Injury + Surgery Flashcards
(489 cards)
1
Q
what is the pathogenesis of avascular necrosis of the femoral head?
A
- increased venous pressure in femoral head
- pressure cuts off arterial supply
2
Q
what are the 3 zones of cartilage?
A
superficial zone
transitional zone
deep zone
3
Q
what is the orientation of the cartilage fibres in the superficial zone?
A
parallel to the surface
4
Q
what is the orientation of the cartilage fibres in the transitional zone?
A
randomly orientated
5
Q
what is the orientation of the cartilage fibres in the
A
perpendicular to the surface
6
Q
what section of the cartilage must the damage reach for healing to occur?
A
the tidemark
7
Q
what cartilage type is the hyaline cartilage replaced with during healing?
A
fibrocartilage
8
Q
what is protrusio?
A
when the femur starts to protrude into the acetabulum itself
9
Q
which is protrusio more common in- RA or OA?
A
rheumatoid arthritis
10
Q
what is an osteotomy?
A
a controlled cut of the bone in order to realign or redistribute weight
11
Q
what is a CAM bony feature of the hip joint? (abnormal)
A
a bigger bump of the femoral neck (no normal taper)
12
Q
what is a pincer bony feature of the hip joint? (abnormal)
A
extra bone on the lateral side of the acetabulum
13
Q
what is the surgical treatment of an asymptomatic pincer or CAM feature on a hip joint?
A
nothing
14
Q
what is the surgical treatment of a symptomatic pincer or CAM feature on a hip joint?
A
shaving of the area of bone to reshape
15
Q
what is the surgical management of early avascular necrosis?
A
decompression
drill a hole to let pressure escape
16
Q
what are the 3 main non-surgical managements of an arthritic hip joint?
A
weight loss
analgesia
physiotherapy
17
Q
when is proprioception more of an issue- hip or knee replacements?
A
knee replacements
18
Q
compare hip arthritis pain to trochanteric bursitis pain?
A
hip arthritis pain: generalised achy pain, tender over groin
trochanteric bursitis: localised lateral hip pain, not tender over groin
19
Q
why can only the peripheral 1/3 of a meniscus be expected to heal?
A
only the peripheral 1/3 has a blood supply
the rest of the meniscus is avascula
20
Q
compare the medial and lateral menisci in terms of mobility?
A
medial menisci- fixed
lateral menisci- more mobile
21
Q
which compartment does the knee mainly pivot on during flexion and extension?
A
medial compartment
22
Q
due to the knee mainly pivoting on the medial compartment during flexion and extension, what way does the tibia slightly rotate during each movement?
A
flexion- slight internal rotation
extension- slight external rotation
23
Q
why is the medial meniscus under greater stress than the lateral menisci?
A
because pivoting of the tibia mainly occurs on the medial compartment
24
Q
which menisci is more likely to tear- medial or lateral?
A
medial menisci
25
what ligament in the knee is the main resistor of valgus stress?
medial collateral ligament
26
what ligament in the knee is the main resistor of varus stress?
lateral collateral ligament
27
what ligament in the knee is the main resistor of anterior subluxation of the tibia?
anterior cruciate ligament
28
what ligament in the knee is the main resistor of posterior subluxation of the tibia? (ie anterior subluxation of the femur)
posterior cruciate ligament
29
what ligament is the main resistor of excessive internal rotation of the tibia?
anterior cruciate ligament
30
what ligament is the main resistor of hyperextension of the knee?
posterior cruciate ligament
31
what ligaments are the main resistor of external rotation of the tibia?
posterolateral corner ligaments
32
what is the posterolateral corner made of
posterior cruciate ligament
lateral collateral ligament
smaller ligaments
popliteus
33
compare the medial and lateral collateral ligaments in terms of capacity to heal?
MCL- great capacity to heal
| LCL- poor capacity to heal
34
what type of instability may a MCL rupture lead to?
valgus instability
35
what type of instability may a ACL rupture lead to?
```
rotatory instability
(excessive internal rotation)
```
36
what type of instability may a PCL rupture lead to?
recurrent hyperextension
or
instability when descending staids
37
what type of instability may a posterolateral corner rupture lead to?
varus instability
and
rotatory instability [excessive external rotation]
38
when must a longitudinal tear in a meniscus be in order to heal?
peripheral
39
how do younger patients get meniscal tears?
trauma-
sporting injury (usually twisting)
getting up from squatting position
40
how do older patients get meniscal tears?
atraumatic spontaneous degenerate tears
41
what are 50% of ACL tears accompanied by?
meniscal tear
42
what is the investigation of choice for a suspected meniscal tear?
MRI
43
what main type of meniscal tears do not heal?
radial tears
44
when do you consider a arthroscopic menisectomy?
for meniscal tear with:
- mechanical symptoms (eg painful catching or locking)
- irreparable tears
- failed meniscal repair
45
what type of menisci tear can give you an acute locked knee?
bucket handle tear
46
what is the treatment for acute locked knee due to a bucked handle tear?
urgent surgery
| -arthroscopic repair
47
what will happen to the knee of a patient with acute locked knee if the knee remains locked?
fixed flexion deformity
48
if the acute locked knee is irreparable, what is the next step to unlock the knee and prevent further damage?
partial menisectomy
49
what type of patients is surgery for degenerative meniscal tears reserved for?
patients with mechanical symptoms
| not solely for pain
50
what is the grading system of ligament injuries?
grade 1 - sprain, some fibres are torn but all macroscopic structures intact
grade 2 - partial tear, some fascicles disrupted
grade 3 - complete tear
51
what type of injuries cause MCL tears?
valgus stressing injuries
52
what is the main treatment of MCL tears?
bracing, early motion and physio
| rarely require surgery
53
what type of injuries cause ACL tears?
twisting injuries
54
what type of injuries causes LCL tears?
varus stressing injuries
| hyperextension injuries
55
what type of injuries cause PCL tears?
direct blow to anterior tibia
| hyperextension injuries
56
what type of surgery is used for the treatment of an ACL tear?
ACL reconstruction with a graft
| ACL repair doesnt work
57
what is the most commonly used graft for ACL reconstruction?
autograft from hamstringe tendon
58
how can physiotherapy help to stabilise ACL deficient knees?
builds up the surrounding muscles
59
what is the ACL rupture rule of thirds?
1/3 patients compensate and are able to function well (no surgery needed)
1/3 patients can avoid instability by avoiding certain activities (no surgery needed)
1/3 patients do not compensate and have freq instability or cannot gt back into high impact sport (surgery might be needed)
60
what is the role of surgery (ACL reconstruction) in ACL rupture?
consider when:
- rotatory instability does not respond to physiotherapy
- young adult/adolescent
- patient keen on high impact sport
- when a meniscal repair also has to be done
61
does ACL reconstuction affect future osteoarthritis risk?
if you rupture your ACL you will get osteoarthritic changes within 10 years, regardless of surgery
ACL reconstruction may even accelerate the osteoarthritic process
62
what nerve is commonly affected in LCL injury?
```
common fibular (peroneal) nerve
[palsy]
```
63
what is the treatment for a complete LCL rupture?
urgent repair (within 2-3 weeks)
64
where does knee pain and bruising occur in a PCL rupture?
popliteal fossa
65
when does PCL require reconstruction?
if part of a multiligament knee injury
| this is more common than isolated PCL ruptures
66
what are the 3 major complications of knee dislocation?
- popliteal artery tear
- nerve injury (common fibular)
- compartment syndrom
67
what needs to be done ASAP with a knee dislocation?
emergency reduction
| check neurovascular status
68
why do you only operate on a knee dislocation a few weeks after the trauma?
wounds don't close so leave fracture blisters
69
what are the 4 main causes of weakened tendons that can lead to extensor mechanism rupture?
- previous tendonitis
- steroids
- chronic renal failure
- drugs (eg ciprofloxacin)
70
what is the main clinical test that indicates extensor mechanism rupture?
unable to perform straight leg raise
71
what is the treatment of extensor mechanism rupture?
surgical repair
72
what does a pop at the time of knee trauma suggest?
ACL rupture
73
what does a haemarthrosis (within an hour) within the knee joint suggest?
ACL rupture
74
what does an effusion (within a day) within the knee joint suggest?
meniscal or chondral injury
75
why can haemarthrosis cause generalised knee pain?
blood is an irritant to the knee capsule
76
why does ACL rupture cause a haemarthrosis?
because the ACL has a big blood vessel through it which can rupture
77
what does knee locking suggest?
bucket handle meniscal tear
78
what does localised pain on joint line suggest?
meniscal tear
79
what are the 4 main substances which comprise hyaline cartilage?
water
collagen
proteoglycans
chondrocytes
80
what type of strength do the proteoglycans provide the hyaline cartilage with?
compressive strength
81
what type of strength does the collagen provide the hyaline cartilage with?
tensile strength
82
how do the proteoglycans provide compressive strength to hyaline cartilage?
hydrophillic so attract water and expand like a balloon
83
what are the 2 main categories of articular cartilage defects?
traumatic
| atraumatic
84
what are the 3 main subgroups of atraumatic articular cartilage defects?
- osteochondritis dissecans
- osteoarthritis
- inflammatory arthritis
85
what is osteochondritis dissecans?
a joint condition causing necrosis of subchondral bone due to lack of blood supply
the bone and cartilage fragment can then break free and cause pain/hinder joint motion
86
who most commonly gets osteochondritis dissecans?
adolescence
87
what is the name of the surgical techniques used for a defect in the articular cartilage (that wont heal itself)?
cartilage regeneration techniques
88
what are the 4 main cartilage regeneration techniques?
- drilling/ microfracture
- osteochondral autograft/allograft
- mosaicplasty
- membrane-induced autologous chondrocyte implantation (MACI)
89
what is the purpose of drilling/ microfracture for the treatment of a defect in articular cartilage?
causes bleeding which stimulates stem cells to come in and differentiate into chondroblasts
(cartilage regeneration technique)
90
what is osteochondral autograft or allograft?
taking cartilage from other areas of the bodyfrom donors
91
what is mosaicplasty?
taking small fragments of cartialge from low-weight bearing surfaces and inserting them into the bigger section of defective cartilage
92
which of the cartilage techniques is used in the NHS?
microfracture
| simplest and cheapest technique
93
compare the causes of shoulder pain of a young adult, middle aged adult or elderly adult?
young adult- instability
middle aged- rotator cuff tear or frozen shoulder
elderly- glenohumeral OA
94
what is impingement syndrome?
when the tendons of the rotator cuff muscles (especially supraspinatus) are compressed within the tight subacromial space during movement producing pain
95
why does a patient with impingement syndrome typically have a painful arc between 60 to 120 degrees of abduction?
painful as the inflamed area of supraspinatus tendon passes through the subacromial space
96
what are the 3 main causes of impingement syndrome?
- tendonitis subacromial bursitis
- acromioclavicular OA with inferior osteophyte
- a hooked acromion
97
what are the 2 clinical tests for suspected impingement syndrome?
painful arc
| Hawkins-Kennedy test
98
what is the first line treatment of impingement syndrome?
NSAIDs
analgesics
physio
subacromial steroid injections
99
if non-operative management of impingement syndrome is ineffective, what surgical management can be carried out?
subacromial decompression surgery
100
what is the non-operative management for rotator cuff tears?
physiotherapy and subacromial steroid injections
101
what is the operative management for rotator cuff tears?
rotator cuff repairs with subacromial decompression
102
why do rotator cuff repairs fail in a 3rd of patients?
the tendon is usually disease or retracted too far
103
why do middle aged patients commonly get rotator cuff tears?
because rotator cuff muscles can tear with minimal or no trauma as a consequence of degenerate changes in te etendons
104
what are the 3 muscles most commonly involved in rotator cuff tears, and which out of theses is the most common?
supraspinatus (most common)
subscapularis
infraspinatus
105
how are rotator cuff tears confirmed?
ultrasound or MRI
106
what is frozen shoulder?
when the capsule and glenohumeral ligaments become inflamed and so thicken and contract
(adhesive capsulitis)
107
what is the principle clinical sign of frozen shoulder?
loss of external rotation
108
what are the 3 conditions associated with frozen shoulder?
diabetes
hypercholesterolaemia
dupuytren's disease
109
how long does frozen shoulder usually last?
18-24 months
| pain first, then stiffness
110
what is acute calcific tendonitis?
calcium deposition in the supraspinatus tendon which causes acute severe shoulder pain
111
what can you see on xray of acute calcific tendonitis?
calcium deposition in the supraspinatus tendon just proximal to the greater tuberosity
112
how is acute calcific tendonitis managed?
pain relief- subacromial steroid and local anaesthetic injections
(condition is self-limiting)
113
what are the 2 types of shoulder instability?
traumatic
| atraumatic
114
in traumatic instability of the shoulder what direction of dislocation mainly occurs?
anterior dislocation
115
in atraumatic instability of the shoulder what direction of dislocation occurs?
multidirectional
| inferior, anterior or posterior
116
what type of patients get atraumatic instability of the shoulder?
patients with generalised ligamentous laxity
117
what surgical treatment can be done for a patient with a shoulder dislocation which didn't stabilise? (ie now has instability)
bankart repair
(open or arthroscopic)
which reattaches the labrum and capsule to the anterior glenoid
118
what forms the carpal tunnel?
the carpal bones of the wrist and the flexor retinaculum
119
what nerve passes through the carpal tunnel?
median nerve
120
what is the cause of carpal tunnel syndrome?
median nerve compression in the carpal tunnel
121
why can rheumatoid arthritis cause secondary carpal tunnel syndrome?
synovitis causes reduced space which causes compression of the median nerve
122
why do conditions sch as pregnancy, diabetes, chronic renal failure and hypothyroidism cause secondary carpal tunnel syndrome?
fluid retention which causes compression of the median nerve
123
who is more affected by carpal tunnel syndrome-F or M?
females
124
fractures of the wrist/around the wrist can cause carpal tunnel syndrome, what particular fracture is especially likely?
colles fracture
125
what do patients with carpal tunnel syndrome present with?
parasthesia (tingling), loss of sensation or clumsiness in the median nerve innervated digits (thumb and radial 2.5 fingers)
126
what are the 2 tests which reproduce the symptoms of carpal tunnel syndrome?
tinel's test
| phalen's test
127
what is tinel's test?
percussing over the median nerve (or ulnar nerve)
| if positive, this will reproduce the symptoms of carpal tunnel syndrome (or cubital tunnel syndrome)
128
what is phalen's test?
holding the wrists hyper-flexed
| if positive this will reproduce the symptoms of carpal tunnel syndrome
129
how do you confirm the diagnosis of carpal tunnel syndrome?
nerve conduction studies
130
what are the non-operative ways to manage carpal tunnel syndrome?
night splints to prevent flexion
| corticosteroid injections
131
what is the surgical management of carpal tunnel syndrome?
carpal tunnel decompression
132
what does carpal tunnel decompression involve?
division of the transverse carpal ligament under local anaesthetic
133
what is the cause of cubital tunnel syndrome?
compression of the ulnar nerve in the cubital tunnel
134
what do patients with cubital tunnel syndrome present with?
paraesthesia in the ulnar 1.5 fingers and weakness of the muscles innervated by the ulnar nerve
135
what tests can be used for detecting cubital tunnel syndrome?
tinel's test (of cubital tunnel)
| froment's test
136
what does Froment's test assess?
weakness of the adductor pollicis
| seen in cubital tunnel syndrome
137
why might there be compression of the ulnar nerve in the cubital tunnel?
due to a tight band of fascia forming over the roof of the tunnel (osborne's fascia)
or
tightness at the intermuscular septum as the nerve passes between the two heads of flexor carpi ulnaris
138
how is he diagnosis of cubital tunnel syndrome confirmed?
nerve conduction studies
139
what causes lateral epicondylitis?
-repetitive strain
-degenerative enthesopathy
causing microtears in common extensor origin
140
what is an enthesopathy?
inflammation at the origin or insertion of a tendon or ligament into bone
141
what are the clinical features of lateral epicondylitis?
painful and tender lateral epicondyle
| pain on resisted middle finger and wrist extension
142
what is the treatment of lateral epicondylitis?
```
usually resolves with:
period of rest
NSAIDs
steroid injections
elbow clasp
(ultrasound therapy)
surgical treatment of refractory cases
```
143
what causes medial epicondylitis?
-repetitive strain
-degenerative enthesopathy
causing microtears in comon flexor origin
144
which is more common- medial or lateral epicondylitis?
lateral epicondylitis
145
why can steroid injections not be used in the treatment of medial epicondylitis?
risk of ulnar nerve injury when injectinf this area
146
what is the surgical treatment of RA/OA of the elbow which has failed non-operative management?
surgical excision of the radial head
or
total elbow replacement
147
what is the major con of total elbow replacement?
lifting weight restriction of 2.5kg
148
what are dupuytren's contracture?
a proliferative connective tissue disorder where the specialised palmar fascia undergoes hyperplasia
normal bands form nodules and cords and progress to contractures
149
which joints are commonly affected in dupuytren's contractures?
MCP and PIPs of ring finger and little finger
150
in dupuytren's contractures, what type of cells proliferate and what abnormal substance do they produce?
myofibroblast cells
abnormal type 3 collagen (should be type 1)
151
who more commonly gets dupuytren's contractures- M or F?
males
152
dupuytren's contractures can sometimes be familial, what sort of inheritance is it?
```
autosomal dominant
(with variable penetrance)
```
153
what condition can dupuytren's contractures be a feature of?
alcoholic cirrhosis
154
what drug can dupuytren's contractures be a side effect of?
phenytoin
155
what population with a chronic condition is dupuytren's contractures seen more commonly in than the normal population? (ignoring other fibromatoses)
diabetics
156
up to what degrees of contracture in dupuytren's contractures can be tolerated at the MCP and the PIP joints?
MCP can tolerate 30 degrees
PIP readily stiffens (any contracture here is usually an indication for surgery)
157
what are the indications of surgery for dupuytren's contractures?
- contractures interfering with function
| - PIP joint involvement
158
what is the surgical treatment of dupuytren's contractures?
```
fasciectomy (removal of diseased tissue)
or
fasciotomy (division of cords)
or
amputation
```
159
what is trigger finger?
tendonitis of a flexor tendon causing a nodular enlargement distal to the A1 fascia pulley of the metacarpal neck
movement of finger causes clicking noise
160
why does movement of a trigger finger cause clicking?
clicks happen as the nodle catches on and then passes underneath the A1 pulley
161
why can a trigger finger lock in a flexed position?
nodule passes under the pulley but can go back through on extension
162
what is the treatment for trigger finger?
steroid injections
| surgery for persistent cases (division of A1 pulley to allow tendon to move freely)
163
what is arthrodesis?
artificial ossification of two bones at a joint (fusion)
164
what is arthroplasty?
surgery to restore integrity of a joint
| an artificial joint can be used, or bones might just be resurfaced
165
what surgical technique can be done to prevent tendon rupture in a RA patient?
tenosynovecomy (excision of synovial tendon sheath)
166
what is the surgical treatment for the rupture an extensor tendon to the wrist/fingers in a patient with RA?
```
tendon transfer
joint fusions
(repair is not possible)
```
167
why do all total hip arthroplasty eventually fail?
due to loosening of the prosthetic components
168
what is revision hip replacement?
a re-do replacement after a hip replacement has failed
| more complex than first time hip replacement
169
if avascular necrosis of the femur head is detected early (pre-collapse) what is the treatment?
decompression by drilling holes into the abnormal area
170
if avascular necrosis of the femur head is detected late (collapse) what is the treatment?
only option is total hip replacement
171
what injury does a direct blow to the anterior tibia with the knee flexed suggest?
PCL rupture
172
what confirms the diagnosis of a meniscal tear?
MRI
173
what is the treatment for a traumatic meniscal tear?
- repair (doesn't usually work)
| - partial menisectomy
174
why should a degenerative meniscal tear not be treated with a menisectomy?
removal of meniscal tissue may cause increase stress on already worn surfaces
175
how can chronic MCL instbility be treated? (ie MCL hasn't healed)
MCL tightening or reconstruction with tendon graft
176
why are regular checks of the foot circulation essential after a knee dislocation?
intimal tears can later thrombose
| Vacular stenting or by-pass would be required
177
in a knee dislocation, what ligaments are torn?
ACL, PCL, MCL and LCL
178
after prolonged ischamia due to a knee dislocation, what may reperfusion result in? (and how can this be treated)
compartment syndrome
| fasciotomy
179
what is the most likely extensor mechanism of the knee rupture in a patient under 40?
patellar tendon rupture
180
what is the most likely extensor mechanism of the knee rupture in a patient over 40?
quadriceps tendon rupture
181
why should steroid injections for tendonitis of the extensor mechanism of the knee be avoided?
high risk of tendon rupture
182
how do you determine whether the extensor mechanism of the knee is intact?
straight leg raise
183
what is the treatment of complete or substantial partial tears of the knee? extensor
surgical treatment (tendon repair or reattachment)
184
what is patellofemoral dysfunction?
a group of disorders of the patellofemoral articulation resulting in anterior knee pain
185
what is chondromalacia patallae?
softening of the hyaline cartilage around the patella
| patellofemoral dysfunction
186
what exacerbates the anterior knee pain of pseudofemoral dysfunction?
going downhill
187
what does physiotherapy of pseudofemoral knee dysfunction aim to do?
rebalance quadriceps
| strengthens vastus medialis
188
what type of locking does patellofemoral dysfunction cause?
pseudo-locking
| knee acutely stiffens in flexed position
189
what direction does the patella almost always dislocate in?
lateral direction
190
what type of fluid builds up within the knee joint after patellar dislocation?
lipo-haemarthrosis
191
how does the risk of recurrent instability vary with age?
risk decreases as age increases
192
what is hallux valgis?
a deformity of the great toe where 1st metatarsal moves medially and big toe moves laterally
193
who is hallux valgis more common in- M or F?
females
194
why does a bunion form over the medial 1st metatarsal head in hallux valgus?
medial aspect of 1st metatarsal will end up rubbing on shoes resultin in inflamed bursa
195
what may happen to the second toe with hallux valgus?
1st toe may override it
| ulceration and skin break down (due to rubbing)
196
surgical treatment of hallux valgus should be considered with caution, what is the treatment?
osteotomies to realign bones
and
soft tissue procedures to tighten slack tissues and release tight tissueshallu
197
what is hallux rigidus?
OA of the 1st MTP joint
198
what is the gold standard surgical treatment of hallux rigidus?
arthrodesis (fusion)
199
what does arthrodesis of hallux rigidus prevent women doing?
wearing heels
200
what is the surgical management of morton's neuroma?
excision
201
where do metatarsal stress fractures most commonly occur?
2nd metatarsal most commonly
| followed by 3rd metatarsal
202
what is the treatment for metatarsal stress fractures?
rest for 6-12 weeks in a rigid soled boot
203
what is achilles tendonitis caused by?
repetitive strain or degenerative process (microtears)
204
what is the treatment of achilles tendonitis?
rest, physio, heel raise, splint or boot
resistant cases may benefit from tendon decompression
205
why should steroid injections not be administered around the achilles tendon?
risk of rupture
206
what age groups does achilles tendon rupture tend to occur in?
middle aged or older groups
207
what clinical signs are present in achilles tendon rupture?
weakness of plantar flexion
palpable gap in tendon
simmonds test positive
208
what is simmonds test?
squeeze calf and ask patient to plantar flex
positive test if no plantarflexion
(achilles tendon rupture)
209
what is plantar fasciitis caused by?
repetitive stress or degenerative
210
what tendon do flat footed people have a higher risk of tendonitis of?
posteiror tibialis tendon
211
what are the 3 most coommon causes of acquired flat foot?
- posterior tibialis tendon rupture or stretch
- RA
- diabetic neuropathic joint destruction
212
how is pes cavus treated?
if supple: soft tissue release and tendon transfer
if rigid: calcaneal osteotomy
severe cases may require arthrodesis
213
explain claw toes?
hyperextension at MTPJ
hyperflexion at PIPJ
hyperflexion at DIPJ
214
explain hammer toes?
hyperextension at MTPJ
hyperflexion at PIPJ
hyper extension at DIPJ
215
what is the surgical treatment of claw or hammer toes?
tenotomy (division of overactive tendon)
tendon transfer
arthrodesis (esp of PIP joint)
toe amputation
216
where does pain from achilles tendonitis present?
achilles tendon itself
| insertion on calcaneus
217
what is the Heston table top test?
where the patient is asked to place their palm flat on the table
failure to do so- fixed flexion contracture at MCPJs (quick screening tool for whether patient with dupuytren's may benefit from surgical management)
218
what are ankle fractures most commonly cause by?
twisting forces (commonly inversion or twisting on a planted foot)
219
what Weber's classification indicated the ankle fracture is definitely unstable?
Weber's C
220
what means an ankle fracture is unstable?
talar shift
221
if an ankle fracture is stable (ie no talar shift) what is the treatment?
cast or boots
222
if an ankle fracture has no talar shift but is a suspected fracture what is the treatment?
cast or boots and X-ray again in a week to see if talus has shifted
223
what are the 2 types of giant cell tumour of the tendon sheath?
(and which is most common)
localised and diffuse
localised is more common
224
what is the presentation of a giant cell tumour of the tendon sheath?
firm, discreet swelling on volar aspect of digits
225
what is the managment of giant cell tumout of tendon sheath?
usually left alone
| if functional issue- marginal excision
226
what is the treatmend of acromioclavicular joint dislocation?
conservatively with NSAIDs, analgesics and steriod or local anaesthetic injections
227
what is the mainstay of treatment of a frozen shoulder?
physio
228
what part of the glenoid labrum is damaged in a SLAP tear?
superior labrum
229
why do young people rarely get rotator cuff tears?
because normal, healthy rotator cuff muscles don't tear (even with trauma)
230
what is the difference between a painful arc and crescendo arc?
painful arc- pain on abduction from around 50- 120 degrees (no pain at the very top) : think rotator cuff impingement
crescendo arc- increasingly painful as you abduct : think ACJ pathology
231
what biglaini grading is a hooked acromion?
biglaini grade 3
232
as the biglaini grade increases what happens to the risk of impingement?
risk of impingemnet increases
233
when are reverse arthroplastys used?
massive rotator cuff tears
234
what is the purpose of a bankart repair?
fixes the defect in the glenoid labrum to prevent from recurrent dislocation
235
which is always abnormal on x-ray of elbow- anterior or posterior fat pad?
posterior fat pad
236
why can anterior and posterior fat pads of the elbow be displaced?
elbow joint effsion
237
why is the growth plate of a bone prone to injury? (ie in children's bone)
the growth plate is the weakest part of the developing bone
238
what is a Salter-Harris fracture?
a fracture that involves the growth plate of a bone (physis)
239
what is a hemiarthroplasty?
only replace one side of the joint
| ie operate on humeral head, leave glenoid alone
240
who tends to get radial buckle fractures?
children with soft bones
241
who tends to get scaphoid fractures?
young males
242
where is the most common area of the scaphoid to fracture?
the mid-scaphoid (waist)
243
what is a bennett's fracture?
a fracture of the base of the first metacarpal bone which extends into the carpometacarpal joint (nearly always associated with subluxation of the carpometacarpal joint)
244
what is the most common fracture of the thumb?
a bennett's fracture
245
why can lower limb fractures appear sclerotic?
because they often involve axial force with bone impaction
246
what direction do hips typically displace in?
posterior direction
247
compare treatment of intra-capsular femoral fractures to extra-capsular femoral fractures?
intra-capsular: hemiarthroplasty (young person- reduction and screw fixation may help)
extra-capsular: internal fixation
248
what space does the effusion accompanied by significant knee soft tissue tend to fill?
the suprapatellar space
249
lipohaemarthrosis collecting within the suprapatellar recess of is a specific sign of what type of fracture?
(can be seen on x ray)
an intra-articular fracture
250
what condylar side is most commonly fractured in a tibial plateau fracture?
lateral condyle fracture
251
how do you treat swan-necking?
splintage
252
when fusing a joint what is the main pro and what is the main con?
- reduced pain
| - reduced range of movement
253
when fusing the wrist joint, what movements are taken away? (but what movements remain?)
flexion /extension removed
pronation and supination remain
254
what type of movement is especially lost in glenohumeral joint OA?
external rotation
255
what is a hemiarthroplasty?
only operate on one side of the joint
| ie operate on humeral head, leave glenoid alone
256
what is the most common operation for glenohumeral OA?
hemiarthroplasty
| -resurfacing the humeral head
257
what does a reverse arthroplasty allow the deltoid to do?
to initiate abduction (ie without the supraspinatus)
258
what are the 4 main surgical strategies for the management of an arthritic joint?
1. arthroplasty (joint replacement)
2. excision or resection arthroplasty
3. arthrodesis
4. osteotomy
259
why will a joint replacement eventually fail?
will eventually either loosen or the components will break down
260
what can metal within the joint replacement cause?
can cause the formation of inflammatory granulomas (pseudotumours) which lead to muscle and bone necrosis
261
what can polyethylene within the joint replacement cause?
an inflammatory response within the bone causing osteolysis which leads to loosening
262
what can ceramics within the joint replacement cause?
shattering of the joint replacement
263
what is the treatment of a deep joint infection if diagnosed within the first 2-3 weeks?
surgical washout and debridement
+ prolonged parenteral antibiotics
(in attempt to salvage joint)
264
what is the treatment of a deep joint infection if diagnosed after 3 weeks';
removal of infected implants and all foreign material
6 weeks with no joint and parenteral antibiotics
re-do joint replacement once infection is under control
265
what is an excision or resection arthroplasty?
removal of bone and cartilage of one or both sides of a joint
266
what do the vast majority of soft tissue inflammatory problems settle with?
rest, analgesia and anti-inflammatory medications
267
what is surgical debridement?
removal of diseased tissue
268
what is radiculopathy caused by?
compression or irritation of a nerve as it exits the spinal column
269
why is a flexor tendon sheath infection a surgical emergency?
can cause loss of finger function (which could be permanent)
270
what is the management of flexor tendon sheath infection?
wash out tendon sheath
271
what is a laceration?
blunt wound with a break in the skin
272
how do you relieve the pressure of a subungual haematoma?
heat a paper clip and use it to melt through the nail
273
what finger is fractures in a boxers fracture?
little finger
274
what is the treatment of a boxer's fracture?
'buddy strap' + early mobilisation
275
how do you make a rotational finger deformity more obvious?
ask patient to flex fingers
276
what is the treatment for a mallet finger?
splint (prevents DIP from moving)
277
why does holding the distal phalanx of the middle finger allow isolation of the FDS when flexing the index finger?
because FDP muscle bellies are all one, so holding the 3rd distal phalynx prevents the FDP being flexed
so flexing the index finger will only be flexing the FDS of that finger
278
what is eschar?
thick, leathery, inlastic skin which can form after burns
279
when would primary bone healing occur vs secondary bone healing?
primary- minimal fracture gap (less than 1mm)
| secondary- gap at fracture site
280
what are the 4 main steps of secondary bone healing?
1. inflammation
2. soft callus
3. hard callus
4. remodelling
281
what 4 things are required for good secondary bone healing?
- good oxygen supply
- good nutrient supply
- stem cells
- a little movement or stress
282
what type of non-union occurs in attempted secondary bone healing with a poor blood supply?
atrophic non-union
283
what type of non-union occurs in attempted secondary bone healing with no movement?
atrophic non-union
284
what type of non-union occurs in attempted secondary bone healing with too big a fracture gap?
atrophic non-union
285
what type of non-union occurs in attempted secondary bone healing with tissue trapped in the fracture gap?
atrophic non-union
286
what type of non-union occurs in secondary bone healing with excessive movement?
hypertrophiic non-union
287
why may smoking severely impair fracture healing?
vasospasm
288
what are the 5 basic fracture patterns?
- transverse fractures
- oblique fractures
- spiral fractures
- comminuted fractures
- segmented fractures
289
which pattern of fracture is most likely to shorten?
oblique fracture
290
which 2 patterns of fracture are the most unstable?
comminuted fracture and segmental fracture
291
what is a comminuted fracture?
fractures with 3+ fragments
292
what type of energy injries cause comminuted fractures?
high energy injuries
293
which patterns of fractures can interfragmentary screws potentially be used in?
oblique fractures
| spiral fractures
294
how is a segmental fracture satbilised?
with long rods or plates
295
which type of fracture has a greater risk of stiffness, pain and post-trauma OA- intra-articular fracture or extra-articular fracture?
intra-articular fracture
296
what fragment of fractured bone does displacement describe the direction of translation of?
displacement describes the direction of translation of the distal fragment
297
what are the 4 main clinical signs of a fracture?
- localised bony tenderness
- swelling
- deformity
- crpitus
298
what are the cardinal clinical signs of compartment syndrome?
- increased pain on passive stretching of teh involved muscle
- severe pain out with clinical context
299
what artery is risked in knee dislocation?
popliteal artery
300
what are the 4 main signs/symptoms of fracture healing?
- resolution of pain and function
- absence of point tenderness
- no local oedema
- resolution of movement at fracture site
301
what are the 3 main signs/symptoms of non-union of a fracture?
- ongoing pain
- ongoing oedema
- movement at the fracture site
302
what type of non-union occurs in attempted secondary bone healing with infection?
hypertrophic or atrophic non-union
303
what is fracture disease?
stiffness and weakness due to a fracture and subsequent splintage in a cast
304
how can you treat fracture disease?
should resolve with time
| possibly physio
305
what is complex regional pain syndrome?
a heightened pain response after injury
306
what is type 2 complex regional pain syndrome caused by?
peripheral nerve damage
307
what is the principle late systemic complication after a pelvic/lower limb fracture?
pulmonary embolism
308
what is the gold standard imaging of the rotator cuff?
ultrasound
309
which head is preominantly affected in biceps tendinopathy?
predominantly long head of biceps
310
where is the pain in biceps tendinopathy?
anterior shoulder radiating to elbow
311
what movements exacerbate the pain of biceps tendinopathy?
shoulder flexion
elbow flexion
pronation of forear
312
where does the most inflammmation of biceps tendinopathy occur and why?
where the long head of biceps passes through the bicipital groove ]due to friction
313
what does the popeye sign indicate?
biceps tendon rupture
314
what movements exacerbate the pain of medial epicondylitis?
wrist flexion, pronation
| grasping actions
315
what 2 tendon sheaths are affected in De Quervain's tenosynovitis?
abductor pollicis longus
extensor pollicis brevis
(extend and abduct the thumb)
316
what are the 2 main clinical findings of knee extensor mechnaism tendon rupture?
palpable gap
| no straight leg raise
317
what is spinal shock?
a physiological response to injury with complete loss of sensation, motor function and reflexes below the level of the injury
318
what is the bulbocavernous reflex?
a reflex contraction of the anal sphincter in response to a squeeze of the glans penis, tapping the mons pubis or pulling on a urethral catheter
319
when does spinal shock usually resolve?
after 24 hours
320
what does neurogenic shock occur secondary to?
temporary shutdown of sympathetic outflow from T1- L2
321
what is the difference between complete and incomplete spinal injuries?
complete- no sensory or motor function below the level of injury
incomplete- some sensory or motor function below the level of injury
322
what type of spinal cord injury (complete or incomplete) does sacral sparing suggest?
incomplete spinal cord injury
323
compare prognosis of complete and incomplete spinal cord injury?
complete- poor prognosis
| incomplete- better prognosis
324
what type of shock (organ hypoperfusion) in the presence of spinal injury is most likely?
```
hypovolaemic shock
(don't assume neurogenic shock)
```
325
what are the 3 main patterns of pelvic injury?
lateral compression fracture
vertical shear fracture
anteroposterior compression injury
326
a RTA will most likely give you what pattern of pelvic injury?
lateral compression fracture
327
a fall from height will most likely give you what pattern of pelvic injury?
vertical shear fracture
328
what pattern of pelvic injury is an 'open-book' pelvic fracture?
anteroposterior compression inury
329
as the degree of wide disruption of a anteroposterior pelvic fracture increases what happens to the pelvic volume?
increases
330
in a lateral compression fracture, where is the affected hemipelvis displaced?
medialy
331
in a vertical shear fracture, where is the affected hemipelvis displaced?
superiorly
332
why is a PR mandatory in a patient with a pelvic injury?
to assess sacral nerve root function
| to look for the presence of blood
333
what does the presence of blood on a PR exam following pelvic injury suggest?
rectal tear
| higher risk of mortality
334
in a fracture of the surgical neck of the humerus, what is the typical displacement of the humeral shaft?
and why?
medially
| due to pull of pectoralis major
335
how are minimally displaced proximal humeral fractures treated?
conservatively with a sling and gradual mobilisation
336
how are persistently displaced fractures of the proximal humerus treated?
internal fixation
337
how are humeral head splitting fractures usually treated? (and when would this not be the case?)
shoulder replacement
| unless patient is young with very good bone quality
338
which is more common- anterior or posterior traumatic shoulder dislocation?
anterior shoulder dislocation
339
what are the main 2 movements/actions which may cause anterior shoulder dislocation?
excessive external rotation
| fall onto the back of the shoulder
340
what is a bankart lesion?
detachment of the anterior glenoid labrum and capsuls
341
what is a Hill-Sachs lesion?
when the posterior head impacts on the anterior glenoid producing an impaction fracture of the posterior head
342
in anterior shoulder dislocation, the axillary nerve can be stretched as it passes through what space?
quadrilateral space
343
what is the principle sign of axillary nerve injury?
loss of sensation in the regimental badge area
344
what is the mainstay of treatment for atraumatic shoulder dislocations?
physiotherapy
345
what movement can cause posterior shoulder disloctions?
posteiror force on the adducted and internally rotated arm
346
what does the light bulb sign on X ray suggest?
posteiror shoulder dislocation
347
when the ACJ is subluxed what ligaments are ruptures?
acromioclavicular ligaments
348
when the ACJ is dislocated what ligaments are ruptures?
acromioclavicular ligaments and coracoclavicular ligaments (conoid and trapezius ligaments)
349
what is a nightstick fracture?
an isolated fracture of the ulna
350
what are nightstick fractures caused by?
a direct blow
351
what is a monteggia fracture?
an isolated ulna fracture with dislocation of the radial head at the elbow
352
why do you need to take an x-ray of the elbow joint after finding an isolated ulna fracture?
may be a monteggia fracture dislocation
| ulna fracture and dislocation at elbow
353
what is the treatment for monteggia fractures?
ORIF of ulna
| that should result in reduction of radio-capitellar joint
354
what is a galeazzi fracture?
an isolated fracture of the radius with dislocation of the ulna at the distal radioulnar joint
355
why do you need to take a lateral x-ray view of the forearm after finding an isolated radial fracture?
may be a galeazzi fracture (radius fracture and dislocation at distal radioulnar joint)
356
what is the treatment for galeazzi fractures?
ORIF of radius
| should cause distal radioulnar joint reduction
357
what is a colles fracture?
an extra-articular fracture of the distal radius within 1 inch of the articular surface wit dorsal displacement or angulation
358
why do colles fractures occur? (what action?)
usually fall onto outstretched hand
359
what nerve is particularly susceptible to compression in a colles fracture? (how is this resolved)
median nerve
| reduction of radius or carpal tunnel decompression
360
what is a specific late local complication of a colles fractures?
extensor pollicis longus tendon rupture
361
how is extensor pollicis longus tendon rupture secondary to a colles fracture treated?
tendon transfer
362
why should all Smith's fractures undergo ORIF using a plate and screws?
as they are highly unstable and malunion with excessive volar angulation reduces grip strengthn and wrist extension
363
what is a Smith's fracture?
an extra-articular fracture of the distal radius which causes volar displacement or angulation
364
what action commonly causes smith fractures?
falling onto the back of a flexed hand
365
what are bartons fractures?
intra-articular fractures of the distal radius causing subluxation of the carpal bones
366
what are the 2 main classifications of bartons fractures?
- volar barton fractures (intra-articular Smith's fracture)
| - dorsal barton fractures (intra-articular Colles fractures)
367
what is the treatment of a barton's fracture?
ORIF
368
what is the treatment of a comminuted intra-articular distal radius fracture?
external fixation with supplementary wires
369
what action causes scaphoid fractures?
fall onto outstretched hand
370
where does tenderness tend to occur in scaphoid fractures?
anatomical snuff box
371
if a scaphoid fracture is suspected clinically but there are no signs on X-ray what is the management?
splint wrist then re-do x-ray after 2 weeks
372
what is the treatment of undisplaced scaphoid fractures?
plaster cast
373
what is the treatment of displaced scaphoid fractures?
special compression screw (to avoid non-union)
374
what is the treatment of non-union of the scaphoid following fracture?
screw fixation and bone grafting
375
what is the treatment of symptomatic avascular necrosis of the scaphoid following fracture?
partial or total wrist fusion
376
what 3 structures do penetrating volar hand injuries risk damage to?
- flexor tendons
- digital nerves
- digital arteries
377
what structures do penetrating dorsal hand injuries risk damage to?
-extensor tendons
378
what is mallet finger?
an avulsion of the extensor tendon from its insertion into the terminal phalanx
379
what is mallet finger caused by?
forced flexion of the extended DIPJ
| can be caused by a ball at sport
380
what is the treatment of mallet finger?
mallet splint
381
after a flexor tendon injury, the fingers are splinted in a flexed position with an elastic traction. What movements does this allow? (and why?)
active extension
passive flexion
to prevent stiffness and adhesions within the tendon sheath
382
compare treatment of intra-capsular hip fracture and extra-capsular hip fractures?
intra-capsular- hemiarthroplasty or THR
extra-capsular- internal fixation
383
femoral fractures can cause fat embolism, where does the fat come from?
the medullary canal of the femur
384
what is the initial management of a femoral fracture?
resuscitation
analgesia
femoral nerve block
thomas spint
385
what is the purpose of a thomas splint for use of femur shaft fracture?
stabilises fracture to minimise further blood loss and fat embolism
386
what is the definitive management of a femoral shaft fracture?
closed reduction and stabilisation with an IM nail
| sometimes plate fixation can be used
387
why is multi-ligament reconstruction typically required for a dislocated knee?
because in order for the knee to dislocate, multiple ligaments are usually torn
388
which are more common- true knee dislocations or patellar dislocations?
patellar dislocations
389
who tends to get patellar dislocations?
female adolescents
390
what are the 4 main predispositions to patellar dislocations?
- generalised ligamentous laxity-valgus alignment of the knee
- shallow trochlea groove
- rotational malaligment
391
are proximal tibia plateau fractures intra or extra-articular fractures?
intra-articular
392
a valgus stress to the knee may cause what plateau fracture?
lateral plateau fracture
393
what nerve injury is indicated in foot drop?
common fibular nerve
394
a varus stress to the knee may cause what plateau fracture?
medial plateau fracture
395
what is required to fill the void in the bone once a depressed tibial plateau fracture has been elevated?
bone graft
396
what displacement of the tibial shaft after fracture is especially poorly tolerated?
internal rotation
397
if the tibia shaft is fractured with the fibula unaffected what alignment does the tibia drift into?
varus
398
if the tibia shaft is fractured and the fibula is also fractured what alignment does the tibia drift into?
valgus
399
what are the 2 major cons of external fixation?
pin-site infection
| loosening
400
is an isolated fracture of the distal fibula stable or unstable?
stable
401
is a fracture of the distal fibula with rupture of the deltoid ligament stable or unstable?
unstable
402
are bimalleoli ankle fractures stable or unstable?
unstable
403
what is the treatment for an unstable ankle fracture?
ORIF
404
what is a lisfranc fracture/dislocation?
fracture of the base of the 2nd metatarsal with dislocation of the base of the 2nd metatarsal from the medial cuneiform
(other metatarsals may also be dislocated at the tarso-metatarsal joints)
405
how does a patient with a lisfranc fracture usually present?
grossly swollen and bruised foot which they are unable to weight bear
406
what is the treatment of a lisfranc fracture?
closed or open reduction with fixation using screws
407
what movement causes fractures of the 5th metatarsal?
inversion injury
408
what is the usual treatment of toe fractures?
protection in a stout boot
409
why do children's fracture heal more quickly than adults?
thicker periosteum which is a rich source of osteoblasts
410
why are greater degrees of displacement or angulation accepted in children's fractures compared to adult fractures?
children have a greater potential to remodel so can correct angulation
411
at what age do fractures start to be treated as an adult fracture?
once child has reached puberty (12 - 14)
412
as the salter-harris classification of physeal fractures increases, what happens to the prognosis?
decreases
413
which salter-harris classification is the commonest of physeal fractures?
salters harris II
414
which salter harris fractures are intra-articular with the fracture splitting the physis?
salter harris III and IV
415
what type of injury occurs to the physis in a salters harris V fracture?
compression injury to the physis
416
what happens to the growth of the bone after a salters harris V fracture?
growth arrests
417
what happens in a salter harris I fracture?
pure physeal separation (metaphyseal intact and still attached to the shaft)
418
where are salter harris II fractures especially common?
distal radial physis
419
in children, are complete fractures more likely to displace/angulate volar or dorsal?
dorsally
420
how are monteggia and galeazzi fractures treated in children?
reduction and rigid fixation with plates and screws
421
how are fractures of both bones in the forearm treated in children?
flexible IM nail
422
which are more common- flexion or extension supracondylar fractures of the elbow?
extension supracondylar fractures
423
what is a simple test to check if the median nerve is working?
ask patient to make an ok sign (flexor pollicis longus and flexor digitorum profunda)
424
what 2 structures are at risk of injury in a supracondylar fracture?
```
brachial artery
median nerve (mainly anterior interosseous branch)
```
425
when in a supracondylar fracture is emergency surgery required?
if radial pulse is reduced (in volume) or absent
426
what are the 2 main reasons you should avoid ORIF in high energy fractures?
- will struggle to get wounds closed
| - bone blood supply is already very impaired (don't want to damage it any further)
427
what is the most common nerve affected by compartment syndrome?
tibial nerve
428
which is more common- valgus stress causing lateral tibial plateau fracture or varus stress causing medial tibial plateau fracture?
valgus stress causing lateral tibial plateau
429
for a tibial shaft fracture, how long does there have to be without healing before you can say it has gone under non-union?
> 1 year
430
compartment syndrome is a clinical diagnosis, when would you do pressure readings?
only if patient is unconscious
431
what is a pilon fracture?
an intra-articular fracture of the distal tibia
432
how are nightstick fractures usually managed?
conservatively
433
what are the 3 degrees of nerve injury?
1st degree- neurapraxia
2nd degree- axonotmesis
3rd degree- neurotmesis
434
what is neurapraxia?
temporary conduction block/demyelination
435
when should neurapraxia resolve by?
28 days
436
what is axonotmesis?
nerve cell axon dies distally from point of injury, endoneurial tubes remain intact
437
how fast does axonotmesis regenerate?
1mm per day
438
what is neurotmesis?
nerve transection
| no recovery without surgery
439
if there is apparent nerve injury, with no function returning, what is the management?
nerve conduction studies
nerve grafting
tendon transfers
440
what is volkmann's ischaemic contracture?
missed compartment syndrome causing necrosis and contraction of the muscles and tendons
causes reduced function of the limb
441
what nerve is being tested by a thumbs up? (what muscles does it test?)
radial nerve
extensor policis longus
442
what nerve is being tested by a starfish sign of the hands? (what muscles does it test?)
ulnar nerve
interossei muscles
443
what nerve is being tested by an OK sign? (what muscles does it test?)
median nerve
flexor policis longus
flexor digitorum profundus and superficialis of index finger
444
what are the 2 main mechanisms of traumatic shoulder dislocations?
fall onto outstretched hand
| traction injury
445
what is luxatio erecta?
an inferior glenohumeral dislocation
446
what is the main nerve at risk with anterior shoulder dislocation?
axillary nerve
447
what area of skin should be tested to assess if the axillary nerve is intact?
regimental badge area
448
what are the main two mechanisms of traumatic posterior shoulder dislocations?
fall with shoulder in internal rotation
| direct blow to anterior shoulder
449
what movement is impaired with posterior dislocation of the shoulder?
external rotation
450
in inferior dislocation of the shoulder, what position is the patients arm stuck in?
abduction
451
what type of shoulder dislocation presents with squaring off of the affected shoulder?
anterior dislocation
452
shoulder dislocations are usually treated with closed reduction under sedation. what type of dislocations are open reduction saved for?
locked posterior dislocations
453
what is the main mechanism of injury causing elbow dislocations?
fall onto outstretched hand
454
what is the main way to reduce an elbow dislocation?
closed reduction
(traction in extension +/- pressure over olecranon)
under sedation
455
what is the recurrent instability risk of elbow dislocation?
low
456
what are the 2 main mechanisms of injury causing interphalangeal dislocations?
hyperextension injury
| direct axial blow
457
what direction do IPJ dislocatioons usually occur in?
posterior dislocations
458
sudden contraction of what muscles with a flexing knee causes patella dislocation?
sudden quads contraction with a flexing knee
459
what direction do patella dislocations usually occur in?
laterally
460
what ligament is always torn in a lateral patella dislocation?
medial patellofemoral ligament
461
why does a big haemarthrosis and medial side tenderness occur in lateral patella dislocation?
due to torn medial patellofemoral ligament
| tenderness also due to torn medial retinaculum
462
what does genu valgum or femoral neck anteversion do to the Q-angle?
increases Q angle
463
as the Q-anlge increases, what happens to the risk of patella dislocation?
increases
464
weakness of what particular quadriceps muscle can play a part in patella dislocation?
weak vastus medialis
465
under-development (hypoplasia) of which femoral condyle can play a part in patella dislocation?
hypoplasia of lateral femoral condyle
466
describe lines 1 and 2 whcih make up the Q-angle?
line 1: ASIS to midpoint of patella
| line 2: tibial tubercle to midpoint of patella
467
who tends to have a larger Q angle- M or F?
females
468
what movements tend to reduce patella dislocation?
extension
469
why might you aspirate the haemarthrosis caused by a patella dislocation?
to make extension more comfortable
470
what should you suspect if there is lateral collateral ligament of the knee injury and common fibular nerve injury?
(transient) knee dislocation
471
which direction are knee dislocations most likely to be?
posterior
472
what nerve is at risk with a true knee dislocation?
common fibular nerve
473
what artery is at risk with a true knee dislocation?
popliteal artery
474
if assessment of vascular supply after a knee dislocation is normal, what should be done?
admit and observe in hospital
| due to high likelihood of vascular injury
475
if assessment of vascular supply after a knee injury is abnormal, what should be done?
arteriogram/MRI
476
what direction are hip dislocations most commonly?
posterior
477
what position usually is the leg of a patient presenting with a posterior hip dislocation in?
hip flexed
hip internally rotated
knee adducted
478
what nerve is at risk of injury with a hip dislocation?
sciatic nerve
479
what is primus varus?
angulation of the 1st metatarsal towards the midline thus increasing the distance and angle between metatrsals 1 and 2
480
when does primus varus typically appear?
teen years
481
what is the driver of primus varus?
ligamentous laxity
482
what deformity of the big toe can primus varus lead to?
secondary hallux valgus
483
what is lesser toes metatarsalgia?
painful lesser metatarsal heads
484
where is the pain felt in lesser metatarsalgia?
plantar surface of foot
485
what heel alignment is common in pes planus?
heel valgus
486
what heel alignment is common in pes cavus?
heel varus
487
what does localised swelling of the olecranon suggest?
bursitis
488
what is the carrying angle of the elbow?
the angle between the shaft of humerus and shaft of forearm
489
compare a distal ulnar nerve lesion to a proximal ulnar nerve lesion in terms of patient presentation?
distal- ulnar clawing
| proximal- ulnar paradox (hand looks normal)
