Orthopaedics (Unit 1 - Joint Conditions) Flashcards Preview

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

Flashcards in Orthopaedics (Unit 1 - Joint Conditions) Deck (87)
Loading flashcards...
1

What cells are involved in acute disease?

Polymorphonuclear leucocyte (polymorph)

2

Why is a polymorph called a polymorph?

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

3

What cells are involved in chronic disease?

Lymphocytes

4

Where are lymphocytes produced

Bone marrow and the spleen

5

What is osteoarthritis?

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

6

What is a congenital cause of secondary OA?

Congenital dislocation of the hip

7

What are childhood causes of secondary OA?

Perthe's disease
Infection

8

What is a traumatic cause of secondary OA?

Fracture in a joint

9

What are metabolic causes of secondary OA?

Gout
Crystal arthropathy

10

What is an infective cause of secondary OA?

TB

11

What is a chronc inflammatory cause of secondary OA?

Rheumatoid

12

Clinical presentation of OA

pain & associated loss of function
Worse with activity
Joint stiffness

13

Conservative management options for OA

Weight loss
Use of a stick
Rest
Physio

14

Surgical options for OA

Arthrodesis
Osteotomy
Arthroplasty

15

What is arthrodesis?

Surgical stiffening of a joint in a position of function

16

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

Arthrodesis

17

What is the long term disadvantage of arthrodesis?

Puts stress on adjacent joints

18

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

"Unpick" and convert to arthroplasty in their 50's

19

Which joints in particular are well suited to arthrodesis?

Wrist and ankle

20

What is osteotomy?

Surgical realignment of a joint

21

What is the aim of osteotomy?

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

22

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

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

23

What is arthroplasty?

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

24

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

Loads are low but need a large range of movement

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