Iraqi Board Orthopedic Surgery key terms

The principle that bone remodels along the lines of mechanical stress it experiences, adding mass where loads are high and resorbing where they are low. It explains adaptive changes around implants, after fracture healing, and in disuse.

Loss of bone density caused by an implant carrying load that would otherwise pass through the bone. It occurs most around stiff stems and plates and can cause pain or later fracture after arthroplasty.

The property of a graft or scaffold that allows host bone and blood vessels to grow into it along its surface. It provides a framework but does not by itself create new bone; cancellous autograft and ceramics show it.

The ability of a material to stimulate undifferentiated host cells to become bone-forming cells. It depends on signalling proteins such as bone morphogenetic proteins and is a key advantage of autograft and demineralised bone matrix.

The contribution of living bone-forming cells within a graft that survive and produce new bone directly. Only fresh autograft reliably provides it, which is why autograft remains the benchmark for spinal fusion and non-union surgery.

Raised pressure within a closed fascial compartment that reduces capillary perfusion and threatens muscle and nerve. It presents with pain out of proportion, pain on passive stretch and tense swelling; pulses usually remain palpable and are unreliable.

Surgical opening of fascial compartments to relieve pressure in compartment syndrome. It must be performed urgently, with all compartments released through adequate incisions, and wounds are usually left open for delayed closure or grafting.

A staged strategy in severely injured patients that prioritises rapid temporary stabilisation of fractures, usually with external fixation, to limit physiological insult. Definitive fixation follows once inflammation, coagulopathy and temperature have improved.

A resuscitation and timing approach in polytrauma in which major fractures are fixed definitively within roughly 24 to 36 hours, provided lactate, base deficit, coagulation and temperature have normalised. It avoids both premature surgery and unnecessary delay.

Failure of a fracture to heal without further intervention, usually judged after at least six to nine months with no progressive radiographic change. Hypertrophic non-union has abundant callus and needs stability; atrophic non-union needs biology.

A fracture occurring near or around an orthopedic implant, most often at the tip of a hip stem or around a knee replacement. Treatment depends on implant stability, bone stock and fracture pattern, ranging from fixation to revision arthroplasty.

Failure of an implant fixation without infection, driven by wear particles, macrophage activation and osteolysis at the bone-implant interface. It is the leading late cause of revision hip and knee arthroplasty.

Infection involving a joint replacement and its surrounding tissue, diagnosed using clinical features, inflammatory markers, synovial fluid analysis and cultures. Treatment may be suppressive antibiotics, debridement with implant retention, or staged revision.

A structured community of bacteria attached to a surface and encased in self-produced matrix, which resists antibiotics and host defences. On implants it explains chronic infection, low-virulence organisms and the need for removal of the device.

Infection within a joint space, commonly from haematogenous spread or direct inoculation. It presents with acute pain, warmth and reluctance to move the joint; urgent aspiration and intravenous antibiotics are needed to limit cartilage destruction.

Infection of bone, which may be acute haematogenous, contiguous from a wound, or chronic with sequestrum and involucrum. Chronic disease requires debridement of dead bone plus targeted antibiotics because avascular bone cannot be cleared by drugs alone.

Compression of the lumbosacral nerve roots causing saddle anaesthesia, bladder or bowel dysfunction, sexual dysfunction and variable leg weakness. It is a surgical emergency requiring urgent decompression to preserve sphincter and sexual function.

Transient loss of all cord function, including reflexes, below a spinal injury, lasting hours to weeks. Return of the bulbocavernosus reflex marks its end; it is distinct from neurogenic shock, which is a haemodynamic state.

Hypotension with bradycardia and warm peripheries caused by loss of sympathetic outflow after a high spinal cord injury. It is treated with fluids cautiously, vasopressors and atropine for bradycardia, and must be distinguished from haemorrhage.

Lateral curvature of the spine with vertebral rotation, measured by the Cobb angle on a standing radiograph. Curves beyond about 45 to 50 degrees in a growing child risk progression and may warrant bracing or surgical correction.

A spectrum of abnormal hip development ranging from mild acetabular shallowness to frank dislocation, often detected by clinical screening or ultrasound in infancy. Early bracing or reduction gives the best chance of a normal joint.

Idiopathic avascular necrosis of the femoral head in childhood, presenting with a limp and groin pain. Prognosis depends on age at onset and head containment; older children with severe involvement may need surgical containment or salvage.

Displacement of the femoral head through the growth plate in older children or adolescents, often with obesity and groin or knee pain. It is stabilised with a single screw; the main risks are avascular necrosis and chondrolysis.

Premature closure of part or all of a growth plate after injury, infection or surgery, causing limb shortening or angular deformity in a growing child. Treatment ranges from observation to corrective osteotomy or guided growth.

A five-type system describing fractures involving the growth plate, based on which bony and physeal layers are crossed. Higher types, especially types III to V, carry greater risk of growth disturbance and later deformity.

Surgical replacement of a torn ACL, usually with a hamstring or patellar tendon autograft, to restore rotational knee stability. Graft choice, tunnel position and rehabilitation determine return to sport, which typically takes nine to twelve months.

Suturing of a meniscal tear to preserve the meniscus rather than excising it, most successful in peripheral vascular-zone tears in younger patients. Preserving meniscal tissue reduces later osteoarthritis compared with total meniscectomy.

Disruption of one or more tendons of the shoulder cuff, causing weakness, night pain and loss of active elevation. Degenerative tears are common with age; acute traumatic tears in younger patients are usually repaired.

Adhesive capsulitis, a painful progressive loss of glenohumeral motion with capsular contracture, more common in diabetes. It typically passes through painful, stiff and recovery phases; treatment is analgesia, physiotherapy and sometimes injection or release.

Fracture of the scaphoid bone, usually after a fall on an outstretched hand, with tenderness in the anatomical snuffbox. Its retrograde blood supply makes proximal-pole fractures prone to non-union and avascular necrosis.

Progressive fibrosis of the palmar fascia causing nodules and cords that pull the fingers, usually the ring and little fingers, into flexion. Treatment options include needle fasciotomy, collagenase injection and surgical fasciectomy.

The Weber or Danis-Weber system groups distal fibular fractures by their level relative to the syndesmosis (A, B, C), predicting stability and the need to assess and fix the syndesmosis. The Lauge-Hansen system instead describes the injury mechanism.

Complete or partial tear of the Achilles tendon, often during push-off sport in middle-aged men, producing a sudden snap and inability to heel-raise. Treatment may be functional bracing or surgical repair, with similar outcomes in many patients.

A primary malignant bone tumour producing osteoid, most common in adolescents around the knee. Standard care is neoadjuvant chemotherapy, wide resection with limb salvage and further chemotherapy; lung metastasis is the main prognostic threat.

A surgical staging system for musculoskeletal tumours based on grade, local extent and metastasis. It guides whether limb salvage is feasible and whether staging investigations such as chest imaging are complete before biopsy.

A fracture through bone weakened by tumour, infection, metabolic disease or osteoporosis, sometimes the first presentation of malignancy. Management addresses both the fracture and the underlying lesion, often with prophylactic or therapeutic stabilisation.

Reduced bone mass and microarchitectural deterioration that increases fragility fracture risk, diagnosed by bone mineral density T-score of minus 2.5 or lower. Treatment combines calcium, vitamin D, exercise and antiresorptive or anabolic drugs.

A patient's voluntary agreement to treatment after receiving and understanding information about the diagnosis, proposed procedure, material risks, alternatives and consequences of refusal. It must be documented and obtained from someone with capacity.

A serious, largely preventable patient-safety incident such as wrong-site surgery or a retained surgical item. Reporting and root-cause analysis are used to identify system failures rather than to blame individuals.

A ranking of study design strength, from systematic reviews of randomised trials at the top to expert opinion and case reports at the bottom. It helps clinicians judge how much confidence to place in a published result.

The number of patients who must receive an intervention for one additional patient to benefit, calculated as the reciprocal of the absolute risk reduction. Smaller values indicate greater clinical benefit, but it says nothing about cost or harm.