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sarah gill trying to kill us Flashcards

1
Q

Fall with shoulder in external rotation?

A

Anterior dislocation of shoulder

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2
Q

What should you check if you have anterior shoulder dislocation?

A

Axillary badge patch!!

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3
Q

Fall with shoulder in internal rotation?

A

Posterior dislocation

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4
Q

Arm held in abduction

Humeral head inferior to the glenoid

A

Inferior dislocation

-NEEDS PROMPT NEUROVASCULAR ASSESSMENT AND REDUCTION

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5
Q

Light bulb sign on x-ray, which type of shoulder dislocation?

A

Posterior shoulder dislocation

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6
Q

Elbow dislocation gives small risk of which two fractures?

A

Coronoid process and radial head

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7
Q

Say you pull a child’s arm upwards, what could you dislocate?

A

Radial head

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8
Q

Management of shoulder dislocation?

A

Closed reduction under sedation
Open reduction
Stabilisation & rehabilitation

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9
Q

Management of elbow dislocation?

A

Closed reduction under sedation
Open reduction rarely required
2 weeks in sling & rehabilitation

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10
Q

Hippocratic, Kocher’s, in-line traction used to reduce which type of dislocation?

A

Shoudler

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11
Q

Traction in extension +/- pressure over olecranon used to reduce which type of dislocation?

A

Elbow dislocation

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12
Q

Closed reduction under digital or metacarpal block
Open reduction rarely required
2 weeks in neighbour strapping
Volar slab in Edinburgh position if unstable ++

A

IPJ dislocation

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13
Q

Which way will the patella dislocate?

A

It will always be a LATERAL dislocation

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14
Q

Always a lateral dislocation?

A

Patella!

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15
Q

Who is most likely to sustain a patella knee dislocation?

A

Teenage girls

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16
Q

Associations/causes of patella dislocation?

A

Hypermobility
Under-developed (hypoplastic) lateral femoral condyle
Increased Q-angle
Genu valgum
Increased femoral neck anteversion
Lateral quads insertions or weak vastus medialis

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17
Q

Q angle

A

Line 1: ASIS to midpoint of patella

Line 2: Tibial tuberosity to midpoint of patella

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18
Q

Examination of dislocated knee cap?

A

Pain medially (from torn medial retinaculum)
Effusion (haemarthrosis)
Patella apprehension test +ve

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19
Q

Management of knee dislocation

A 
Reduce with knee extension
Radiographs
Aspiration
Brace
Physiotherapy
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20
Q

Surgery for repeat dislocations of the knee

A

Lateral release with medial reefing

Patellar tendon reallignment

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21
Q

Lateral collateral ligament injury and peroneal nerve injury, what have you probably done to your knee?

A

Dislocated it

-beware of spontaneous relocation, you do not want to miss diagnosis of dislocation!!

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22
Q

Knee dislocation and vascular damage, when do you observe and when do you do arteriorgram?

A

Vascular injuries: Popliteal artery / vein injury
May not be obvious (intimal tear or thrombus

NORMAL EXAM = OBSERVE IN HOSPITAL

CLINICAL CONCERN = ARTERIOGRAM / MRI
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23
Q

How would you stabilise a knee after reduction?

A

Splint or external fixation

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24
Q

Time window for vascular repair following knee dislocation?

A

6 hours

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25
Q

Complications of knee dislocation

A

Arthrofibrosis and stiffness
Ligament laxity
Nerve or arterial injury

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26
Q

Fractures associated with hip dislocation?

A

Posterior acetabular wall

Femoral fractures

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27
Q

Flexed, internally rotated and adducted knee

A

Hip dislocation

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28
Q

Complications of hip dislocation

A

Sciatic nerve palsy
Avascular necrosis of the femoral head
Secondary osteoarthritis of hip
Myositis ossificans

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29
Q

General principles for treatment of open fractures?

A

Antibiotics, tetanus, early debridement and operative stabilisation

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30
Q

Approx blood loss in femoral fracture?

A

1 litre

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31
Q

Risks associated with femoral shaft fracture?

A

Fat embolism, ARDS

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32
Q

Analgesia for femoral shaft fracture?

A

Femoral block

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33
Q

Splintage for femoral shaft fracture?

A

Thomas splint

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34
Q

Treatment for unstable femoral shaft fracture?

A

IM nailing

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35
Q

Treatment for distal femur fractures?

A 
Extra-articular
If not too distal, can nail
Distal = plating
Intra-articular:
Anatomical reduction, rigid fixation
Plate and screws
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36
Q

Usual fracture of proximal tibia?

A

High energy young, low energy old

Usually Valgus stress  lateral tibial plateau # with disruption articular surface

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37
Q

What investigation should you carry out for proximal tibial fracture?

A

CT scan!! (to determine personailty of fracture)

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38
Q

Internal rotation and tibial shaft fracture?

A

Internal rotation POORLY toerated

Can tolerate 5 degress angulation any plane, 50% bony contact

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39
Q

Pilon fracture?

A

Intra-articular distal tibial fracture

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40
Q

Injuries associated with a distal tibial fracture?

A

Calcaneous
Pelvis
Spine
(distal tibial fracture is usually high energy)

THIS IS A SIGNIFICANT SOFT INJURY

  • external fixation
  • +/- limited internal fixation
  • CT
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41
Q

What happens if you have a distal fibular fracture with deltoid ligament rupture?

A

Talar shift

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42
Q

Often avulsion fracture from triceps contraction

A

Olecranon fracture

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43
Q

Radial head fracture

A

can occur with dislocation elbow

Minimally displaced marginal fractures treated conservatively (unless fragment blocking ROM)
Can fix displaced fractures with large fragments

Comminuted fractures  excise +/- replacement

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44
Q

Galeazzi fracture

A

Fracture of radius, dislocation of DRUJ

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45
Q

Monteggia

A

Fracture of ulna and dislocation of radial HEAD

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46
Q

Management of night stick fracture?

A

Conservative

(direct blow to ulna may cause isolated ulna fracture

47
Q

Management of galeazzi or monteggia?

A

ORIF fractured bone

Once reduced, radial head or distal ulna should reduce

48
Q

Treatment for Colles fracture

A

Colles fracture – FOOSH  extra-articular #, dorsal angulation, dorsal displacement
Stable, minimally displaced / angulated  POP
Displaced simple #  MUA
Displaced, comminution  MUA & K-wiring, ORIF

49
Q

Complications of colles fracture

A

Complications – Median nerve compression, EPL rupture, CRPS, loss grip strength
(CRPS: complex regional pain syndrome)

50
Q

Treatment for smiths fracture?

A

Smiths fracture is VERY UNSTABLE!!! Colles you might be able to get away with conservative but smiths you need to ORIF!
(Smiths = fall on back of hand, extra-articular, volar displacement and angulation)

51
Q

Which x-ray view do you need for Barton’s wrist fracture?

A

Lateral view

52
Q

What is a bartons fracture?

A 
INTRA-articular fracture of the radius
-extend through dorsal aspect
-Usually associated with carpal displacement
(colles and smiths = extra articular)
Need a lateral view
Ex-fix +/- k wires
53
Q

Lethal triad associated with polytrauma?

A

Hypothermia
Acidosis
Coagulopathy

54
Q

Polytrauma –> what do you do?! This is serious

A

Aim for rapid skeletal stabilisation with reduced biological load  reduce bleeding & fat embolism

Ex-fix, rapid plate fixation, ?nailing

Leave minor fractures until later

55
Q

Fractures to prioritise in polytrauma?

A 
Treat only :
 	Unstable pelvic #, femoral #, tibial #
 	Injuries with vascular compromise
 	Open fractures
  	(Impending) Compartment syndrome
56
Q

Open debridement / removal of osteophytes suitable for which joints?

A

Ankle
1st MTP
Elbow

57
Q

Arthrodesis is gold standard for which joints?

A 
Hallux rigidus
Ankle
Wrist
PIP and DIPJ hand
Spine (temporarily)
58
Q

Gold standard for hallux valgus?

A

Osteotomy

59
Q

Gold standard for hallux rigidus?

A

Excision arthroplasty

60
Q

Main indication for joint replacement (lower limb)?

A

Pain relief
-May not improve ROM
(upper limb, may improve function)

61
Q

Success and survival rates for joint replacement?

A

Success rate = 80%

Lasts for 15-20 years

62
Q

Gold standard surgery for shoulder arthritis?

A

Total shoulder replacement

  • not if glenoid bone loss
  • needs intact rotator cuff
63
Q

Requirements for shoulder replacement?

A

Not if glenoid bone loss

Needs intact rotator cuff

64
Q

Reverse polarity shoulder replacement?

A

Allows fulcrum for deltoid to work
Can give decent function in difficult cases
High complication rate – glenoid loosening 25- 50%

65
Q

Scarf test

A

Acromioclavicular joint

66
Q

Maximum lifting in elbow replacement?

A 
5 kg
Total elbow replacement
 Best results for RA
 For low demand
 Max 5kg lifting
 14-25% complication rate – infection, loosening, fracture, triceps dysfunction, ulnar nerve injury
67
Q

Gold standard for wrist arthritis?

A

Fusion!! (arthrodesis)

  • maintains movement (90 degrees)
  • high complication rate
  • reduced grip strength
68
Q

DRUJ and ulno-carpal arthritis

A

Excision arthroplasty
Hemiresection arthroplasty
Fusion & osteotomy
Replacement (long term results not known)

69
Q

Treatment for extensor tendon rupture?

A

Tendon transfer

70
Q

Boutonniere and swan neck surgery treatment?

A 
Boutonniere & swan neck
 Complex! Splintage first line
 Tendon releases & reconstructions
 PIP fusion vs replacement for severe   Boutonniere
 DIPJ fusion for swan neck
71
Q

Treatment for 1st CMC joint arthritis?

A

Trapeziectomy
Good pain relief
Can have weakness pinch

Arthrodesis

72
Q

Most common cause of acquired flatfoot deformity in adults?

A

Posterior tibial dysfunction

73
Q

Primary dynamic stabiliser of medial longitudinal arch – elevates arch
Invertor & plantar-flexor

A

Tibialis posterior

74
Q

Where does the tibialis posterior attach?

A

The navicular tuberosity and the plantar aspect of the medial and middle cuneiforms

75
Q

Risk factors for posterior tibialis dysfunction?

A 
Obese middle aged female
Increases with age
Flat foot
Hypertension
Diabetes
Steroid injection
Seronegative arthropathies
Due to a tendinosis of unknown aetiology
76
Q

Pain and/or swelling posterior to the medial malleolus (very specific)

A

Posterior tibialis dysfunction

77
Q 
Pain and/or swelling posterior to medial malleolus – very specific 
Change in foot shape
Diminished walking ability/balance
Dislike of uneven surfaces
More noticeable hallux valgus
Lateral wall “impingement” pain
A

Tibialis posterior dysfunction

78
Q

Type 1-3 of posterior tibial dysfunction?

A

Type 1: no deformity
Type 2: flat foot deformity, cannot single heel raise, can see “too many toes” at side
-passively correctable!!
Type 3: rigid, deltoid ligament compromise, ANKLE PAIN

79
Q

Treatment for posterior tibialis dysfunction

A 
Physiotherapy
Insole to support medial longitudinal arch
NO steroid injections
Orthoses to accommodate foot shape
Bespoke footwear
Surgery
80
Q

Pes Cavus

A

Idiopathic commonest
Variety of other causes (mostly neurological: HSMN, CP, Polio, Spina bifida, club foot)
Often clawing of toes
Surgery if required may be complex (soft tissue releases, tendon transfers, calcaneal osteotomy, arthrodesis)

81
Q

Typical ankle sprain?

A

Lateral (anterior talofibular ligament and calcaneofibular ligament)

82
Q

5th metatarsal injury?

A
  1. Avulsion by peroneus brevis tendon (heal predictably in moonboot, do well)
  2. Jones fracture, poor blood supply, 25% risk non-union
  3. Proximal shaft (common site for stress fracture)
83
Q

Which muscle might cause an avulsion fracture of the fifth metatarsal?

A

Peroneus brevis

-this fracture will do well in a moon boot :)

84
Q

Common site for stress fracture of 5th metatarsal?

A

Proximal shaft

85
Q

Problem with jones fracture of 5th metatarsal?

A

Poor blood supply, 25% risk of non-union

86
Q

Fall from height = might fracture what?

A

Calcaneus

  • look for other injuries e.g. spinal
  • often intra-articular
  • lots of swelling
  • no proven beenfit of surgery
87
Q

Fracture following forced dorsiflexion/rapid deceleration of foot?

A

Talus fracture

-Talus has reverse blood supply, risk of AVN and OA

88
Q

Tinel’s test positive for Baxter’s nerve?

A

Plantar fasciitis

89
Q

“heel spurs” and “heel pad pain syndrome”

A

Plantar fasciitis

90
Q

Causes of plantar fasciitis?

A

overload – excessive exercise, excessive weight
Seronegative arthropathy
Diabetes – why?
Abnormal foot shape – planovalgus or cavovarus
Improper footwear

91
Q

Abnormal foot shape associated with plantar fasciitis?

A

Planovalgus, cavovarus

92
Q

Treatment for plantar fasciitis?

A 
NSAIDS
Night splints
Taping
Heel cups or medial arch supports
Physiotherapy – eccentric exercise programme
Steroid injection
Usually self-limiting over 18-24 months
Self management
93
Q

Plantar fasciitis is usually self limiting over how many months?

A

Self limiting over 18-24 months

94
Q

Splayed forefoot assoc with loss of muscle tone and age

A

Hallux valgus

95
Q

Problems with Hallux valgus?

A 
Problems
Transfer metatarsalgia
Lesser toe impingement
Pain, deformity, cosmesis
Shoe difficulties

Management
Non-operative (shoe modifications,padding)
Operative

96
Q

Operative indications for Hallux valgus?

A

Operative management
Indications – failure of non-op, pain, lesser toe deformities, lifestyle limitation, overlapping, ulceration, functional limitation
Many osteotomies (not core)
Aim to realign the hallux and decrease the HV angle

97
Q

Operation for Hallux valgus?

A

Break the bone and move the head laterally?

98
Q

Osteoarthritis of 1st MTPJ is called what?

A

Hallux rigidus?

99
Q

Drugs associated with tendo-achilles tendinosis?

A

Ciprofloxacin, steroids

100
Q

Tendo-achilles tendinosis?

A

Implicated – over-training, some drugs (cipro,steroids), CTDs
Pain, morning stiffness, eases with HEAT/walking

101
Q

Clinical features of tendo-achilles rupture?

A 
Usually over 40s
Often pre-existing tendinosis
Sudden deceleration with resisted calf contraction
Patients often think somebody has hit them
Clinically
Unable to bear weight
Weak plantar flexion
Palpable painful gap
Positive calf squeeze (Simmonds) test
102
Q

Surgery for claw, hammer and mallet toes?

A

Acquired imbalance between flexors and extensors
Can cause painful callus/corns with skin breakdown
Surgery can include tenotomies (division of tendons), tendon transfer, fusions (PIP) or amputation

103
Q

When do you refer for bow legs?

A 
If painful, asymmetry, height more than 2 SDs below normal
Not resolving
(bow legs normal under 2 years, internal tibial torsion if more than 2 years)
104
Q

Curly toes

A 
Many resolve
3rd/4th toes
6 years
No splints
Tenotomy
105
Q

Getting up from squatting

A

Meniscal tear

106
Q

Twisting injury to knee

A

ACL or meniscal tear

107
Q

Dashboard/hyperextension

A

PCL

108
Q

McMurrays

A

Meniscal provocation test

109
Q

Grade 1 sprain

A

Macroscopic structure intact

110
Q

Grade 2 strain

A

Partial tear - some fascicles disrupted

111
Q

Grade 3 strain

A

Complete tear

112
Q

LCL injury associated with which nerve injury?

A

Common peroneal nerve
-complete rupture needs urgent repair (later will need reconstruction)

(MCL usually heals with time, PCL usually damaged with other ligaments = reconstruction, if isolated, can consider leaving alone)

113
Q

Fall onto flexed knee with quads contraction

A

Extensor mechanism rupture

114
Q

Risk factors for extensor mechanism rupture?

A

Previous tendonitis, steroids, chronic renal failure, ciprofloxacin

Musculoskeletal (44 decks)

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