Combo Set1
Bacteria in the orthopaedic realm depends on what?
Ability to attach, reproduce, and damage the host Chapter 20 - Page 239
What four intrinsic skin conditions provide areas for bacterial entry?
1. Chronic dermatitis 2. Psoriasis 3. Traumatic burns 4. Rashes Chapter 20 - Page 245
What are four classifications of the Denis classification?
1. Compression 2. Burst 3. Seat Belt 4. Fracture Dislocation Chapter 49 - Page 644
What are three AO classifications?
1. Compression 2. Distraction, 3. Multidirectional and Translation Chapter 49 - Page 644
What percentage of patients older than 70 years and 80 years will experience a compression fracture?
1. 20-25 percent older than 70 years 2. 50 percent older than 80 Chapter 49 - Page 647
Name four ways that a surgical infection can occur?
1. Bacteria is in sufficient amount 2. Opening on human host 3. Bacteria can sustain themselves/reproduce 4. Bacteria liberate toxin to cause damage to host Photo shows how bacteria collects together to cause an infection. Chapter 20 - Page 239
What are three general components of conservative treatment of thoracolumbar fractures?
1. Bracing (usually 10 to 12 weeks minimum) 2. Pain management 3. Serial imaging TLSO brace Chapter 49 - Page 644
What three significant factors reduce bacteria in the operating room?
1. Reduce personnel bacterial shedding 2. Reducing turbulent flow 3. Eliminate bacteria in the room Chapter 20 - Page 240
What are the two primary host defense mechanisms against bacteria?
1. Systemic defense 2. Local defense Chapter 20 - Page 243
What two references should physicians consult to guide them in the evaluation of a patient with a spinal injury
1. The American Spinal Injury Association's form 2. Frankel Impairment Scale Frankel impairment scale Chapter 49 - Page 642
What three types of fractures can be treated with short segment instrumentation (one level above and one level below)?
1. Chance fracture 2. Compression fracture 3. Some Burst AP (A) and lateral (B) radiographs of a patient who underwent short-segment pedicle screw fixation for a burst fracture. Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 647 Chapter 49 - Page 647
What are five injuries that can be seen on the AP x-ray view?
1. Coronal mis-alignment indicating lateral instability 2. Malalignment of spinous processes indicating rotational injury 3. Widening of the interpedicular distance indicating burst fracture 4. Increase in interspinous distance indicating flexion injury 5. Focal scoliosis indicating lateral compression injury Increased interpedicular distance from an L1 burst fracture (arrow). Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, pp 642 Chapter 49 - Page 642
What are three major classifications of thoracolumbar spine injuries?
1. Denis 2. AO 3. Thoracolumbar Injury Classification and Severity Score (TLICS) Chapter 49 -, Page 644
What are the three major routes of bacterial bone inoculation in adult osteomyelitis?
1. Direct inoculation 2. Hematogenous 3. Contiguous spread from an adjacent infection Chapter 20 - Page 245
What are four conclusions of non-surgical treatment of stable neurologically intact Burst fractures, A3 compared to surgically treated similar fractures?
1. Equivalent functional outcomes 2. Less pain 3. Fewer complications 4. Lower costs Chapter 49 - Page 645
What are four components of the posterior ligamentous complex (PLC)?
1. Facet capsule 2. Ligamentum Flavum 3. Interspinous ligament 4. Supraspinous ligament NB Posterior longitudinal ligament is not part of PLC Chapter 49 - Page 641
The Thoracolumbar Injury Classification Scale (TLICS) was found to be more reliable compared to the Denis and AO classification systems. What three areas does the Thoracolumbar Injury Classification Scale evaluate?
1. Fracture morphology 2. Neurologic status 3. PLC injury Thoracolumbar Injury Classification Scale Category Points Injury morphology Compression 1 Burst +1 Translational/rotational 3 Distraction 4 Neurologic status Intact 0 Nerve root 2 Cord, conus medullaris Incomplete 3 Complete 2 Cauda equina 3 PLC Intact 0 Injury suspected/indeterminate 2 Injured 3 (Adapted with permission from Vaccaro AR, Lehman RA Jr, Hurlbert RJ, et al: A new classification of thoracolumbar injuries: The importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine (Phila Pa 1976) 2005;30:2325-2333.) Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, pp 644 Chapter 49, Page 644
Some studies suggest that initial evaluation should be done with CT instead of plain x-rays. What are five advantages of using CT scanning for spine injuries?
1. Greater detail 2. Finding smaller fractures 3. More accurate in determining fracture severity 4. Sagittal and coronal reformats are superior to plain X-rays 5. Obese patients (better visualization) Chapter 49, Page 642
Name three ways that patients can be exposed to bacteria?
1. Health care personnel 2. Visitors 3. Nearby patients Chapter 20 - Page 241
What are the four major routes of bacterial bone inoculation in adult osteomyelitis?
1. Hematogenous 2. Direct 3. Contiguous 4. Reactivation Chapter 20 - Page 245
What are four factors that can improve a patient's immune system?
1. Improved nutrition 2. Cessation of immune suppressive drugs (if possible) 3. Cessation of smoking and alcohol 4. Optimizing diabetic care Chapter 20 - Page 244
In what two ways does vascular insufficiency encourage bacterial growth?
1. Inability to deliver immune functional cells 2. Limited cellular response to microorganism attack Chapter 20 - Page 245
With short segment instrumentation, what are three predictors of hardware failure?
1. Increase vertebral body comminution 2. Poor bony fragment opposition 3. Increased kyphosis Chapter 49 - Page 647
For implanted medical device surgeries, name seven ways to prevent bacteria transfer?
1. Least amount of OR personnel 2. No mandatory breaks 3. Minimal traffic 4. Strict adherence to sterile technique 5. Complete change of surgical attire 6. Vigorous cleaning 7. Pre-positioned equipment Chapter 20 - Page 242
Name four ways that biofilm protects bacteria from human attack?
1. Mechanical barrier 2. Dorminant bacteria 3. Antiphagocytic properties 4. Resistance to antibiody attack Chapter 20 - Page 244
What are two techniques that neutralize bacteria?
1. Mechanical filtration 2. Ultraviolet light deactivation Chapter 20 - Page 240
What are the four types of anatomical osteomyelitis according to Cierny-Mader classification?
1. Medullary 2. Superficial 3. Localized 4. Diffuse Chapter 20 - Page 246
What are five postoperative wound care measures to reduce wound contamination?
1. Multilayered wound closure 2. Single hospital rooms for patients (with implanted medical devices) 3.Keep wounds dry with frequent dressing changes 4.Clean surround incision edges 5. Rigorous post discharge cleaning Chapter 20 - Page 243
What two findings decide which surgical approach (anterior, posterior or circumferential) is used when using the TLICS system?
1. Neurologic status of the patient 2. Integrity of the PLC Chapter 49 - Page 646
In staging osteomyelitis with the Cierny-Mader classification, what are the three types of hosts?
1. Normal 2. Compromised 3. Treatment worse than the disease Chapter 20 - Page 246
In a study reviewing Kyphoplasty surgical patients and non-surgical patients at one year follow up, what three comparisons can be made?
1. Pain outcomes were the same 2. Kyphoplasty patients had less activity restrictions 3. Kyphoplasty patients had less narcotic use. Chapter 49 - Page 647
What three factors prevent people from preventing bacterial wound contamination?
1. Physical limitations 2. Financial resources 3. Skill level of staff Chapter 20 - Page 241
What is the order of procedures with combined approach?
1. Posterior approach first with realignment and stabilization 2. Anterior column reconstruction either same setting or staged Chapter 49 - Page 647
What two bacteria lead to osteomyelitis in intravenous drug abusers?
1. Pseudomonas aeruginosa 2. Gram-negative organism Chapter 20 - Page 245
What are two reasons that most spinal injuries occur at the thoracolumbar Junction?
1. Transition from relatively stiff thoracic spine to relatively mobile lumbar spine 2. Different planes of motion Thoracic spine: torsion and lateral flexion (facet joint almost in coronal plane) Lumbar: flexion and extension spine (facet joints almost in sagittal plane) Chapter 49 - Page 641
How does postoperative bacterial wound contamination occur? Name two ways.
1. Via direct contamination of incision that has not been sealed 2. Hematogenous seeding of bacteria Chapter 20 - Page 241
What two generalities is surgery warranted for thoracolumbar injuries?
1.With patients with unstable spine injuries 2.With patients whose nonsurgical treatment failed Chapter 49 - Page 645
The TLSO brace is the most commonly used brace for the thoracolumbar fractures that are treated conservatively, how long typically is it used?
10 to 12 weeks Chapter 49 - Page 645
Up to what percentage of thoracolumbar injuries are there cervical injuries?
11%, therefore x-rays of the entire spine are indicated with thoracolumbar injuries Chapter 49 - Page 642
What is the Denis classification based upon?
3 columns Chapter 49 -, Page 644
A study of Thoracolumbar injuries revealed that there were fewer complications if surgery was done before how many days?
3 days Chapter 49 - Page 645
In the sagittal plane of a normal spine, how many degrees is the average kyphosis?
35° (range, 20° to 50°) Chapter 49 - Page 641
In the sagittal plane of a normal spine, how many degrees is the average lordosis?
40° (range, 30° to 50°) Total Lordosis determined by Cobb Method Chapter 49 - Page 641
A patient with one vertebral compression fracture (VCF) is what risk of having a 2nd VCF within one year?
5 times likely Chapter 49 - Page 647
A loss of what vertebral body height or greater indicates a potential injury to the posterior longitudinal ligament complex?
50% Chapter 49 - Page 642
What percentage of patients with vertebroplasty and kyphoplasty (balloon) has immediate pain relief?
60-100 percent Chapter 49 - Page 647
The spinal cord has one anterior and two posterior arteries supplying it. These arteries receive segmental perfusion from the posterior intercostal arteries. What is the name of the dominant anterior radicular artery seen in up to 16% of patients and arises from the left intercostal vessel between T8-T12.
Adamkiewicz In these patients this artery supplies the major portion of blood to the anterior thoracolumbar spinal cord. Diagram: 3= artery of Adamkiewicz Chapter 49 - Page 641
With a pincer-type fracture, there is a high risk of non-union and instability. What approach is done to stabilize this fracture?
Anterior Chapter 49 - Page 646
What approach in general would be used with the TLICS classification, if there was incomplete spinal cord injury and intact PCL?
Anterior approach alone Chapter 49 - Page 646
What approach in general would be used with the TLICS classification, if there was a Cauda Equina syndrome?
Anterior approach, posterior or combined depending where decompression and stabilization is needed. Chapter 49 - Page 646
What approach in general would be used with the TLICS classification, if there was a complete spinal cord injury with instability?
Anterior approach, posterior or combined depending where decompression and stabilization is needed. There is a preference for the posterior approach. Chapter 49 - Page 646
Where is the place to culture Staphylococcus aureus in humans?
Anterior nares Chapter 20 - Page 239
In one study, did the anterior only or posterior only have better outcomes with a stable burst fracture?
Anterior only Chapter 49 - Page 646
At what levels of spinal cord injury is there loss of central sympathetic regulation and potential neurogenic shock?
At or above T6 Chapter 49 - Page 641
What bacterial defense confers significant resistance to host immunological attack?
Biofilm Chapter 20 - Page 243
With neurogenic shock, what happens with blood pressure and pulse?
Bradycardia and hypotension Chapter 49 - Page 641
Which laboratory examination is used to assess the effectiveness of treatment with osteomyelitis?
C-reactive protein Chapter 20 - Page 246
With significant anterior posterior column disruption and loss of anterior column integrity, what is the best approach?
Combined Anterior-posterior Chapter 49 - Page 647
What approach should be done with significant osteoporotic spine?
Combined approach to prevent hardware failure Chapter 49 - Page 647
How do most postoperative bacterial infections occur?
Contamination of wound via open pathways into deep tissues Chapter 20 - Page 239
What does movement of air in the operating room cause?
Creates currents by which bacteria circulates throughout the room. Photo shows the flow of vertical laminar flow in the operating room. Chapter 20 - Page 240
How does wound contamination occur on the hospital floor?
Direct contact Chapter 20 - Page 241
What type of bracing can a truly bony Chance fracture treated?
Extension bracing or casting Chapter 49 - Page 644
What does a "naked" or "empty" facet sign indicate?
Facets subluxation or dislocation Arrow show bilateral "naked" facets Chapter 49 - Page 642
The Chance fracture has what type mechanism of injury?
Flexion-distraction Chapter 49 - Page 644
What is a pincer-type fracture?
Fracture of the vertebral body where the superior and inferior disc rupture and displace into the vertebral body Chapter 49 - Page 646
With posterior surgery, when is a direct decompression useful?
Incomplete neurologic injury with cord encroachment from a retropulsed fragment C. = Indirect decompression E. = direct decompression of retropulsed fragment by removing the left pedicle Chapter 49 - Page 646
What is the importance of testing voluntary and sphincter tone as well as perianal sensation?
Incomplete spinal cord injury Chapter 49 - Page 642
Is the incidence of osteoporotic vertebral compression fracture (VCF) likely to increase or decrease in the baby boomer generation?
Increase Chapter 49 - Page 647
Most patients with VCF can be treated conservatively. What are the indications for Vertebroplasty and Kyphoplasty?
Intractable pain Chapter 49 - Page 647
Which procedure Kyphoplasty or Vertebroplasty have less risk of cement extravasation?
Kyphoplasty (Kyphoplasty creates a space for the cement there is less extravasation) Chapter 49 - Page 647
How does a kyphoplasty differ from the vertebroplasty?
Kyphoplasty creates a cavity with a balloon tamp with injection of a more viscous cement (NB Kyphoplasty corrects kyphosis) Chapter 49 - Page 647
In the adult, at what level does the spinal cord terminate?
L1 Diagram demonstrates that a child cord terminates lower in the spine Chapter 49, Page 641
What is the AO spine injury classification based on?
Mechanism of injury Chapter 49 - Page 644
What is the loss of central sympathetic regulation from a spinal cord injury at or above T6 called?
Neurogenic Shock Chapter 49 - Page 641
Has there been a study to demonstrate an advantage of the more expensive Kyphoplasty over Vertebroplasty?
No Chapter 49 - Page 648
Burst type fractures with an incomplete spinal cord injury often require a subtotal corpectomy, structural allograft or a cage. For most patients with an intact PLC, is posterior surgery indicated?
No Radiograph showing an anterior-only construct. Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 646 Chapter 49, Page 646
Are there any current methods to totally eradicate Biofilm?
No Chapter 20 - Page 244
What (or who) is the primary culprit in spreading bacteria?
Operating room personnel Chapter 20 - Page 239
What ligament must be intact to do indirect decompression with posterior instrumentation?
PLL Chapter 49 - Page 647
What is the best approach for rotational injuries and fracture-dislocations?
Posterior approach Chapter 49 - Page 647
What approach in general would be used with the TLICS classification, if there was intact neurologic status or root injury?
Posterior approach alone Chapter 49 - Page 646
In cases where anterior column decompression and stabilization are required, what precedes the anterior surgery?
Posterior realignment and stabilization Chapter 49 - Page 646
Why is prompt diagnosis of acute osteomyelitis imperative?
Prevents chronic osteomyelitis Chapter 20 - Page 246
What is a direct decompression, posteriorly?
Removing facet/lamina/pedicle ipsilaterally to retropulsed bone with removal of fracture fragment or tapping it anteriorly C. = Indirect decompression E. = direct decompression of retropulsed fragment by removing the left pedicle Chapter 49 - Page 646
A recent study of AO classification, A3 fractures (Burst Fracture) sub group of neurologically intact and less than 35 degrees of kyphosis compared custom TLSO bracing to no bracing and found what results?
Similar outcomes Chapter 49 - Page 645
List three features of spinal shock and four features of neurogenic shock.
Spinal shock 1. Due to acute spinal cord injury 2. Absence of voluntary and reflex neurologic activity (bulbocavernosa reflex) below level of injury 3. Duration: days to months (transient usually 24-48 hours) Neurogenic shock 1. Hemodynamic phenomenon secondary to lack of vasomotor tone 2. Results in Impaired cellular metabolism 3. Hypotension, bradycardia and unable to regulate temperature 4. Immediately after cord injury (at or above T6) and up to 6 weeks Chapter 49 - Page 641
Which bacterium is the most common cause of osteomyelitis?
Staphylococcus aureus Chapter 20 - Page 245
What type of MRI images with increased signal indicates injuries to the annulus fibrosis, anterior longitudinal ligament, posterior longitudinal ligament and spinal cord?
T2 weighted Increased signal within the spinal cord on a T2- weighted MRI after a fracture-dislocation injury(arrow). Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, pp 642 Chapter 49 - Page 642
What type of MRI images with increased signal is helpful in diagnosing the PLC injuries?
T2 weighted and fat suppressed T2 weighted images Ligamentum flavum, interspinous, and supraspinous ligament injury after facet dislocation. Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, pp 642 Chapter 49 - Page 642
What type of MRI images with increased signal can indicate an occult fracture?
T2 weighted or short tau inversion recovery (STIR) STIR views showing occult vertebral fracture Chapter 49 - Page 642
At which intercostal level does the artery of Adamkiewicz arise?
T8 to L2 Chapter 49 - Page 641
What is biofilm?
The conglomerate of bacterial cells plus extracellular matrix which attaches to any implant or compromised body tissue Chapter 20 - Page 243
What is the definition of spinal instability including what three sequele?
The loss of the ability of the spine under physiologic loads to maintain its pattern of displacement, so that there is: 1. No initial or additional neurological deficit 2. No major deformity 3. No incapacitating pain. Chapter 49 - Page 643
What is an important factor when determining the stability of a fracture?
The state of the posterior ligamentous complex (PLC) also known as the "posterior tension band" Chapter 49 - Page 641
How is the information from the Thoracolumbar Injury Classification Scale (TLICS) used to determine if surgery is indicated?
Thoracolumbar Injury Classification System and Severity Score Treatment Guide Management Points Nonsurgical <4 Nonsurgical or surgical 4 Surgical >4 JAAOS February 2010vol. 18 no. 263-71
What is the most commonly affected areas involving spinal fractures?
Thoracolumbar Junction (T11-L2) Chapter 49 - Page 641
With either pedicle screws or hook and rod constructs how many levels above and below the fracture must be spanned to prevent progressive kyphosis and hardware failure?
Two levels above and two levels below AP (A) and lateral (B) radiographs of a patient who underwent short-segment pedicle screw fixation for a burst fracture. Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 647 Chapter 49 - Page 647
Sensory exam determines thoracic spinal cord injury levels. What levels innervate the umbilicus, lower abdomen and inguinal areas?
Umbilicus T10 Lower Abdomen T12 Inguinal area L1 Chapter 49 - Page 642
When do most postoperative musculoskeletal infections occur?
Via bacterial inoculation at the time of surgery Chapter 20 - Page 239
