Flashcards in 218 Hip # Deck (49):
What is the mortality rate in the first year following a fractured hip?
Which anatomical landmark splits classification of NOF#'s?
Which type of #NOF is Garden's classification relevant for?
Which arteries supply the femoral head?
Medial and lateral femoral circumflex arteries + foveal artery (small proportion)
What is a Garden type I NOF#?
Incomplete #, u displaced
What is a Garden type II #?
Complete #, undisplaced
What is a Garden type III NOF #?
Complete #, incompletely displaced
What is a Garden type III NOF #?
Complete #, completely displaced
What is the surgical option with undisplaced NOF extracapsular #'s?
Dynamic hip screw
Which type of screws are added to DHS's when there's concern about rotational stability in #NOF?
What are the 5 types of long bone #'s?
What are the 4 types of deformities which can occur in #'s?
Shortening (due to muscle action)
What is periosteal elevation a sign of post fracture?
Name the 4 stages of fracture healing
In which stage of fracture healing do signs and symptoms subside? (i.e. Pain, loss of function, deformity, swelling, tenderness, bruising)
In which stage of fracture healing do osteoblasts mineralise cartilage?
Hard callus formation
What is the mediator for infiltration of inflammatory cells into fracture sites?
In which stage of fracture healing is mechanical stress important?
What is the mediator for recruitment of inflammatory cells into a haematoma of a fracture site?
In which stage of # healing do fibroblasts lay down stroma to help vascular growth?
In which stage of fracture healing is smoking particularly harmful?
Soft callus stage - nicotine = vasoconstrictor
What happens in the hard callus stage of fracture healing?
Cartilage is mineralised into woven bone by osteoblasts
What facilitates the remodelling stage of fracture healing?
What type of fixation produces absolute stability of a fracture?
Which group of patients is traction appropriate for?
Paeds - quick bone healing and therefore no risks of bed sores, institutionalisation... Etc which would happen in older pts
Which surgical option is appropriate for pathological fractures?
What is THR treatment of infection following an open fracture?
Thorough debridement and skeletal stabilisation (6hrs)
Early skin cover (72 hours)
What are the S&S of vascular trauma post fracture?
Plum coloured/pale limb
What are the S&S of compartment syndrome?
Pain disproportional to injury and on passive stretching
(Pins and needles + pulsessness are very late signs)
Where is myositis ossificans commonly found?
Elbow and acetabulum
Which 4 bones are at risk of AVN if their blood supply is compromised?
What are the 2 types of non-union?
Hypertrophic = increase of callus size due to too much movement - stabilise to allow healing
Atrophic = cellular activity has ceased and bone ends are porotic - treat by removing fibrous tissue from ends and graft
Where are secondary bone mets most commonly found?
Proximal humerus, proximal femur
Where do secondary bone mets commonly arise from originally?
Which group of people tend to suffer from stress fractures?
What are 'buckle', 'greenstick' and plastic deformation examples of?
Name a group of drugs which can cause falls in the elderly
Psychotropic drugs, antiepileptics, antihypertensives
What does a T- score of -2.5 SD below the mean signify?
What does a Z score measure?
Bone mineral density to closest SD to an age and gender matched mean
Which group of patients is a Z score used for?
What is the first line treatment for OP?
Alendronate - Bisphosphonate which decreases bone resorption
What is the MOA of the bisphosphonate alendronate?
(1st line Tx of OP)
Inhibits FPP synthase which is required for osteoclast function, therefore inhibiting bone resorption
Name an example of a RANKL inhibitor used in the treatment of OP
What are the special instructions for taking alendronate?
Upright for half an hour
Full glass of water
NBM for half an hour
What is the rare but devastating side effect of alendronate?
Osteonecrosis of the jaw
What is the MOA of RANKL inhibitor Denosumab?
Prevents RANKL from activating its receptor RANK on the surface of osteoclasts and their precursors which interfere with their survival and function.
At which plasma concentration of vitamin D is osteomalacia and rickets a risk?
< 25 nmol/L
What happens in Paget's disease?
Disordered mosaic bone which is weaker than normal due to increased osteoclast activity and compensatory osteocblast activity.