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Pass Medicine > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

Drugs that increase risk of tendon problems?

A

Quinolones (e.g. ciprofloxacin)

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2
Q

Imaging of choice for achilles ruptures?

A

Ultrasound

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3
Q

What is a risk factor for tendon xanthoma?

A

Hypercholestolaemia

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4
Q

How might a patient describe an achilles tendon rupture?

A

Pop in the back of the foot

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5
Q

What is Simmond’s triad?

A

A triad of signs that one gets with achilles rupture.
Lie the patient down with their feet off the bed.
There will be more dorsiflexion in the ruptured foot
A gap in the tendon on ruptured foot
Squeezing the calf won’t move the foot in the ruptured leg

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6
Q

Adhesive capsulitis symptoms

A

Frozen shoulder causes a stiff and painful shoulder
External/internal rotation of the arm is difficult, so is abduction
Often in non-dominant hand

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7
Q

Risk factors for adhesive capsulitis

A

Female gender

Diabetes

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8
Q

Adhesive capsulitis treatment

A

NSAIDs
Physio
Intra-articular corticosteroid injections
Oral corticosteroids

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9
Q

What causes carpal tunnel syndrome

A

Compression of the median nerve

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10
Q

Symptoms of carpal tunnel

A

Numbness, weakness, pins and needles (in the thumb, index and middle finger)
Shaking hand relieves pain

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11
Q

What is tinel’s sign?

A

Tap on the median nerve, causes paraesthesia in carpal tunnel

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12
Q

What is phalen’s sign?

A

Flex wrists together and it reproduces symptoms of carpal tunnel

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13
Q

Treatment options for carpal tunnel?

A

Wrist splint, corticosteroid injection, surgical decompression, pain relief

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14
Q

What is lumbar spinal stenosis?

A

A narrowing of the spinal cord

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15
Q

What causes lumbar spinal stenosis?

A

Tumours
Degenerative changes
Vertebral disc prolapse

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16
Q

What are the symptoms of lumbar spinal stenosis?

A

Claudication like symptoms
Neuropathic pain
Back pain

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17
Q

What relieves symptoms in lumbar spinal stenosis?

A

Positional changes, e.g. walking up a hill, riding a bike and sitting all help reduce the symptoms

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18
Q

Lumbar spinal stenosis treatment

A

Laminectomy

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19
Q

What is osteomyelitis?

A

Infection of the bone

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20
Q

What is the most common causative organism of osteomyelitis?

A

Staph. aureus

Salmonella if the patient has sickle-cell anaemia

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21
Q

What increases osteomyelitis risk?

A 
DM
Sickle cell anaemia
IVDU
Immunosuppression
Alcohol excess
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22
Q

How do we treat osteomyelitis?

A

Flucloxacillin (6 weeks)

Clindamycin if pen allergic

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23
Q

Where is osteomyelitis most commonly found?

A

Epiphysis in adults
Metaphysis in children
(due to changing blood supply)

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24
Q

What is compartment syndrome?

A

Raised pressure within a closed anatomical space (compartment)

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25
Q

Features of compartment syndrome?

A 
Pain - especially on movement (even passive)
Parasthesiae
Pallor
Paralysis of muscle group
Pulseless
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26
Q

Can you have a pulse in compartment syndrome?

A

Yes

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27
Q

How to diagnose compartment syndrome?

A

Intracompartmental pressure measurements
Above 20mmHg is abnormal
Above 40mmHg is diagnostic

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28
Q

Treatment of compartment syndrome

A

Prompt and extensive fasciotomies (death of muscle group can occur within 4-6 hours)

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29
Q

What nerve is most likely damaged during TKA?

A

Common peroneal nerve

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30
Q

Damage to which nerves causes foot drop?

A

Sciatic and common peroneal nerve

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31
Q

Which muscle dorsiflexes the foot?

A

Tibialis anterior and extensor hallucis longus

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32
Q

What muscle plantar flexes the foot?

A

Tibialis posterior

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33
Q

What movements does extensor hallucis longus control?

A

Extension of the big toe and dorsiflexion of the foot

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34
Q

What is De Quervain’s tenosynovitis?

A

A common conditiion in which the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed

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35
Q

What are the features of De Quervain’s tenosynovitis?

A

Pain on radial side of the wrist
Tenderness over radial styloid process
Abduction of the thumb against resistance is painful

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36
Q

How do you manage De Quervain’s tenosynovitis?

A

Analgesia
Steroid injection
Immobilisation with a thumb splint (spica)
Surgical

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37
Q

What is Finkelstein’s test?

A

Examiner pulls the thumb of patient in ulnar deviation. A positive test will cause pain over the radial styloid process and along the length of extensor pollisis brevis and abductor pollicis longus

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38
Q

Lateral epicondylitis features

A

Otherwise known as tenniis elbow:
Pain/tenderness
Pain worse on wrist extension against resistance (Cozen’s test)

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39
Q

Management of lateral epicondylitis?

A

Avoid muscle overload
Simple analgesia
Steroid injectiion
Physiotherapy

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40
Q

How do we manage osteoporosis?

A

Vitamin D and calcium supplementation

Bisphosphonates: Alendronate
Risedronate (if patients can’t tolerate alendronate due to upper GI problems [usually])

Strontium ranelate/raloxifene/denosumab if patient can’t tolerate bisphosphonates

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41
Q

What are the 3 main types of cell in bone?

A

Osteoblasts (builders of bone)
Osteoclasts (resorb bone)
Osteocytes (mature, inactive osteoblasts)

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42
Q

Which vitamin is fat soluble?

A

Vitamin D

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43
Q

What is the active component of vitamin D?

A

1,25-dihydroxy-D3

It is formed from hepatic and renal hydroxylation

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44
Q

What are the two effects of 1,25-dihydroxy-D3?

A

Gut: increase calcium absorption
Bone: increase mineralisation and resorption

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45
Q

What does parathyroid hormone do?

A

Increase plasma calcium

Lowers plasma phosphate

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46
Q

Where does PTH act?

A

Gut: increases calcium absorption
Bone: Increases osteoclastic resorption of bone
Renal: Increase calcium reabsorption and phosphate excretion

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47
Q

What is osteoporosis?

A

Systemic skeletal disease in which one has low bone mass and deterioration of bone tissue, increasing likelihood of fracture

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48
Q

Risk factors for osteoporosis?

A

Maternal family history of hip fracture
Oestrogen deficiency
Corticosteroid therapy
Low BMI <19

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49
Q

How do we diagnose osteoporosis?

A

DEXA scan

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50
Q

What are the Z and T scores in DEXA scans?

A

These tell you the relative bone mineral densities

T score is compared with young mean
Z score is compared with someone of your age and gender

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51
Q

T score interpretation

A
  • 1 to 1 is normal

- 1 to -2.5 is osteopaenia

52
Q

Open vs closed fracture

A

Open fracture there is communication between the site of fracture and the exterior of the body
(This does NOT include if there is a wound at the site, it is ONLY if the wound goes to the level of the fractured bone)

Closed fracture there is no communication between the two

53
Q

What are the six common patterns of fracture?

A

Transverse fracture (horizontal across)

Oblique fracture (diagonal across)

Spiral fracture (spirals)

Comminuted (lots of pieces)

Compression fracture

Greenstick fracture (bent on one side and broken the other)

54
Q

Who commonly gets greenstick fractures?

A

Children

55
Q

What are fatigue/stress fractures?

A

Fractures without any real trauma, just progress slowly over time

56
Q

Open fractures risk

A

These are considered emergencies due to the high risk of osteomyelitis

57
Q

Open fractures treatment

A

Immediately photograph it and then cover it to prevent further contamination

Antibiotics

Arrange for urgent surgical:
Debridement
Lavage

58
Q

What are the two steps involved in managing a displaced fracture

A

Reduction

Fixation

59
Q

What does reduction involve?

A

First, you move the bone in the same direction as the original fracture force
Then, use the periosteum as a hinge to guide the two pieces back into their correct position

60
Q

Why do we first move the bone in the direction of the fracture force when reducing?

A

Allows the fracture pieces to be separated without causing further damage to the capsule or the periosteum

61
Q

What does fixation involve?

A

You need to hold the fracture in its correct place:
Simple sling
Plate and screws (if lots of fragments I guess?)
Plaster of Paris (in children sometimes)

62
Q

Complications of fractures

A 
Infection
Delayed union
Non-union
Avascular necrosis
Mal-union
Shortening
Compartment syndrome
Fat embolism
63
Q

What type of fracture is infection found in

A

Only really found in compound (open) fractures

64
Q

Which antibiotics may be prescribed to treat infection in fracture?

A

Flucloxacillin and fusidic acid

65
Q

What is delayed union

A

No arbitrary line, but if fracture is still freely mobile after 3-4 months it is considered a delayed union

66
Q

How to treat delayed union

A

Expectant

Surgical if it does not appear to be progressing (bone grafts)

67
Q

What is non-union

A

This is where a fracture remains ununited for many months with radiological evidence to suggest that union will never occur

68
Q

Radiological signs of non-union

A

Rounding of fracture edges

Fracture line becomes more clear cut

69
Q

What is pseudoarthrosis?

A

This is where a cavity appears between the fractured bones in an attempt to form a false joint

70
Q

What is in the gap between the fractured bones in non-union?

A

Fibrous tissue

71
Q

Risk factors for non-union

A 
Infection
Dead bone ends
Unfavourable mechanical environment (e.g. excessive shearing)
Soft tissue between fragments
Loss/dissolution of fracture haematoma
NSAIDs/other non-steroidal drugs
Destruction of bone (as by a tumour)
72
Q

How to treat a non-union?

A

If it doesn’t cause any problems, can be untreated

Surgical (bone grafts, prosthesis)

73
Q

What is avascular necrosis?

A

Death of bone due to a deficient blood supply

74
Q

What do bones usually develop following avascular necrosis?

A

Osteoarthritis

75
Q

Which bones are particularly susceptible to avascular necrosis?

A

Head of femur following femoral neck fracture/dislocation of the hip

76
Q

How do we diagnose avascular necrosis?

A

When fractured, bones tend to go through some osteoporosis due to disuse. If a bone has gone through avascular necrosis, it does not lose bone density like the vascularised bone. It therefore sticks out on x-ray (usually after 1-3 months)

77
Q

What might you see on imaging in later stages of avascular necrosis?

A

Collapse causing shortening and a crumbled appearance

78
Q

What is the treatment for avascular necrosis?

A

Surgery, early (ie before collapse)
Drilling of the avcascular bone to promote vascularisation
Excision of the avascular bone

79
Q

What is malunion

A

Union of fragments in an imperfect position

80
Q

Treatment of malunion

A

Detach and reattach/fixate in the correct position

81
Q

What are the 3 causes of bone shortening?

A

Mal-union
Crushing/actual loss of bone
Interference with the growth epiphysial cartilage (growth plate - only in children)

82
Q

Treatment for bone shortening?

A

If lower limb:
Corrective shoes
Shortening of other limb
Lengthening of shortened limb

83
Q

What does bone shortening typically cause

A

Back pain
Scoliosis
Hip adduction and therefore pain/osteoporosis

84
Q

Important major vessel damages to know about

A

Axillary artery in fracture/dislocation of the shoulder
Brachial artery from supracondylar fracture of humerus
Popliteal artery from dislocation of the knee/upper tibia

85
Q

Signs of major artery damage following fracture

A

Severe pain, especially on passive extension of toes/fingers

Numbness/loss of sensibility of digits

86
Q

Treatment of major vessel damage from fracture

A

Depends on whether primary or secondary (i.e. if it was caused by the fracture itself or by fixation

1 - removal of external splint/bandage
2 - reduction of any fractures
3 - if steps 1/2 fail to work <30 mins: Surgery

87
Q

Three types of nerve injury complicating fractures

A

Neurapaxia - transient physiological block. Recovery spontaneous within 3 weeks

Axonotmesis - axons badly damaged. Peripheral degen. occurs. Recovery takes months

Neurotmesis - structure of the nerve is destroyed. Requires excision and bridging with nerve graft

88
Q

What is fat embolism syndrome?

A

An uncommon, but potentially fatal complication of fractures in which there is an occlusion of vessels by fat globules

89
Q

Where do you usually get occlusion of small vessels in fat embolism?

A

Brain and lungs

Most common fracture site causing this is lower limbs

90
Q

What are other common symptoms with fat embolism?

A

Petechial rash
SOB
Tachycardia
Confusion/other cerebal side effects

91
Q

How to diagnose fat embolism

A

ABG - PO2 down

92
Q

Treatment of fat embolism

A

Spontaneously reversible if the patient makes it past the O2 deprivation period
100% O2
Methylprednisolone can reduce risk of fat embolism
Heparin can be helpful as well

93
Q

Ix of choice in avascular necrosis of hip?

A

MRI

X-ray shows osteopenia, microfractures and crescent sign (collapse of articular surface)

94
Q

How do we classify proximal femur fractures?

A

Intracapsular - neck (thinner bit)

Extracapsular - trochanteric (large bit beneath)

95
Q

Clinical features of a neck of femur fracture?

A

Hx - patient tripped and fell usually
Pain
Externally rotated leg
Shortened leg

96
Q

How can we classify neck of femur fractures?

A

Garden system

97
Q

Garden type I

A

Incomplete fracture

98
Q

Garden type II

A

Complete fracture without displacement

99
Q

Garden type III

A

Complete fracture with partial displacement

100
Q

Garden type IV

A

Complete fracture with full displacement

101
Q

Which garden types are most likely to cause blood supply disruption

A

III and IV

102
Q

Management of garden types I and II

A

Internal fixation

Hemiarthroplasty

103
Q

Management of garden types III and IV

A

Reduction and fixation
If above >70/reduced mobility:
Hemiarthroplasty/total hip replacement

104
Q

What does arthroplasty mean

A

Joint replacement

105
Q

What views are important for imaging in NOF’s?

A

AP

Lateral

106
Q

Treatment of extracapsular hip fractures?

A 
Dynamic hip screw (screw through intracapsular space)
Intramedullary device (screw down femur and through intracapsular space to the head)
107
Q

What is Colle’s fracture?

A

A fracture of the lower part of the radius

108
Q

How common is Colle’s fracture?

A

It is the most common fracture in people, particular women, over 40 years of age

109
Q

What is often the first sign of osteoporosis?

A

Colle’s fracture

110
Q

What is the mechanism of injury in a Colle’s fracture?

A

Falling on to an outstretched hand

111
Q

How do we treat Colle’s fracture?

A

Manipulative reduction under local/gen. anaesthetic

Immobile with below elbow plaster

112
Q

What sort of appearance might you see with Colle’s fracture?

A

Dinner fork appearance

113
Q

Distal fragment position in Colle’s fracture

A

Posterior displacement and tilting

114
Q

What is a Smith’s fracture?

A

A fracture of the radius in which the distal fragment is displaced forwards and tilted forwards

115
Q

Mechanism of injury in Smith’s fracture

A

Falling on to a flexed wrist

116
Q

Treatment of Smith’s fracture

A

Reduction/immobilisation with cast including elbow
Weekly check radiographs for the first 3 weeks to ensure position stays correct
Plaster for at least 6 weeks

117
Q

How can we classify ankle fractures?

A

Weber’s classification (Danis-Weber)

118
Q

Type A Weber’s classification

A 
Below level of ankle joint
The tibiofibular syndesmosis is intact
Medial malleolus often fractures
Deltoid ligament intact
Usually stable
119
Q

Type B Weber’s classification

A 
At the level of the ankle joint
Syndesmosis intact or partially torn
Medial malleolus may be fractured
Deltoid may be torn
Variable stability
120
Q

Type C Weber’s classification

A 
Above the level of the ankle joint
Syndesmosis disrupted
Medial malleolus fractured
Widening of tibiofibular articulation
Deltoid ligament injury
Unstable (requires ORIF)
121
Q

What is a syndesmosis

A

Fibrous joint between two bones linked by ligaments

122
Q

What treatment does type C Weber’s require?

A

Open reduction and internal fixation (ORIF)

123
Q

When do we x-ray an ankle?

A

Inability to weight bear for 4 steps
Tenderness over distal tibia
Tenderness over distal fibula

124
Q

Fracture of which bone is described by Weber’s classification

A

Fibula

125
Q

X-ray features in osteoarthritis

A 
LOSS
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

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