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BMSc SB > Orthopaedics Unit 1 > Flashcards

Orthopaedics Unit 1 Flashcards

(104 cards)

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1
Q

what is acute disease characterised by

A

polymurphonuclear leucocyte or polymorph

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2
Q

what is chronic disease characterised by

A

lymphocytes produced by bone marrow and the spleen

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3
Q

when is “…..octomy” and “….ectomy” used in surgery

A

otomy - when surgeons operate and open something up

ectomy - when something is removed in operation

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4
Q

what is most joint replacement surgery aimed at

A

pain relief

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5
Q

what is gout caused by

A

uric acid crystal deposited on the cartilaginous surface of the joints

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6
Q

what are the 2 principles symptoms of orthopaedics

A

pain

stiffness

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7
Q

what is OA and what causes this

A

wear and tear of the joints leading to degeneration

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

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8
Q

what are causes of secondary OA

A

congenital - CDH

childhood - Perthe’s disease, infection

trauma - fracture into a joint

metabolic - gout

infection - TB

chronic inflammatory - rheumatoid

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9
Q

Sx of OA

A

Pain
Stiffness
Loss of function
Limitation of movement

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10
Q

when is secondary care sought in OA

A

when sleep is disturbed

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11
Q

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

A

better ROM when under anaesthetic (patient not feeling pain)

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

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12
Q

what are conservative Tx for OA

A

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

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13
Q

what joints are particularly affect by obesity

A

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

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14
Q

why is physiotherapy controversial in Tx for OA

A

Over-exercise issues

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

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15
Q

what should young and old be told in relation to physio

A

Young - should be advised against excessive activity

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

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16
Q

surgical Tx for OA

A

Nothing
Arthrodesis
Osteotomy
Arthroplasty

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17
Q

why is nothing an option for Tx of OA

A

if risks outweigh the benefits

patient needs to be allowed to decided for themselves

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18
Q

what is arthrodesis

A

surgical stiffening of a joint in a position of function

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19
Q

when is arthrodesis an appropriate operation

A

for a young person with a painful and limited ROM

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20
Q

what is done in arthrodesis

A

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

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21
Q

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

A

30 degrees in flexion and some adduction

disliked in females as it can interfere with sexual activity

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22
Q

what is the recovery period of arthrodesis

A

6 months

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23
Q

what are the disadv of arthrodesis

A

puts stress of adjacent joints

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

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24
Q

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

A

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

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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

BMSc SB (18 decks)

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