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LOCO2 > intro to Orthopaedics > Flashcards

intro to Orthopaedics Flashcards

1
Q

What are the main 4 stressors of the musculoskeletal system?

A

TRAUMA - sports injuries, road traffic accidents, overuse
INFECTION - bone and joint
ALTERED METABOLISM - age related, disease related OA/RA
NEUROLOGICAL - muscle spasticity, muscle paralysis

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2
Q

Which joints can be replaced?

A
  • upper limb = shoulder/elbow/wrist/hand
  • lower limb = hip/knee/ankle
  • spine = disc displacements
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3
Q

What are some indications for replacement?

A
  • degenerative disease (OA)
  • inflammatory disease (RA)
  • trauma (fracture of neck of femur/neck of humerus)
  • tumour
  • vascular disease (avascular necrosis)
  • previously failed/worn out replacements
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4
Q

What is the mechanism of action of cemented hip replacements?

A
  • femoral stem and acetabulum cemented into place
  • bone and cement lock together to make insertion last
  • cement is a filler between bone and implant
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5
Q

In what cases is a cemented hip replacement used for?

A
  • obese patients
  • dysplastic hips
  • Osteoporosis
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6
Q

What are the benefits of a cemented hip replacement?

A
  • less chance of intra-operative fracture
  • weight bear immediately
  • better prognosis in age 65 and over
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7
Q

What is the disadvantage of a cement hip replacement?

A
  • high chance of fat embolism and aseptic loosening
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8
Q

What is the mechanism of an uncemented hip replacement?

A
  • rough surface covered with porous membrane with hydroxyapatite covering
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9
Q

Who is uncemented hip replacements for?

A
  • younger and more active patients
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10
Q

What are the benefits of uncemented hip replacement?

A
  • less chance of aseptic loosening
  • lower incidence of fat embolism
  • more popular
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11
Q

What is the disadvantage of uncemented hip replacement

A
  • 4-6 weeks of non weight bearing

- more expensive

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12
Q

What are the other ways of doing hip replacements?

A
  • hybrid = cemented stem and cementless cup

- reverse hybrid = cementless stem and cemented cup

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13
Q

What are the old materials used in replacements?

A
  • Metal on polyethene

- fragments = immune reaction

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14
Q

What are the new materials used in replacements?

A

Least to most wearable

  • ceramic on ceramic
  • metal on metal
  • ceramic in cross-linked polyethylene
  • oxinium in cross linked polyethylene
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15
Q

When is spinal decompression surgery done?

A
  • spinal stenosis
  • damaged IV disc
  • fractured vertebrae
  • tumours
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16
Q

What is spinal fusion?

A
  • when 2 or more vertebrae are joined together with section of bone
  • stabilise and strengthen vertebral column
17
Q

What are some examples of soft tissue orthopaedics?

A
  • tendon repair
  • tendon transfer
  • tendon lengthening
  • ligament repair
  • ligament replacement
  • free muscle transfer
18
Q

What is an example of a tendon transfer in the lower limb?

A
  • tibialis posterior to tibialis anterior when loss of dorsiflexors
  • detach distal attachment point, pull out and feed through anterior side
19
Q

What is an example of a tendon transfer in the upper limb?

A
  • more complicated than lower limb as more complicated movements in upper limb
20
Q

What are the requirements of donor muscles in upper limb tendon transfer?

A
  • under conscious voluntary control
  • expendable
  • adequate tendon length
  • innervated
21
Q

What muscle transfer can be done for radial nerve palsy to fix wrist extension?

A
  • pronator teres to extensor carpi radialis brevis
22
Q

What muscle transfer can be done for radial nerve palsy to fix MCP extension?

A
  • flexor carpi ulnaris to extensor digitorum
23
Q

What muscle transfer can be done for radial nerve palsy to fix thumb extension?

A
  • plantaris to extensor pollicis longus
24
Q

When is tendon lengthening done?

A
  • for Achilles
  • when plantar flexors are under tension so patient only able to walk on toes
  • open achilles tendon and lengthen
25
Q

When would a ligament replacement be done?

A

ACL reconstruction

26
Q

in free muscle transfer what muscles can be used?

A
  • gracilis
  • rectus femoris
  • any muscle that is expendable and relatively superficial
27
Q

What can the gracilis be used for in free muscle transfer?

A
  • deltoid reconstruction
  • elbow flexion/extension
  • finger flexion/extension
28
Q

Why may fracture healing be delayed?

A
  • failure to consolidate within 1.5x normal expected time
29
Q

When may there be mal-union in fracture healing?

A
  • misalignment of proximal and distal fragments

- leads to biomechanical deformity = rotation, angulation, shortening, translation

30
Q

When may there be non-union in fracture healing?

A
  • failure to consolidate within x2 normal expected time
  • atrophic/hypertrophic
  • depends on blood supply/degree of stability
31
Q

What are 2 methods of reconstructive orthopaedics?

A
  • osteotomy (re-alignment)

- distraction (bone lengthening procedure) (use external fixator)

32
Q

What do bone grafts allow?

A
  • osteogenesis (formation/development of new bone cells contained in graft)
  • osteoconduction
  • osteoinduction
  • osteopromotion
33
Q

What is osteoconduction?

A
  • physical effect by which matrix of graft forms scaffold favouring outside cells to penetrate graft and form new bone
34
Q

What is osteoinduction?

A
  • chemical processes: molecules contained in the graft convert neighbouring cells into osteoblasts
35
Q

What is osteopromotion?

A
  • when grafted material enhances osteoinduction
36
Q

What are the types of bone grafts?

A

Human Bone -> autografts and allografts

Bone substitutes -> xenografts and alloplast

LOCO2 (26 decks)

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