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Flashcards in MSK Deck (78):
1

What score is used for growth plate #?

Salter Harris

2

What score system is used for open #?

Gustillo Anderson

3

What score is used for hip SA in a child?

Kocher

4

What score is used for ACJ joint disruption?

Rockwood

5

What score is used for ankle #?

Weber

6

What score is used to predict the need to amputate an open fracture?

Mangled

7

What score is used to indicate the need to fix a pathological #?

Mirels

8

Give three indications for surgery in a #

• Failed non-op management
• Unstable # that cannot be maintained in reduced position
• Displaced intra-articular #
• # known to heal poorly without op
• Large avulsion # that disrupts muscles, tendons or ligaments functioning
• Impending pathological #
• Multiple traumatic # including pelvis, femur and vertebrae
• Unstable open #, type ii or type iii #
• # in patients who would poorly tolerate prolonged immobilisation
• # in growth areas in skeletally immature individuals that risk growth stopping
• Non or mal union in non-surgical treatment
• Polytrauma to one side of the body

9

What are the different implants that can be used for fracture fixation?

- screws
- plates
- wires
- IM nails

10

What is the function of screws in fracture fixation?

transform rotational force into compression between 2 or more surfaces

11

what is the function of plates in the healing of fractures?

stabilize the bone fragments to allow early movement

12

what is the function of IM nails?

prevent rotational deformity and shortening of long bones

13

What are the indications for external fixation?

Temporary until the patient is able to have surgery

14

What are some of the contraindications for surgical fixation of fractures?

Active infection or osteomyelitis
soft tissue that compromises overlying # or surgical approach
Medical conditions that contraindicate anesthesia

15

What are the complications of EF?

infection
non union
refracture
implant failure

16

Apart from surgery and more traditional methods what other methods can be tried for bone healing

- Bone morphogenic proteins – promote differentiation of fibroblast like cells into pre-osteoblasts into osteoblasts which form new bone
- USS- low intensity pulsed US to speed up # by stimulating bone cells to grow and repair- best used in delayed healing and non union

17

What class of analgesia shouldnt be prescribed in a fracture and why?

NSAIDs due to their anti inflammatory nature which would hinder healing

18

Explain direct healing of fractures and when is this needed

Direct healing doesnt involved a cutting cone or a haematoma
Needed in intra-articular fractures to prevent too much joint desruption.

19

Explain the traditional healing of bones

1) haematoma
2) soft callus formation
3) hard callus formation
4) bony remodelling

20

`Through what law does bony remodelling occur and what does it state

Wolff's Law
Form follows function

21

What displacement can we not accept and why?

Rotational as remodelling doesnt counteract this
( as compared to malalignment which is corrected automatically)

22

Explain what physical features about bones affects the healing and how this affects our treatment

Bones heal better where there are large muscle bulks due to larger blood supply and supporting tissues
Metaphysis heals better than a shaft due to increased SA and increased cancerous bone which heals better.
- Lower shaft of tibia fracture heals very badly due to no muscle belly and this has implications of treatment. They are usually treated with a nail rather than a plate.

23

Explain the fractures seen in immature bones

Salter Harris fracture - fracture involving the epiphyseal growth plate
1) Transverse through growth plate - SLIPPED
2) Fracture through growth plate and metaphysis ABOVE
3) Fracture through growth plate and epiphysis LOWER
4) Fracture through all 3 physes EVERYTHING
5) Compression fracture at growth plate THROUGH EVERYTHING
6) Onwards are rare. RAMMED
Torus/buckle fracture
Axial loading on a long bone leads to a buckle and a characteristic bulge in the cortex.
Typically occur in 5-10 year olds- typically self limiting and do not usually require ops
Greenstick fracture
One side of the bone is broken and the other side is only bent - occurs more in children as bones are softer and more flexible.

24

Give some feature that may make you consider if an injury is non accidental

delayed presentation, delayed milestones, lack of concordance between injury and mechanism of injury, multiple injuries and injuries not at usual sites

25

What is a periosteal reaction?

Non specific change to bone seen on XR where the periosteum has been irritated

26

What types of periosteal reaction are there?

Benign - low grade inflammation allows bone to form a near normal cortex
Aggressive -acute and rapid irritation doesnt allow for the formation of a normal cortex

27

What is the most common cause of death after a orthopaedic operation?

MI

28

Name some complications after an othorpaedic operation?

wound infection
local neurovascular complications
DVT
PE
compartment syndrome
chronic regional pain

29

What are contraindications for a joint aspiration?

Bursitis
overlying cellulitis or psoriasis

30

What can a joint aspiration be tested for?

appearance, viscosity, WBCs, neutrophils, gram staining, polarised light microscopy and culture.

31

How do we measure leg length?

True - ASIS to medial mallelous
Apparent - umbilicus to medial mallelous

32

Explain the pathophysiology behind Dupuytren's contractures

Fibromatosis of the palmar fascia
typically over the ulnar aspect that results in fixed flexion deformity

33

Who are dupuytren's contractures most common in?

Males, alcoholics, smokers, diabetics, epileptics and FH

34

Explain the management of dupuytrens contractures

Normally painless so can be managed conservatively until they become problematic

35

What is the test that indicates when a duputyrens contracture may need fixing?

Huestons Tabletop test

36

What surgical management can be done for dupuytrens?

Fasciotomy of there is isolated pretendionous cords and if not then a fasiectomy can be used

37

What is the problem with treatment in duputyrens contractures?

reoccurance

38

What is trigger finger?

nodular thickening of the flexor tendon and A I pulley

39

How can trigger finger be treated?

Conservatively with night splintage in extension, waiting for spontaneous resolution or steroid injections
surgically can release the pulley

40

What is De quervains synovitis ?

painful disorder of 1st dorsal compartment of the wrist as a result of inflammation

41

Explain the clinical findings of someone with De Quervains syndrome?

pain over the tendons
worse on thumb movement especially against resistance and pain is elicited on ulnar deviation with the thumb in the palm.

42

What tests are used for DDH?

Ortolani test - abduction and gentle elevation will create a clunk of reduction if there is a dislocated hip
Barlow test - gentle depression of adducted hip will cause dislocation

43

What are the risk factors for DDH?

FH
oligohydroaminos
Female
Breach
High birth weight

44

What is the manaagement of DDH?

Pavlick harness if present before 3y/o
Delayed presentation often requires surgical intervention

45

What is osteochondritis dissecans?

AVN of the subchondral bone and dissection of the overlying cartilage
Commonly affects the knee and often presents in adolescence

46

How does osteochondritis dissecans present?

Poorly localised pain
swelling and knocking the knee

47

What is the management of osteochondritis dissecans?

Skeletally immature - conservative
Once mature - surgical options such as debribement or grafts/fixation

48

What causes the displacement of a NOF#?

Iliopsoas

49

What specific pain relief should be done in a NOF#?

Fascia ilaca block

50

What si greater trochanteric pain syndrome?

Trochanteric bursitis
Degenerative damage to the ITB leading to inflamation of the trochanteric bursa

51

How is GTPS managed?

Steriod injections
Exercise
WL
Physio to stretch ITB

52

What are the Ottowa rules at the knee?

>55
Tender over the head of fibula
Isolated tenderness over the patella
Inability to flex the knee to 90 degrees
Inability to weight bear

53

What is the difference between true and pseudolocking of the knee?

True locking - where the knee is actually stuck in a position of flexion and needs wiggling side to side to get it moving again
Psuedolocking - limited by the pain and consequential muscle contraction

54

what is a morton neuroma?

Benign neuroma of the intermetatarsal plantar nerve
causes pain and numbnesss

55

Outline the antibacterial prophylaxis for limb surgery

- Co Amox 1.2 Iv at induction followed by 2 further doses 600mg at 8 hourly intervals
- If MRSA positive or previously positive then add 400mg IV tecoplanin

> Pen allergy give 400mg Teicoplanin and 120 mg IV gentamicin at induction

56

What is the protocol for open fractures and antibiotics?

Antibiotics should be given ASAP and within 3 hours of injury
- Co amox (or mero if pen allergy)

Photograph, initial debridement if large foreign materials, cover in warm saline gauze, reduce and splint if possible, pressure on circulation, tetanus booster (revaxis), involve specialist senior teams

57

what is osteomyletis?

Infection of the bone

58

How may osteomyelitis present?

Continuous throbbing pain in affected area
Often worse at night
Fever
Malaise
swelling of surrounding soft tissue

59

Ehen does osteomyeltiis become chronic?

Present for greater than 4 weeks

60

What changes are present in chronci osteomyelitis?

Large abscesses
lytic cavities
sclerotic regions
periosteal reaction

61

Outline the management of osteomyelitis

Antibiotics
If a collection, sequestrum (walling off of bone) or involucrum (new bone formation) is present it may not respond entirely to IV abx and may require surgical intervention – debridement, excision, irrigation, stabilisation and sometimes the dead space will need to be filled (blood acts as a perfect culture)

62

What are the types of cancer that most commonly metastasize to bone?

Thyroid
Breast
Lung
Kidney
Prostate

63

What is different about prostatic mets rather than the other types of cancer?

Prostate are often sclerotic whereas the others are lytic

64

What is the pathophysiology behind multiple myeloma?

B cell lymphoproliferative disorder of the bone marrow affecting plasma cells

65

How does multiple myeloma present?

CRAB symptoms
- high Calcuim - increased bone turnover leads to increased Ca
- Renal failure - proliferation of plasma cells leads to increased levels of proteins, mainly immunoglobulins in the blood which increases viscosity of the blood and damages the kidney
- Anaemia - inhibition of erythropoesis in the bone marrow
- Bone pain - increased osteoclastic activity causing lytic lesions of the bone and pathological fractures
--> tends to affect the spine and ribs the most

66

What ccan be detected in the urine for multiple myeloma?

Bence jones proteins

67

How is the radial nerve tested?

Sensory - dorsal aspect of the thumb and index finger webspace
motor - wrist and finger extension

68

how is the median nerve tested?

Sensory - radial aspect of the index finger
Motor - thumb abduction against resistance with palm flat on the table

69

How do you test the ulna nerve? What is meant by Froment's test?

Sensory - ulnar aspect of tip of little finger
Motor function - Froment’s test (+ve for damage if thumb bends as unable to use adductor pollicis) or pushing the little fingers against each other testing the dorsal interossei

70

What is meralgia paraesthetica?

compression of the lateral cutaneous nerve causing burning pain in this region
can often result from weight gain

71

What is Charcot Marie Tooth disease?

Hereditary motor and sensory neuropathy characterised by motor and sensory loss

72

What are the signs and symptoms of Charcot Marie Tooth?

High arch of the foot and clawing of the toes
Muscle weakness in the feet, ankles , hands and legs
Lack of sensation in the arms and feet
Poor peripheral circulation
Muscle wasting in the lower legs - upside down champagne bottle appearance

73

What is Gullain Barre Syndrome?

autoimmune destruction of the peripheral nervous system typically causing muscle weakness accompanied by pain or sensory changes developing distally and spreading proximal over hours to weeks
Can compromise respiratory muscles requiring intubation and ventilation

74

What is a terrible traid at the elbow?

elbow dislocation, radial head fracture and coronoid fracture

75

What score is used to check for hypermobility?

Beighton

76

What sites are most common for disk herniation?

L4/L5 or L5/S1

77

What is radiculopathy?

Dermatomal pain, weakness, loss of sensation and reduced reflexes

78

What are the main symptoms of cauda equina?

saddle anaesthesia, overflow incontinence and pain down the back of the legs