Week 11 - Orthopaedics
Card Set Information
Week 11 - Orthopaedics
Ortho, Rheumatology, Bone stuff
Draw and label a synovial joint
For Rhuematoid Arthritis give
Autoimmune → inflammatory response
proliferation of T cells [CD4+]
Synovitis → macrophages, T cells & plasma cells
Formation of pannus [thickened inflamed synovium] → loss of hyaline cartilage
Rice bodies [Fibrin]
Early morning stiffness
small joints & symmetrical
Fingers → swan neck deformity
Rheumatoid nodules [subcut necrosis w macrophages]
[Assoc features, corneal melt, scleritis etc]
What are the systemic effects of RA?
Lungs → rheumatoid fibrosis, Pleural Effusion
Heart → pericarditis
Liver & spleen → hepatosplenomegaly [Feiltys syndrome → neutropenia]
Kidneys → amyloidosis, Nephrotic syndrome, CKD
Skin → Erythema nedosum & Pyoderma gangrenosum
What Ix would you do for RA?
Subluxation & deformity
joint space narrowing
soft tissue swelling
FBC, ESR, CRP, LFTs [Raised CRP]
RF → Ig against Fc of Ig [IgM]
Anti-CCP → specific for RF
[Anti-cyclic citrulinated protein]
How is RA managed?
NSAIDs → inhibit Pg synth decrease inflammation
DMARDs → Salazopyrin, methotrexate
Steroids → Intra-articular, IM, PO
Biologics → Anti-TNF [Infliximab]
Joint fusion [Arthordesis]
For Psoriatic Arthritis give
PMH → psoriasis
FH → 1st degree relative
Asymetrical oligoarthritis/ Symmetrical polyarthritis
Enthisitis [tendon swelling, dont give fluoroquinolones]
For spondyloarthropathies give
improve w exercise, no improve w rest
pain at night [2am]
FH → psoriasis & colitis
Loss of lumbar lordosis
Chronic spinal changes → sclerosis, syndesmophytes, bridging syndesmophytes [Bamboo spine]
What is the DDx for Inflammatory arthritis?
Lyme disease → erosive arthritis
For septic Arthitis give
Painful swollen joint
Loss of function
H. Influenzae [Children]
Joint aspirate → C+S
FBC → Leukocytosis
For Reactive Arthritis give
Sterile synovitis following infection
HLA B27 assoc
Acute symmetricla lower limb arthritis
days - wks after infection
Enthesitis, spondylitis & Anteritor Uveitis
For Gout Give
excess uric acid → urate crystals in joints/ soft tiss [Tophi]
Acute → precipitation in joint → inflammation = pain
Chronic → tophi formation, subcut around joints, elbows, fingers & toes
Serum urate & U+Es
FFine needle aspiration → needle shaped crystals in polarised light
^NSAIDs for pain
Allopurinol → Xanthine oxidase inhibitor, dec production
For Pseudogout give
Calcium phosphate crystal deposition
Acute → synovila deposition
Chronic → Cartilage & extra-articular cartilage
FNA → rhomboid crystals
Aspirate to reduce pain & swelling
For OA give the
Loss of hyaline cartilage
due to; Cartilage composition, excessive loading, abnormal loading, direct damage [trauma/ infection]
decreased range of movement
joint locking/ instability
What are the non-operative options for OA?
What are the surgical options for OA?
Replace bearing side
restore joint mechanics [both sides]
^ function, relieve pain
Fibrous union, floppy joint
relieve pain, poor function
remove pain & function
Draw the stages of fracture healing
What are the stages of Secondary healing?
Natural healing of fractures
Cellular movement & proliferation
Fibroblasts → chondroblasts → osteoblasts
Cartilage → ossified
Resorption followed by depostion
What is Primary healing?
How does it differ from secondary?
Reduction & plating of bone
No callus formation
What is osteoporosis?
Low bone mass
architectural eterioration of bone
w enhanced bone fragility
Patho → ^osteoclast activity
What fractures are associated with osteoporosis?
extracapsular → inter/pertrochanteric, Tx = internal fixation
Intracapsular → reduced & internally fixed Avascular necrosis → hemi-arthoplasty
For bisphosphonates give
Bisphosphonates e.g. Alendronate, residronate
incorporated into bone [calcium hydroxapaptite matrix]
ingestion by osteoclasts [reduce osteoclastogenesis, promote apoptosis & disrupt cytoskeleton]
osteoporosis in males
Osteonecrosis of jaw
Atypical femoral # → unusual appearance
TAking sitting up on empty stomach → dyspepsia
Name another drug used in Tx of osteoporosis
What is the commonest bone tumour?
Commonest = Mets from other tumours
[Bronchial, BrCa, Prostate, Kidney]
Commonest primary tumour = Myeloma
What are the CF of a secondary tumour of bone?
Bone pain/ Destruction
Long bones → patho #
Spinal mets → vertebral collapse, spinal cord compression, nerve root compression
What is myeloma?
Myeloma = monoclonal neoplasm of plasma cells
solitary or multiple
Bone lesions → lytic foci [pepperpot skull], general osteopenia
Marrow Replacement → anaemia, infections & bleeding
Renal impairment → precipitated paraprotein = nephrotoxic
Name 2 malignant tumours of bone?
Osteosarcoma → 10-25yo ^^malignant, early mets
Chondrosarcoma → >45 M:F 2:1
Ewings sarcoma → 5-15yo, dia/metaphysis of longbones, 11-22 translocation
Name 3 benign tumours of bone?
Osteoid osteoma → small, benign osteoblastic proliferation
Endochondroma → benign proliferation of cartlage, hands & feet
Giant cell tumour
What is pagets disease?
Disorder of excessive breakdown & formation of bone
^^bone formation → structurally weak
Lytic moth eaten cortex
Deafness → CN8 compression
Spinal cord compression
^CO → vascular bone → cardiac failre
What are the Ix for Pagets?
Radiology → lytic lesions & new formed bone
Bone scan → extent of disease
Bloods → Ca, Phos & PTH normal
Alk Phos = variable
What are the blood results of osteoporosis?
Alk Phos Variable
What are te blood results of osteopetrosis?
Alk Phos → Elevated
What are the blood results of osteomalacia & rickets?
Ca → decreased
Phos → decreased
Alk Phos → Variable
PTH → Elevated