Orthapaedics

Question 1

Indications for joint replacement

Answer 1

Degenerative disease
Inflammatory disease
Trauma
Tumour
Vascular disease
Revision of previous replacement

Question 2

3 types of hip replacement

Answer 2

Cemented
Hybrid
Uncemented

Question 3

Difference between cemented and uncemented hip replacement

Answer 3

Cemented uses bone cement to fix implant to bone
Uncemented relies on bone in growth onto implant

Question 4

What substance is used as cement in cemented joint replacements

Answer 4

Poly(methyl methacrylate) - acrylic polymer

Question 5

How are Uncemented joint implants designed to increase bone ingrowth

Answer 5

Porous or hydroxyapetite covering

Question 6

How can cement cause damage to tissue

Answer 6

Cause burns as it sets

Question 7

Which materials for joint replacements have the lowest wear rate

Answer 7

Ceramic on ceramic

Question 8

Are intra operational fractures more common in cemented or Uncemented joint replacements and why

Answer 8

Uncemented
Forcing prosthesis into too small hole

Question 9

How long before a pt can bear weight on a cemented or Uncemented hip replacement

Answer 9

Cemented - immediately
Uncemented - 4-6wks

Question 10

Spinal fusion

Answer 10

2+ vertebrae joined together with screws and bone graft to stabilise vertebral column

Question 11

Indications for spinal decompression surgery

Answer 11

Spinal stenosis
Damaged IVD
fractured vertebrae
Tumours

Question 12

3 types of spinal decompression surgery

Answer 12

Spinal fusion - vertebrae are joined together to stabilise and strengthen the spine
Laminectomy - area of bone from vertebrae is removed to relieve nerve pressure
Discectomy - section of damaged disc is removed to relieve nerve pressure

Question 13

Vertebroplasty

Answer 13

injection of bone cement into the vertebral body in order to relieve pain and / or stabilise the fractured vertebra

Question 14

Soft tissue orthopaedic procedures

Answer 14

Tendon repair
Tendon transfer
Tendon lengthening
Ligament repair
Ligament replacement
Free muscle transfer

Question 15

Free muscle transfer

Answer 15

Replacing damaged or destroyed muscle with other skeletal muscle (+ often overlying skin) from elsewhere in body

Question 16

Which muscles are most commonly used for free muscle transfer

Answer 16

Gracilis
Rectus femoris

Question 17

Which tendons are most commonly used for ACK reconstruction

Answer 17

Semitendinous tendon
Gracilis tendon

Question 18

What procedure can improve toe walking

Answer 18

Achilles tendon lengthening

Question 19

Tendon lengthening

Answer 19

surgically cutting part, or all, of a tendon to create a longer, more functional tendon

Question 20

Types of poor fracture healing

Answer 20

Delayed
Mal union
Non union

Question 21

Delayed fracture healing

Answer 21

Failure to consolidate within 1.5x expected time

Question 22

Fracture Non union

Answer 22

Failure to consolidate within 2x expected time

Question 23

Fracture Mal union

Answer 23

Misalignment of proximal and distal fragments

Question 24

Types of fracture Mal union

Answer 24

Rotation
Angulation
Shortening
Translation

Question 25

2 types of fracture non union

Answer 25

Atrophic Hypertrophic

Question 26

Difference between Atrophic and hypertrophic non union

Answer 26

Atrophic - no Blood supply Hypertrophic - has blood supply

Question 27

What causes Atrophic non union

Answer 27

Lack of blood supply to bone ends or metabolic conditions

Question 28

What causes hypertrophic non union

Answer 28

Inadequate fracture stability - bone ends move too much

Question 29

What type of poor fracture healing leads to ‘elephant foot’ or ‘horse hoof’ appearance

Answer 29

Hypertrophic non union

Question 30

Osteotomy

Answer 30

Surgical cutting of a bone usually for realignment

Question 31

Distraction osteogenesis

Answer 31

Bone lengthening cutting and slowly separating bone using a distractor and allowing the bone healing process to fill in the gap

Question 32

Reconstructive orthopaedic procedures

Answer 32

Osteotomy Distraction osteogenesis

Question 33

4 sources/types of bone graft

Answer 33

Autograft Allograft Xenograft Alloplast

Question 34

Autograft, allograft, xenograft, and alloplast sources

Answer 34

Auto - pts own tissue Allo - tissue from another person Zeno - tissue from an animal Allo - synthetic material, eg hydroxyapetite

Question 35

4 processes involved in bone grafting

Answer 35

Osteogenesis Osteoconduction Osteoinduction Osteopromotion

Question 36

Osteogenesis

Answer 36

Formation/development of new bone cells from graft

Question 37

Osteoconduction

Answer 37

Physical effect where matrix of graft forms a scaffold which favours outside cells to penetrate the graft and form new bone (Bone growing on a surface)

Question 38

Osteoinduction

Answer 38

Chemical process where molecules in graft converts neighbouring cells into osteoblasts

Question 39

Osteopromotion

Answer 39

Grafted material enhances Osteoinduction

Question 40

Aseptic loosening

Answer 40

failure of the fixation of a prosthetic component in the absence of infection

Question 41

Difference between wear and corrosion of a prosthetic

Answer 41

Wear - mechanical process from changes in load distribution and micro motion Corrosion - electrochemical process of metal degradation

Question 42

Which areas of bone are most commonly affected by cancer metastases

Answer 42

Spine Pelvis Proximal femur Proximal humerus

Question 43

Effects of cancer metastasising into bone

Answer 43

Severe pain Decr mobility Pathological fractures

Question 44

Treatment of cancer metastases lesions in bones

Answer 44

Surgical resection Joint reconstruction w bone graft

Question 45

Lytic bone metastases

Answer 45

distant tumour deposits of a primary tumour within bone characterised by a loss of bone with the destruction of the bone matrix