Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Charis & Ellie vs Complete MSK > Elective Surgery > Flashcards

Elective Surgery Flashcards

1
Q

when is surgical management considered in MSK referrals?

A

if there is an appropriate surgical solution conservative measures have not controlled symptoms surgical intervention more appropriate (e.g. tumour)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

the decision to undertake surgery is based on

A
  • the underlying condition - the prognosis without surgical intervention - degree of symptoms the patient is experiencing- disability caused by the condition - status of the patient’s health
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what needs to happen through consultation for surgery to take place?

A

appropriate consenting explanation of risks & benefits explanation of the alternatives to surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what conditions are common orthopaedic surgical elective procedures used to manage?

A 
Arthritis soft tissue inflammatory problems 
Tendonitis
Tendon rupture 
Correction of deformity 
Nerve decompression 
Joint instability 
Joint contractures 
Chronic infection 
Tumour diagnosis and treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is arthroplasty?

A

reshaping of a joint general term - synonymous with joint replacement can also be used to describe the removal of a diseased joint - excision/resection arthroplasty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is a joint replacement?

A

replacement of part of the joint - hemiarthroplasty replacement of the whole joint - total joint replacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the most successful joint replacements?

A

hip and knee
-good function satisfactory
-pain relief
-last a reasonable length of time
-complication rates are low

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what other joints can be replaced other than hip and knee?

A

shoulder (glenohumeral)
elbow
ankle
1st MTP joint of the great toe
MCP joints of the hand and wrist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are joint replacements made of?

A 
Stainless steel 
Cobalt 
Chrome 
Titanium ally polyetylene 
Ceramic 
The components can be - cemented and uncemented
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is the prognosis of joint replacements?

A

no perfect joint replacement

Could fail due to - loosening
(wear particles produce inflammatory response, high stresses)-

Breakage of the joint replacement Components metal particles can cause an inflammatory granuloma (pseudotumour)

    • Muscle and bone necrosis
  • Polyethylene particles can cause inflammatory response in bone with bone resorption (osteolysis)
  • Loosening ceramics can shatter with fatigue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is a revision procedure?

A

remove old components & insert a new replacementmuch more difficult than first procedurecomplication rates higherfunctional outcomes poorerpatient satisfaction is less

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what kind of patient is more likely to have an early joint replacement failure?

A

younger patient higher demand on the JR makes there a higher likelihood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are the potential complications of a joint replacement?

A

Deep infection
Recurrent dislocation
Neurovascular injury
Pulmonary embolism

Medical complications -renal failure, MI, chest infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is done to prevent deep infections in JR?

A

strict aseptic and aseptic precautions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what to do if a deep infection in a JR is diagnosed within 2-3 weeks?

A

surgical washout and debridement and prolonged antibiotic therapy about 6 weeks 50% success

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what to do if a deep infection following a JR is present for longer than 3 weeks - not salvageable by washout?

A
  • bacteria adhere to foreign surfaces
    – Biofilm- prevent patient’s immune system attacking
  • Remove implant & all foreign material (cement)
    extensive surgery, without a joint for about 6 weeks, parenteral antibiotics, if infection under control = wound healed clean & dry, CRP reduced
    – Revision replacement
    80-90% success, soft tissues scar & lose elasticity, joint stiffens, overall functional outcome compromised
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

early complications of a joint replacement?

A

-Infection
-Dislocation
-Instability
-Fracture
-Leg length discrepancy
-Nerve injury
-Bleeding
-Arterial injury/ischaemia
-Bleeding
-DVT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

early general complications of a JR?

A

-Hypovolaemia
-Acute renal failure
-MI
-ARDS
-PE
-Chest infection
-Urine infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

late local complications of a JR?

A

o infection – from hemategoneous spread
o loosening
o fracture
o implant breakage
o pseudotumuor formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is an excision/ resection arthroplasty?

A

removal of bone and cartilage of one or both sides of a jointdisabling for longer joint - 1st surgical procedure for hip OA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

indications for a excision/ resections arthroplasty?

A

Effective for smaller joint
1st carpometacarpal joint in hand
Keller’s procedure for hallux valgus after failure of hip/ shoulder replacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is arthrodesis?

A

surgical stiffening/ fusion of a joint in a position of function hyaline cartilage and subchondral bone removed

  • joint stabilized
  • bony union and fusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the affect of arthrodesis?

A

alleviates pain function may be limited particularly in large joints may increase pressure in surrounding joints - OA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what are the indications for arthrodesis?

A

end stage ankle arthritis
wrist arthritis
arthritis of 1st MTP of the foot (hallux rigidus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what is an osteotomy?

A

surgical realignment of a bone deformity correction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the purpose of osteotomy?

A

to redistribute load across an arthritic joint
-Offload diseased part of the joint
-Shift load to undiseased part e.g. medial compartment of the knee to the lateral compartment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what are the indications for osteotomy?

A

early arthritis in the knee early arthritis in the hip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what are some common soft tissue problems?

A 
- Tendinopathies = tears & ruptures- 
Enthesopathies = inflammation of a tendinous origin from / insertion into bone- 
Cartilage tears- Labrum tears-
 Inflammatory bursitis- 
Tenosynovitis- 
Capsulitis- 
Non-infective fasciitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what can soft tissue problems be related to?

A 
degenerative processes
injuries
overuse
inflammatory conditions 
– RAdrugs 
– quinolone antibiotics, 
steroids
chronic disease 
– renal failure
idiopathic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what is the conservative treatment for soft tissue problems?

A

conservative treatment is often very effective rest analgesia anti-inflammatory medications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what tendons and entheses are amenable to steroid injection around tendon?

A

rotator cuff tennis elbow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

which tendons have a high risk of rupture so are not advised for steroid injection

A

achilles extensor mechanism of the knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what is debridement?

A

removal of diseased tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what is decompression?

A

making more space - supraspinatus tendonitis and subacromial decompression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what is a synovectomy?

A

extensor tendons of the wrist in RA inflammation of tibialis posterior to prevent rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Examples of major tendon tears

A

splintage-Achilles
Surgical repair –quadriceps / patellar tendon (sometimes Achilles)
Tendon transfer – tibialis posterior, extensor pollicis longus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what are the indications of a cartilage (meniscal) tear in the knee?

A

pain fails to settlecause mechanical symptoms (locking or catching)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what is the management of a labral tear of the acetabulum or glenoid

A

resection/repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what is joint instability?

A

abnormal motion of a joint (rotation/translation)resulting in:subluxation dislocation with pain and/or giving away

40
Q

common examples of joint instability

A
  • instability from knee
  • ligament injuries
  • recurrent subluxation of the shoulder
  • recurrent dislocation of the shoulder
  • recurrent subluxation of the patella
  • recurrent dislocation of the patella
  • ankle instability with frequent giving away
  • spinal instability
41
Q

what causes instability?

A
  • injury
  • ligamentous laxity
  • anatomic variation predisposing:
  • shallow trochlea of distal femuro femoral neck anteversion
  • o genu valgum in patellofemoral instability
  • underlying disease process
  • cervical spine instability in rheumatoid arthritis
  • knee hyperextension in polio
42
Q

what is the conservative treatment for joint instability?

A

-physiotherapy
-improve proprioception
-splints
-calipers
-braces

43
Q

what are the surgical soft tissue procedures?

A

ligament tightening / advancement – e.g. ankle instability
ligament reconstruction using tendon graft – e.g. ACL reconstruction
Tissue reattachment – shoulder instability
Significant ligament laxity (EDS) – soft tissue procedures are highly unlikely to work

44
Q

what are the surgical bony procedures for joint instability?

A

FUSION: in significant ligament laxity (EDS) where soft tissue doesn’t work –

Skeletal predisposition to dislocation (eg patellar instability) –

Osteotomy: spinal instability: pain, nerve root compression/
spinal cord compression – fusion of abnormal spinal motion segment

45
Q

what is the purpose of correcting a deformity?

A

improve function prevent arthritis improve cosmesis

46
Q

what causes deformity?

A

congenital – limb malformationdevelopmental – bow legsacquired – post-traumaticidiopathic – hallux valgus, claw toes

47
Q

what is the management of congenital deformity?

A

may require complex bony and soft tissue surgery restore as much function as possible some best served by functional amputation

48
Q

management of angular deformity of long bones of the lower limb?

A

this can lead to early arthritis of the knee/ankle growth plate manipulation surgery osteotomy

49
Q

management options for leg length discrepancies?

A

shortening the longer limb
lengthening the short limb using special external fixator = llizarov technique

50
Q

management options for foot deformities?

A

these can give rise to pressure problems with footwear osteotomy arthrodesis soft tissue procedures joint excisions

51
Q

why is surgery done for spine deformities?

A

cosmesis
improve wheelchair sitting
severe scoliosis - restrictive respiratory defect - correction to prevent this

52
Q

most common sites of peripheral nerve trapping?

A

median nerve at the wrist = carpal tunnel syndrome
Ulnar nerve at the elbow = cubital tunnel syndrome

53
Q

how is peripheral nerve trapping treated?

A

nerve decompression surgery

54
Q

what causes spinal nerve compression?

A

disc material
bony osteophytes causes radiculopathy

55
Q

how is spinal nerve compression treated?

A

spinal decompression/discectomy

56
Q

what causes joint contractures?

A

neuromuscular disease
spasticity – eg. strokesoft tissue imbalance
arthritis
injury
fibrosing disease (Dupuytren’s)disease burns

57
Q

what is a joint contracture?

A

an inability to move a joint through its full range of motion

58
Q

what is the conservative treatment for joint contractures?

A

passively correctable & may be amenable
splintage
physiotherapy medications – Baclofen,
Botox injections – to relieve spasticity

59
Q

what is the surgical treatment options for joint contractures?

A

Fixed or resistant contractures
Tendon lengthening
Tendon transfer
Tight soft tissue release or lengthening
Bony procedures: osteotomy, arthrodesis

60
Q

what are the types of infections orthopaedics are involved in?

A

Soft tissue infections e.g. infected bursitis, arm or leg abscesses,
Wound infections - if abscess might need surgery
Bone infection
Joint infection: septic arthritis - emergency

61
Q

what is osteomyelitis?

A

infection of the bone including - compact bone, spongy bone and bone marrow

62
Q

levels of ostomyelitis?

A

superficial - affecting the outer surface of bone
Localized - affecting cortex and medullary
Diffuse - segment of bone is infected resulting in skeletal instability - infected non-union

63
Q

what causes the infection to reach the bone?

A

direct infection - penetrating trauma or surgery
Indirect infection - haematogenous spread from an infection, bacteremia at a distant site (area of cellulitis)

64
Q

what is involucrum?

A

new bone formed around the area of necrosis

65
Q

what are the factors which an infection depends on?

A

bacterial load
Inoculated virulence of the organism
Host’s immune defenses

66
Q

what is the pathogenesis of osteomyelitis once the bone is infected?

A

there are enzymes from the leukocytes which cause local osteolysis and pus there is impaired local blood flow - infection is difficult to eradicate

67
Q

what makes staph aureus such a bad infection?

A

it can infect the osteocytes intracellularly - which makes it very hard for the immune system to reach

68
Q

what is a sequestrum?

A

a dead fragment of bone which normally breaks off - once there is a sequestrum present then antibiotics won’t be enough

69
Q

who gets osteomyelitis?

A

immunocompromised patients
Chronic disease
Elderly
Young

70
Q

what bacteria cause osteomyelitis in newborns (less than 4 months)?

A

S. aureus
Enterobacter sp.
Group A & B Strep

71
Q

what bacteria cause osteomyelitis in children (4 months to 4 years)?

A

S. aureus
Group A strep
Haemophilus influenzae - reduced by vaccine
Enterobacter sp.

72
Q

what bacteria cause osteomyelitis in children/ adolescents (4 - adult)

A

S aureus (80%)
Group A strep
H influenzae
Enterobacter sp.

73
Q

What bacteria cause osteomyelitis in adults?

A

S. aureus and occasionally Enterobacter or Streptococcus sp.

74
Q

what bacteria cause osteomyelitis in sickle cell patients?

A

S. aureus - most common
Salmonella:common as well

75
Q

what causes acute osteomyelitis?

A

surgery

If no surgery has happened, it can occur in children/ immunocompromised without surgery

76
Q

what is the pathogenesis of acute osteomyelitis in children?

A

Metaphyses of long bones get tortuous vessels
> this causes sluggish flow accumulation of bacteria infection spreads towards the epiphysis

77
Q

what is the pathogenesis of acute osteomyelitis in neonates and infants?

A

Certain metaphyses are intra-articular (proximal femur, proximal humerus, radial head, ankle) > infection here can spread into the joint co-existing septic arthritis
(infants have a loosely applied periosteum so an abscess can extend widely along the subperiosteal space)

78
Q

What is a Brodie’s abscess?

A

Subacute osteomyelitis with a more insidious onset -

Bone reacts with walling off the abscess with a thin rim of sclerotic bone

79
Q

How is acute osteomyelitis managed?

A

best guess antibiotics by IV if abscess then surgical drainage If the infection fails to resolve then

  • 2nd line antibiotics
  • Surgery
  • Gain samples for culture, remove infected bone, washout infected area
80
Q

who gets chronic osteomyelitis?

A

Untreated acute osteomyelitis
-Sequestrum and/or involucrum adults in the axial skeleton because of haematogenous spread from pulmonary/urinary infection or from infection of IV disc (discitis)
Peripheral skeleton
- Open fracture or fixation
-TB
-Chronic osteomyelitis from haematogenous spread from the primary lung infection

81
Q

What is the pathogenesis of chronic osteomyelitis?

A

can be suppressed with antibiotics can lay dormant for many years before reactivating

82
Q

what are the signs and symptoms of chronic osteomyelitis?

A

Localized pain
Inflammation
Systemic upset
Possible sinus formation

83
Q

how is chronic osteomyelitis managed?

A

Cannot be cured by just antibiotics
-Active infection - can be suppressed by antibiotics

  • Surgery - gain deep bone tissue cultures - remove sequestrum
  • Excise infected or non-viable bone = debridement
  • Samples from discharging sinus may not accurately reflect the organism causing deep infection

External fixation - might be needed is to lengthen the bone if debridement shortens it
Local antibiotic delivery systems bone grafting plastic surgery
-If skin and soft tissue coverage of the bone isn’t possible IV antibiotics for several weeks following surgery

84
Q

who gets osteomyelitis of the spine?

A

Poorly controlled diabetics
IV drug abusers
Immunocompromised patients

85
Q

What is the pathogenesis of osteomyelitis in the spine?

A

Lumbar spine is most common can complicate spinal surgery
-If below LI:
- lower motor neurone, cauda equina below
- If above LI: upper motor neurone, myelopathy

Pus may extrude - paravertebral/ epidural abscessvertebral end plates weaken
- The vertebrae might collapse
- Kyphosis
- Vertebra plana (flat)- disc space may reduce

86
Q

what are the signs and symptoms of osteomyelitis of the spine?

A

Insidious onset of back pain
Constant and unremitting pain
Paraspinal muscle spasm
Spinal tenderness
Fever
Systemic upset if severe (neurologic deficit) -
Below LI - lower motor neurone, cauda equina syndrome
Above LI - upper motor neurone, myelopathy kyphosis

87
Q

what investigations would you do for suspected osteomyelitis of the spine?

A

MRI - shows extent of infection and abscess formation

FBC- for causative organism (S. aureus, MRSA, atypical)

Endocarditis should be considered - clubbing splinter haemorrhages, murmur, ECHO

88
Q

how is osteomyelitis of the spine managed?

A

CT guided biopsy to obtain tissue cultures
High dose IV antibiotics -may be for several months
Response assessed - clinically,
Serial CRP

50% go on to spontaneous fusion and resolution surgery -
debridement -
stabilization - fusion of adjacent vertebrae

89
Q

what are the indications for surgery in the treatment for osteomyelitis of the spine?

A

Inability to obtain cultures by needle biopsy
No response to antibiotic therapy
Progressive vertebral collapse
Progressive neurological deficit

90
Q

what are some common orthopaedic implants?

A

Joint replacements - for arthritis, instability and tumour
Surgery:fracture fixation and skeletal stabilization
Pins, wires, plates screws
Intramedullary nails external fixators

91
Q

what precautions are taken to prevent infection of orthopaedic surgical implants?

A

Strict antisepsis
Sterilisation of implants and instruments
Special air flow theatres
Perioperative antibiotics

92
Q

how common is deep infection in non-contaminated orthopaedic procedures?

A

1-2%

93
Q

how do bacteria enter to cause infection of orthopaedic surgical implants?

A

Operative site at the time of surgery
- Patient’s own skin and bacteria deep within hair follicles and from shed skin cell from staff in theatre
- Wound post-operatively before it has healed
- Haematoma
- In soft tissues, bacteria thrive on can also infect prosthetic joint at a later stage by haematogenous spread

94
Q

what are the signs that a chronic infection has developed post prosthetic joint replacement complicating it?

A

Pain
Poor function
Recurrent sepsis
Chronic discharging sinus formation
Implant loosening

95
Q

What happens when a deep infection complicates a fracture fixation or stabilization?

A

chronic osteomyelitis
Non-union of the fracture

96
Q

what organisms cause an infection of orthopaedic surgical implants?

A

Staph aureus
Gram -ve bacilli: coliforms
Staph epidermidis
Enterococcus
Late onset haematogenous infection
- staph aureus
- beta haemolytic strep. - enterobacter

97
Q

how is an infection of an orthopaedic surgical implant treated?

A

Usually surgical rather than antibiotics
Antibiotics - not given until there’s a decision made about surgery (any AB can interfere with the bacteriological tissue cultures and causative organism may not be identified from debridement)

Charis & Ellie vs Complete MSK (163 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions