Ortho Overview Part 1 (Steiner)

Question 1

What does orthopaedics literally mean?

Answer 1

Straight child

Question 2

Orthopedics is the medical discipline devoted to which system?

Answer 2

Musculoskeletal

Question 3

Functions of MSK system

Answer 3

Support, protection, movement

Question 4

Function of bone

Answer 4

Provides support

Question 5

Function of cartilage

Answer 5

Provides smooth surface for articulating bones

Question 6

Function of intervertebral disks

Answer 6

Sustains and distributes load

Question 7

Function of muscles

Answer 7

Contract to create movement

Question 8

What do tendons connect?

Answer 8

Muscle to bone

Question 9

What do ligaments connect?

Answer 9

2 bones

*Defines the motion of the joint

Question 10

Is bone tissue dynamic or static?

Answer 10

Dynamic - osteoblasts make new bone and osteoclasts remove necrotic bone

Question 11

2 types of bone

Answer 11

• Cortical (less porous, denser outer portion)

- Cancellous (more porous, trabecular, surrounded by cortical bone)

Question 12

Strength and stiffness of bone is generally in which direction?

Answer 12

In the direction of load application

Question 13

Which bones deal with longitudinal stresses best?

Answer 13

Long bones

Question 14

Long bones deal with which stresses best?

Answer 14

Longitudinal stresses

Question 15

How do fractures generally occur?

Answer 15

1. Single momentary load exceeds the tolerance of that bone (usually from trauma)
2. Repeated loading (stress)

Question 16

When do stress fractures occur?

Answer 16

Repeated loading where rate of damage exceeds rate of repair

Question 17

5 stages of fracture healing

Answer 17

1. Impact
2. Inflammation (hematoma formation)
3. Soft callus formation
4. Hard callus formation
5. Remodeling

Question 18

How does a hematoma progress at fracture site?

Answer 18

• Granulation tissue replaces hematoma
• Fibroblasts make collagen
• Osteoclasts remove necrotic bone

Question 19

When does a fracture appear clinically healed?

Answer 19

When soft callus becomes hard callus

Question 20

What procedure is performed when a fracture requires surgical intervention?

Answer 20

ORIF (open reduction and internal fixation)

Question 21

ORIF vs. conservative tx of fractures

Answer 21

ORIF heal more quickly but are more at risk for infection, complications of anesthesia or surgery

Question 22

Which type of hardware placed for fractures is better tolerated?

Answer 22

Deeper hardware

Question 23

Are plates or rods better tolerated by pts?

Answer 23

Rods

Question 24

What happens when a fracture fails to heal properly?

Answer 24

Non-union or malunion

Question 25

Describe non-union of fracture

Answer 25

- When fragments fail to unite and heal - If healing has not occurred w/in 6 months, it is called a "delayed union" - Beyond 6 months it is considered a non-union

Question 26

When can non-unions occur?

Answer 26

- Poor blood supply (elderly) - Poor nutritional status - Inadequate immobilization - Soft tissue interposed b/w fragments - Presence of infection or dead bone (sequestrum)

Question 27

What is a sequestrum?

Answer 27

Piece of dead bone

Question 28

Treatment of non-union

Answer 28

- Initially, stimulate normal osteogenic mechanisms - Functional bracing combined w/wt bearing - Use of implantable rods or compression plates - Electrically w/bone stimulators - Chemically w/autogenous bone transplants

Question 29

How does bone respond to stress?

Answer 29

Becomes more dense

Question 30

What is the most technologically advanced means of treating a non-union fracture?

Answer 30

Ilizarov method | -Application of an external fixator

Question 31

Bony regeneration with the Ilizarov method occurs at what rate?

Answer 31

1 mm per day

Question 32

Describe malunion of fracture

Answer 32

Healing has occurred but with an unacceptable degree of angulation, rotation, or shortening

Question 33

Which type of fractures are more likely to be a/w nerve transections?

Answer 33

Open fractures

Question 34

Which types of fractures are MC at risk of infection?

Answer 34

- Open | - Those treated surgically

Question 35

What predisposes female athletes to osteopenia?

Answer 35

Amenorrhea

Question 36

What may x-rays show with stress fractures?

Answer 36

Subtle cortical disruption or evidence of prior bone healing

Question 37

What imaging is usually more helpful for stress fractures?

Answer 37

Bone scan

Question 38

Treatment of stress fractures

Answer 38

- Rest - Splints - In some cases, casting * Best thing is prevention

Question 39

What can help amenorrheic women reduce the risk of osteopenia?

Answer 39

OCPs

Question 40

Untreated stress fractures may evolve into:

Answer 40

Complete fracture

Question 41

Definition and function of joints

Answer 41

- Articulation where 2 bones meet | - Allow movement of 1 bone on another

Question 42

Types of joints

Answer 42

1. Cartilaginous (minimal movement) 2. Fibrous (immovable) 3. Synovial (freely moveable)

Question 43

Examples of cartilaginous joints

Answer 43

- Symphysis pubis - Vertebral bodies - AC joint - Sternoclavicular joint

Question 44

Examples of fibrous joints

Answer 44

Skull sutures

Question 45

Examples of synovial joint

Answer 45

- Hip, shoulder (ball & socket) - Fingers, elbow (hinge) - Knee, TMJ (condylar)

Question 46

Examples of ball & socket synovial joints

Answer 46

Hip, shoulder

Question 47

Examples of hinge synovial joints

Answer 47

Fingers, elbow

Question 48

Examples of condylar synovial joints

Answer 48

Knee, TMJ

Question 49

Describe articular cartilage

Answer 49

- Avascular tissue composed of chondrocytes and an organic matrix - Found at ends of bones (joint) - One dimensional

Question 50

Osteoarthritis occurs from:

Answer 50

Wearing down of articular cartilage and subsequent exposure of underlying bone

Question 51

Why does articular cartilage have little capacity to repair itself?

Answer 51

Chondrocytes have a low rate of metabolism

Question 52

How does the body attempt to repair articular cartilage?

Answer 52

- With new hyaline cartilage | - This results in fibrocartilage (not ideal for joint surfaces)

Question 53

When is there NO capacity for repair to cartilage defects?

Answer 53

If they extend through entire thickness to the calcified plate at the bony junction