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Ortho unit 1 Flashcards

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1
Q

orthopaedics

A

straight children

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2
Q

acute disease

A

strikes suddenly, production of polymorphs- leucocytes

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3
Q

chronic disease

A

takes a long time to develop, characterised by lymphocytes- produced in bone marrow and spleen

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4
Q

opening a joint

A

arthrotomy

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5
Q

removing something e.g. removing a meniscus

A

ectomyw eg menisectomy

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6
Q

what is most joint replacement surgery aimed at

A

pain relief

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7
Q

self limiting

A

temporary and will get better e.g. muscle tears and ligament sprains

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8
Q

congenital abnormalities

A

defects associated with development in the womb

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9
Q

inflammatory abnormalities

A

bacterial infection causing inflammation of joint (infective arthritis) or bone (osteomyelitis). Sometimes inflammation is unknown cause e.g. RA

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10
Q

metabolic disorders

A

gout- uric acid crystals deposited on cartilaginous surface of joints

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11
Q

degenerative disorders

A

normal structure of the joint has been disturbed through deterioration and wear- OA

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12
Q

trauma

A

msk system suffered damage

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13
Q

2 principle symptoms in orthopaedics

A

pain and stiffness

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14
Q

osteoarthritis

A

pain and limitation of movement of joints associated with excessive wear of articular cartilage resulting from the break down of balance between wear and repair processes

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15
Q

Aetiology of OA

A

known cause- secondary arthritis, unknown cause - primary OA- majority

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16
Q

secondary oa

A

congenital dislocation of hip, perches disease, infection, trauma, gout, infection-TB, chronic inflammatory- rheumatoid

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17
Q

OA clinical picture

A

can occur at any age but becomes increasingly common later in life. Pain, loss of function of joint, stiffness (nearly always secondary to pain)

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18
Q

when would a GP refer OA to secondary care

A

when the patients sleep is disturbed by pain

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19
Q

examination of OA

A

symptoms of pain and associated limitation of movement

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20
Q

management of OA

A

all aimed at pain relief
conservative- weight loss- quite modest reductions in body weight will result in significant reductions in total loads being borne by joint
walking stick- shoulder girdle can help in tilting the pelvis and so help in weight bearing. Stick reduces the work required of the weight bearing abductor muscles
Physio- controversial- balance between excessive exercising and excessive resting (both are bad)

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21
Q

surgical options for OA

A

Arthrodesis, osteotomy, arthroplasty

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22
Q

arthrodesis for OA

A

surgical stiffening og a joint in a position of function- appropriate for a young person with a painful and limited range of movement. Stiff painful bit of bone is cut out, raw bone ends held together by external splint or screws until they heal with a bony bridge

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23
Q

long term disadvantage of arthrodesis

A

puts stress on adjacent joints e.g. in hip more stress on spine or adjacent hip

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24
Q

joints that can usefully be fused

A

ankle and wrist- small joints easier to hold bone ends together

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25
double op for OA
fuse joint until 5th decade then unpick and do arthroplasty
26
osteotomy for OA
surgical realignment of joint. Aim- redirect forces across a joint so that they distribute the load more evenly. Generally performed where joint has become deformed and the loads crossing it are distorted- e.g. knee- bow legged- load passes down medial side of joint instead of middle
27
principle indication for operative treatment of OA
pain
28
value of osteotomy
young who have retained good range of movement
29
arthroplasty
replacement of one or both surfaces of a joint
30
limitations of joint replacement
artificial joint begins to wear out from the moment its put in. Arthroplasty improves pain related loss of function but does relatively little for intrinsic stiffness
31
amount of flexion required by knee to get up and down stairs
90
32
most successful and common joint replacement
hip
33
3 requirements of any joint replacement
functional pain free movement, stability and resistance to forces wear and loosening
34
1 principle difference between requirements of an upper limb and lower limb joint replacement
upper limb- less load but greater range of movement required
35
important type of movements for knee
flexion and extension
36
important types of movements for hip
flexion extension and abduction
37
early complications of arthroplasty
dislocation- immediately post op- prosthesis won't be supported by the surrounding tissues. Risk of dislocation reduces over time DVT- prophylaxis eg heparin Infection- staph aureus, staph albus- antibiotic prophylaxis
38
late complications of arthroplasty
infection- bacteraemia | Loosening and wear- loosening to some degree is probs inevitable
39
general complications of surgery
DVT, pressure sores, infection
40
Rheumatoid arthritis clinical picture
severe pain, swelling and deformity of the joints
41
principle joints affected in RA
small joints of hands and feet- affected symmetrically, no pattern in larger joints
42
Typical RA patient
women more free affected than men, can occur at any age
43
first symptoms of RA
stiffness worse in mornings, improving throughout the day
44
role of surgery for RA
synovectomy- removal of the synovial membrane. Excision arthroplasty may be combined with synovectomy at elbow and wrist. Most of the surgeons role is salvage- goals are pain relief and return of function
45
Avascular necrosis
bone tissue loss due to lack of blood supply
46
Areas at risk of AVN following trauma
femoral head proximal part of scaphoid proximal part of talus
47
femoral neck fractures
damage to capsular blood vessels puts femoral head at risk
48
where is avascular necrosis of the femoral head seen
chronic alcohol abuse, high dose steroid therapy and in deep sea divers (caissons disease)- patient presents with acute and often severe joint pain, made worse by movement and to some degree relieved by rest.
49
typical age of patient with AVN
many are young
50
diagnosis of AVN
difficult- no changes to be seen on x ray. later, the bone appears dense, reflecting the absence of blood vessels
51
can AVN be reversed
yes if a blood supply can be re established naturally- bone soft and prone to distortion in re vascularising stage with secondary arthritic changes
52
management of AVN
treatment non specific, joint should be rested if possible, surgery is of no value in treating the underlying condition - often surgeon left to salvage the joint with joint replacement - highly problematic as patients often young
53
why do crystal arthropathies occur
excess production or kidneys failing to eliminate
54
gout
urate crystal deposition. rate is a waste product of cell metabolism- becomes deposited in circumstances such as dehydration and after chemo.
55
what is probably the most common cause of gout
overuse of diuretics
56
gout presentation
hot, tender, swollen joint
57
where is gout commonly seen
knee, 1st MTP- important to exclude infection
58
diagnosis of gout
detecting the presence of a high level of uric acid in the blood. more accurate- extracting joint fluid through a syringe and testing for presence of urate crystals
59
gout treatment
anti inflammatory drugs- reduce inflammation and help kidneys to eliminate
60
pseudo gout
less acute presentation than gout. Deposition of calcium pyrophosphate crystals
61
what does chronic pseudo gout cause
calcification of joint surfaces and the menisci in the knee
62
treatment of pseudo gout
symptoms may be controlled with anti- inflammatory drugs but long term degradation is likely
63
possible long term complication of crystal arthroplasty
secondary arthritis
64
two types of AVN
post traumatic, caissons disease
65
acute septic arthritis
infection caused by bacteria- spread to joint via the blood from site of trivial infection. rarely occurs from direct penetration of the jointly a sharp object
66
clinical presentation of acute septic arthritis
children- acute illness during which the child is unwell with a high temp- affected joint is stiff, hot sonf tender Adults- less acute illness. Patient remains unwell for several days before presenting with blood poisoning- many patients die because of the delay in recognising the condition
67
Most likely cause of young adult with septic arthritis
gonococcus- venereal disease
68
management of acute septic arthritis
surgery and IV antibiotics- joint should be opened and washed. First guess antibiotic- anti staphylococcal agent in children
69
risks of septic arthritis if treatment inadequate
septicaemia, disintegration of articular cartilage leading to fibrous or even bony fusion of the joint
70
chronic septic arthritis
joint TB - aids patients particularly prone. TB bacteria spread to joints via blood, kidney and joint TB often found together
71
clinical presentation of chronic septic arthritis
chronic ill health, weight loss and considerable muscle wasting around the affected joint. X rays show marked thinning of the bone
72
management of chronic septic arthritis
antibiotics for tb - RIPE
73
mechanical knee problems key symptoms
swelling, locking, giving way, pain
74
meniscal knee lesions
more common in men, can rarely occur in adolescents and occasionally children are born with an abnormal lateral meniscus
75
symptoms of meniscal lesions
pain, joint effusion, sometimes locking and giving way. abnormality is poorly localised on examination
76
principle cause of meniscal lesions
twisting injury
77
which meniscus is more frequently torn
medial - can be torn at its peripheral attachment or actually within its substance
78
cleavage lesion
meniscus split horizontally- common in old age. Occasionally cleavage lesions act like flap valves and allow a build up of synovial fluid within the meniscus, forming a cyst
79
bucket handle tear
vertical split, anchored at each end
80
parrot beak tear
split off one end of the lateral meniscus
81
degenerate tear
tear due to degeneration
82
consequence of a meniscal tear
torn part becomes jammed in the joint, stopping it extending
83
management of meniscal lesions
meniscus is important and should be preserved as much as possible during surgery. Peripheral tears can be reattached with sutures. Tears within the substance have no capacity to repair and the torn peripheral part should be removed
84
examination of meniscal lesions
arthroscopy- small optical instrument introduced into the knee koint- most meniscal lesions can now be removed by the arthroscope (arthroscopic meniscectomy)- some require a small opening made into the joint (arthrotomy)
85
arthroscopic meniscectomy vs open meniscectomy
patients recover quickly from arthroscopic
86
Loose bodies
osteochondral fragments may be sheared off in an injury- knee subsequently swells up due to haemarthrosis. Osteochondral fragment is called a loose body and is often not resorbed but lives floating free in the synovial fluid
87
clinical presentation of loose body
may settle in the first incidence buy months or years later the patient can present with locking, pain and giving way, often with effusion
88
management of loose body
removal with arthroscope
89
osteochondritis dissecans
osteochondral fragments occurring spontaneously in adolescents. Tends to settle spontaneously but loose bodies may require removal
90
why do soft tissues to collateral ligaments heal spontaneously and cruciate tears don't
collateral ligaments have an excellent blood supply. Cruciate ligaments aren't capable of spontaneous healing because the blood supply is lost when torn
91
How is cruciate ligament injured
hyperextension or twist, often associated with foot being anchored by a studded boot or ski
92
clinical presentation of cruciate ligament injury
swelling- indicating haemarthrosis, patient can feel a pop, swelling resolves over a few weeks, loss of AP stability, particularly in flexion and loss of rotary stability when twisting or turning
93
management of cruciate injury
ligament should be left untreated for a while and the knee muscles rehabbed. Treatment should only be offered if symptoms interfere with daily life. Treatment- replacing torn ligament with artificial one- artificial ligament more likely to fail because it has no sensory receptors in it to let the brain know if the ligament is being over stretched
94
dislocation of the patella
usually associated with malformation of the patella or the lateral femoral condyle- leads to patella moving abrasively over the femur (malt racking) which is painful due to the associated muscle spasm
95
clinical presentation- dislocation of the patella
spontaneous dislocation of patella and failure of quads group to act as an extensor, so the person falls to the ground
96
management of dislocation of the patella
minor degrees of mal tracking- dealt with by surgical splitting of the vests laterals muscle insertion into the patella, allowing the patella to fall back into a normal relationship to the femur. If its recurrent and severe- medial tightening (plication) of vests medals muscle may be required. In adulthood- the patellar tendon may be rested more medially
97
define plication
medial tightening of the vests medals muscle

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