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Aneesha Flashcards BRS 2 > Management of orthopaedic conditions > Flashcards

Management of orthopaedic conditions Flashcards

(61 cards)

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1
Q

What are osteogenic cells? What do they do?

A

Bone stem cells

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2
Q

What are osteoblasts? What do they do?

A

Bone forming cells
Secrete osteoid
Catalyse mineralisation of osteoid

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3
Q

What are osteocytes? What do they do?

A

Mature bone cells
Formed when an osteoblast gets embeded in its secretions
Sense mechanical strain to direct osteoblast and osteoclast activity

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4
Q

What are osteoclasts? What do they do? From where are they derived?

A

Bone breaking cells
Dissolve and resorb cells by phagocytosis
Derived from bone marrow

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5
Q

What is the fundamental unit of compact bone?

A

Osteon

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6
Q

How does having few spaces between osteons in compact bone contribute to function?

A

Provides protection, support and resists stresses produced by weight of movement

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7
Q

Describe the structure of osteons

A

concentric ‘Lamellae’ around a central ‘Haversian Canal’

‘Haversian Canal’ – contain blood vessels, nerves and lymphatics.

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8
Q

What are lacunae and what radiates from lacunae?

A

Lacunae – small spaces containing osteocytes
Tiny Canaliculi radiate from lacunae filled with extracellular fluid.

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9
Q

What are Volkmann’s canals?

A

Transverse perforating canals

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10
Q

Structure of long bones (layers)

A
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11
Q

Mechanisms of bone fracture

A
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12
Q

Pahtological causes of bone fracture

A
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13
Q

Classification of fracture patterns

A
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14
Q

Describe this radiograph

A

Mid/distal third tibia
Simple
Transverse
15%lateral translation- you describe translation based off distal fragment
Minimal angulation (distal part anteriorly tilted 10degrees)

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15
Q

Describe this fracture

A

Mid/distal third tibia/fibula
Immature skeleton- growth plate still open
Multifragmentary
Oblique (butterfly)
Valgus angulation (20 degrees)
Anterior?? tilt (20 degrees)
Minimal translation

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16
Q

Why are children’s bones more elastic than an adults and what can this lead to?

A

Increased density of haversian canals
Therefore you can get:
Plastic deformity
bends before breaks

Buckle fracture

Greenstick
– like the tree
One cortex fractures but does not break the other side

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17
Q

Fracture reduction classification

A
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18
Q

Holding a fracture: classification

A
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19
Q

Fixation classification

A
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20
Q

What is done in rehabilitation and what are the principles of rehabilitation?

A

Physiotherapy

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21
Q

Urgent fracture complications

A

Local visceral injury
Vascular injury
Nerve injury
Compartment syndrome
Haemarthrosis
Infection
Gas gangrene

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22
Q

Less urgent fracture complications

A

Fracture blisters
Plaster sores
Pressure sores
Nerve entrapment
Myositis ossificans
Algodystrophy
Joint stiffness
Tendon lesions
Ligament injury

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23
Q

Late fracture complications

A

Delayed union
Mal union
Non union
Avascular necrosis
Muscle contracture
Osteoarthritis
Joint instability

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24
Q

What do we mean when we say that the femoral head has a retrograde blood supply?

A

blood supply comes up through capsule, not down through heart

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25
Describe the risk to blood supply and of AVN in the case of extracapsular, intracapsular undisplaced and intracapsular displaced fractures
Extracapsular: minimal risk to blood supply and AVN Intracapsular: if undisplaced: less risk to blood supply If displaced: 25-30% risk AVN
26
How would we define fitness/ mobility in >65 when deciding whether to do total hip replacement or hemiarthroplasty in NoF fractures?
Fit and mobile: Walks >mile day Independent Minimal comorbidities Less fit: Lower mobility Multiple comorbities
27
How do we classify joints? Describe the mobility and give examples for each type
Fibrous (immoveable): sutures, syndesmosis, interosseous membrane Cartilaginous (semi-moveable): Synchondroses (e.g. sine), symphyses (e.g. pubic) Synovial (freely moveable): ball and socket, plane, pivot, hinge, saddle, condyloid
28
Give examples for each type of synovial joint
29
How are synovial joints stabilized?
30
What is cartilage composed of and what is its blood supply?
Cartilage is composed of: 1) specialized cells (chondrocytes) 2) extracellular matrix: water, collagen and proteoglycans (mainly aggrecan) Cartilage is avascular – it has no blood supply
31
What is aggrecan?
a proteoglycan that possesses many chondroitin sulfate and keratin sulfate chains -characterized by its ability to interact with hyaluronan (HA) to form large proteoglycan aggregates
32
Two major divisions of arthritis?
33
Radiographic changes in Rheumatoid Arthritis vs. osteoarthritis
34
What does joint space narrowing indicate and how does it differ between osteoarthritis and rheumatoid arthritis
Joint space narrowing indicates articular cartilage loss. This can occur in osteoarthritis (primary abnormality) and in Rheumatoid Arthritis (secondary damage due to synovitis)
35
What are osteophytes at a)DIP joints b) PIP joints known as
a) Heberden's nodes b) Bouchard's nodes
36
Early radiographic sign of rheumatoid arthritis? What other types of inflammatory arthritis can this indicate?
Juxta-articular osteopenia is common early radiographic sign in inflammatory arthritis of any cause
37
Where do bony erosions initially occur in rheumatoid arthritis?
Erosions occur initially at the margins of the joint where the synovium is in direct contact with bone (the ‘bare’ area)
38
WHO definition of osteoarthritis?
chronic disease characterized by the deterioration of cartilage in joints which results in bones rubbing together and creating stiffness, pain, and impaired movement.
39
OA is a degenerative disease of what type of cartilage?
Chondral cartilage
40
What occurs in late stage OA?
Inflammation occurs late in disease cf. rheumatoid Inflammatory mediators include proteinases, e.g., matrix metalloproteinases (MMPs) and aggrecanases, and inflammatory cytokines, including interleukin (IL)-1β and tumor necrosis factor α (TNFα), which enhance the synthesis of proteinases and other catabolic factors to degrade the articular cartilage membrane
41
OA risk factors
42
What are the key history points for suspected OA?
Pain (exertional/rest/night) Disability: walking distance/stairs/giving way Deformity Previous history: trauma/infection Treatments given (physio/injections/operations) Other joints affected
43
What is this deformity?
Valgus
44
Likely reason for this scar?
ACL reconstruction surgery
45
46
What special tests can be used to look for ACL injury?
Anterior drawer test Lachmanns (pictured)
47
Radiographic changes seen in OA?
Joint space narrowing Subchondral sclerosis Subchondral cysts Osteophytes
48
OA management
49
Which type of operation is this?
Total knee replacement
50
What type of operation is this?
Ankle fusion
51
Give examples for bone infection
Bone: osteomyelitis Joint: septic arthritis
52
How can osteomyelitis be classified
Acute or chronic Primary or secondary
53
Give examples for bone infection
Bone: osteomyelitis Joint: septic arthritis
54
Signs of osteomyelitis
Pain/swelling/discharge Systemic signs: Fevers, sweats wt loss
55
Signs of septic arthritis
Pain Joint swelling/stiffness Fevers, sweats, wt loss
56
Bone infection investigations
Radiology: Plain films MRI scans: bony architecture/collections CT if MRI not available Bone scans: multifocal disease Labelled White cell scans Bloods: CRP (acute marker) ESR slower response WCC TB culture/PCR
57
Treatment of osteomyelitis
Antibiotics: iv weeks Surgical drainage: especially collections/sequestrum Chronic: antibiotic suppression/dressings ??amputation
58
Treatment of septic arthritis
Surgery: joint washout and drainage (repeated if required) Iv antibiotics (days/weeks) Immobilise joint in acute phase Physiotherapy once over acute phase
59
Shoulder conditions by age
60
Hip conditions by age
61
Knee conditions by age

Aneesha Flashcards BRS 2 (47 decks)

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