Ortho 3 Flashcards by John Darlington

What is the single most important part of the management of a bone tumour?

referral to MDT

surgeons
pathologist
radiologist

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When should you do a bone biopsy of a suspected tumour?

Only when guided by MDT

- otherwise may make it worse

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What generalised investigations would you do into bone tumours? and which is gold standard

Full history & examination 
Blood 
Myeloma screen 
X-ray 
\+/- 
CT scan

*most will require a biopsy for definitive diagnosis but this must be done after MDT - require guidance
x-ray is gold standard
- huge amount of info regarding the lesion can be seen

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What are the general broad rules regarding lytic and sclerotic lesions of bone?

If there is narrow lytic or sclerotic lesion its likely narrow

If there is a large area its likely aggressive

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What is meant by the zone of transition on a bony tumour?

an area where new bone is forming around the lesion to try and protect it

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Name some specific descriptions used to describe periosteal retraction that occurs with bone tumours:

Lamellated/ onion ring:
- new layers of bone forming over a tumour growing just to fast to keep up with it

Speculated/ sun-set burst
- where the tumour protrudes and breaks through the Sharpe’s fibres that then ossify in a perpendicular fashion to the bone

Codman’s
- where the Sharpe’s fibres do not even get a chance to ossify and only do so at the edges

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What is a solitary tumour of multiple myeloma called?

Plasmacytoma

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How would you inform a patient to take their bisphosphonate in the morning?

30mins before breakfast and sit up straight for 30mins after

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What is the most common benign bony tumour? how many become malignant and when should their removal be thought of?

Osteochondroma

1% become malignant. removal if cartilaginous cap exceeds >2cm

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If a patient has a pacemaker and has symptoms suggestive of cauda equina, what investigation should they have?

CT myelogram

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What are the compications of cauda equina syndrome?

Bowel dysfunction

Bladder dysfunction

Sexual dysfunction

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What are the anatomical differences of a surgical neck of humerus and anatomical neck?

Surgical is a weaker place under the head, more prone to fracture

Anatomical neck is the old epiphyseal plate. usually stronger and less likely to fracture.

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Define a simple and complex elbow dislocation:

Simple

only a dislocation.
usually posterolateral

Complex

associated fracture
typically in form of terrible triad (dislocation, radial head fracture, coronoid tip fracture)

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What is the position of safety when immobilising the hand?

30 degrees wrist extension

90 degrees of MCJ flexion

0 degrees PIP, DIP

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What is a Bennet’s fracture?

Fracture at the base of the 1st which extends into the CMC joint.
- usually with subluxation due to the pull of the abductor pollicis longus

*note a Roland fracture is the same but Comminuted

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Where is a boxer’s fracture?

Surgical neck of the 4th or 5th

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When x-raying a shaft fracture of a metacarpal what x-rays do you get and why?

AP
Lateral
oblique

Oblique allows for visualisation of the 4th and 5th base

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Name some deformities which can occur from phalanx fractures:

Mallet finger

Boutonniere deformity

Swan neck deformity

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What is the name of a fracture that can occur on the distal phalanx causing an open fracture and nail damage, typically due to hyperflexion?

Seymore fracture

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What determines whether a finger tip following injury can be preserved?

The amount of bone loss and nail loss

> 50% of nail loss it may be better to shorten nail

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What are the key ideas of treatment following finger tip injuries?

Preserve as much length as possible

Try to preserve the FDP

Preserving nail bed

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Anatomically where on a finger amputation may it be suitable for replantation?

Distal to the FDS and proximal to the FDP

if the amputation occurs proximal to the FDS then it is unlikely to suitable for replantation
typically only replanted if multiple digits involved

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Following tendon and nerve injuries what should be checked?

Study These Flashcards

Vascular assessment

cap refill
pulses
if vascular compromise but potential for replant hten it is a medical Emergancy

Neurological assessment

Tendon assessment
- make sure on hand to differentiate between FDS and FDP

What is the management for a tendon/ nerve injury?

Study These Flashcards

LA and irragation
- do not LA until neurological assessment is completed

Tetanus

Antibiotics
- maybe IV

Dressing

Back slab

Refer to ortho for washout if needed

In human bites or fist fights why should you always organise an x-ray, and which joint is particularly susceptible to damage?

x-rays to check not only for bone damage but also teeth MCP joints are at high risk of damage and infection

What is the most common muscle to be affected by lateral epicondylitis/ tennis elbow?

Extensor Carpi Radials Brevis

What nerves innervate the flexor digitirum profundus?

Medial half - ulnar nerve Lateral half - Anterior interosseous nerve of the median nerve

What two muscles in the forearm does the ulnar nerve innervate?

Flexor carpi ulnaris Medial half of the flexor digitorum profundus

Which muscles does the ulnar nerve innvervate in the hand?

Hypothenar muscles Medial 2 lumbricals Adductor pollicis interossei muscles

What are the interossei muscles?

There are two sets of interossei muscles. Dorsal - which abduct the digits Plantar - which adduct the digits also aids in flexion of the digits

What tendon can often be injured alongside a distal radius fracture?

Extensor Pollicis longus

Following a suspected scaphoid fracture - how should the patient be managed following a negative x-ray?

Placed into a cast to hold thumb in neutral position. | - re xray in 2 weeks

What are the clinical signs of a scaphoid fracture and What type of x-ray should be requested for suspected scaphoid fractures?

Anatomical snuff box tenderness Pain on telescoping of the the thumb Pain on ulnar deviation Wrist joint effusion (>4 years old maybe delayed) Scaphoid views x-ray: - PA - Lateral - Oblique - Ziter view (ulnar deviated whilst oblique)

Describe the 3 main types of pelvic fractures:

``` Type A: Stable fracture. usually includes: - avulsion - pubic fracture - iliac wing fracture ``` ``` Type B: Unstable fracture: open book fracture - lateral internal rotation forces - stable in vertical motion - unstable in rotational forces ``` Type C: Very unstable fracture. At least 2 points broken. - unstable in vertical forces - unstable in rotational forces Other classification: Young Burges classification: Lateral compression: - internal rotational forces AP compression: - external rotational forces - if the posterior sacro-iliac ligaments are damaged the pelvis is extremely unstable Vertical sheer - vertically moved. - very unstable

What is the most common place for the ulnar nerve to become entrapped?

Between the two heads of the flexor carpi ulnaris

List signs and symptoms of cubital tunnel syndrome and Name two clinical tests to help diagnose cubital tunnel syndrome:

- pain at elbow - paraesthesia in little and ring finger - weakness in abduction of little finger - interossei wasting - claw hand Tinnels test Froment's sign - unable to pincer grip - weak adductor pollicis so the flexor pollicus longus flexes the IPJ instead Finger grip strength

Give some differentials for elbow pain:

Medial/ lateral epicondylitis Bicep tendon rupture OA Cubital tunnel syndrome Medial collateral ligament injury Olecranon bursitis

What conditions pre-dispose to quadriceps tendon rupture?

``` Diabetes RA Hyperparathyroidism Gout Steroid injection around the area ```

List the three main functions of the meniscus:

Shock absorber Load Sharing Joint stabiliser

What are the treatment options for a meniscus tear?

``` Small <4mm Red Zone Degenerative - physiotherapy - NSAIDs - Steroids injections ``` Surgical: - Meniscectomy (usually for white zone) - Mencius repair (usually red zone) - Mencius transplant

What is a game keeper's thumb and what complications can occur? what is diagnostic?

Where there is damage to the ulnar collateral ligament of the MCJ Stenner lesion may occur where they avulsed ligament gets trapped in the aponeurosis of the adductor pollicis >40 degree abduction when the thumb is fully extended.

What is the diagnostic test for iliopsoas abscess?

CT scan

What is the most important blood vessels to the neck of the femur:

Medial Femoral Circumflex Artery

If a patient presents due to NOF fracture and has been lying on the ground for a few days, what do you need to consider?

Dehydration Ulcers Rhabdomyolysis

What signs may be seen on an x-ray of a patient with osteoporosis?

there needs to be >30% bone mass loss to be seen, thus x-ray is unreliable. some signs though may include: - wedge fractures - kyphosis

What biochemical marker may be found in the urine of a patient with osteoporosis?

Telopeptides | - collagen degradation products

Outwith a DEXA scan name two other investigations that can be done to quantify bone density:

Quantitative CT scan Quantitative US - usually of the calcaneum

Highlight some side effects of bisphosphonates:

Peptic ulcers/ GORD Osteonecrosis of jaw Sub-trochanteric hip fractures - more so in young affective people

Out with bisphosphonates, name some other therapies used in treating osteoporosis:

Calcium and Vitamin D - doesn't increase BMD but reduces reabsorption Selective oestrogen receptors Teriparatide -PTH Oestrogen therapy (HRT) Calcitonin Increased physical activity

What are the phases of Paget's disease?

"LAB" 1. Lytic lesions - increased size and number of osteoclasts 2. Active phase - osteoblast activity 40x over, creating disorganised woven bone - increased blood flow 3. Burn out stage - little to no cellular activity

What are the most common areas affected by Paget's disease:

Pelvis Lumbar spine Skull Femur

Describe the phalens test and tinels test:

Phalens: - flexing then extending the wrist will elicit symptoms in the median nerve distribution Tinel's test: - taping over the volar aspect of the carpal tunnel elicits symptoms

In nerve conduction studies of carpal tunnel, what is being measured?

Velocity of conduction

What are the complications of carpel tunnel syndrome surgery?

Damage to blood vessels/ tendons of hand Infection Complex regional pain syndrome Failure to resolve symptoms

What is the most serious bacteria infection to follow from an open fracture?

Clostridium perfringes

Ortho 3 Flashcards

(55 cards)