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NAM: med / surg / specialties > ortho > Flashcards

ortho Flashcards

1
Q

management intracapsular #NOF

A

undisplaced → DHS
displaced + < 65yrs → reduction + DHS
displaced + > 65yrs + independent → total hip replacement
displaced + > 65yrs + less independent → hemiarthroplasty

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2
Q

management extracapsular #NOF

A

intertrochanteric → DHS

subtrochanteric → proximal femoral nail

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3
Q

causes of #NOF

A

osteoporosis

trauma

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4
Q

McMurray’s test: how + what does it test

A

medial meniscus: flexion + internal rotation then extension → pain / click over medial joint line
lateral meniscus: flexion + external rotation then extension → pain / click over lateral joint line

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5
Q

principles of fracture management

A
  1. resuscitation
  2. reduction: open / closed
  3. restriction: closed (plaster, traction) / fixation (internal: plates, nails / external)
  4. rehabilitation: movement + physiotherapy
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6
Q

osteoarthritis management

A

cons: exercise + physio, weight loss, orthotics / walking aids
med: analgesia (WHO ladder), steroids (intra-articular injections)
surg: arthroplasty

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7
Q

signs on exam osteoarthritis

A 
heberden's nodes (DIP)
bouchard's nodes (PIP)
squaring at base of thumb
varus / valgus deformities 
crepitus 
joint tenderness / reduced ROM
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8
Q

common joints for OA

A

weight bearing: hips, knees, shoulders

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9
Q

special tests for hip

A

trendelenburg’s: weak hip abductor causes drop on opposite side
Thomas test → fixed flexion deformity (passive hyperflexion of leg w hand under spine): NOT in pts w hip replacement (risk dislocation)

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10
Q

special tests shoulders

A

impingement: Kennedy-Hawkins (internal rotation of shoulder w elbow at 90)
supraspinatus: beer car empty
intraspinatus: external rotation against resistance
teres minor (hornblower’s): external rotation against resistance w arm in horizontal plane
subscapularis: internal rotation against resistance (Gerber lift-off test)

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11
Q

special tests knee

A

McMurray’s → menisci
anterior / posterior drawer → cruciates
valgus / varus stress tests → collateral ligaments

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12
Q

fracture complications

A 
local: 
non-union / mal-union 
injury to surrounding structures: neurovascular injury, tendon / muscle injury 
pain / restricted movement around joint
local infection

general: fat embolus, sepsis immobility → pressure sores, DVT

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13
Q

stages of fracture healing

A
  1. haematoma + inflammation
  2. soft callus formation: connective / fibrous tissue
  3. bony callus formation
  4. remodelling: osteoblasts / clasts
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14
Q

management of open fractures

A 
(resus)
extent of injuries + any associated injuries 
control haemorrhage 
neurovascular assessment 
xray 
analgesia + IV ABx + tetanus
wound irrigation (saline)  
stabilisation (external fixator) 
definitive: washout, debridement + fixation in theatres
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15
Q

RFs for fracture non-union / poor bone healing

A

infection
intercurrent disease: diabetes, malignancy
too little / too much movement
smoking

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16
Q

approaches for hip arthroplasty

A

anterolateral: risk superior gluteal nerve injury → trendelenburg gait
posterior: risk sciatic nerve injury → foot drop

17
Q

complications arthroplasty

A 
infection, bleeding, VTE
neurovascular injury 
dislocation, fracture, pain
wearing of arthroplasty 
arthrofibrosis: postoperative limitation of range of motion from scar tissue formation
18
Q

indications for hip arthroplasty

A

pts over 65 w displaced hip fracture
THR if independent (risk of dislocation w particular movements)
hemiarthroplasty if not

19
Q

types of hip arthroplasty

A
  1. Total hip replacement: replacement of femoral head + neck + acetabulum
  2. Hemiarthroplasty: replacement of femoral head + neck
  3. Hip resurfacing: replacement of surface of femoral head
20
Q

indications for knee arthroplasty

A

to reduce pain in:
osteoarthritis
inflammatory arthritis: rheumatoid, psoriatic
post-traumatic degenerative joint disease

21
Q

types of knee arthroplasty

A
  1. total knee replacement

2. unicompartmental knee replacement: if disease confined to 1 compartment

22
Q

management carpal tunnel

A

cons: physiotherapy, avoidance of repetitive movements
wrist splint
med: steroid injections
surg: carpal tunnel release (flexor retinaculum transection)

23
Q

causes of carpal tunnel

A

idiopathic
mechnical compression: repetitive movements, acromegaly
radial fracture
diabetes
inflammation: rheumatoid, gout
altered fluid balance: renal failure, hypothyroidism, pregnancy, obesity

24
Q

salter harris classification

A 
for epiphyseal fractures (paediatric) 
I: straight across (physis) 
II: above (metaphysis, most common) 
III: lower (epiphysis) 
IV: through everything (physis, metaphysis, epiphysis)
V: cRush (worst prognosis)
25
Q

dupuytren’s contractures causes / associations

A 
idiopathic
FHx 
alcoholism / liver cirrhosis
diabetes
hand trauma / manual labour
phenytoin
26
Q

management dupuytren’s contracture

A

cons: splints, physio
med: analgesia
surg: surgical resection / fasciectomy (may recur + risk of neurovascular damage)

27
Q

carpal tunnel syndrome signs on examination

A

thenar eminence wasting
motor: reduced thumb abduction
Tinel’s sign: tapping of nerve → paraesthesia in median nerve distribution
positive Phalen’s test (wrist flexion > 90degrees → paraesthesia)

28
Q

investigations for compartment syndrome

A

compartment pressures
> 20mmHg = abnormal
> 40mmHg = diagnostic

29
Q

actions of rotator cuff muscles + special tests

A

supraspinatus → abduction (inital 20degrees): empty can test (Jobes)
intraspinatus → external rotation: against resistance
teres minor → external rotation + adduction: passive w elbow at 90
subscapularis → internal rotation + adduction: Gerber lift-off test

30
Q

presentation rotator cuff impingement

A 
pain on overhead activity 
popping / snapping / grinding sensation
stiffness 
tenderness over greater tuberosity / supraspinatus
reduced ROM 
difficulty initiating abduction 
painful arc (60-120 degrees of abduction) 
\+ve empty can (Jobes) test 
\+ve Hawkins-Kennedy test

NAM: med / surg / specialties (18 decks)

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