Osteonecrosis and Osteochondritis Quiz
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Questions and Answers

What is the approximate incidence of infection in orthopaedic trauma patients?

  • 2% to 5%
  • 5% to 10% (correct)
  • 15% to 20%
  • 10% to 15%

    • What method is recommended for diagnosing implant-related infection in orthopaedics?

  • Multilocus Polymerase Chain Reaction (MPCR) with electrospray ionization-mass spectrometry (correct)
  • X-ray imaging
  • Blood culture
  • Physical examination

    • How can biofilm formation on orthopaedic implants be treated?

  • Surgical removal of the implant
  • Antibiotic injection
  • Physical therapy
  • Irrigation and debridement (correct)

    • What is the recommended method to prevent orthopaedics infection?

    <p>Antibioticimpregnated implant coatings and cement</p> Signup and view all the answers

    Who authored 'Apley & Solomon’s System of Orthopeadics & Trauma'?

    <p>Dr. Anthony Kwok and Dr. Apley</p> Signup and view all the answers

    What is the role of Multilocus Polymerase Chain Reaction (MPCR) in diagnosing orthopaedics infection?

    <p>It is used to diagnose implant-related infection</p> Signup and view all the answers

    What are some signs of wound infection?

    <p>Fever, malaise, purulent drainage, pain, redness, swelling, hot skin, and loss of function and movement</p> Signup and view all the answers

    What is the best independent predictor of infection according to a retrospective review?

    <p>Preoperative serum tests (ESR and CRP levels)</p> Signup and view all the answers

    What new technologies are being used to improve identification and localization of bacterial infections?

    <p>Multilocus PCR/ESI-MS and bacterial imaging</p> Signup and view all the answers

    How are antibiotics commonly incorporated into implant devices to prevent infections?

    <p>Using antibiotic-impregnated cement and biodegradable polymer coatings</p> Signup and view all the answers

    What is the bacterial count for a fast-flowing alpine stream at altitude approximately?

    <p>1–5 bacteria per cubic centimeter</p> Signup and view all the answers

    What causes orthopaedic implant infection and osteomyelitis?

    <p>The prevalence of the glycocalyceal mode of bacterial growth</p> Signup and view all the answers

    What is the prevalence of osteomyelitis per 100,000 people per year?

    <p>2.4</p> Signup and view all the answers

    What is the primary cause of osteomyelitis?

    <p>Bacteria</p> Signup and view all the answers

    What is the main factor that makes treatment of post-traumatic osteomyelitis challenging?

    <p>Formation of biofilm</p> Signup and view all the answers

    What is another name for osteonecrosis?

    <p>Aseptic necrosis</p> Signup and view all the answers

    What may be required in cases of osteonecrosis with limited joint use?

    <p>Joint fusion surgery</p> Signup and view all the answers

    How is osteonecrosis often staged for avascular necrosis of the hip?

    <p>Steinberg staging</p> Signup and view all the answers

    What is a key symptom of osteochondritis dissecans (OCD)?

    <p>Joint effusion</p> Signup and view all the answers

    How can adolescents participating in organized sports reduce the risk of OCD?

    <p>Learning proper mechanics and using protective gear</p> Signup and view all the answers

    What is a risk factor for septic arthritis?

    <p>Diabetes</p> Signup and view all the answers

    What is involved in the initial treatment of septic arthritis?

    <p>Antibiotics</p> Signup and view all the answers

    What are the commonest HIV-1 subtypes in Hong Kong?

    <p>CRF01_AE and B</p> Signup and view all the answers

    What is monitored as part of the surveillance efforts in Hong Kong regarding HIV?

    <p>HIV prevalence among blood donors</p> Signup and view all the answers

    Which imaging techniques are involved in the diagnosis of osteonecrosis?

    <p>X-rays, bone scans, and MRI</p> Signup and view all the answers

    What are the common causes of osteonecrosis?

    <p>Trauma, corticosteroid medications, excess alcohol consumption, and various medical conditions and treatments</p> Signup and view all the answers

    What is the recommended management for advanced cases of osteonecrosis?

    <p>Surgical procedures such as core decompression, osteotomy, or joint replacement</p> Signup and view all the answers

    Which joints are commonly affected by osteonecrosis?

    <p>Weight-bearing joints like hips and knees, and non-weight-bearing joints like shoulders, hands, and feet</p> Signup and view all the answers

    What is the Ficat and Arlet classification used for in relation to osteonecrosis?

    <p>Staging avascular necrosis of the femoral head based on radiographs, MRI, and clinical symptoms</p> Signup and view all the answers

    What is the role of short-term bisphosphonate treatment in osteonecrosis?

    <p>It may slow or prevent bone collapse in the hip and knee</p> Signup and view all the answers

    What is the primary cause of osteomyelitis?

    <p>Bacterial infection</p> Signup and view all the answers

    What is the role of Multilocus Polymerase Chain Reaction (MPCR) in diagnosing orthopaedics infection?

    <p>Identifying multiple genetic loci to detect infection</p> Signup and view all the answers

    What are the commonest HIV-1 subtypes in Hong Kong?

    <p>Subtype B and CRF01_AE</p> Signup and view all the answers

    What method is recommended for diagnosing implant-related infection in orthopaedics?

    <p>Multilocus Polymerase Chain Reaction (MPCR) with electrospray ionization-mass spectrometry</p> Signup and view all the answers

    What is the approximate incidence of infection in orthopaedic trauma patients?

    <p>5% to 10%</p> Signup and view all the answers

    What are the predictors of infection in orthopaedic cases?

    <p>ESR and CRP levels</p> Signup and view all the answers

    What is a common cause of orthopaedic implant infection?

    <p>Glycocalyx-mediated bacterial growth</p> Signup and view all the answers

    How is recognition of wound infection dependent?

    <p>Immune system, wound location, and patient's chronic conditions</p> Signup and view all the answers

    What is a method to reduce hardware infection after orthopaedic treatments?

    <p>Sonication of implants</p> Signup and view all the answers

    What is a common sign of wound infection?

    <p>Drainage, pain, and redness</p> Signup and view all the answers

    What is a method used to improve identification and localization of bacterial infections?

    <p>PCR/ESI-MS and bacterial imaging</p> Signup and view all the answers

    What is a key symptom of osteomyelitis?

    <p>Swelling and warmth at the infection site</p> Signup and view all the answers

    What is the prevalence of osteomyelitis per 100,000 people per year?

    <p>2.4</p> Signup and view all the answers

    What is the primary cause of osteomyelitis?

    <p>Bacterial infection</p> Signup and view all the answers

    What is a risk factor for osteonecrosis?

    <p>Smoking</p> Signup and view all the answers

    What is a classification of osteomyelitis?

    <p>Suppurative and non-suppurative</p> Signup and view all the answers

    What is a recommended treatment for post-traumatic osteomyelitis?

    <p>Surgical debridement and antimicrobial therapy</p> Signup and view all the answers

    What is the estimated annual incidence of osteonecrosis in Americans between 20 and 50 years old?

    <p>10,000 to 20,000</p> Signup and view all the answers

    What is the recommended imaging technique for detecting early osteonecrosis?

    <p>MRI</p> Signup and view all the answers

    Which of the following is a potential risk factor for osteonecrosis?

    <p>Systemic lupus erythematosus</p> Signup and view all the answers

    What is a possible management option for advanced cases of osteonecrosis?

    <p>Core decompression</p> Signup and view all the answers

    What is a potential consequence of living with osteonecrosis?

    <p>Development of osteoarthritis</p> Signup and view all the answers

    What distinguishes osteochondritis dissecans (OCD) from osteochondritis?

    <p>Involves the creation of a flap of cartilage that dissects away from its underlying subchondral attachments</p> Signup and view all the answers

    Which of the following is a common risk factor for both osteochondritis dissecans and septic arthritis?

    <p>High activity in sports</p> Signup and view all the answers

    What is the approximate incidence of prosthetic joint infections in knee joints?

    <p>0.86-1.1%</p> Signup and view all the answers

    What are the commonest primary AIDS defining illnesses mentioned in the text?

    <p>PCP (Angel Dust) and TB</p> Signup and view all the answers

    What is the common mode of infection for prosthetic joint infections?

    <p>Through the bloodstream</p> Signup and view all the answers

    What is the median age of HIV cases reported in Hong Kong in 2016?

    <p>35</p> Signup and view all the answers

    What are the common HIV-1 subtypes mentioned in the text?

    <p>CRF01_AE and B</p> Signup and view all the answers

    What is the estimated incidence of infection in orthopaedic trauma patients?

    <p>5% to 10%</p> Signup and view all the answers

    What method is recommended for diagnosing implant-related infection in orthopaedics?

    <p>Multilocus Polymerase Chain Reaction (MPCR)</p> Signup and view all the answers

    What is the role of biofilm formation on orthopaedic implants?

    <p>It promotes bacterial growth and can lead to infection</p> Signup and view all the answers

    What is a potential consequence of living with osteonecrosis?

    <p>Increased risk of bone fractures</p> Signup and view all the answers

    What is the primary cause of osteomyelitis?

    <p>Bacterial infection</p> Signup and view all the answers

    What new technology is recommended for diagnosing the implant-related infection?

    <p>Multilocus Polymerase Chain Reaction (MPCR) with electrospray ionization-mass spectrometry</p> Signup and view all the answers

    What is the approximate prevalence of osteomyelitis per 100,000 people per year?

    <p>2.4</p> Signup and view all the answers

    What is the primary cause of osteonecrosis?

    <p>Decreased blood flow</p> Signup and view all the answers

    What is the key symptom of osteomyelitis?

    <p>Bone pain</p> Signup and view all the answers

    What is the main treatment for osteomyelitis?

    <p>Surgery and antimicrobials</p> Signup and view all the answers

    How much did pre-operative smoking cessation reduce postoperative complications by?

    <p>49%</p> Signup and view all the answers

    What are the classifications of osteomyelitis?

    <p>Suppurative and non-suppurative</p> Signup and view all the answers

    Which of the following is a common sign of wound infection?

    <p>Malaise</p> Signup and view all the answers

    What is a predictor of infection in orthopaedic cases?

    <p>Erythrocyte sedimentation rate (ESR)</p> Signup and view all the answers

    What is a method to reduce hardware infection after orthopaedic treatments?

    <p>Sonication of implants</p> Signup and view all the answers

    What is the cause of orthopaedic implant infection?

    <p>Glycocalyx-mediated bacterial growth and intracellular residency in osteoblasts</p> Signup and view all the answers

    What is a technology used to improve identification and localization of bacterial infections?

    <p>PCR/ESI-MS</p> Signup and view all the answers

    What is a common factor increasing hardware-related infections?

    <p>Increase in older population with chronic conditions</p> Signup and view all the answers

    Which imaging technique is considered excellent for detecting early osteonecrosis?

    <p>MRI</p> Signup and view all the answers

    What is the estimated annual incidence of osteonecrosis in Americans between 20 and 50 years old?

    <p>15,000 to 20,000</p> Signup and view all the answers

    What is the recommended prevention strategy for osteonecrosis?

    <p>Minimizing corticosteroid use</p> Signup and view all the answers

    What is a potential consequence of living with osteonecrosis?

    <p>Osteoarthritis</p> Signup and view all the answers

    What is the primary cause of osteonecrosis?

    <p>Serious trauma</p> Signup and view all the answers

    What is the primary classification used for avascular necrosis of the femoral head?

    <p>Ficat and Arlet classification</p> Signup and view all the answers

    Which of the following is a common risk factor for both osteochondritis dissecans and septic arthritis?

    <p>Genetic predisposition</p> Signup and view all the answers

    What is the approximate incidence of prosthetic joint infections in knee joints?

    <p>0.1-0.5%</p> Signup and view all the answers

    What distinguishes osteochondritis dissecans (OCD) from osteochondritis?

    <p>Involvement of bone</p> Signup and view all the answers

    What are the commonest primary AIDS defining illnesses mentioned in the text?

    <p>Pneumocystis pneumonia (PCP) and tuberculosis (TB)</p> Signup and view all the answers

    What is the common mode of infection for prosthetic joint infections?

    <p>Hematogenous spread</p> Signup and view all the answers

    What is monitored as part of the surveillance efforts in Hong Kong regarding HIV?

    <p>Viral load in the blood</p> Signup and view all the answers

    Study Notes

    Osteonecrosis, Osteochondritis, and Their Management

    • Osteonecrosis is classified into six stages, ranging from normal radiographs to advanced degenerative changes.
    • The Ficat and Arlet classification stages avascular necrosis of the femoral head based on radiographs, MRI, and clinical symptoms.
    • Osteonecrosis most commonly affects weight-bearing joints like hips and knees, but can also affect non-weight-bearing joints like shoulders, hands, and feet, and rarely the jaw.
    • Common causes of osteonecrosis include trauma, corticosteroid medications, excess alcohol consumption, and various medical conditions and treatments.
    • Around 10,000 to 20,000 Americans aged 20-50 develop osteonecrosis each year, often due to a history of trauma, corticosteroid use, or other risk factors.
    • Diagnosis of osteonecrosis involves X-rays, bone scans, and MRI, with bone pain being a key symptom.
    • Management of osteonecrosis includes pain management, limiting weight-bearing, and, in advanced cases, surgical procedures such as core decompression, osteotomy, or joint replacement.
    • There is no proven medical therapy for osteonecrosis, though short-term bisphosphonate treatment may slow or prevent bone collapse in the hip and knee.
    • Prevention strategies for osteonecrosis include avoiding excessive alcohol consumption, tobacco use, and prolonged corticosteroid use.
    • Living with osteonecrosis may involve developing osteoarthritis, and physical therapy and partial weight exercises can help manage pain and stiffness.
    • Osteochondritis is an inflammatory condition affecting the cartilage and bone in joints, while osteochondritis dissecans involves the creation of a flap of cartilage that detaches from its underlying attachments.
    • Osteochondritis dissecans can occur in various joints, such as the capitular head of the femur or the spinal vertebrae, in conditions like Scheuermann's disease.

    Joint Conditions: Osteochondritis dissecans, Septic arthritis, Prosthetic joint infections, and HIV Surveillance

    • Osteochondritis dissecans (OCD) is a condition where bone under joint cartilage dies due to lack of blood flow, causing pain and hindering joint motion, commonly affecting children and adolescents.
    • Symptoms of OCD depend on the size of the injury and whether the fragment is detached, leading to pain, swelling, joint effusion, and decreased range of motion.
    • The cause of OCD is unknown, but it may be related to reduced blood flow and genetic components, with high activity in sports being a risk factor.
    • Septic arthritis involves joint inflammation due to an infectious agent, with symptoms including redness, heat, pain, fever, weakness, and headache, and it can occur due to bacteria, viruses, fungi, or parasites.
    • Risk factors for septic arthritis include artificial joints, prior arthritis, diabetes, and poor immune function, and it can occur via blood, trauma, or infection around the joint.
    • Septic arthritis is diagnosed through joint aspiration and culture, and initial treatment involves antibiotics and, in some cases, surgery to clean out the joint.
    • Without early treatment, long-term joint problems may occur, and septic arthritis is more common in older people.
    • Prosthetic joint infections occur in about 0.86-1.1% in knee joints and 0.3-1.7% in hip joints, with early, delayed, and late phases, and common bacteria involved are Staphylococcus aureus and others.
    • The mode of infection for prosthetic joint infections can be through the bloodstream or direct penetration into the joint, and risk factors include age, diabetes, osteoarthritis, rheumatoid arthritis, immunosuppressive medication, and recent joint surgery.
    • HIV surveillance in Hong Kong in 2016 reported 692 HIV cases and 111 AIDS cases, with 86.1% male, 73.0% Chinese, and a median age of 35, and common risk factors included homosexual/bisexual contact and heterosexual contact.
    • The common HIV-1 subtypes were CRF01_AE and B, and the commonest primary AIDS defining illnesses were PCP (Angel Dust) and TB.
    • HIV prevalence among blood donors was also mentioned.

    Joint Conditions: Osteochondritis dissecans, Septic arthritis, Prosthetic joint infections, and HIV Surveillance

    • Osteochondritis dissecans (OCD) is a condition where bone under joint cartilage dies due to lack of blood flow, causing pain and hindering joint motion, commonly affecting children and adolescents.
    • Symptoms of OCD depend on the size of the injury and whether the fragment is detached, leading to pain, swelling, joint effusion, and decreased range of motion.
    • The cause of OCD is unknown, but it may be related to reduced blood flow and genetic components, with high activity in sports being a risk factor.
    • Septic arthritis involves joint inflammation due to an infectious agent, with symptoms including redness, heat, pain, fever, weakness, and headache, and it can occur due to bacteria, viruses, fungi, or parasites.
    • Risk factors for septic arthritis include artificial joints, prior arthritis, diabetes, and poor immune function, and it can occur via blood, trauma, or infection around the joint.
    • Septic arthritis is diagnosed through joint aspiration and culture, and initial treatment involves antibiotics and, in some cases, surgery to clean out the joint.
    • Without early treatment, long-term joint problems may occur, and septic arthritis is more common in older people.
    • Prosthetic joint infections occur in about 0.86-1.1% in knee joints and 0.3-1.7% in hip joints, with early, delayed, and late phases, and common bacteria involved are Staphylococcus aureus and others.
    • The mode of infection for prosthetic joint infections can be through the bloodstream or direct penetration into the joint, and risk factors include age, diabetes, osteoarthritis, rheumatoid arthritis, immunosuppressive medication, and recent joint surgery.
    • HIV surveillance in Hong Kong in 2016 reported 692 HIV cases and 111 AIDS cases, with 86.1% male, 73.0% Chinese, and a median age of 35, and common risk factors included homosexual/bisexual contact and heterosexual contact.
    • The common HIV-1 subtypes were CRF01_AE and B, and the commonest primary AIDS defining illnesses were PCP (Angel Dust) and TB.
    • HIV prevalence among blood donors was also mentioned.

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