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MSK - Cortex > Week 5 > Flashcards

Week 5 Flashcards

1
Q

what is arthroplasty also known as

A

joint replacement

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2
Q

what is replacing one half of the joint known as

A

hemiarthroplasty

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3
Q

when can excision of a joint be useful

A

in smaller joints

e.g. CMC jt

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4
Q

what is arthrodesis and when is it used

A

surgical stiffening or fusion of a
joint in a position of function

used for end stage ankle arthritis, wrist arthritis and arthritis of the first MTP jt of the foot (hallux rigidus)

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5
Q

what is osteotomy and when is it used

A

surgical realignment of a bone

used for deformity correction or to redistribute load across an arthritic joint

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6
Q

what type of soft tissues would benefit from decompression

A

supraspinatus tendonitis

subacromial decompression

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7
Q

what can be performed in the extensor tendons of the wrist in RA to prevent rupture

A

synovectomy

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8
Q

Mx of joint instability

A

physio - strengthen surrounding muscles
splints

Surgery

  • ligament tightening/advancement (e.g. ankle instability)
  • ligament reconstruction using tendon graft (e.g. ACL reconstruction)
  • soft tissue reattachment (e.g. shoulder instability)
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9
Q

conditions that cause significant ligamentous laxity

A

Ehlers-Danlos

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10
Q

why would spinal instability need to be fused

A

may cause pain, nerve root compression or spinal cord compression

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11
Q

what is osteomyelitis

A

infection of bone

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12
Q

pathogenesis of osteomyelitis

A
  • bone infected
  • enzymes from leucocytes cause local osteolysis
  • pus forms which impairs blood flow
  • infection difficult to eradicate
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13
Q

what is sequestrum

A

dead fragment of bone which has broken off

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14
Q

with the presence of sequestrum, osteomyelitis can be cured by antibiotics - true or false

A

false

antibiotics will not cure the infection alone

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15
Q

what is involucrum

A

new bone forming around the area of necrosis

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16
Q

who gets acute osteomyelitis

A

children + immunocompromised

in absence of recent surgery

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17
Q

chronic osteomyelitis

A

evelops from an untreated acute osteomyelitis and may be associated with a sequestrum and/or involucrum

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18
Q

where does the infection tend to be in chronic osteomyelitis in adults

A

axial skeleton (spine or pelvis) with haematogenous spread from pulmonary or urinary infections, or from infection of the intervertebral disc (discitis)

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19
Q

what can suppress chronic OM and what can this cause

A

antibiotics
lay dormant for many years before reactivating causing localized pain, inflammation, systemic upset and possible sinus formation

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20
Q

what disease can cause chronic OM

A

TB

particularly in the spine through haematogenous spread from primary lung infection

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21
Q

what organisms cause OM in newborn

A

s.aureus
enterobacter sp
group A & B strep

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22
Q

what organisms cause OM in children (up to 4y/o)

A

s.aureus
group A strep
H.influenzae
Enterobacter sp

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23
Q

what organisms cause OM in children/adolescents)

A

s.aureus
group A strep
H.influenzae
Enterobacter sp

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24
Q

what organisms cause OM in adults

A

S. aureus

occasionally enterobacter or streptococcus sp

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25
what organisms cause OM in sickle cell anaemia patients
s. aureus | salmonella
26
acute OM Tx
best guess antibiotic IV surgical drainage of pus remove infected bone washout area
27
chronic OM Tx
``` antibiotics IV Surgery - debridement - to gain deep bone tissue cultures, - remove any sequestrum - excise any infected or non‐ viable bone ```
28
what happens if the bone becomes unstable after removing infected bone in OM
internal or external fixation
29
adv of external over internal fixation in treatment of chronic
bone can be subsequently lengthened if it has been shortened as a result of the debridement
30
who is at risk of OM of the spine
Poorly controlled diabetics intravenous drug abusers immunocompromised patients
31
Sx of OM of the spine
insidious onset of back pain which is constant and unremitting. paraspinal muscle spasm spinal tenderness fever and/or systemic upset. neurologic deficit paravertebral or epidural abscess
32
Ix for OM of the spine
MRI | Blood cultures
33
Tx for OM of the spine
high dose IV antibiotics | CT guided biopsy to obtain tissue culture
34
Indications for surgery of OM of the spine and the surgery
inability to obtain cultures by needle biopsy, no response to antibiotic therapy progressive vertebral collapse progressive neurological deficit. surgery - debridement, - stabilisation - fusion of vertebrae
35
what is the concern when a deep infection complicates a prosthetic joint replacement
development of chronic infection with pain, poor function, recurrent sepsis, chronic discharging sinus formation and implant loosening
36
what is there a risk of with deep infections
chronic OM | non-union fracture
37
what is primary bone healing
1st intention healing minimal fracture gap (less than 1mm). Bone bridges the gap with new bone from osteoblasts. Occurs for healing of hairline fracture and when # are fixed with compression screws and plates
38
what is secondary bone healing
2nd intention - used in majority of fractures Gap at # needs filed temporarily to act as a scaffold for new bone. Involved inflammatory response.
39
fracture process of secondary bone healing
Fracture occurs Haematoma occurs with inflammation from damaged tissues Macrophages and osteoclasts remove debris and resorb the bone ends Granulation tissue forms from fibroblasts and new blood vessels Chondroblasts form cartilage (soft callus) Osteoblasts lay down bone matrix (collagen type 1)– Enchondral ossification Calcium mineralisation produces immature woven bone (hard callus) Remodelling occurs with organization along lines of stress into lamellar bone
40
when does soft and hard callus formed
soft - 2nd to 3rd week | hard - 6-12 weeks
41
what is required for secondary healing
good blood supply for oxygen, nutrients and stem cells and also requires a little movement or stress
42
what can causes atrophic non union
Lack of blood supply, no movement (internal fixation with fracture gap), too big a fracture gap or tissue trapped in the fracture
43
what can impair healing of fracture
smoking vascular disease chronic ill health malnutrition
44
what type of fractures have greater risk of stiffness, pain or OA
intra-articular
45
Ix of #
AP and lateral X-ray Bone scans for stress fractures MRI - when clinical suspicion but normal X-ray CT - assess + determine degree of damage (e.g. polytrauma)
46
initial Mx of long bone fracture
Analgesia e.g. IV morphine Splintage/immobilisation Ix
47
what splint is used in femoral shaft fractures
Thomas splint
48
Tx for stable, undisplaced, minimally displaced and minimally angulated fractures
non-operatively period of splint age or immobilisation rehab
49
Tx for Displaced or angulated fractures where the position is deemed unacceptable
reduction under anaesthetic | Closed reduction and cast application
50
Tx for unstable injuries
surgical stabilisation small percutaneous pins (K‐wires) for small fragments, cerclage wires, screws, plates & screws, intramedullary nails or external fixation.
51
Tx for Unstable extra‐articular diaphyseal fractures
Open reduction and Internal Fixation (ORIF) using plates and screws goal - anatomic reduction and rigid fixation leading to primary bone healing
52
when might ORIF be avoided
soft tissues too swollen blood supply to the fracture site is tenuous (high energy), ORIF may cause extensive blood loss (eg femoral shaft)
53
if ORIF cannot be used what can be done
closed reduction and indirect internal fixation with an intramedullary nail with dissection distant to the fracture site
54
Tx for intra-articular fractures
ORIF using wires, screws and plates Poor outcome predicted then Joint replacement or arthrodesis
55
why are elderly more likely to be treated non-operatively
co-morbities osteoporosis dementia lower functional demand
56
signs of compartment syndrome
1 - increased pain on passive stretching of the involved muscle 2 -severe pain outwith the anticipated severity in the clinical context 3 - limb very swollen and tender to touch
57
what artery is at risk with knee dislocations
popliteal artery
58
what is at risk in paediatric supracondylar fracture of the elbow
brachial artery
59
what artery is at risk with shoulder trauma
axillary artery
60
Signs/Symptoms of non-union
ongoing pain and oedema | movement at fracture site
61
what fractures have delayed union
tibia fracture - slowest healing fracture, 16 weeks | femoral shaft fracture - 3-4 months
62
what causes hypertrophic and atrophic non-union
hypertrophic - instability and excessive motion atrophic - rigid fixation with a fracture gap, lack of blood supply to the fracture site, chronic disease or soft tissue interposition.
63
what fractures are prone to poor healing
scaphoid wrist fractures fractures of the distal clavicle subtrochanteric fractures of femur Jones fracture of 5th metatarsal
64
what fractures are prone to AVN
femoral neck scaphoid talus
65
Initial management of open fractures
IV broad spectrum antibiotics
66
what are the 3 grades of ligament ruptures
grade 1 - sprain grade 2 - partial tear grade 3 - complete tear
67
Mx of soft tissues injuries
RICE

MSK - Cortex (5 decks)

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