptoms of OA?
Pain (exertional/rest/night) Disability: walking distance/stairs/giving way Deformity
42
what deformity might occur in OA?
Valgus deformity
43
Which procedure can be done for ACL injury?
Lachmann's
44
Which test suggests ACL injury?
Anterior draw
45
what are the risk factors for OA?
Age Weight Menopause as less oestrogen Injury Overuse
46
What are the conservative principles of OA management?
Analgesics Physiotherapy Walking aids Avoidance of exacerbating activity Injections (steroid/viscosupplementation)
47
What are the operative management principles of OA?
Replace (knee/hip) Realign (knee/big toe) Excise (toe) Fuse (big toe) Synovectomy (Rheumatoid) Denervate (wrist)
48
What is infection of the bone called?
Osteomyelitis
49
What is septic arthritis?
Infection of the joint resulting in swelling, stiffness, fevers and weight loss
50
What causes septic arthritis?
Bacterial infection of a joint (usually caused by spread from the blood)
51
Why is septic arthritis important?
Medical emergency
52
How many joints are effected in septic arthritis?
usually one
53
Why is gonococcal septic arthritis an exception?
Affects multiple joints, and less likely to cause joint destruction so do not need to aspirate the joint
54
What are the signs and symptoms of a septic arthritis?
Consider septic arthritis in any patient with an acute painful, red, hot, swelling of a joint, especially if there is fever
55
How is septic arthritis diagnosed?
by joint aspiration. Send sample for urgent Gram stain and culture
56
what is the treatment of septic arthritis?
Treatment is with surgical wash-out (‘lavage’) and intravenous antibiotics
57
What bloods are done for septic arthritis?
CRP: acute marker ESR slower response WCC TB culture/PCR
58
What are the treatments for osteomyelitis?
Antibiotics: iv weeks Surgical drainage: especially collections/sequestrum Chronic: antibiotic suppression/dressings ??amputation
59
What are the treatments for septic arthritis?
Surgery: joint washout and drainage (repeated if required) Iv antibiotics (days/weeks) Immobilise joint in acute phase Physiotherapy once over acute phase
60
Describe the organisation of compact bone?
Repeated structural units ‘Osteons’ – concentric ‘Lamellae’ around a central ‘Haversian Canal’
61
What is a haversian canal?
‘Haversian Canal’ – contain blood vessels, nerves and lymphatics.
62
What are Volkmans canals?
transverse perforating canals
63
What are lacunae?
small spaces containing osteocytes
64
What does the medullary cavity contain?
Yellow bone marrow
65
What is the difference between a stress and pathological fracture?
Stress = Abnormal stresses on normal bone Pathological = Normal stresses on abnormal bone

BRS 5 Musculoskeletal (13 decks)

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