Orthopedic Study Guide

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Describe a Total Knee Arthroplasty.

...

What are the common indications for Total Knee Replacement?

Instability, degenerative, rheumatoid or traumatic arthritis

What patient position is most frequently used for total knee replacement?

supine so the knee may be flexed to check for range of motion

Describe the two principle methods of implant fixation used for joint arthroplasty.

a) cemented b) nocemented

Describe the ideal candidate (patient) for each of the above.

a) older patient b) younger more active

What is bone cement (P.M.M.A.)

poly methyl methacrylate monomer

How is it used to ensure fixation?

adheres to metal not bone

List the adverse reactions to use of PMMA.

hypersensitivity, thrombo phlebitis, cardiac arrhythmias

Describe osteoarthritis.

degeneration of joint cartilage and the underlying bone

Describe rheumatoid arthritis.

a chronic progressive disease causing inflammation in the joints and resulting in painful deformity

Describe osteomalacia.

softening of the bones due to defiencies of vitamin D and calcium

. Describe osteoporosis.

bones become brittle and fragile from loss of tissue- typically a result of hormonal changes or calcium, vitamin D defiency

What is Continuous Passive Motion (CPM) and why is it used?

a form of physical and rehabilitation- more continuous movement that stimulates healing of articulating cartilage, tendons, and ligaments

What are the benefits of CPM?

prevents the developing of stiffness, provide continuous motion, decreased recovery time

What is osteomyelitis?

bone infection- caused by bacteria or other germs

What is a diarthrotic joint?

always a joint cavity, end of bone covered in hyaline carttilage

What is an amphiarthrotic joint?

slightly movable joints-found in the axel skeleton

Describe an avulsion fracture.

injury to the bone in a place where the tendon or ligament attatches to the bone. when an avulsion occurs the tendon or ligament pulls off the bone

Describe a luxation.

a condition in which the patella or knee cap dislocated or moves out of its normal location ( dislocation) - complete not only knee cap (patella)

Describe a subluxation.

incomplete or partial dislocation

Describe a monteggia fracture.

proximal ulnar FX with radial head disslocation

Describe a Colles' fracture.

a fracture of the distal radius in the forearm with dorsale displacement of the wrist and hand

Describe a Compound fracture.

an open fracture is an injury that occurs when there is a break in the skin around a broken bone

Describe a Comminuted fracture.

one in which the bone is splintered or crushed

Describe a Spiral (Oblique) fracture.

the bone has twisted apart

Describe a Pathologic fracture.

due to weakening of the bone structure by pathological process. Such as - neoplasia, osteomalacia

Describe a Greenstick fracture.

one side of the bone is broken, the other is being bent

Describe a Stress fracture.

caused by unusual stress or repeated stress on a bone

Describe the five stages of bone healing.

1)Hematoma formation 2)Fibrin network formation 3)Invasion of osteoblasts 4)Callus formation 5)Remodeling

Describe Malunion.

Incomplete union or union in a faulty position after a fracture or wound

Describe nonunion.

the failure of a fractured bone to heal normally

Describe delayed union.

a delay in the healing of the ends of a fracture

Describe the injury known as the "terrible triad" as it happens in the knee.

torn- ACL, Medial Meniscus, MCL

Where is a Baker's cyst located?

behind the knee- popliteal fossa

What type of cast is most commonly employed for complete knee immobilization?

cylinder cast

What type of cast is most commonly used for complete hip immobilization?

spica cast

Describe the anatomy of the knee joint.

...

What is another name for supraspinatus syndrome?

impingement syndrome, painful arc ayndrome

Why might a tourniquet be used during appendicular surgery?

to reduce blood loss, bloodless surgical field

Why is an Esmarch bandage used in conjunction with a tourniquet?

to achieve limb exsangunation

List 3 contraindications of tourniquet use.

compartment syndrome, McArdle disease, hypertension

List 3 considerations for safe use of the tourniquet.

pre-op assessment, check machine for function

What is the recommended maximum time limit for tourniquet inflation?

less than 1 hour on an upper extremity and less than 2 on a thigh

What should be done when this limit has expired?

deflate for 5 min for every 30 min of inflation

Give 3 examples of commonly used antibiotic therapy used in orthopedic surgery.

IV, Irrigation, Ointments,

Give two examples of antibiotics commonly used in irrigation for orthopedic surgery.

polymixin and bacitration

How many bones are found in the human skeletal system?

206 adult born with 300

What is the appendicular skeleton?

the portion of the skeleton that includes the limbs

How many bones are in the appendicular skeleton?

126

What is the axial skeleton?

the portion of the skeleton that includes the skull, spinal column, sternum and ribs

How many bones are found in the axial skeleton?

80

Describe cortical bone.

a compact type of bone tissue. denser than other types of bone. mostly present in the shaft portion of long bones. arms-bones

Describe cancellous bone.

spongy interior of the bone that protects the bone marrow. its also called spongy bone or trabecular bone. resembles honey comb.

Describe the difference between cortical and cancellous bone screws (used for internal fixation).

cortical- closely spaced, shallow threads and larger core to outer diameter ratio stronger than cancellous screws, blunt ended
cancellous- more deeply cut and widely spaced threads. the screws cut their path in the bone when the screw is inserted. self tapping

What is the difference between allograft and autograft bone?

allograft- obtained from a doner. acts as a temporary calcium depostit (not living)
autograft- taken from patients body pertains osteophytes

From where is the autogenous bone graft harvested?

The patients own body- illiac crest, femoral head, acetabulum, posterior patella

Describe the anatomy of the hip joint and the proximal femur.

ball and socket

What are the 3 bones fused to form the os coaxes (hip bone or innominate bone)?

pubis, ischium, ilium

What is the acetabulum?

the cup shaped cavity at the base of the hip bone into which the ball shaped head of the femur fits

Describe Total Hip arthroplasty.

Alexanders 782 B&K 775

What are the surfaces replaced?

femoral head and acerabular surfaces alex 782 B&K 775

List the common indications for total hip arthroplasty.

degenerative hip disease, trauma, auascular necrosis

What is a bunion (Hallux valgus)?

a deformity charcterized by lateral deviation of the great toe, often erroneously described as an enlargement of bone. tissue around the joint at the head of the big toe.

What group of patients most frequently experiences bunions?

women

What is the goal of a bunionectomy?

to reduce pain and fix the deformity of the toe

Briefly describe a Keller procedure.

a release of soft tissue and removal of the medial eminence w/ resection of the proximal end of the proximal pharynx.

Briefly describe a Mayo procedure.

...

Briefly describe a McBride procedure.

the McBride procedure extends the simple bunionectomy by releasing the adductor tendon from the proximal pharynx

Describe the triple arthrodesis procedure.

surgical fusion of the talocalcaneal, talonavicular, and calcaneocuboid joints in the fact.

Why might a triple arthrodesis be performed?

correction of deformity and creation of a stable balanced plantigrade foot for ambulation

What is the goal of the triple arthrodesis procedure?

releave pain from arthritic, deformed or unstable joint.

Name the four bones and three fusions which are involved in a triple arthrodesis.

talus, calcaneus, cuboid, and navicular bones, tabcalcaneal, talonavicular and calcanealaboid joints

Name the eight carpal bones.

1) lunate 2)capitate 3)trapezium 4)trapezoid 5)scaphoid 6)pisiform 7)triquetral 8)hamate

Which carpal bone is the most frequently fractured?

scaphoid

How is the above bone most commonly fixated internally?

pins and k-wires

. Describe carpal tunnel syndrome.

progressive painful hand and arm condition caused by a pinched nerve in the wrist

How is it treated surgically?

by cutting the ligament at the top of the carpal tunnel

Name the 7 tarsal bones.

1)medial cuneiform 2) intermediate cuneiform 3)navicular 4)talus 5)lateral cuneiform 6)cuboid 7)calcaneus

. Describe shoulder dislocation surgery.

the labrum is evaluated from an inferior position and brought back up onto the glenoid rim. the way in which the labrum and or ligaments are reattached. can be by way of pure sutures passed through, drill holes in the bone and more commonly used anchors

What are the goals of shoulder dislocation surgery?

restore the anatomy and repair the instability

Briefly describe a Putti-Platt procedure.

simple shortening of the muscle

Briefly describe Bankart procedure.

alex 753

Briefly describe Bristow procedure.

transfer of the corcoid process through the subscapularis tendon

What position is commonly used for shoulder dislocation surgery?

beach chair, supine with cushion in lateral

Name the four muscles of the rotator cuff.

1)supraspinatus 2)infraspinatus 3)teres minor 4)sub scapularis

What function does the rotator cuff serve?

stabalizing the shoulder and elevating and rotating the arm

Name the three bony articulations of the shoulder girdle.

1)glenohomeral 2)sterno clavicular 3)acromio clavicular

Describe the anatomy of the shoulder joint.

most mobile joint in the body. provides upper extremity w/tremendous range of motion. adduction, abduction, flextion, extension, internal rotation, external rotation and 360 circumduction.

Describe arthroscopy.

the surgeon will insert pencil thin device w/ small lens and lighting system into the incision to look inside the joint. instruments can be inserted to make repairs

On what joints are arthroscopy procedures frequently performed?

shoulders, elbows, hip, knees, and ankles

List three procedures that may be performed via arthroscopy?

ACL meniscal repair, patellar tendon grafts

What types of irrigating solution is preferred for joint distention during arthroscopy?

ringer's lactate, saline

Why might epinephrine be added to the irrigating solution during arthroscopy?

`aid in hemosiesis

What are the advantages and disadvantages to arthroscopic surgery?

less cost, less invasive, faster healing time, less pain post op

Describe open reduction and internal fixation (ORIF).

a method of surgically repairing a fractured bone. plates and screws or an im to stabalize the bone

Describe closed reduction and external fixation.

alex 746-747

Describe open reduction and external fixation.

alex 746- 747

What are the common indications for external fixation?

alex 747

Describe intramedullary fixation (IM).

b&k 772-773

What are the benefits of closed reduction and intramedullary fixation?

b&k 773

Describe the difference between dynamic and static IM fixation.

dynamic-closest to fracture site
static-both proximal and distal end of the nail

Why might flexible IM rods be beneficial to the healing process.

b&k 772

What is a fracture table?

ast 885
alex 732

What are the benefits of using a fracture table in orthopedic surgery?

alex 733

Describe the use of traction.

ast 855 alex 735 b&k 769-770

What are the benefits of traction?

alex 735 b&k 769-770

How does skeletal traction differ from skin traction?

alex 735

Name the three commonly used forms of traction and give an example of each.

manual, skin, skeletal

Describe a lumbar laminectomy.

removal of a small portion of bone over the nerve root and or disc material from under the nerve root to give more room

What is the most common indication for a lumbar laminectomy?

back pain, spinal stenonsis, sciatica, removal of herniated disk

What is the most common position used for a lumbar laminectomy?

prone

Describe a spinal fusion.

designed to stop the motion of painful vertebral segment, adding bone graft to an area of spline to stop a biological response that causes bone graft to grow. between the two vertebral element and create fusion, there by stopping the motion of that segment.

List the common indications for a spinal fusion.

degenerative disc disease
degenerative spondylolisthesis
isthmicspondylolistnesis
mechanical back pain
spinal stenosis
fractures
tumors

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