Orthopedics Flashcards
(93 cards)
1
Q
what body parts is orthopedic medicine used for?
A
bones joints muscles tendons nerves
2
Q
what system is orthopedics?
A
musculoskeletal aka locomotor
3
Q
what is the scope of orthopedics?
A
prevention, investigation, dx and tx of disorders and injuries of the musculoskeletal system by medical, surgical and physical means.
4
Q
what are orthopedics diagnostic categories?
A
Congenital or Developmental Infection or Inflammation Injury or Mechanical Derangement Metabolic Dysfunction Arthritis Sensory Disturbances Tumors/Lesions
5
Q
what are examples of congenital or developmental abnormalities?
A
Club Foot
Hip Dysplasia
Muscular Dystrophy
6
Q
what are examples of infection or inflammation?
A
Osteomyelitis
Septic Arthritis
7
Q
what are examples of injury or mechanical derangement?
A
Fractures
Back Injuries
8
Q
what is an example of Metabolic Dysfunction or Degeneration?
A
gout
9
Q
what is an examples of arthritis?
A
Osteoarthritis (Degenerative Joint Disease)
Rheumatoid Arthritis
10
Q
what are examples of sensory disturbances?
A
peripheral nerve injury
11
Q
what is the function of fascia?
A
Enhances organ system, provides strength
12
Q
what is the function of tendons?
A
Connects muscle to bone
13
Q
what is the function of ligaments?
A
Connects bone to bone
14
Q
what is the function of joint capsules?
A
Surrounds joint, crisscross collagen fibers
15
Q
what are the types of muscles?
A
Involuntary, smooth, striated
16
Q
what is the function of bone and cartilage?
A
Modified collagen, increased amounts of calcium
17
Q
what is an example of injury to fascia?
A
Planter fasciitis
18
Q
what are examples of skin injuries?
A
Bruise contusion
Laceration
19
Q
what are examples of injury to tendons?
A
Lacerations
Injection
Avulsion, rupture, tear
20
Q
what is a sprain?
A
injury to a ligament
21
Q
how does sprain occur?
A
stretched when the joint is carried through a range of motion greater than normal, but without dislocation or fracture.
22
Q
what are the degrees of sprain?
A
grade 1: small tearing, some swelling, full/partial weight bearing
grade 2: partial tearing, moderate swelling, moderate joint instability, unable to weight bear
grade 3: complete rupture, severe swelling and joint instability, unable to weight bear
23
Q
what is a strain?
A
injury to a muscle or tendon
24
Q
what causes strains?
A
Pulling muscle too far
Pulling muscle in one direction while it is contracting
Chronic or over use activities that cause overstretching of muscle fibers
25
what are the anatomical functions of individual bones?
Rigid framework for trunk, extremities Levers for locomotion
| Protection for viscera
26
what are the physiological functions of skeleton?
Hemopoietic tissue for production of erythrocytes
| Storage for calcium, phosphorus, magnesium & sodium
27
what do joints provide?
segmentation of skeleton & allows for motion
28
what is a syndesmosis joint?
it is bound by fibrous tissue
29
what is a synchondrosis joint?
its bound by cartilage
30
what is a synostosis joint?
joint becomes obliterated by bony union
31
what is a symphysis joint?
covered by hyaline cartilage, joined by fibrocartilage, provides stability
32
what is a synovial joint?
covered by hyaline cartilage, joined by fibrous capsule enclosing cavity, contains synovial fluid
33
what do tendons provide for muscles?
Inert intracellular matrix in collagen fibers providing tensile strength
34
what do ligaments provide for muscles?
Have firm attachment to bone via collagen fibers that penetrate deeply into cortical bone
35
what are observations to make for orthopedic evaluation?
Attitude
Deformity
Gait
Emotions stability (secondary gain)
36
what are pain observations to make for orthopedic evaluation?
```
Location, distribution, radiation
Associated signs
Tenderness
Pain at rest
Pain on motion
Precipitating factors
```
37
what are abnormalities to observe for evaluation?
```
Obvious deformity
Swelling
Ecchymosis, bruising – Heat
Muscle atrophy
Trophic changes
```
38
what are stability observations to make during evaluation?
Musculature
| External support
39
What types of functioning do you look for during an evaluation?
```
Locomotion
Muscle action
Sensation
Joint contracture
Autonomic status
```
40
what is the part that remains after an amputation called?
Residual limb
Residuum
Stump
41
what are the types of amputation?
acquired and congenital
42
what is disarticulation?
Amputation cutting through a joint
43
what is a flap?
Partially detached tissue with skin, muscles & vessels
44
what is a myoplasty?
suturing muscle to bone anterior & posterior
| uses muscle for anchor and cushioning
45
what is a myodesis?
Anchoring muscle to bone
46
what is a neuroma?
Tumor of nerve cells
47
what do amputations affect in a patients life?
```
Body image
Mood
Mobility
Self-care
Work
Play/leisure
```
48
what is the highest cause of upper limb amputation?
trauma
49
what is the highest cause of lower limb amputation?
dysvscular diseases
| then trauma
50
what is below/above knee amputation called?
```
below = transtibial
above = transfemoral
```
51
what is below/above elbow amputation called?
```
below = transradial
above = transhumeral
```
52
what are types of acute vascular disease?
Venous Thrombosis
| Acute Arterial Occlusion
53
what are types of chronic vascular disease?
Arteriosclerosis Obliterans
Chronic Venous Insufficiency
Buerger’s Disease
54
what are the factors that determine levels of amputation?
```
Pathology
Anatomy
Surgery
Prosthetic
Personal
```
55
what are options for proximal amputations?
hemipelvectomy (one side)
| Bilateral proximal Hemicorporectomy (both)
56
what are the issues for prosthetics of lower limb amputation?
Pelvis becomes residual limb
| not much of a lever arm to bring leg forward
57
what are the goals of amputation surgery?
Preserve as much of limb length as possible
Skin covering stump must have normal sensation, free of scar tissue
End of stump must be covered with adequate muscle/skin
58
what are the surgical procedures for amputations?
greatest length of skin possible for muscle coverage & tension free closure
Muscle: placed over end of bone via myodesis
Nerve: transected under tension near end of bone in scar and tension free environment
Final suture
Apply compression dressing
59
what are symptoms post amputation?
```
Anxiety
Crying spells
Insomnia
Loss of appetite
Suicidal ideation
```
60
what are the immediate post-op procedures?
Wound care
Controlled environment
Early ROM
61
what are the early post-op procedures?
Compression shapes & shrinks stump
| Positioning to prevent joint contracture
62
what are pre-prosthetic training procedures?
ROM, MS, Endurance (maintain/improve)
Sitting/standing balance/transfers
Gait training
Prosthetic Training
63
what is OT responsible for in therapy with amputees?
```
Wound/stump care
Positioning to prevent contractures
Don/doff prosthesis
ADL training
Wheelchair selection
```
64
what is the extra Energy Requirements of Amputees Using Prostheses?
Unilateral BKA = 10-20%
Bilateral BKA = 20-40 %
Unilateral AKA = 60-70%
Bilateral AKA = >200%
65
what are residual limb issues?
Neuroma
Skin break down
Stump “choking”
Bony spurs
66
what is phantom limb sensation?
sensation that an amputated part is still attached to the body
67
what is phantom limb pain?
described as burning, shooting,
ischemic or crushing
depends on peripheral & central factors
stump manipulation, revision, nerve blocks etc can modify the pain
68
what can hemotoma cause?
can attract bacteria & inhibit proper wound healing
| drain can minimize it
69
who is most likely to have infection of amputation site?
Pts who are immuno-compromised or have history of vascular diseases, also pts with infected wounds
70
how do you tx infection?
Superficial: txd with wound care, antibiotics, & observation.
Deep: surgical debridement & possibly revision amputation to a more proximal level
71
how do you tx necrosis?
Superficial skin neurosis: txed conservatively, b/c healing usually continues under the eschar.
Larger neurosis = insufficient vascularization & need resection or revision amputation to more proximal level
72
what is a neuroma?
non-neoplastic, unorganized mass of nerve fibers & Schwann cells produced by hyperplasia of nerve fibers & supporting tissues after accidental or purposeful sectioning of nerve
73
how does a neuroma cause pain?
If its compressed against rigid surface (bone or prosthetic) or if it experiences traction as it remains trapped in the healing scar
74
what is terminal overgrowth? who does it happen to?
over growth of bone often occurring in children sometimes requiring a stump revision
75
when does terminal overgrowth not happen?
in children with disarticulation b/c the articular cartilage acts as a natural barrier to this activity
76
in what amputation is terminal overgrowth most common?
in above-elbow amputation b/c the humerus frequently overgrows distally with various angulation
77
how do you tx symptomatic terminal overgrowth?
revision amputation
78
how does joint contraction occur?
Usually due to poor positioning & lack of activity
79
what % of UE amputees receive prosthetics?
50%
80
when is UE forequarter amputation done?
malignant tumors that extend to the region of the shoulder joint or infiltrate the deltoid, pectoral, or subscapular muscles
81
what is UE forequarter amputation?
Remove entire UE & shoulder girdle in the interval between the scapula & thoracic wall
fx prognosis: poor
82
what are the implications for shoulder disarticulation? what is the goal?
Severely hinder prosthetic fx because virtually all shoulder motion is lost
goal: Sparing humeral head
83
what are implications for transhumeral amputation?
(above elbow) Important to have bone below the insertion of pectoralis major.
goal: Preserve humeral head to retain normal contour of the shoulder
84
what are the implications for elbow disarticulation?
Preferred by surgeon & prosthetists over above-elbow amputation.
Epicondyles provide good support for the prosthesis
85
what are the implications for transradial amputation?
(below elbow) preserve as much length as possible to preserve pronation & supination
for proximal amputations, the biceps can be reattached to the ulna at a position that approximates the normal resting length of the muscle
86
what are the implications of wrist disarticulation?
rare (usually replanted)
Preferable in children vs. disarticulation below elbow to preserve growth
Preserving DRUJ allows full pronation & supination
87
what are the implications for transcarpal amputations?
rare (usually replanted)
| Pt can be fitted with hand prostheses
88
what are the implications for finger amputation?
Index finger = most important
If length, sensation, mobility are inadequate, pt will bypass index finger & use middle finger for pinch
89
what can impede pinch grip in finger amputation?
index stump can impede middle finger
90
what is the reduction in fx after a finger amputation?
20% reduction in power grip, key pinch, supination strength, & 50% reduction in pronation strength
91
what is the most critical digit to hand fx?
thumb
| length of the thumb is more important than active motion
92
what is the best option if only the thumb tip is involved in injury?
replantation provides best return to fx, even if IPJ fusion is required
93
what is osteointegration?
anchorage mechanism where nonvital components are incorporated into living bone
can persist under all normal conditions of loading
