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AY BMSc Orthopaedics > Orthopaedics (Unit 1 - Joint Conditions) > Flashcards

Orthopaedics (Unit 1 - Joint Conditions) Flashcards

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1
Q

What cells are involved in acute disease?

A

Polymorphonuclear leucocyte (polymorph)

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2
Q

Why is a polymorph called a polymorph?

A

Because it’s nucleua is in many sections and it appears white

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3
Q

What cells are involved in chronic disease?

A

Lymphocytes

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4
Q

Where are lymphocytes produced

A

Bone marrow and the spleen

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5
Q

What is osteoarthritis?

A

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

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6
Q

What is a congenital cause of secondary OA?

A

Congenital dislocation of the hip

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7
Q

What are childhood causes of secondary OA?

A

Perthe’s disease

Infection

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8
Q

What is a traumatic cause of secondary OA?

A

Fracture in a joint

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9
Q

What are metabolic causes of secondary OA?

A

Gout

Crystal arthropathy

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10
Q

What is an infective cause of secondary OA?

A

TB

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11
Q

What is a chronc inflammatory cause of secondary OA?

A

Rheumatoid

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12
Q

Clinical presentation of OA

A

pain & associated loss of function
Worse with activity
Joint stiffness

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13
Q

Conservative management options for OA

A

Weight loss
Use of a stick
Rest
Physio

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14
Q

Surgical options for OA

A

Arthrodesis
Osteotomy
Arthroplasty

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15
Q

What is arthrodesis?

A

Surgical stiffening of a joint in a position of function

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16
Q

What is a good surgical option in a young person with painful OA and a limited range of movement

A

Arthrodesis

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17
Q

What is the long term disadvantage of arthrodesis?

A

Puts stress on adjacent joints

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18
Q

What can be done to try and reduce stress on other joints following arthrodesis in a young person?

A

“Unpick” and convert to arthroplasty in their 50’s

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19
Q

Which joints in particular are well suited to arthrodesis?

A

Wrist and ankle

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20
Q

What is osteotomy?

A

Surgical realignment of a joint

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21
Q

What is the aim of osteotomy?

A

To more evenly distribute the load to which the joint is subjected

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22
Q

In a young person with OA when would osteotomy be most useful and why?

A

If they have maintained a good range of movement despite the pain. If severely limited osteotomy won’t work as useful function cannot be restored

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23
Q

What is arthroplasty?

A

Surgery which creates a new joint or changes the shape of a joint

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24
Q

Why does arthroplasty not work as well for the upper limb?

A

Loads are low but need a large range of movement

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25
Which is the most successful and common joint replacement?
Hip
26
What are specific early complications of joint replacement?
Dislocation DVT Infection
27
What are the most likely causative organisms in an early infection following joint replacement?
Staph Aureus | Commensals (e.g. staph albus)
28
What are specific late complications of joint replacement?
Infection | Loosening and wear
29
What is the likely route of infection if late after joint replacement?
Blood steam (bacteraemias)
30
Symptoms of RA
Severe pain. swelling and deformity of joints Symmetrical small joint involvement Stiffness worse in the morning
31
What soft tissue surgery can affect sufferers of RA?
Synovectomy (particularly at the wrist)
32
In what patients is synovectomy particularly valuable?
Young person, who retains movement, but has pain
33
What often accompanies a synovectomy for RA at the elbow & wrist?
Excision arthroplasty
34
What is AVN?
Bone tissue death through loss of blood supply
35
What are the causes of AVN?
Trauma | Spontaneous
36
Which areas are at risk for post traumatic AVN?
Femoral head Proximal part of the scaphoid in the wrist Proximal part of the talus
37
Which 2 sites does spontaneous AVN tend to occur?
Femoral head | Lunate
38
In what individuals is AVN of the head of femur seen?
Chronic alcohol abuse High dose steroid therapy Caisson's disease
39
What is Caisson's disease?
Decompression sickness in deep sea divers
40
How does a patient with AVN of the femoral head present?
Acute severe joint pain Made worse by movement To some degree relieved by rest
41
How can AVN be reversed?
If blood supply is restored naturally (however bone is soft and prone to distort)
42
What is the role of surgery in the management of AVN?
Surgical restoration of blood supply not possible | Sometimes joint replacement
43
What are crystal arthopathies?
Crystals of the by products of body metabolism are deposited in the joints, on the surface of articular cartilage and within synovial fluid
44
Why do crystal arthropathies occur?
Abnormality of metabolism causing excess production or kidneys failing to eliminate them
45
Which crystal is deposited in gout?
Urate
46
What is urate?
A waste product of cell metabolism
47
What are the causes of gout?
Dehydration Chemo Diuretic overuse
48
Clinical presentation of gout
Hot, tender swollen joint
49
Which condition can mimic gout?
Infection
50
Where is gout most commonly seen?
Knee | First MTP
51
How is gout diagnosed?
High level of uric acid in the blood or urate cystals in joint fluid
52
What crystals are deposited in pseudogout?
Pyrophosphate
53
What is the prognosis of pseudogout?
Symptoms can be controlled by anti-inflammatory drugs but long-term degeneration is likely
54
What effect does chronic pseudogout have on joints?
Calcification of joint surfaces and menisci in the knee
55
What is acute septic arthritis?
Infection caused bacteria spread to the joint via the blood from a site of trivial infection
56
How does acute septic arthritis present in children?
Unpleasant acute illness High temperature Stiff hot and tender joint
57
How does acute septic arthritis present in adults?
Less acute illness chronically abnormal joint may give false impression of minor upset Unwell for days before presenting with blood poisoning
58
What is the most likely causative organism in a young adult with septic arthritis with little constitutional upset?
Gonococcus
59
How is acute septic arthritis managed?
Surgical washing | IV antibiotics
60
What is the first guess antibiotic in kids with acute septic arthritis?
Anti-staphylococcal agent
61
What is the cause of chronic septic arthritis?
TB spread to joints via the blood
62
How does chronic septic arthritis present?
Chronic ill health Weight loss Muscle wasting around affected joint
63
What is seen on an x-ray of chronic septic arthritis?
Marked thinning of the bone
64
How is chronic septic arthritis treated?
Combo of antibiotics (streptomycin, ethambutol, rifampricin)
65
Symptoms of a meniscal lesion
Pain Effusion Locking and/or giving way Generalised discomfort
66
What is the main cause of meniscal lesions?
Twisting injury (femur twists over stationary tibia)
67
Which meniscus is more frequently torn?
Medial
68
Describe a cleavage lesion
Meniscus splits horizontally Common in old age Can act like flap valves and allow build up of synovial fluid within the meniscus (cyst)
69
List 3 different types of meniscal tear
Bucket handle (vertical split anchored at both ends) Parrot beak (split off one end of the lateral meniscus) Degenerate tear
70
How are patients with a suspected meniscal tear investigated?
Arthroscopy
71
How can peripheral meniscal tears be managed?
Sutures
72
How should tears within the substance of the meniscus be managed?
Torn peripheral part should be removed
73
What is the advantage of arthroscopic over open meniscectomy?
Patients recover quickly (within days)
74
What is a loose body?
When fragments of cartillage and bone are sheared off in a shearing injury and knee swells up from associated bleeding into the joint
75
How do loose bodies present?
First incident settles | Months or years later patient presents with lock, pain and giving way, often with effusion
76
Describe osteochondritis dissecans
Adolescents Osteochondral fragments occur spontaneously Tends to settle spontaneously Loose bodies may require removal
77
How are cruciate ligaments injured?
Hyperextension or twist
78
Why are cruciate ligaments not capable of spontaneous healing?
If torn blood supply is lost
79
In what situation might cruciate ligament retain its blood supply after an injury?
If cruciate ligament pulled off with a fragment of bone at one end and put back within a few hours
80
Clinical presentation of cruciate injury
Acute swelling (haemarrthrosis) Feel a "pop" Antero-posterior instability Rotational instability
81
Management of cruciate ligament injuries
Left untreated for a while Knee muscle rehab Only offer treatment if interfering with daily life or wanting to return to sport
82
What are the surgical treatment options for cruciate ligament injuries?
Synthetic ligament
83
Why is a prosthetic ligament more likely to fail?
Has no sensory receptors to indicate the brain that ligament is being overstretched (no muscle action to protect joint)
84
What is dislocation of the patella usually associated with anatomically?
Malformation of either the patella or lateral femoral condyle
85
How does dislocation of the patella usually present clinically?
Failure of quads to act as extensor so patient falls to the ground
86
How are minor degrees of patellar dislocation treated?
Surgical splitting of vastus lateralis muscle insertion into th patella, allows the patella to fall back into a normal relationship with the femur
87
How is recurrent and severe patellar dislocation treated?
``` Medial tightening (plication) of the vastus medialis muscle In childhood patellar tendon may be re-sited more medially ```

AY BMSc Orthopaedics (5 decks)

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