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T&O Flashcards

1
Q

Classification system for intracapular neck of fracture

A

The garden classification

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2
Q

Relevence of ligamentum arteriosum in NOF fracture

A

There is blood supply in the early days of life from the ligamentum arteriosum to the femoral head - which lies within the ligamentum teres

however this dramatically reduces in size in later life, and is of negligible importance in adults

Meaning if circumflex femoral a. damaged then there will be avascular necrosis

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3
Q

What is a Skeletal survey ?

A

Series of radiographs, performed systematically to cover the entire skeleton or the anatomic regions appropriate for the clinical indications.

e.g. paeds when suspicion of NAI, multiple myeloma etc.

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4
Q

Classification system for ankle fractures

A

Weber classification

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5
Q

Management of ankle fractures

A
  1. All ankle fractures –> promptly reduced to remove pressure on the overlying skin and subsequent necrosis

If Non-displaced medial malleolus, weber A, Weber B without talar shift or unfit for surgery:
- conservative management

If displaced bimalleolar/trimalleolar fractures, Weber C, Weber B with talar shift or open fractures:
- Open reduction and internal fixation

May need external fixation first if swelling too extensive for cast/inscision

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6
Q

What is the talar shift (ankle fracture)

A

Displacement of the talus in relation to the articular surface of the distal tibia and malleolar end segment

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7
Q

What is varus deformity

A

Bone distal (above) a joint is angled inwards, towards body midline

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8
Q

What is valgus deformity

A

Bone distal (away) to a joint is angled outwards, away from body midline

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9
Q

Serious complication after talar fracture

A

Avascular necrosis - talus is reliant predominantly on extraosseous arterial supply, which is highly susceptible to interruption

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10
Q

Tarsal bones

A

Calcaneus (most common to fracture)
Talus (2nd most common to fracture)
Navicular
Cuboid
Cuneiforms

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11
Q

Hawkins classification

A

Is for talar bone fracture, aids management planning and can determine risk of avascular necrosis

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12
Q

What is Lisfranc injury

A

Injury to the tarsometatarsal (lisfranc) joint between the medial cuneiform and base of 2nd metatarsal

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13
Q

Features suggestive of a Acetabular labral tear

A

hip/groin pain
snapping sensation around hip
there may occasionally be the sensation of locking

Labral tears may occur following trauma (most commonly in younger adults) or as a result of degenerative change (typically in older adults).

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14
Q

What is a maisonneuve fracture

A
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15
Q

What is the most sensitive investigation for avascular necrosis (AVN) of the hip?

A

MRI of hip

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16
Q

Causes of avascular necrosis of the hip

A

Long-term steroid use
Chemotherapy
Alcohol XS
Trauma

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17
Q

Characteristic features of avascular necrosis of the hip

A

Initally asymptomatic
then
Pain in anterior groin region

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18
Q

First line analgesic for back pain

A

NSAIDs

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19
Q

What is an abnormal intracompartmental pressure measurement? and what measurement is diagnostic of compartment syndrome?

A

Pressure > 20mmHg = abnormal
>40mmHg = diagnostic

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20
Q

Fractures high risk of compartment syndrome

A

Supracondylar fracture
TIbial shaft frature

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21
Q

Features of acute limb ischaemia (the 5 Ps)

A

Pain - disproportionate to injury
Pallor
Pulselessness
Perishingly cold
Paralysis

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22
Q

Features of compartment syndrome

A

Severe pain (disproportionate to injury)
Worsened by passively stretching muscle
Paraesthesia
Tense/pressure
+/- feature of acute limb ischaemia

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23
Q

Compartment syndrome investigations

A

Clinical diagnosis
Intra-compartmental pressure monitor (if there is clinical uncertainty)
Creatine kinase may aid diagnosis

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24
Q

Causes of acute limb ischemia

A

Embolism
Thrombosis
Trauma (incl. compartment syndrome)

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25
Q

Classification system for acute limb ischaemia

A

Rutherford

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26
Q

Most common shoulder dislocation

A

Anterior

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27
Q

Cause for anterior shoulder dislocation

A

FOOSH

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28
Q

Cause for a posterior shoulder dislocation

A

Seizures and electric shocks (although anterior dislocations still more common in seizures)

but can occur through trauma (a direct blow to the anterior shoulder or force through a flexed adducted arm)

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29
Q

Nerves vulnerable to injury in shoulder dislocation

A

Axillary and suprascapular

30
Q

What are boney bankart lesions?
What are soft bankart lesions?

A

Boney = Fractures of the anterior inferior glenoid bone, commonly seen in those with recurrent dislocations

Soft = labrum tears from the glenoid

31
Q

What are hill-sachs defects?

A

impaction injuries to the chondral surface of the posterior and superior portions of the humeral head, present in approximately 80% of traumatic dislocations

32
Q

Meniscal tear - common mechanism of injury

A

Twisting injury - while knee is flexed and weight bearing

Or can be degenerative disease

33
Q

Features of meniscal tear

A

“tearing” sensation + intense sudden onset pain
Knee may be locked in flexion
Joint line tenderness
Joint effusion
Limited knee flexion

34
Q

Specific test for meniscal tear

A

McMurrray’s test - often prove very painful to the patient so many clinicians no longer advocate their use

Thessaly’s test - weight bearing at 20 degrees of knee flexion, patient supported by doctor, postive if pain on twisting knee

35
Q

Investigations for meniscal tear

A

X-ray - initially to exclude fracture
MRI = gold standard

36
Q

Complications of Knee arthroscopy

A

DVT
Damage to local structures (e.g. saphenous nerve and vein, peroneal nerve, popliteal vessels)

37
Q

Mechanism of injury for ACL tear

A

twisting the knee whilst weight-bearing.
result from a sudden change of direction twisting the flexed knee.

38
Q

Specific tests to identify potential ACL damage

A

Lachman test (more sensitive)
Anterior draw test

39
Q

Features of ACL tear

A

Rapid joint swelling
Significant pain
Instability

50% of ACL tears have a meniscal tear ! (similar mechanism of injury)

40
Q

Mechanism of injury in a medal collateral ligament tear

A

Trauma to the lateral aspect of the knee
Direct blow in a valgus stress direction

Non-contact can occur - e.g. skiing where there is a valgus stress with external rotation force

41
Q

Features of medial collateral ligament tear

A

“pop” with immediate joint line pain
Delayed swelling after a few hours (unless there is an associated haemarthrosis)
Increased Laxity (valgus stress test)

42
Q

Specific test to identify MCL injury

A

Valgus stress test

A Grade II and III tear can be distinguished clinically on medial stress testing; Grade II is lax in 30 degrees of knee flexion but solid in full extension, whereas Grade III is lax in both these positions.

43
Q

Nerve injury that can occur as a result of a Colles fracture

A

Median nerve injury –> acute carpal tunnel syndrome
+ weakness or loss of thumb/index finger flexion

44
Q

Colles fracture deformity

A

Dinner for deformity
Dorsally displaced distal radius

45
Q

What is a colles fracture

A

extra-articular fracture of the distal radius with dorsal angulation and dorsal displacement

46
Q

3 common distal radius fractures

A

Colles’ (90%)
Smiths’s
Bartons

47
Q

What is a smiths fracture

A

volar angulation of the distal fragment of an extra-articular fracture of the distal radius (the reverse of a Colles fracture), with or without volar displacement.

48
Q

What is a bartons fracture

A

intra-articular fracture of the distal radius with associated dislocation of the radio-carpal joint.

49
Q

Which artery supplies the scaphoid

A

Radial artery

50
Q

Contents of the anatomical snuffbox

A

Radial artery
Superficial radial nerve
Cephalic vein.

Floor = scaphoid, trapezium, radial styloid

51
Q

When after inital presentation should another X-ray of schapoid be taken

A

Repeat x-ray 10-14 days after

If initial radiographs do not show evidence of a fracture however there is sufficient clinical suspicion, treat conservatively and re-image in two weeks

52
Q

Imaging modality for osteomyelitis

A

MRI

then consider a bone biopsy to determine causative organism

53
Q

Organism involved in osteomyelitis

A

Staph. aureus is the most common cause except in patients with sickle-cell anaemia where Salmonella species predominate

54
Q

Management of osteomyelitis

A

flucloxacillin for 6 weeks
clindamycin if penicillin-allergic

55
Q

Features of carpel tunnel syndrome

A

Pain, numbness, and/or paraesthesia - throughout the median nerve sensory distribution.
Pain worse at night
Sx temporarily relieved by shaking hand or hanging It over side of bed

Palm spared -due to the palmar cutaneous branch of the median nerve branching proximal to the flexor retinaculum and passing over the carpal tunnel.

Later stages - weakness of thumb abduction (due to denervation of thenar muscles) +/- wasting of thenar eminence

56
Q

Specific clinical tests for carpel tunnel syndrome

A

Tinel’s test
Palen’s test

57
Q

DDx for carpel tunnel syndrome

A

Cervical radiculopathy (C6 nerve root involvement may produce pain/paraesthesia similar to CTS)

Pronator teres syndrome - compression by pronator teres

Flexor carpi radialis tenosynovitis

58
Q

Management of carpal tunnel syndrome

A

Wrist spint (commonly worn at night)
Corticosteroid injections
NSAIDs

Carpal tunnel release surgery

59
Q

Contents of the carpal tunnel

A

Median nerve
Flexor pollicis longus
Flexor digitorum profundus
Flexor digitorum superficialis

60
Q

Clinical test for achilles tendon rupture

A

Simmons test
- absence of plantar flexion on squeezing the calf of the affected leg

61
Q

Most common cause for cauda equina syndrome

A

Central disc prolapse at L4/5 or L5/S1

62
Q

What is the femoral stretch test?

A

Patient is prone, knee is passively flexed to the thigh and the hip is passively extended

Positive = pain in anterior thigh
Suggestive of a high lumbar radiculopathy
L3/L4 nerve root compression

63
Q

What is the sciatic stretch test?

A

raise one leg - knee absolutely straight - until pain is experienced in the thigh, buttock and calf.
record angle at which pain occurs - a normal value would be 80-90 degrees

L5/S1 nerve root compression

64
Q

Cause of foot drop

A

compromise of common peroneal nerve (supplied by sciatic)

65
Q

Classification system for tibial plateau fractures

A

Schatzker Classification

65
Q

Arteries at risk in tibial shaft fracture

A

Peroneal
Anterior / posterior tibial artery

66
Q

Management of undisplaced tibial shaft fracture

A

Closed reduction + cast for 16 weeks (Sarmiento cast)

67
Q

Managment of displaced tibial shaft fracture

A

Intramedullary nailing
May need to start with external fixator while swelling reduces

Particularly proximal or distal fractures, especially those which extend into the joint, may require open reduction internal fixation (ORIF) with locking plates.

68
Q

Complications of a tibial shaft fracture

A

Compartment syndrome
Ischaemic limb
Open fracture

69
Q

Classification of Open Fractures

A

Gustilo-Anderson classification

70
Q

What is traction splinting used for?
e.g. Kendrick traction splint

A

suspected or isolated fractures of the mid-shaft femur, acting to hold the femur in correct position against action of the large thigh muscle mass.

finals (19 decks)

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