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Flashcards in 218 Hip # Deck (49):
0

What is the mortality rate in the first year following a fractured hip?

20%

1

Which anatomical landmark splits classification of NOF#'s?

Inter-trochanteric line

2

Which type of #NOF is Garden's classification relevant for?

Intracapsular

3

Which arteries supply the femoral head?

Medial and lateral femoral circumflex arteries + foveal artery (small proportion)

4

What is a Garden type I NOF#?

Incomplete #, u displaced

5

What is a Garden type II #?

Complete #, undisplaced

6

What is a Garden type III NOF #?

Complete #, incompletely displaced

7

What is a Garden type III NOF #?

Complete #, completely displaced

8

What is the surgical option with undisplaced NOF extracapsular #'s?

Dynamic hip screw

9

Which type of screws are added to DHS's when there's concern about rotational stability in #NOF?

Cannulated screws

10

What are the 5 types of long bone #'s?

Transverse
Spiral
Oblique
Comminuted
Segmental

11

What are the 4 types of deformities which can occur in #'s?

Displacement
Angulation
Rotation
Shortening (due to muscle action)

12

What is periosteal elevation a sign of post fracture?

Fracture healing

13

Name the 4 stages of fracture healing

Inflammatory
Soft callus
Hard callus
Remodelling

14

In which stage of fracture healing do signs and symptoms subside? (i.e. Pain, loss of function, deformity, swelling, tenderness, bruising)

Soft callus

15

In which stage of fracture healing do osteoblasts mineralise cartilage?

Hard callus formation

16

What is the mediator for infiltration of inflammatory cells into fracture sites?

Prostaglandin

17

In which stage of fracture healing is mechanical stress important?

Remodelling

18

What is the mediator for recruitment of inflammatory cells into a haematoma of a fracture site?

Prostaglandins

19

In which stage of # healing do fibroblasts lay down stroma to help vascular growth?

Soft callus

20

In which stage of fracture healing is smoking particularly harmful?

Soft callus stage - nicotine = vasoconstrictor

21

What happens in the hard callus stage of fracture healing?

Cartilage is mineralised into woven bone by osteoblasts

22

What facilitates the remodelling stage of fracture healing?

Mechanical stress

23

What type of fixation produces absolute stability of a fracture?

ORIF

24

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

25

Which surgical option is appropriate for pathological fractures?

IM nails

26

What is THR treatment of infection following an open fracture?

Pain management
Thorough debridement and skeletal stabilisation (6hrs)
Early skin cover (72 hours)

27

What are the S&S of vascular trauma post fracture?

Pain
Plum coloured/pale limb
Pulselessness

28

What are the S&S of compartment syndrome?

Pain disproportional to injury and on passive stretching
(Pins and needles + pulsessness are very late signs)

29

Where is myositis ossificans commonly found?

Elbow and acetabulum

30

Which 4 bones are at risk of AVN if their blood supply is compromised?

Scaphoid
Femoral head
Talus
Lunate

31

What are the 2 types of non-union?
(Explain)

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

32

Where are secondary bone mets most commonly found?

Proximal humerus, proximal femur

33

Where do secondary bone mets commonly arise from originally?
(5 listed)

Breast
Bronchus
Prostate
Kidney
Thyroid

34

Which group of people tend to suffer from stress fractures?

Athletes

35

What are 'buckle', 'greenstick' and plastic deformation examples of?

Paediatric fractures

36

Name a group of drugs which can cause falls in the elderly

Psychotropic drugs, antiepileptics, antihypertensives

37

What does a T- score of -2.5 SD below the mean signify?

Osteoporosis

38

What does a Z score measure?

Bone mineral density to closest SD to an age and gender matched mean

39

Which group of patients is a Z score used for?

Children

40

What is the first line treatment for OP?

Alendronate - Bisphosphonate which decreases bone resorption

41

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

42

Name an example of a RANKL inhibitor used in the treatment of OP

Denosumab

43

What are the special instructions for taking alendronate?

Empty stomach
Upright for half an hour
Full glass of water
NBM for half an hour

44

What is the rare but devastating side effect of alendronate?

Osteonecrosis of the jaw

45

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.

46

At which plasma concentration of vitamin D is osteomalacia and rickets a risk?

< 25 nmol/L

47

What happens in Paget's disease?

Disordered mosaic bone which is weaker than normal due to increased osteoclast activity and compensatory osteocblast activity.

48

What are risendronate and zolendronate examples of and what are they used to treat?

Bisphosphonates - to treat Paget's disease when symptomatic