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MSK Flashcards

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1
Q

What score is used for growth plate #?

A

Salter Harris

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2
Q

What score system is used for open #?

A

Gustillo Anderson

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3
Q

What score is used for hip SA in a child?

A

Kocher

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4
Q

What score is used for ACJ joint disruption?

A

Rockwood

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5
Q

What score is used for ankle #?

A

Weber

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6
Q

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

A

Mangled

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7
Q

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

A

Mirels

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8
Q

Give three indications for surgery in a #

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
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9
Q

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

A
  • screws
  • plates
  • wires
  • IM nails
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10
Q

What is the function of screws in fracture fixation?

A

transform rotational force into compression between 2 or more surfaces

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11
Q

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

A

stabilize the bone fragments to allow early movement

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12
Q

what is the function of IM nails?

A

prevent rotational deformity and shortening of long bones

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13
Q

What are the indications for external fixation?

A

Temporary until the patient is able to have surgery

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14
Q

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

A

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

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15
Q

What are the complications of EF?

A

infection
non union
refracture
implant failure

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16
Q

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

A
  • 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
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17
Q

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

A

NSAIDs due to their anti inflammatory nature which would hinder healing

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18
Q

Explain direct healing of fractures and when is this needed

A

Direct healing doesnt involved a cutting cone or a haematoma

Needed in intra-articular fractures to prevent too much joint desruption.

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19
Q

Explain the traditional healing of bones

A

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

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20
Q

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

A

Wolff’s Law

Form follows function

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21
Q

What displacement can we not accept and why?

A

Rotational as remodelling doesnt counteract this

as compared to malalignment which is corrected automatically

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22
Q

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

A

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.

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23
Q

Explain the fractures seen in immature bones

A

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.

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24
Q

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

A

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

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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

MSK for IPE (2 decks)

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