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Y2 MSK > Week 6 > Flashcards

Week 6 Flashcards

1
Q

What are the arteries supplying head of femur

A

Obturator artery
Medial and lateral circumflex arteries

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2
Q

Which artery did the medial and lateral circumflex arteries branch off from

A

Deep femoral artery

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3
Q

Why does intracapsular hip fracture have a higher likelihood of causing femoral head necrosis

A

Because intracapsular fracture occurs at neck of femur hence cut off the blood supply to femoral head from the medial and lateral circumflex (hence retinacular arteries) and intramedullary arteries

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4
Q

What is extracapsular hip fracture

A

Hip fracture that occurs below the intertrochanteric line, below the neck of femur

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5
Q

Where is the intertrochanteric line

A

anterior aspect of the junction of the femoral neck and shaft
runs slanted between the greater and lesser trochanters

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6
Q

Where is the subtrochanteric line

A

5 cm below the lesser trochanter

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7
Q

What is the management for high function patient with displaced intracapsular hip fracture

A

Total hip replacement

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8
Q

What is the management for high function patient with undisplaced intracapsular hip fracture

A

CHS (compression hip screw)

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9
Q

What is the management for intracapsular hip fracture in elderly patients with co morbidities, low mobility

A

Hemiarthroplasty

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10
Q

What is the management for young patients with intracapsular hip fracture

A

CHS (compression hip screw) and see if it heals
If fails -> total hip replacement

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11
Q

What is the management for extracapsular hip fracture at intertrochanteric line

A

DHS (dynamic hip screw)

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12
Q

What is the management for intracapsular hip fracture at subtrochanteric line

A

IM nail (intramedullary nail)

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13
Q

Which muscle compartments are most commonly affected by compartment syndrome

A

Anterior and deep compartments

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14
Q

Fracture at which bone has high risk of causing CS

A

Tibial shaft fracture

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15
Q

Which compartment is most commonly affected by tibial shaft fractures

A

Anterior leg compartment

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16
Q

Early symptoms of compartment syndrome

A

Disproportionate pain
Pain on passive stretch of muscles

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17
Q

Late symptoms of compartment syndrome

A

pallor
paraesthesia
pulselessness

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18
Q

What is acute compartment syndrome

A

Increase in pressure in a muscle compartment, causing damage to the surrounding tissues, nerves and vascular supply

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19
Q

At what compartment pressure does it cause significant muscle damage

A

> 30-40 mmHg

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20
Q

Patients with what injuries can get CS

A

Tibial fractures
Open fractures
Forearm fractures
Burns

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21
Q

Management of CS

A

Phone senior ASAP
Release all dressings / cast to skin
Place limb at level of the heart

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22
Q

Why should you place the limb at level of the heart in CS

A

To reduce the blood pressure needed in the compartment to pump blood back

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23
Q

Where is weber B ankle fracture at

A

At the level of syndesmosis between the tibia and fibula

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24
Q

Where is weber A ankle fracture at

A

Below the level of syndesmosis between the tibia and fibula

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25
Q

Where is weber C ankle fracture at

A

Above the level of syndesmosis between the tibia and fibula

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26
Q

What is the weber classification used for

A

to assess the stability of the fracture and to determine future management

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27
Q

Management of open fractures

A

Antibiotics within 3 hours and until the wound is closed
Surgery

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28
Q

What antibiotics are given for open fractuers

A

IV co-amoxiclav

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29
Q

What antibiotics are given for open fractures in patients who are penicillin allergic

A

Co-trimoxazole
Metronidazole

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30
Q

What injuries are associated with tibial plateau fracture

A

Injury to common fibular nerve
Compartment syndrome
Soft tissue injuries of knee joint

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31
Q

How may tibial plateau fractures cause injury to common fibular nerve

A

Associated proximal fibular fracture

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32
Q

What arteries are at risk of damage due to tibial plateau fracture

A

Popliteal artery
Anterior tibial artery
Posterior tibial artery
Peroneal arteries

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33
Q

Management for tibial plateau fractures

A

Plates and screws
Bone graft
External fixator
ORIF
Total knee replacement if all the above fails

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34
Q

Why are plates and screws used in tibial plateau fractures

A

To elevate the depressed tibia

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35
Q

Why is bone grafting used in tibial plateau fractures

A

To fill in subchondral space due to loss of bone

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36
Q

management for tibial shaft fractures

A

Above knee cast

Surgery - IM nail / Internal Fixation / ORIF

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37
Q

Why is IM nail used more commonly than ORIF to fix tibial shaft fractures

A

Because ORIF can disrupt periosteal blood supply to fracture site, risking non-union, whereas IM nail does less disruption to the blood supply

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38
Q

Why do patients need frequent cast changes and xrays after a tibial shaft fracture

A

Because the position of the tibia is difficult to control

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39
Q

Management for ankle fractures

A

Cast

Surgery - ORIF

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40
Q

In any joint dislocations, what must be examined and documented before intervention

A

Neurovascular supply

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41
Q

What does pulseless arm indicate in a shoulder dislocation

A

That the vascular supply is damaged

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42
Q

What is the most common type of shoulder dislocation

A

Anterior shoulder dislocation

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43
Q

How does anterior shoulder dislocation occur

A

excessive external rotation force or a fall onto the back of the shoulder

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44
Q

What nerve is at risk of damage in anterior shoulder dislocation

A

Axillary nerve

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45
Q

What are the lesions associated with anterior shoulder dislocation

A

Bankart lesion
Hill Sach’s lesion

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46
Q

What causes recurrent shoulder dislocations after an anterior shoulder dislocation

A

Bankart lesions and Hill Sach’s Lesion makes the shoulder joint unstable hence more susceptible to recurrent dislocations

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47
Q

What is Hill Sach’s lesion

A

Injury of the humeral head secondary to anterior dislocation of the shoulder due to it colliding with the glenoid fossa

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48
Q

Where is regimental badge area

A

The skin covering the lower deltoid muscle

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49
Q

What is regimental badge area sensory assessment used for

A

To test the function of axillary nerve; axillary nerve supplies sensory information to the regimental badge area hence by assessing the senses in that area after a dislocation, it shows whether the axillary nerve is damaged or not

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50
Q

Signs of anterior shoulder dislocation

A

Loss of sensory in regimental badge area
Loss of roundness of shoulder
Muscle wasting of the deltoid (prolonged axillary nerve damage)
Positive Hamilton’s ruler sign

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51
Q

What is Hamilton’s ruler sign

A

When a ruler touches both the acromion and lateral epicondyle

Positive = dislocated shoulder

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52
Q

What is a light bulb sign

A

Xray sign of posterior shoulder dislocation; when the humeral head dislocates, it will also be internally rotated, giving a light bulb shape in AP xray

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53
Q

Management of joint dislocations

A

Reduction
Reassess neurovascular function
Repair
Rehabilitate (physio)

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54
Q

Management of shoulder dislocations (not delayed presentation)

A

Closed reduction under sedation -> reassessment of neurovascular function -> rehabilitation

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55
Q

Management of shoulder dislocations with delayed treatment

A

Open reduction surgery

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56
Q

Who has the highest risk of recurrent shoulder dislocation

A

Those under 20 years old ; recurrence rate decreases with age

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57
Q

What can a displaced fragment resulting from intra-articular radial and ulnar fracture cause

A

blocks full extension of the arm

58
Q

Management of elbow dislocation

A

Closed reduction under sedation
Sling
rehabilitation

59
Q

Management of elbow dislocation + radius / ulnar fracture

A

ORIF if radial head or neck fractured
ORIF + screws if coronoid process is fractured
Surgery to remove bone fragments if it is blocking full extension

60
Q

What causes elbow instability and recurrent elbow dislocations

A

Damage to bony architecture of the elbow - fractures of the radial head / neck / coronoid process / epicondyle

61
Q

Why should you have a high index of suspicion of other fractures when there is 1 identified fracture of radius / ulnar

A

Because the forearm bones and the ligaments joining them form a ring structure; a bony ring structure will have multiple injuries

62
Q

Types of forearm fracture-dislocations

A

Monteggia
Galeazzi

63
Q

What is Monteggia’s Fracture

A

Fracture of ulna associated with dislocation of radial head at elbow

64
Q

What is Galeazzi’s fracture

A

Fracture of the radius associated with dislocation of ulnar at elbow

65
Q

GRIMUS

A

Site of fracture and whether the dislocation is inferior / superior

Galeazzi
Radius
Inferior
Monteggia
Ulnar
Superior

66
Q

GRUsome MURder

A

Galeazzi
Radial fracture
Ulnar dislocation

Monteggia
Ulnar fracture
Radial dislocation

67
Q

What is peri-lunate dislocation

A

Dislocation of a carpal bone around lunate

68
Q

What other conditions can be caused by peri-lunate dislocation

A

Carpal tunnel syndrome
Damage to median nerve

69
Q

What bones does cortical bone tissue cover

A

Long bones only

70
Q

What bones does periosteum cover

A

All bones

71
Q

Difference between children’s bones and adults’ bones

A

Presence of growth plate
Thicker periosteum
More elastic
Can remodel themselves and correct angulation

72
Q

Why do children’s fractures heal more easily than adults’

A

Thicker periosteum

73
Q

How does thicker periosteum help heal the child’s bone quicker

A

Often stays intact with injury because it is thick -> stabilize the fracture
It also has a rich supply of osteoblasts -> promotes healing

74
Q

Why is surgical remodeling of the bone not often used in children’s fracture and dislocation

A

Because they can remodel the bones easily and correct angulation

75
Q

At what age should we start considering a child’s fracture as an adult’s fracture and why

A

12-14 ; once they hit puberty

Because after they hit puberty, there is less chance of remodeling / correcting angulation by themselves

76
Q

What is Salter Harris classification used for

A

Links patterns of physeal (growth plate) fractures to prognosis

77
Q

What is Salter Harris I pattern

A

Transverse fracture at physis, separating epiphysis and metaphysis

78
Q

What is Salter Harris II pattern

A

Fracture of the physis up to the metaphysis

79
Q

What is Salter Harris III pattern

A

Intraarticular fracture that crosses physis and exits through ephiphysis at joint space

80
Q

What is Salter Harris III pattern

A
81
Q

What is salter Harris IV pattern

A

Fracture extending upwards from joint line, cutting through physis and out the metaphysis

82
Q

What is Salter Harris V

A

When the physis is compressed / crushed

83
Q

Which salter harris pattern is the most common

A

Salter harris II

84
Q

Which salter harris pattern will / may lead to growth arrest

A

Salter V
Salter IV
Salter III

85
Q

Why may the fast healing of children’s bones be a disadvantage

A

Malaligned fragments become solid sooner

86
Q

What type of elbow fracture is common in children

A

Supracondylar fracture

87
Q

Injury mechanism of extension elbow fracture in children

A

Heavy fall onto outstretched hand

88
Q

Management of undisplaced supracondylar fractuer

A

Splint

89
Q

CRITOL

A

Sequence of ossification around the elbow

Capitellum
Radial Head
Internal (medial) epicondyle
Trochlea
Olecranon
Lateral epicondyle

90
Q

What sign on xray may be seen in an elbow fracture

A

Posterior fat pad sign

91
Q

Management of angulated / rotated / displaced elbow fracture in children

A

Closed reduction with pinning wires to prevent deformity

92
Q

What structures can be damaged by a severely displaced extension fracture of the elbow

A

Brachialis muscle
Brachial artery
Median nerve
Ulnar nerve

93
Q

What sign cannot be made by the patient due to severely displaced extension fracture of the elbow and why

A

They cannot make an OK sign

Because Flexor pollicis longus and lateral aspect of flexor digitorum profundus cannot function due to damage of ulnar and median nerve

94
Q

Which branch of median nerve supplies FPL and lateral aspect of FDP

A

Anterior interosseous branch

95
Q

Which nerve innervates the medial aspect of FDP

A

Ulnar nerve

96
Q

What should be checked when there is an elbow fracture

A

Radial pulse
Capillary refill
Nerve function

97
Q

Management of pulseless elbow fracture in children

A

Closed reduction and wiring

If the pulse does not return -> emergency surgery

98
Q

What signs should raise your suspicion of child abuse

A

Rib fractures
Scapular fractures
Genital injuries
Femoral fractures in children under 2 years old
History doesn’t match with injury
Multiple trips to A&E for different sites of injuries
Inconsistent history
Metaphyseal fracture in infants

99
Q

Management of Galezzia / Monteggia fractures in children

A

Plates and screws

100
Q

Why isn’t cast and manipulation used in Galezzia / Monteggia fractures in children

A

High rate of re dislocation

101
Q

What are toddler’s fractures

A

Undisplaced spiral fracture in tibial shaft

Common in toddlers

102
Q

Management of toddler’s fractures

A

Cast

103
Q

Injury mechanism of distal femoral fracture

A

Fall onto flexed knee in osteoporotic bone

104
Q

Management of distal femoral fracture

A

Plate and Screws

105
Q

Around what % of patients with previous patellar dislocation experience recurrent patellar dislocations

A

50%

106
Q

How to prevent further patellar dislocations

A

Physiotherapy strengthening vastus medialis

107
Q

What lower limb fractures usually occur in osteoporotic bone

A

Distal femur
Tibial plateau

108
Q

Which type of tibial plateau fracture is more common

A

lateral tibial plateau

109
Q

Stress from which direction causes lateral tibial plateau fracture

A

Valgus stress

110
Q

What ligaments are damaged in lateral tibial plateau fracture

A

MCL and ACL

111
Q

Why are open fractures common in tibial shaft fractures

A

Because tibia shaft is subcutaneous (i.e. quite superficial)

112
Q

Management of extra-articular distal tibia fracture

A

IM nail if not too distal

Plating if too distal

113
Q

What are Pilon fractures

A

Intra-articular distal tibial fractures

114
Q

Injury mechanism of Pilon fractures

A

Fall from height

This causes the talus to be driven into distal tibial articular surface

115
Q

What type of fractures can Pilon fractures be

A

Comminuted / impaction fractures at articular surface

116
Q

Management of Pilon fracture

A

Temporary external fixation -> internal fixation once swelling settles

117
Q

Common injury mechanisms of ankle injuries

A

Inversion injury
Rotational force on planted foot

118
Q

What are the requirements for requesting an xray for ankle injury

A

Severe localized tenderness at distal tibia / fibula
Inability to weight bear for 4 steps

119
Q

Types of ankle fractures

A

Stable / Unstable

120
Q

What counts as a stable ankle fracture

A

Distal fibular fracture with no medial fracture / rupture of deltoid ligaments

121
Q

What counts as an unstable ankle fracture

A

Distal fibular fracture with rupture of deltoid ligaments

122
Q

What signs would suggest rupture of deltoid ligaments

A

Swelling and bruising at medial side of ankle

123
Q

What xray signs would suggest rupture of deltoid ligaments

A

Talar shift
Talar tilt
Asymmetric increased space around the talus

124
Q

What condition can be caused by talar shift

A

Post trauamatic OA
Because talar shift greatly increases the ankle joint contact pressures

125
Q

Management of stable ankle fracture

A

Walking cast / splint

126
Q

Management of unstable ankle fracture

A

ORIF

127
Q

Injury mechanism of calcaneal fractures

A

Fall from height landing on heel

128
Q

Management of calcaneal fracture

A

ORIF

129
Q

Why is ORIF controversial for calcaneal fractures

A

Because there is risk of wound breakdown (re-opening) and wound healing problems

130
Q

Where does the body of talus get its blood supply from

A

Anastomotic ring around the neck and head formed by anterior tibial, posterior tibial and peroneal arteries

131
Q

Displacement of fracture of talus / subluxation or dislocation of talus can cause

A

AVN of the talar body due to disruption of blood supply

132
Q

What can be caused by AVN of the talus body

A

Secondary osteoarthritis

133
Q

What is Lisfranc fracture-dislocation

A

Fracture at the base of the 2nd metatarsal in the foot with dislocation of the base of the 2nd metatarsal

134
Q

Signs of Lisfranc fracture-dislocation

A

Very swollen, bruised foot
Unable to weight bear
Xray may look normal

135
Q

Injury mechanism of avulsion 5th metatarsal fracture

A

Inversion injury causing peroneus brevis tendon to pull a small fragment of bone away from its main part

136
Q

Management of avulsion 5th metatarsal fracture

A

Walking cast
Supportive bandage
Stout boot

137
Q

Is it problematic if non union occurs in 5th metatarsal

A

No because it forms a stable fibrous non-union which is asymptomatic

138
Q

What is a Jones fracture

A

When the fracture occurs at proximal diaphysis of the 5th metatarsal

139
Q

Why is Jones fracture problematic

A

Because the area of the fracture has poor blood supply and higher risk of non-union

140
Q

What technique is used to reduce chronic pain in multiple displaced fractures in the metatarsals

A

K wires

141
Q

Rupture of which tendons can usually be treated conservatively

A

Achilles tendon
Long head of biceps
Distal biceps
Rotator cuff

142
Q

Rupture of which tendons are usually treated surgically

A

Quadriceps tendon
Patellar tenodn

Y2 MSK (19 decks)

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