Principles of Joint Surgery Flashcards

(36 cards)

1
Q

synarthroses

A

immovable: joints between bones of skull

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1
Q

what are indications to perform joint surgery?

A
  • osteoarthritis/synovitis
  • osteochondral fragments
  • osteochondrosis/dissicans (with flap)
  • trauma
  • sepsis
  • diagnostic exploration if lameness not improving
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2
Q

diarthroses

A

movable

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3
Q

what is the central structure constituting joint function?**

A

articular cartilage!

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3
Q

anatomy of a joint

A
  • synovial membrane: secretes synovial fluid that allows motion of joint
  • periarticular ligaments and joint capsule
  • subchondral bone
  • articular cartilage
  • maybe menisci, TMJ etc
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4
Q

articular cartilage function ***

A
  • provides frictionless movement of joint
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5
Q

T/F: articular cartilage lacks vascular/lymphatic/neural supply**

A

true

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6
Q

articular cartilage summary**

A
  • central structure for joint function: provides frictionless movement of joint
  • lacks vascular/lymphatic/neural supply
  • depends on diffusion for nutrients and waste removal
  • consists of chondrocytes, ECM (collagen, water, etc)
  • limited ability for shock absorption
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7
Q

what are the zones of articular cartilage?**

A
  1. superficial/tangenital zone: 10-20%
  2. intermediate/transitional zone: 40-60%
  3. deep/radiate zone: 30%
  4. calcified zone
  5. tidemark
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7
Q

T/F: articular cartilage is a primary component of shock absorption

A

FALSE it has limited ability for shock absorption

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7
Q

what are proteoglycans

A
  • single protein core where glycosaminoglycans side chains attach
    **polyanionic nature: core proteins repel each toher and attract hydration shell: leads to stiffness and cartilage permeability
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8
Q

what collagens make up the primary amount of articular cartilage?**

A
  • primarily type 2!!
    a lot of minor types too
  • fibrocartilage at menisci, transition zone
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9
Q

T/F: articular cartilage damaged doesn’t heal well

A

true, get fibrocartilage replacement bc cartilage is hypocellular and avascular

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9
Q

what is the function of proteoglycans in articular cartilage?

A
  • other major component of matrix
  • combination of protein and glycosaminoglycan
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10
Q

joint innervation

A
  • none in articular cartilage
    but there is in the capsule, ligaments, muscle, and subchondral bone
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11
Q

what is the main source of pain in the joint capsule?

A

outer fibrous layer

12
Q

what part of the joint capsule is responsible for producing synovial fluid?

A

inner synovial membrane

13
Q

inner synovial membrane of joint capsule

A
  • lines inside of joint capsule
  • essentially a modified CT
  • numerous blood vessels present
  • responsible for producing synovial fluid!!
14
Q

joint capsule arrangement

A
  1. outer fibrous layer
  2. inner synovial membrane
15
Q

outer fibrous layer of joint capsule

A
  • continuous w periosteum or perichondrium
  • made of dense CT
  • provides mechanical stability to joint
  • more pain sensitive
16
Q

what are the main functions of synovial lining

A
  1. phagocytosis particulate material (move waste products out of joint)
  2. regulate protein/hyaluronate content
  3. synovectomy often performed in sx - debated now
17
Q

kinematics

A

study of motion of articulating surfaces in relation to each other

18
Q

kinetics

A

forces that are created during motion of joint and loads created across articular surface

19
Q

lubrication

A

provides frictionless movement of soft tissues and articular cartilages

20
what are indications for arthroscopy?
- diagnosis - osteocondral fragments - intra-articular fractures - debride OCD/cystic lesions - synovectomy/lavage for sepsis
21
what are benefits of arthroscopy?
- less invasive - visualize more articular surface
22
what are the goals of arthroscopy?
- view joint structures (cartilage, ligaments, meniscus) - remove/repair pathology - stimulate healing: debride, pin etc - lavage joint (remove debris and inflamm mediators)
23
why is the incision location for arthroscopy so important?
- avoid muscles, tendons, ligaments - avoid damage to articular cartilage (blunt trocar)
24
what are arthroscopy indications?
- osteochondral fragmentation - fetlock arthroscopy - intra-articular slab fracture repair (reattach usually)
25
what is transcondylar screw technique?
- often as a last resort after all other things have been done - gives good relief tho - newer lately
26
how do you close arthroscopy?****
- skin only - simple interrupted or cruciate pattern
27
when is arthrotomy indicated?***
- large intra-articular fragments - large intra-articular fracture - sepsis not able to achieve distension needed for arthroscopy
28
how do you close arthrotomy?***
- synovial layer: small diameter absorbable suture - simple continuous pattern - REAPPOSE ANY MAJOR SUPPORTING STRUCTURES, SUCH AS LIGAMENTS THAT HAVE BEEN INCISED: large diameter absorbable or non-absorbable suture, simple interrupted or vertical mattress - skin: interrupted or continuous depending on location
29
what is arthrodesis?
- assisted fusion of joint - indicated when joint destruction is beyond other treatments - internal fixation for high motion joints (carpus, fetlock, pastern) - can also do facilitated ankylosis (environment where it will fuse faster)
30
diagnostic evaluation of joint disease should include
- history - musculoskeletal palpation - radiography
31
what are surgical options for joints?
- arthroscopy - arthrotomy