Orthopaedics Unit 1 Flashcards Preview

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Flashcards in Orthopaedics Unit 1 Deck (104):
1

what is acute disease characterised by

polymurphonuclear leucocyte or polymorph

2

what is chronic disease characterised by

lymphocytes produced by bone marrow and the spleen

3

when is ".....octomy" and "....ectomy" used in surgery

otomy - when surgeons operate and open something up


ectomy - when something is removed in operation

4

what is most joint replacement surgery aimed at

pain relief

5

what is gout caused by

uric acid crystal deposited on the cartilaginous surface of the joints

6

what are the 2 principles symptoms of orthopaedics

pain
stiffness

7

what is OA and what causes this

wear and tear of the joints leading to degeneration

breakdown of the balance between wear and repair processes in the joint

8

what are causes of secondary OA

congenital - CDH

childhood - Perthe's disease, infection

trauma - fracture into a joint

metabolic - gout

infection - TB

chronic inflammatory - rheumatoid

9

Sx of OA

Pain
Stiffness
Loss of function
Limitation of movement

10

when is secondary care sought in OA

when sleep is disturbed

11

what is important to remember about OA in regards to limitation of movement

better ROM when under anaesthetic (patient not feeling pain)

successful surgeries are related to adequacy of pain relief rather than improving mobility of joint

12

what are conservative Tx for OA

weight loss
- modest reduction in weight can have significant reduction in total loads

use of a stick
- used in opposite hand, means shoulder girdle can help in tilting the pelvis
- reduces work of abductor muscles and reduces load on the hip

rest
physio

13

what joints are particularly affect by obesity

lower limb joints
- e.g. hip joint = joint loading during the stance phase of walking can reach 3x body weight and during activities of greater hip muscle exertion joint loading can reach 5x body weight

14

why is physiotherapy controversial in Tx for OA

Over-exercise issues

some exercise does relieve stiffness and muscle spasm and therefore pain.

15

what should young and old be told in relation to physio

Young - should be advised against excessive activity

Elderly - Total rest is however equally counterproductive, maintenance of the activities of daily living is essential.

16

surgical Tx for OA

Nothing
Arthrodesis
Osteotomy
Arthroplasty

17

why is nothing an option for Tx of OA

if risks outweigh the benefits

patient needs to be allowed to decided for themselves

18

what is arthrodesis

surgical stiffening of a joint in a position of function

19

when is arthrodesis an appropriate operation

for a young person with a painful and limited ROM

20

what is done in arthrodesis

stiff and painful joint is cut out and the remaining raw bone ends are held together either by an external splint or screws until they heal with a bony bridge

21

what is the position the hip joint is fused in and who dislike this position

30 degrees in flexion and some adduction

disliked in females as it can interfere with sexual activity

22

what is the recovery period of arthrodesis

6 months

23

what are the disadv of arthrodesis

puts stress of adjacent joints

e.g. in the hip, it causes extra stress on the lumbar spine

24

what procedure can be done on the hip joint to avoid the disadv of arthrodesis

fuse the joint until the fifth decade and then performing a second operation to “unpick” the arthrodesis and convert it to an arthroplasty

25

what joints can undergo arthrodesis with good response

ankle
wrist

26

what is osteotomy and what is the aim of the operation

surgical alignment of a joint

redirect forces across a joint so that they more evenly distribute the load to which the joint is subjected.

27

when is osteotomy normally used

joint is deformed and the loads crossing it are distorted by the deformity

28

what is the disadv of osteotomy

seen as a temporary measure lasting from 1 to 2 years to around 10

rarely tackles underlying cause

29

when is osteotomy used in arthritis

young patient who have maintained a good ROM, despite the pain and preservation of articular cartilage


which is typical of the early stages of osteoarthritis

30

what joints are suitable for osteotomy and how is the operation carried out

hip
knee

performed on the femoral side by altering the angle of the femoral neck to change the attitude of the femoral head relative to the acetabulum.

31

what is arthroplasty

surgery that creates a new joint or changes the shape of a joint

32

what is the aim of arthroplasty

reduce pain and the restricted ROM pain brings

not likely to alleviate disability due to stiffness

33

what is important to remember about the artificial joints

From the moment it is put in, it begins to wear out, whereas a natural joint has the capacity to regenerate.

34

for the knee and hip joint, what is the current success rates

knee joint - very successful

hip joint - more successful in the elderly

35

why has there been difficulty in joint replacements in the arm

loads involved are low but the ROM of the elbow and shoulder required are quire large

36

why does arthroplasty improve pain related Loss of function but does less for intrinsic stiffness

due to soft tissue distortion of the capsule and ligaments remaining even after replacing articular surfaces

37

what angle must the elbow be able to flex to to permit eating

90 degrees

38

what is the functional range of hip motion required

30-50 degrees flexion
10-15 degrees extension

few degrees of abduction and rotation

39

what is the functional range of knee motion required

90 degrees flexion

40

what is essential for the surgeon to ensure in a knee joint replacement and how is this achieved

stability in extension so that we can support the full weight of the body on a single straight leg

accurate soft tissue balance

41

how does the surgeon achieve accurate soft tissue balance

must balance the collateral ligaments

ensure the medial and lateral collateral ligaments are under equal tension

surgeon cuts ligaments and puts in artificial surface replacements of sufficient thickness to re-tighten the ligament

42

what are 3 requirements for any joint replacement

functional and pain-free range of movement

stability and resistance to forces

wear and loosening

43

what are general complications post surgery

chest infection
UTI
DVT
PE

44

what are specific early complications of joint replacement surgery

dislocation
DVT
infection

45

why is the hip at a period of risk of dislocation after surgery

[when is the period of risk]

prosthesis will not be fully supported by the surrounding soft tissues.

muscles and proprioceptors out of action due to surgery and pain inhibition

[before the effects of anaesthesia wears off]

46

what movement of the leg can particularly cause a hip dislocation

twisting the leg into extreme flexion with adduction and internal rotation

47

what are prophylaxis of DVT

heparin
stockings [prevent blood pooling in the legs]

48

what organisms most commonly infect the hip joint

staph aureus

commensals - staph albus [found on the skin]

49

what measures are taken to try prevent infection

antibiotic prophylaxis

ultra-clean air operating environment

50

when does late specific surgical complications occur

what are the late specific surgical complications

may occur as late as 10 years post surgery

infection
loosening and wear

51

what are the ways an artificial joint can become infected

bacteria being introduced at the time of insertion

blood borne (bacteraemia) i.e. after tooth extraction

52

what Sx of RA

severe pain
swelling
deformity of the joints

F > M

53

what are the principal joints affected in RA

small joints of hands and feet that are affected symmetrically

54

how does RA differ from OA Sx

RA - first notice stiffness, worse in the morning and improves during the day

OA - stiffness worse after activities

55

what are operations that can be done to tackle RA

soft tissue surgery
- synovectomy = helps with damage to tendon sheath and tendons.

joint surgery
- excision arthroplasty

56

what synovectomy surgery is successful in RA and what can it relieve

at the wrist
- clears up damage around extensor tendons

can reduce pain and stiffness
- good for younger patents who retains movement, but who has pain

57

what is the adv and disadv of excision arthroplasty

relieves pain

but as part of joint has been removed, there can never be full return of function

58

what is the surgeons role in RA

salvage joint
pain relief
return of function

59

what is AVN

bone tissue death through loss of blood supply

can be caused by trauma or be spontaneous

60

what areas are at risk of AVN after trauma

femoral head
proximal part of the scaphoid
proximal part of the talus

61

what areas are at risk of AVN spontaneously

lunate of the wrist
femoral head

62

when is AVN of the femoral head seen

chronic alcohol abuse

high dose steroid therapy

deep sea divers [Caisson's disease]

63

Sx of AVN

acute, severe joint pain

worse on movement

relieved a little by rest

patients tend to be younger

over time becomes indistinguishable from OA

64

why is AVN difficult to diagnose

no changes are seen on an x-ray

65

Mx of AVN

may be reversed if blood supple is re-established naturally

Tx underlying cause

joint replacement if needed

66

what causes gout

urate crystal
- urate = waste product of cell metabolism normally passed in the urine

67

causes of gout

dehydration [i.e. post-op]

after chemo

overuse of diuretics

68

Sx of gout

hot, tender, swollen joint

seen in 1st metatarsophalangeal joint and knee joint

69

Ix of gout

high level of uric acid in the blood

extract joint fluid and test for the presence of urate crystals

70

Mx of gout

NSAID

71

what is the cause of pseudogout

calcium pyrophosphate crystals on the articular surface of the joint

causes calcification of joint surfaces and menisci of the knee

72

what is the consequences of pseudo gout and gout

long term degeneration

73

what causes acute septic arthritis

infection which has spread to the joint via the blood

74

Sx of acute septic arthritis

in children
- acute illness
- high temperature
- joint is stiff, hot and tender

in adults
- can have less acute illness
- present with blood poisoning
- can be easy to miss septic arthritis

75

if a young adult presents with acute septic arthritis, what is the likely organism

gonococcus

76

Mx of acute septic arthritis

surgery - open and wash the joint

IV antibiotics
- first guess IV anti-staphylococcal agent in children [most likely organism]

77

what is the consequences of septic arthritis if not managed adequately

septicaemia

articular cartilage may disintegrate, may cause fibrous or bony fusion of the joint

78

what causes chronic septic arthritis

TB
- chronic SA seen commonly in AIDS patients

79

if there is TB in the joints, where else is it likely to be

Kidneys

80

Sx of chronic septic arthritis

chronic ill health

weight loss

muscle wasting around the joint

thinning of the bone

81

Mx of chronic septic arthritis

streptomycin, ethambutol and rifampicin

82

what are the Sx of mechanical knee problems

swelling
locking
giving way
pain

83

Sx of meniscal lesions

M > F

pain
effusion
locking
giving way

abnormality poorly localised O/E

84

MOI of meniscal lesions

twisting injury
- foot gets stuck on the ground, femur twists over stationary tibia cause a wrench to the meniscus
- may be torn or pulled off the bone
- seen in football, skiing

85

what menisci is more likely to be injury

medial more than lateral

86

what are the different types of meniscal lesions

cleavage lesion
- meniscus splits horizontally
- common in old age
- can cause the formation of a cyst due to build up of synovial fluid

bucket handle tear
- vertical split, which is anchored at both ends

parrot beak tear
- split off ones end of the lateral meniscus

degenerate tear
- tear due to generation

87

consequence of meniscal tear

torn part can become jammed in the joint
- stops the joint extending

88

why is your menisci important

shock absorber

helps distribute loads between femur and tibia

89

Mx of menisci tear

peripheral tears
- reattached with sutures
- have ability to heal due to good blood supply

tears within centre of menisci
- no ability to heal
- should be removed by arthroscopic meniscectomy
- patients recover quicker with arthroscopic

90

Ix of menisci tear

arthroscopy

91

what are osteochondral fragments

small fragments of cartilage and bone sheared off in injury a.k.a loose body

causes haemarthrosis (bleeding into the joint) and swelling

92

why can osteocondral fragments be difficult to diagnoses

invisible on x-ray

93

Sx of osteocondral fragments

after first incident may settle

months/years later
- locking
- pain
- giving way
- effusion

94

Mx of osteocondral fragments

removed with arthroscope

95

what is osteochondritis dissecans.

osteochondral fragments occurring spontaneously in adolescents

can settle spontaneously

96

why do collateral ligaments of the knee injuries heal by themselves but injuries to the cruciate do not

collateral ligaments have an excellent blood supply

when cruciate ligament is torn, blood supply is lost

97

how is the cruciate ligament commonly injured

by hyperextension or twist, often with the foot being anchored

98

Sx of ACL rupture

haemarthrosis
- knee swells quickly
- caused by bleeding from artery in cruciate

loss of antero-posterior stability
- particular flexion

loss of rotatory stability
- when twisting and turning

patients may report feeling a "pop"

99

what activities will cause the patient to experience Sx in ACL rupture

descending stairs

twisting or turning

100

Mx of ACL rupture

Tx offered when Sx interfere with daily life or if patients wishes to return to sport

replace torn ligament with synthetic one

101

why are synthetic ligaments more likely to fail compared to a natural ligament

it has no sensory receptors to let the brain know if the ligament is being overstretched

The brain is therefore unable to initiate muscle action to protect the joint.

102

what is patella dislocations associated with and what is the clinical presentation

malformation of the patella or lateral femoral condyle
- leads to patella moving on the femur (mal-tracking)
- painful and associated muscle spasm present

- spontaneous dislocation
- failure of quads to act as an extensor = person falls to the ground

103

Mx of patella dislocation

minor mal-tracking
- surgical splitting of the vastus laterals muscle insertion into the patella
- allows patella to fall back into a normal

recurrent/severe mal-tracking
- medial tightening (PLICATION) of the vastus medialis muscle

104

what can patella dislocation be confused with

anterior knee pain often seen in adolescent girls