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Medicine > Orthopedics > Flashcards

Orthopedics Flashcards

1
Q

Give 3 early complications of a fracture?

A

DVT/PE
Compartment syndrome
Infection
Neurovascular damage

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2
Q

What is compartment syndrome?

A

This results from swelling of a muscle or bleeding within its compartment. The inability of the compartment to expand means that vessels are liable to be occluded and nerves impinged.

Can lead to Volkmanns ischaemic contracture

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3
Q

How do you manage compartment syndrome?

A

Fasciotomy of the compartments involved

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4
Q

Give 5 late complications of fractures?

A 
Mal-union, Nonunion & Delayed union 
Infection
Growth disturbance
Avascular necrosis
Myositis ossificans
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5
Q

In a neck of femur fracture, how might the leg look?

A

Shortened and externally rotated

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6
Q

What sign on examination would you expect on posterior dislocation of the femur?

A

Shortened and internally rotated

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7
Q

In an intracapsular fracture of the head of the femur, which vessel is in danger and where does it arise?

A

Medial circumflex artery from the femoral artery

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8
Q

What are the treatment options for a NoF fracture? 3 things

A

Non displaced = Cannulated screw or Dynamic hip screw

Displaced intracapsular =
Hemiarthroplasty (old, less fit, comorbidities) or THR (mobile, medically fit)

Extracapsular = Intra medullary device or DHS or Arthroplasty

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9
Q

Suggest 4 functions of the meniscus and how would you test integrity

A

Buffer between joint
Shock absorption
Lubrication
Limits flexion and extension

McMurrays test

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10
Q

In knee ligament tears, what investigations might you consider?

A

MRI

Arthroscopy

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11
Q

In a knee ligament tear/damage, what is the basic treatment and what advice would you give? 6 things

A 
RICE
Knee immobiliser
Ice
NSAIDs
Don't fully weight bear
Advice about high intensity activities
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12
Q

Give 2 early and 2 late symptoms of an ACL tear?

A

Early-Pain and swelling

Late-Arthritis and joint instability

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13
Q

What causes an ACL tear?

A

Hyper extension and inversion of the knee

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14
Q

In ACL damage, name 3 examinations that might show an abnormality?

A

Anterior draw test
Lachmans test
Pivot shift test

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15
Q

What is the surgical option for an ACL tear?

A

ACL reconstruction using graft

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16
Q

Give 3 possible complications of Arthroscopy?

A 
DVT
Infection
Excessive bleeding
Damage to cartilage
Paraesthesia over knee
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17
Q

Which 2 types of fractures only occur in children?

A

Green stick fracture

Salter Harris epiphyseal fractures

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18
Q

Give 4 aspects of the management of a fracture?

A

Resuscitation - A to E assessment & Skeletal survey for other fractures

Reduction - closed, traction or open

Restriction - maintenance of reduction (slings, plaster, external/internal fixing, functional bracing, continuous traction)

Rehabilation - Mobilise with Physio ASAP

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19
Q

In a child, give 3 features that might suggest non accidental injury?

A 
Fractures in immobile kids
Inconsistent story
Delayed presentation
Repeated injuries
Withdrawn child
Kid appears scared of guardian
20
Q

How do you test for painful arc syndrome?

A

Hawkins test

21
Q

In painful arc syndrome, where will the patient feel pain during your examination?

A

70-120 degrees during active abduction

22
Q

Which classification can you use for an open fracture?

A

Gustillo-Anderson Classification

23
Q

What is the Abx therapy in an open fracture?

A

Co-Amoxiclav and Metronidazole

24
Q

Name 3 complications of a shoulder dislocation?

A

Neurovascular damage
Bankart Lesion (glenoid labrum avulsion)
Recurrence (100-age=%)

25
Q

Give 3 predisposing factors for carpal tunnel syndrome?

A 
Diabetes
Obesity
Pregnancy
Hypothyroidism
Heavy manual work
26
Q

Give 3 symptoms of osteoarthritis?

A

Pain
Reduced ROM
Morning stiffness <30mins
Deformity

27
Q

Name the 4 characteristic findings of osteoarthritis on an X-ray?

A

Joint space narrowing
Osteophytes
Subchondral cysts
Subchondral sclerosis

28
Q

Give the aspects involved in management of osteoarthritis? 6 things

A

Conservative: Analgesia, Lifestyle changes (weight loss and exercise), physio, walking aids, steroid injections

Surgical: Arthroplasty, Arthrodesis, Osteotomy

29
Q

What is a pathological fracture?

A

A fracture through abnormal bone caused by tumour, infection, osteoporosis etc.

30
Q

Name the 5 common places where bone metastases come from?

A 
Breast
Lung
Thyroid
Kidney
Prostate
31
Q

State the phases of fracture healing?

A

Reactive phases-

  • fracture and inflammatory phase
  • Granulation tissue formation

Reparative phase

  • Callus formation
  • Lamellar bone deposition

Remodelling
-remodelling to original bone contour

32
Q

What is the T score in DEXA scanning and what is its significance?

A

Measure of how bone density compares to normal average young healthy adults’ bone density

0 to -1 = normal

  • 1 to -2.5 = osteopenia
  • 2.5 or worse = osteoporosis
33
Q

Which drugs are the best for osteoporosis and how should they be taken?

A

Bisphosphonate

Weekly
Empty stomach
Remain upright for 30mins after taking them

34
Q

Give 2 methods of preventing osteoporosis in post menopausal women?

A

Exercise
Bisphosphonates
Smoking cessation
Calcium/Vit D supplements

35
Q

Give 5 causes of delayed union of a fracture?

A 
Separation of fragments
Soft tissue between fragments
Excessive movement at site
Poor local blood supply
Smoking
36
Q

Name 4 ways you can manage carpal tunnel syndrome?

A 
Conservative-lifestyle changes (computer keyboard, machine use)
Splint
Pain relief (NSAIDs)
Carpal injection (hydrocortisone)
Surgical decompression
37
Q

What deformity can occur from a supracondylar fracture? 2 things

A

Volkmanns contracture

Gun stock deformity (cubitus varus)

38
Q

What is the Salter Harris classification? Describe the different types?

A

Classification of growth plate injuries
SALTR
Type I - (Same) - fracture of growth plate
Type II - (Above) - fracture above physis
Type III - (Lower) - fracture below physis
Type IV - (Through) - fracture through meta, epi and physis
Type V - (Rammed) - physis is rammed/crushed

39
Q

Give 4 clinical features seen in Carpal tunnel syndrome?

A

Hand of benediction
Pain - worse at night
Parasthaesia (numbness/tingling)
Muscle wasting in advanced cases

40
Q

What is the arterial supply to the head of the femur? 3 things

A

Retinacular arteries
Nutrient vessels
Artery of the ligament of the head of the femur

41
Q

What is the Gustillo Anderson classification? Describe the types?

A

Classification for open fractures

Type 1 - Open fracture with wound 1cm. Soft tissue cover adequate
Type 3a - Open fracture with extensive soft tissue damage. Cove is adequate
Type 3b - Open fracture with bone exposure and periosteal stripping.
Type 3c - Above plus arterial damage

42
Q

Give 5 factors which affect fracture healing?

A 
Bone affected
Position of fragments
Blood supply to fragments
Age and comorbidities of patient
Method of restriction (plaster or surgery)
43
Q

Give 3 signs you might see in osteoarthritis?

A 
Restricted movement
Bouchards nodes (PIPJ)
Heberdens nodes (DIPJ)
44
Q

Give 6 complications of a Total Hip Replacement?

A

Immediate:
Fat embolism
Fracture of femur

Early:
Infection
Leg length difference
Dislocation

Late:
Periprosthetic fracture
Bone stock loss

45
Q

Give 4 risk factors for developing osteoporosis?

A

Biological: Old age, female, FHx
Lifestyle: Anorexic/Slender, smoker
Endocrine: Early menopause, Amenorrhoea
Medication: Steroids

46
Q

What are the management steps in septic arthritis? 4 things

A

Analgesia
Joint washout
Empirical ABx - flucloxacillin, benzylpennicilin, gentamicin
Splint then physio

Medicine (17 decks)

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