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Flashcards in week 5 Deck (83):
1

aa 2 year old has recently been in an motorcycle accident and arrives to A&E with an open extra-articular femur fracture. How should he be initially managed

surgical debridement
IV Abx
Tetanus jag

2

What is the main treatment for a pt >65yrs with end stage hip OA that is causing them a lot of pain

arthroplasty/joint replacement

3

If there is deep infection after a joint, what is the management

wash out wound and give Abx

4

Excision/resection arthroplasty is

removal of one/both parts of either the bone/cartilage of a joint

5

Arthrodesis is what

fusion/stiffening of a joint

6

What condition is arthrodesis good for

ankle OA
wrist OA
hallux rigidus

7

An osteotomy is the best treatment for which type of patient

for severe deformity (varus/valgus)

8

In someone with secondary arthritis due to slight valgus deformity, where would the load be distributed

laterally

9

In someone with a varus deformity, where would the load be distributed

medially

10

In RA,, what is the best treatment for a patient having trouble with the extensor tendons of the wrist

synevectomy
Also best treatment for posterior tibialis tendon problems (dont give steroids as may rupture)

11

Which part of the meniscus being torn would warrant surgery if necessary

the outer 1/3rd (only bit with good blood supply)
- usually how bucket handle tear presents

12

What treatment would be given to someone who was suffering from a locked knee in a meniscal tear at a point where there is bad blood supply (inner 2/3rd)

it would be shaved/trimmed to prevent further locking

13

What is osteochondritis dissicans

a bit of the knee loses its blood supply
damage to the cartilage +/- a bit of bone falls off

14

what is the treatment for osteochondritis if the bone has detached

pin it in place or remove it
- both have similar prognosis

15

When cartilage is damaged it regenerates as what type of cartilage

fibrocartilage

16

What is the treatment for a young person with early knee OA

exercise
weight loss
analgesia

17

In elderly patients, which knee replacement has an 80% satisfaction rate

total knee replacement

18

what do the menisci do

distribute the load from the convex femoral condyles to the relatively flat tibial articular surface
- the knee pivots on the medial compartment of it during flexion and extension

19

Instability on descending the stairs is caused by what type of tear in the knee

PCL

20

What may occur in a PCL rupture

hyperextension

21

What type of meniscal tear is more common (medial/lateral)

medial (10x more common)

22

What is the treatment for ACL tears in young people

physio
if rotatory instability and no response to physio -reconstruction

23

What is used in an ACL reconstruction

middle 1/3rd of the patellar tendon
hamstrings

24

Who is more likely to get an ACL reconstruction

people who are in need of rapid return to work or play a professional sport

25

What can ACL not cause

sometimes a reduction in pain
doesnt decrease the risk of getting early OA

26

What is the management of a complete rupture of the LCL

urgent repair within 2-3weeks
(LCL doesn't heal by itself and can cause varus and rotatory instability if not tx)

27

which nerve may be damaged in LCL rupture

common fibular nerve

28

Which ligament rupture in the knee would cause popliteal fossa bruising

PCL

29

what is the treatment for a PCL rupture with gross instability

reconstruction

30

what are the complications of knee dislocation

popliteal artery injury
peroneal nerve injury

31

What is usually damaged during knee dislocation

multi-ligamentous damage - in anterior knee dislocation, 3 ligaments are likely to be damaged
needs multi- ligament reconstruction

32

A fall onto a flexed knee with quadriceps contraction will cause what injury

extensor tendon rupture
(patellar tendon)

33

what will be felt in a patellar tendon rupture

a palpable gap

34

What are the risks that increase the chance of extensor mechanism rupture

previous tendonitis
steroids
chronic renal failure
ciprofloxacin

35

what manouvre is a patient unable to do if they have an extensor mechanism rupture

straight leg raise

36

What is the treatment for an extensor mechanism rupture

surgical repair

37

An effusion is more likely to occur in which type of injury

meniscal tear
chondral injury

38

Haemarthrosis is more likely to occur in which type of injury

ACL rupture
fracture

39

If there is pain in the joint line of the knee, what is the differential diagnosis

meniscal injury
chondral injury

40

What is haemarthrosis consistent with

generalised pain all over the knee

41

What is osteomyeltitis

infection of the bone, including the bone marrow

42

What is usually the cause of osteomyelitis

bacteria

43

What is a sequestrum

a dead fragment of bone

44

If there is a sequestrum in the case of osteomyelitis, what is the treatment

Abx and surgical removal of dead bone

45

What is the most common cause of acute osteomyelitis

post-traumatic or open fractures

46

What is the 2nd most common cause of acute osteomyelitis

haematogenous infection in children

47

In acute osteomyelitis, pus can form due to the infection of bacteria and cause blood flow impairment. what is the management

open the wound and let the pus out

48

How does chronic osteomyelitis usually occur

in untreated acute

49

Where does chronic osteomyelitis usually occur in adults

pelvis
spine

50

what other condition can cause chronic osteomyelitis

TB

51

Involucrum is what

when there is new bone growth outside of the existing bone

52

What condition is involucrum seen in

chronic osteomyelitis

53

What is the most common bacteria to cause acute osteomyelitis in adults

staph aureus

54

What is the treatment for acute osteomyelitis

IV "best guess" Abx
if this fails - go to 2nd line Abx or do surgery to obtain a culture

55

A brodie's abscess is what

where new bone walls off an abscess with a rim of sclerotic bone
- comes on insidiously

56

Osteomyelitis of the spine will present as

constant, unremitting back pain
lumbar region

57

Which patient is acute osteomyelitis of the spine likely to be seen

PWID
Diabetics
Immunocompromised

58

What is the investigation for osteomyelitis

MRI

59

What is the treatment for osteomyelitis of the spine

high dose IV Abx (AFTER CT guided biopsy to obtain culture)

60

In chronic osteomyelitis of the spine, what may be needed

surgical debridement
fusion of the vertebrae
stabilisation

61

What is the 1st line treatment for infection of surgical implants

surgical debridement
needed as this is a deep infection

62

What drugs are given as prophylaxis for 24hrs before joint replacement surgery

Co-amoxiclav
flucloxicillin
gentamicin
clindamycin
co-trimoxazole
(NOTE - Abx also put in the joint cement)

63

Which of the following organisms is the prophylaxis before joint replacement surgery trying to prevent

staph epidermidis
staph aureus

64

What is the primary survey in advanced trauma life supprot

ABCDE

65

What is the secondary survey in advanced trauma life support

AMPLE
head to toe exam

66

What is the first thing you do in someone with a long bone fracture

early stabilisation

67

Primary bone healing is likely to occur in which situation

when there is a minimal fracture gap <1mm
e.g. hairline fractures

68

what happens in primary bone healing

the bone fills the gap by being made by osteoblasts

69

what is the best surgical treatment for primary fractures

compression plates and screws

70

What is the best surgical treatment for secondary fractures

Intramedullary nail and external fixation

71

The first part of secondary bone healing begins with

a haematoma which causes macrophages and osteoclasts to remove the debris and resorb the bone ends
- granulation tissue forms

72

what is granulation tissue formed from in secondary bone healing

fibroblasts and new blood vessels

73

What happens to the granulation tissue in secondary bone healing

chondroblasts come and form new cartilage around it

74

What is the new cartilage in secondary bone healing called

soft callus

75

when is the soft callus present after a fracture

2-3 weeks after

76

What starts to occur after the new soft callus is made in secondary bone healing

osteoblasts lay down a new bone matrix

77

What is it called when osteoblasts lay down a new bone matrix in secondary bone healing

enchondral ossification

78

What occurs after enchondral ossification

calcium mineralisation produces a new immature woven bone

79

What is it called when new immature woven bone is made in secondary bone healing

hard callus (this is when remodelling occurs into lamellar bone)

80

When is the hard callus formed after a fracture

6-12 weeks

81

what is needed for secondary bone healing

oxygen
nutrients
stem cells
little movement

82

If there is excessive movement during secondary bone healing, what will occur

hypertrophic non-union

83

What will too big a fracture gap cause

atrophic non-union