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JG Year 2 > 218 Hip # > Flashcards

218 Hip # Flashcards

0
Q

Which anatomical landmark splits classification of NOF#’s?

A

Inter-trochanteric line

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1
Q

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

A

20%

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2
Q

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

A

Intracapsular

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3
Q

Which arteries supply the femoral head?

A

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

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4
Q

What is a Garden type I NOF#?

A

Incomplete #, u displaced

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5
Q

What is a Garden type II #?

A

Complete #, undisplaced

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6
Q

What is a Garden type III NOF #?

A

Complete #, incompletely displaced

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7
Q

What is a Garden type III NOF #?

A

Complete #, completely displaced

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8
Q

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

A

Dynamic hip screw

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9
Q

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

A

Cannulated screws

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10
Q

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

A 
Transverse
Spiral 
Oblique
Comminuted 
Segmental
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11
Q

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

A

Displacement
Angulation
Rotation
Shortening (due to muscle action)

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12
Q

What is periosteal elevation a sign of post fracture?

A

Fracture healing

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13
Q

Name the 4 stages of fracture healing

A

Inflammatory
Soft callus
Hard callus
Remodelling

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14
Q

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

A

Soft callus

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15
Q

In which stage of fracture healing do osteoblasts mineralise cartilage?

A

Hard callus formation

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16
Q

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

A

Prostaglandin

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17
Q

In which stage of fracture healing is mechanical stress important?

A

Remodelling

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18
Q

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

A

Prostaglandins

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19
Q

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

A

Soft callus

20
Q

In which stage of fracture healing is smoking particularly harmful?

A

Soft callus stage - nicotine = vasoconstrictor

21
Q

What happens in the hard callus stage of fracture healing?

A

Cartilage is mineralised into woven bone by osteoblasts

22
Q

What facilitates the remodelling stage of fracture healing?

A

Mechanical stress

23
Q

What type of fixation produces absolute stability of a fracture?

A

ORIF

24
Q

Which group of patients is traction appropriate for?

A

Paeds - quick bone healing and therefore no risks of bed sores, institutionalisation… Etc which would happen in older pts

25
Q

Which surgical option is appropriate for pathological fractures?

A

IM nails

26
Q

What is THR treatment of infection following an open fracture?

A

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

27
Q

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

A

Pain
Plum coloured/pale limb
Pulselessness

28
Q

What are the S&S of compartment syndrome?

A

Pain disproportional to injury and on passive stretching

Pins and needles + pulsessness are very late signs

29
Q

Where is myositis ossificans commonly found?

A

Elbow and acetabulum

30
Q

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

A

Scaphoid
Femoral head
Talus
Lunate

31
Q

What are the 2 types of non-union?

Explain

A 
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
Q

Where are secondary bone mets most commonly found?

A

Proximal humerus, proximal femur

33
Q

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

A 
Breast
Bronchus 
Prostate 
Kidney
Thyroid
34
Q

Which group of people tend to suffer from stress fractures?

A

Athletes

35
Q

What are ‘buckle’, ‘greenstick’ and plastic deformation examples of?

A

Paediatric fractures

36
Q

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

A

Psychotropic drugs, antiepileptics, antihypertensives

37
Q

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

A

Osteoporosis

38
Q

What does a Z score measure?

A

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

39
Q

Which group of patients is a Z score used for?

A

Children

40
Q

What is the first line treatment for OP?

A

Alendronate - Bisphosphonate which decreases bone resorption

41
Q

What is the MOA of the bisphosphonate alendronate?

1st line Tx of OP

A

Inhibits FPP synthase which is required for osteoclast function, therefore inhibiting bone resorption

42
Q

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

A

Denosumab

43
Q

What are the special instructions for taking alendronate?

A

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

44
Q

What is the rare but devastating side effect of alendronate?

A

Osteonecrosis of the jaw

45
Q

What is the MOA of RANKL inhibitor Denosumab?

A

Prevents RANKL from activating its receptor RANK on the surface of osteoclasts and their precursors which interfere with their survival and function.

46
Q

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

A

< 25 nmol/L

47
Q

What happens in Paget’s disease?

A

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

48
Q

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

A

Bisphosphonates - to treat Paget’s disease when symptomatic

JG Year 2 (28 decks)

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