Orthopaedics Flashcards
Define spondylosis?
Describes pain from degenerative conditions of the spine.
Age-related wear and tear to the spine.
Define Cervical spondylosis?
Age-related wear and tear affecting the spinal discs in your neck.
Results from osteoarthritis.
Complications include radiculopathy and myelopathy.
Flexion facilitated by:
A - Ulnar nerve
B - Median nerve
C - C8 Nerve
A - flexion of 4th and 5th DIPJs of the fingers
B - Flexion of PIPJs of all digits and 1st, 2nd and 3rd DIPJs of the fingers
C- finger flexion and wrist flexion
Explain the mnemonic?
“Closer to the paw the bigger the claw”
Compression at the wrist causes a bigger ulnar claw than at the elbow
Dupuytren’s contracture?
A - CAUSES
B - FEATURES
C - MANAGEMENT
Hand Deformity where there is an abnormal thickening of the skin in the palm of your hand at the base of your fingers.
A - Manual labour jobs, phenytoin treatment, DMT, Hand Trauma
B - Nodules + Pitting of of the palm -> Cord forming in the palm -> Fingers bend towards the palm
Ring finger and little finger are the fingers most commonly affected
C -Surgical treatment if MCPJs cannot be fully straighten and hand can’t be placed flat on a table.
What condition causes paraesthesia and tingling to occur in obese patients?
Meralgia paresthetica
Can occur spontaneously in individuals who are obese. Characterised by tingling, numbness and burning pain in the outer part of the thigh, caused by compression of the lateral cutaneous nerve.
First line treatment for lower back pain according to NICE?
NSAIDS (+PPI >45)
First line treatment for lower back pain according to NICE?
NSAIDS (+PPI >45)
Lower back pain: Appproach to management and investigation?
Conservative management - Encourage self- management
Stay physically active and exercise
Group exercise programmes
Radiofrequency denervation -i.e. lumbar
Massage
Imaging
Lumbar spine XR - Not routinely offered
MRI - ONLY with non-specific back pain, IF RESULT LIKELY TO CHANGE MANAGEMENT, or suspected - malignancy, infection, fracture, cauda equina, Ank.Spond
1st Line Analgesia - NSAIDS (+PPI >45)
Sciatica?
Treatment
Neuropathic pain medications
Epidural injections of local anaesthetic and steroids for acute and severe sciatica
Avascular Necrosis?
Define
Causes
Features
Investigations
Management
D - Death of bone tissue secondary to loss of the blood supply. Most commonly affects the epiphysis of long bones (e.g. femur)
C - Long-term steroid use, Chemotherapy, Alcohol excess, Trauma
CAST Bent LEGS
Corticosteroids, Alcoholism, Sickle cell disease, Trauma
Bends (decompression sickness) ,LEgg-Calves Perthes disease, Gaucher’s disease, SCFE (Slipped capital femoral epiphysis)
F - Initially asymptomatic, painful in all directions
I - Plain Hip XR - often normal (Osteopenia and microfractures may be seen early on.)
MRI - More sensitive
M - Surgical (joint replacement may be necessary)
Fracture management?
Description of the fracture - Location, Type of fracture, Open/Closed, Mechanism of injury (Trauma, pathological, stress injury)
Types of fractures - Oblique, Transverse, Spiral, Comminuted, Segmental
Any distal neurovascular deficit at all from a fracture, surgery is urgently indicated, no matter how the XR looks.
Management
Immobilise the fracture including the proximal and distal joints
Carefully monitor and document neurovascular status, particularly following reduction and immobilisation
Open fractures constitute an emergency and should be debrided and lavaged within 6 hours of injury
Manage infection including tetanus prophylaxis,
IV broad spectrum abx for open injuries
All open fractures should be thoroughly debrided ( and internal fixation devices avoided or used with extreme caution)
Gustilo and Anderson classification system
What is it used for?
Name + Describe the stages ?
Classification system for open fractures
3 Stages 1, 2, 3A, 3B,3C
1 - Low energy wound <1cm
2 - Greater than 1cm wound with moderate soft tissue damage
3- High energy wound > 1cm with extensive soft tissue damage
3A - Adequate soft tissue coverage
3B - Inadequate soft tissue coverage
3C - Associated arterial injury
Compartment Syndrome
Define?
Features?
Investigations?
Management?
Most common fractures sites that lead to this complication?
Compartment syndrome occurs when excessive pressure builds up inside an enclosed muscle space in the body .Raised pressure within the compartment will eventually lead to inadequate tissue perfusion resulting in necrosis.
F - Pain, especially on movement (passive + active),
excessive use of breakthrough analgesia should raise suspicion for compartment syndrome
Paraesthesia, Pallor, Parlaysis of muscle group,
+/- Arterial pulsation (Even when necrosis is occurring, microvascular compromise), muscle group paralysis
6Ps - Pain (Out of proportion), Pallor, Polikothermia (Affected limb colder), pulselessness, Paresthesia, Paralysis
I - Measurement of intracompartmental pressure measurements (18g Needle, Anaestheia + mercury manometer put into the compartment) . Pressures >20mmHg are abnormal and >40mmHg is diagnostic
Only done if an adequate examination can’t be performed
XR - Don’t show pathology for CS
M - Fasciotomies (Fascia is cut to relieve tension, swelling or pressure in order to treat the resulting loss of circulation to an area of tissue or muscle) Reducing
IV Fluids (Aggressive Tx) - Myoglobinuria may occur following fasciotomy and result in renal failure
Myoglobinuria (Due to increase muscle breakdown)
Short Window Time period - Death of muscle groups may occur within 4-6 hours
Necrotic tissue/muscle (following fasciotomy) should be debrided and amputation may have to be considered.
Most common sites - Supracondylar fractures and tibial shaft injuries.
Managing the risk of Osteoporosis?
All women aged >= 65 years and all men aged >= 75 years should be assessed. Younger patients should be assessed in the presence of risk factors
FRAX Tool for assessment
Estimates 10-year risk of fragility fracture
Valid for patients aged 40-90 years
Areas of assessment - Age, sex, weight, height, previous fracture, parental fracture, current smoking, glucocorticoids, RA, secondary osteoporosis, alcohol intake
Bone mineral density (BMD) is optional, but improves the accuracy of the results.
NICE recommend arranging a DEXA scan if FRAX (without BMD) shows an intermediate result.
DEXA scan immediate indications:
1- Starting meds which can change their bone density quickly
2- On long term steroids
Results of FRAX Assessment
low risk: reassure and give lifestyle advice
intermediate risk: offer BMD test then check risk
high risk: strongly recommend bone protection treatment
