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6th Year > Ortho > Flashcards

Ortho Flashcards

1
Q

Causes of a true leg length shortening?

A 
NOF fracture
hip dislocation
developmental delay - SUFE/ Perthes
osteomyelitic
surgery
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2
Q

Causes of apparent shortening of leg length?

A

scoliosis or poor posture

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3
Q

Where is the pain in hip pathology?

A

groin

pain going to the back of the hip is usually referred from the spine

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4
Q

Causes of a positive trendelenberg

A

Wasting secondary to chronic pain
surgery damaging the superior gluteal nerve
UM/LM lesions
Developmental dysplasia of the hip

?gluteus medius weakness is root

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5
Q

What stance is common in OA

A

Varus - wide knees

valgus - knock kneed is RA

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6
Q

how does spinal stenosis present?

A

spinal claudicant like buttock or leg pain worsened by walking which eases of but is helped by flexing at the hips i.e beding forward or crouching down.
pain is rapid onset and may be associated with numbness or tingling.

generalised narrowing of the spinal canal can be worsened by osteoarthritis or may be a genetic developmental issue

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7
Q

cauda equina management?

A

MRI spine within 6 hours urgent

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8
Q

Symptoms of cauda equina syndrome?

A

Radicular pain in legs
saddle anaeshesia
incontinence of bladder and bowel
loss of anal tone

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9
Q

Acute cord compression syndrome?

A

Upper motor neurone signs in legs with LMN at the level of the lesion
back and radicular pain
sphincter disturabnce

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10
Q

Management of a tumour compressing a cord?

A

radiotherapy and steroids

discectomy or laminectomy if others

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11
Q

Tennis elbow signs?

A

lateral epicondyle

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12
Q

Golfers elbow signs?

A

medial epicondyle

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13
Q

imaging of choice for osteomyelitis?

A

MRI

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14
Q

thenar eminence nerve supply

A

median - wasting occurs in carpal tunnel

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15
Q

talipes management?

A

early surgical correction and casting

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16
Q

management of suspected compartment syndrome

A

measure compartmental pressures
fasciotomy extensive
aggressive fluid management to prevent renal failure due to myogobinurea

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17
Q

Dupytrens contracture?

A

alcoholic liver disease
phenytoin
trauma
manual labour

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18
Q

Salter harris classification of fractures?

A 
SALTCRUSH
Straight through
Above
Lower
Through
Crush
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19
Q

management of suspected scaphoid fracture - strong suspicion?

A

orthopaedic clinic urgently - may need MRI or CT scan

vascularised bone graft

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20
Q

what sign is positive with a prolapsed disc?

A

straight leg raise - therefore without this it may just be facet joint pain

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21
Q

Frozen shoulder?

A

initially painful

active and passive movements reduced with external rotation being the worst affected

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22
Q

symptoms of supraspinatus tendonitis

A

painful arc at 60-120 with tenderness on palpation

may show calcification on x ray

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23
Q

causes of carpal tunnel

A 
idiopathic
pregnancy
heart failure and odema
rheumatoid arthritis
lunate fracture
24
Q

FRAX

A

should be used in all women over 65 and men over 75 or those younger at risk of fractures.

it will inform the managemetn and say whether they require scanning DEXA or immediate management bisphos

25
Q

What is an avulsion fracture?

A

when ligament or tendon pulls off bit of bone

26
Q

What is an articular fracture?

A

involvement of the surface which interacts at the joint etc

27
Q

What benefits does reduction confer?

A

reduced pain
reduced bleeding
reduced risk of neurovascular compromise

this should be considered even before x ray in unstable patients

28
Q

What are the 4 R’s of fracture management?

A

resuscitation
reduction
restriction
rehabilitation

29
Q

what are the 6A’s of open fracture management?

A

Analgesia - M+M
Assess - Neurovasc, soft tissues
Alignment
Antisepsis - copious irrigation and cleaning
Anti-tetanus
Antibiotics - dependant on gustillo classification
fluclox/1st gen cephalosporin (cephalexin)

debride and fix in theatre
cross match 2 units in tibial fracture and 4 units in femoral fracture

30
Q

What medications should be given to protect against clostridium perfrigens

A

ben pen, clindamycin

31
Q

Main complication of open fractures?

A

gas gangrene - clostridial myonecrosis

causes shock and renal fauilure - muscle necrosis and sepsis

32
Q

What are the indications for open reduction?

A 
open fracture
intra articular
more than 1 fracture int he same limb
requirement for accurate reduction
failed conservative rx
33
Q

What are the benefits of fixation?

A

Reduces pain, increases stability, increases patient functionality, decreases strain on the healing bone therefore improving healing process.

34
Q

Difference between internal and external fixation?

A

EX - better for allowing infection resolution in open fractures. less risk of compartment synrome and infecion

internal(pins plates, screws, nails) - allow perfect alignment, mobilise quickly

35
Q

what is neuropraxia?

A

temporary loss of nerve conduction without axonal damage

36
Q

What are the clinical findings in compartment syndrome?

A

increased pain on passive stretching of muscles
pain which is much greater than the clinical findings.
warm, red swollen limb.

mx - elevate, remove bandages, fasciotomy

37
Q

5Is of delayed or nonunion (mal means bad)

A 
Infection
Inflamation secondary to underlying diseasemalignancy?
Ischemia - poor supply
interfragmental strain
interspersed tissue
38
Q

Name 3 common sites of AVN?

A

Scaphoid
femoral head
talus

Also occurs in Sicklecell, SLE, steroid use

39
Q

salter harris types?

A 
SALT Crush
Straight 
above
lower
Trhough
Crush
40
Q

Risk factors for osteoporosis?

A 
Age+female +SHATTERED
Steroid
Hyperpara/thyroidism
Alcohol and cigarettes
Menopause early
BMI/testosterone low
Liver/renal failure
41
Q

What is the prognosis after hip fracture?

A

30 percent mortality at 1yr

50% dont recover premorbid function

42
Q

different management for unidirectional and multidirectional recurrent shoulder instability?

A

uni - surgery

multi - rehab (may require inferior capsular shift)

43
Q

Which motion is restricted most in adhesive capsulitis?

A

external rotation <30deg

absuction too

44
Q

Weber classification?

A

to classify distal fibula fractures
A below syndesmosis - POP/boot
B involving syndesmosis
C above synd.

B/C boot/pop unless displaced in which case closed reduction and pop

45
Q

What are the causes of a knee haemarthrosis?

A

most common ACL tear

1- Coagulopathy - warfarin/haemophilia

2-Trauma
ACL -80%
Patella dislocation 10%
outer meniscal injury

46
Q

What is the management for knee injuries?

A

x ray to ensure no fractures
Rest elevate, ice, compression
MRI to check for ligament or meniscal damage

47
Q

What is the management for ACL tear?

A

Prehab
repair using harvest of semitenonosus/gracilis/patella tendon
held using screws?

48
Q

What is osteoarthritis

A

Pathological process of joints, whereby softening of articular cartilage leads to eventual loss of cartilage and joint space, leading to ossification and fibrosis of the articular surfaces, resulting in painful damage within the joint capsule?

49
Q

What is osteochondritis dissecans?

A

small piece of bone falls into the joint space requiring arthroscpic removal

50
Q

What are the risk factors for osteomyeltitis

A 
D VITS
diabetes
vascular diesease
Immunosuppression
Trauma
Sickle Cell disease - salmonella

children - rich blood supply?

51
Q

workup for osteomyelitis?

A

CRP, WCC, ESR
blood cultures - 60% pos
xray

MRI - gold standard

52
Q

most common infective agent in osteomyeltis and septic arthritis?

A

staphylococcus

53
Q

Management of septic arthritis

A

WCC CRP ESR
Blood cultures
xray
aspiration - MC and S

54
Q

Management for oseomyelitis and septic arthritis

A

Debridement/washout where possible or if required
IV vanc and Cefotaxime
analgesia
physio after

55
Q

Complications of septic arthritis?

A

For the Attention Of
FAO

Fusion
Arthritis
Osteomyelitis

56
Q

most common bone tumour?

A 
secondary metastasis from:
bronchus
thyroid
kidney
breast
prostate

6th Year (19 decks)

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