Ortho Flashcards
(212 cards)
1
Q
What is a fracture?
A
Break in the continuity of a bone
2
Q
What is a colles fracture?
A
Distal radius +/- ulnar
3
Q
What is a Smith fracture?
A
Distal radius
4
Q
What is a Monteggias fracture?
A
Proximal 1/3 ulnar and dislocation radial head
5
Q
What is a Galeazzi fracture?
A
Radial distal shaft and dislocation of radioulnar joint
6
Q
What is a boxer’s fracture?
A
5th metacarpal bone
7
Q
What is the presentation of a fracture?
A
Pain, swelling, deformity, neurovacsular disturbance, palpable step-off or gap, soft tissue injury
8
Q
How is a fracture Dx on X-Ray?
A
2 views, 2 joints, pre- and post-reduction
Radio-lucent line
Cortical disruption
9
Q
General principles of fracture management?
A
Analgesia
Wound care
Assessment of VTE risk
Fracture care - Reduction, fixation (open/closed), rehab
10
Q
Immediate complications fractures?
A
Pain
Nerve/skin damage
Fat embolus
Soft tissue injury
11
Q
Early complications of a fracture?
A
Compartment syndrome
Infection
DVT
12
Q
Late complications of a fracture?
A
Stiffness Complex regional pain syndrome Malunion - abnormal position Delayed union - longer than expected Non-union - not healing after expected time
13
Q
Mx Dislocation
A
Reduction - closed if possible
14
Q
Mx Open Fracture
A
Tetanus IV Abx Photos of wound to prevent taking off dressings Saline-soaked gauze Ortho and plastics
15
Q
Mx Compartment Syndrome
A
Fasciotomy, cool and position limb
Analgesia
16
Q
Mx Vascular Injury
A
Angiography +/- Repair +/- Fasciotomy
17
Q
What is the Gustilo-Anderson Classification of Open Fractures
A
Type 1: Clean, low energy wound < 1cm
Type 2: 1-10cm, moderate damage
Type 3: >10cm, high energy
18
Q
What is compartment syndrome?
A
Pressure in fascial compartment leads to impaired tissue perfusion
19
Q
Causes of Compartment syndrome?
A
Burns, fracture haematoma, constrictive bandages, reperfusion syndrome
Pathology - Compartment pressure > capillary pressure
–> Ischaemia –> Oedema and increased pressure –> cycle continues
20
Q
What are the clinical features of compartment syndrome?
A
Pain out of proportion
Pain on passive stretching
Palpable tense compartment
Pulselessness - late –> 6Ps ischaemic limb
21
Q
DDx Compartment Syndrome?
A
Rhabdomyolysis - High CK, LDH, myoglobin
DVT
Acute limb ischaemia
22
Q
Septic Arthritis Aetiologies
A
Haematogenous/Direct spread
S Aureus
23
Q
Clinical Features Septic Arthritis
A
Acute onset
Mono-arthropathy
Triad - fever, pain, decreased RoM
24
Q
Ix Septic Arthritis
A
US-guided arthrocentesis - WCC >50 - yellow/green - send for biorefringence (gout)
Sepsis 6
Bloods - U&Es (urate)
Urethral, cervical and anorectal swabs - gonorrhoea
25
DDx Septic Arthritis
Gout
Pseudogout
OA
Haemarthrosis if anticoagulated in reactive arthritis
26
Mx Septic Arthritis
Abx for 2 or more weeks - Vanc/Ceftriaxone
Aspirate and drain
PTx
27
Complications Septic Arthritis
Joint destruction
Osteomyelitis
Sepsis
28
Acute causes of Spinal Cord Compression
```
Minutes - hours
Fracture
Herniation
Trauma
Haematoma
```
29
Insidious Causes of Spinal Cord Compression
Tumour
Abscess
Degenerative
30
Ix Spinal Cord Compression
MRI Spine
31
Clinical Features Spinal Cord Compression
Back/radicular pain
Neuro deficits below level of lesion
Sensory before motor
Painless retention and increased reflexes
32
Mx Spinal Cord Compression
Steroids - IV
Opioids
Decompression and stabilisation definitive
Inoperative - RTx
33
Mx of a Spinal Abscess
IV Abx
| Drainage
34
Mx for Spine Mets
Steroids
RTx
Decompression
35
What is the cauda equina?
Nerve roots of Lumbar, sacral and coccyx spinal nerves
Supplies lower limbs, perineum and pelvic organs
Internal and external anal sphincter
Parasympathetic to bladder
36
What is the Conus Medullans
Caudal end of spinal cord - ends at L2
37
What is the cause of a Cauda equina syndrome?
Damage/compression of cauda equina (nerve roots L3-S5)
Trauma
Tumour
Large posteromedial disc herniation
38
Clinical features of a Cauda equina syndrome?
Gradual unilateral, severe radicular pain
Motor: asymmetrical leg reflexes - hypo to areflexic (LMN)
Sensory: Saddle anaesthesia, asymmetrical paraesthesia and numbness
Neurogenital: urinary retention, altered rectal tone, erectile dysfunction
39
Ix Cauda equina syndrome?
MRI within 4h to identify nature and site of lesion
40
Mx Cauda equina syndrome?
Surgery
| Metastatic --> RTx
41
What is Carpal Tunnel Syndrome?
Peripheral neuropathy caused by acute or chronic compression of median n, deep to flexor retinaculum
42
What is the pathology in Carpal Tunnel Syndrome?
Carpal tunnel has carpal bones below and transverse carpal lig above
Contains flexor tendons and median n
Raised P compresses structures within
--> Decreased blood flow and axonal degeneration
43
Causes of a Carpal Tunnel Syndrome?
Distal radial fracture
DM
RA
Pregnancy
44
Clinical Features of a Carpal Tunnel Syndrome?
```
Palmar aspect of thumb, index, middle and radial half ring finger
Burning
Numbness
Loss of sensation
Worse at night
Altered/weakened pinch grip
Thenar atrophy
```
45
Ix of Carpal Tunnel Syndrome?
Tinnel's sign - Repeatedly tap over
Phalen's signs - Wrist in full flexion - Inverse prayer
NCS - prolongation in motor and sensory
46
Mx of Carpal Tunnel Syndrome?
Conservative: Immobilise, steroid injection and NSAIDs
Surgery: Median nerve decompression - release of transverse carpal lig, and flexor retinaculum
47
What is Flexor Tenosynovitis?
Inflammation tendon and synovial sheath
48
Cause of Flexor Tenosynovitis?
Overuse or systemic disease
49
What is Dupytren's Disease?
Common fibroproliferative disorder of the palmar fascia of the fourth and fifth fingers.
50
What is the pathology of Dupytren's Disease?
Fibroproliferative disorder
Nodules adhere to overlying dermis
Leads to characteristic skin puckering
Nodules then lead to cords, and contractures
51
Clinical Features of Dupytren's Disease?
Skin tethering near the proximal flexor crease of the fourth and fifth fingers
Palmar nodules in cords
Fixed contractures
52
Ix for Dupytren's Disease?
BM
| LFTs
53
Mx Dupytren's Disease?
Conservative: Splint and PT
Medical: Intra-lesional steroid injections; PO Steroids; Collagenase injection
Surgery: Fasciotomy or fasciectomy if functional disability
54
What is the surgical neck of the humerus?
Circumferential constriction between the tubercles
55
What runs in surgical neck of humerus?
Axillary n.
| Circumflex humeral vessels
56
What is the mechanism of injury to the surgical neck of humerus?
Common in elderly - OP
| High velocity FOOSH in young
57
How are fractures to surgical neck of humerus classified?
Via Neer's classification
Defines comminution
Anatomical neck, shaft, greater- and lesser tuberosity
58
How to Dx surgical neck of humerus fracture?
AP and lateral X-Rays
59
X-Ray findings in supracondylar fracture?
```
Sail sign (ant fat pad)
Posterior fat pad
```
60
Mx of surgical neck of humerus fracture?
Conservative: Collar and cuff (non-displaced, closed)
Surgical: (displaced, comminuted) ORIF or Hemiarthroplasty
61
Complications of surgical neck of humerus fracture?
Adhesive capsulitis
AVN humeral head (axillary a. injury)
Axillary n. palsy
62
3 Signs of an Axillary n. palsy?
Flat deltoid
Decreased sensation over regimental badge area
Reduced shoulder abduction to 15 degrees
63
Complications of Humeral Shaft Fracture?
Wrist drop - Radial n. palsy --> Decreased wrist strength and decreased sensation over dorsal hand
64
Complications of Distal Humeral Fracture?
Brachial a. injury common
| Radial/ulnar/median n. palsy
65
Most common joint dislocation?
Shoulder
| Ant > Post
66
Causes of Shoulder Dislocation?
Head humerus larger than glenoid fossa
FOOSH
Recurrent dislocation - loose capsule and ligament damage
Post - Seizures and shocks
67
2 Lesions on X-Ray in shoulder dislocation
Hill-sach's - Depression fracture humeral head
| Bankart lesion - Damage to ant labrum head
68
Classification of Shoulder Dislocation
Anterior
- Subcoracoid:
- Subglenoid:
Posterior
69
Classification of Humeral Shaft/Diaphysis Fracture
According to Prox, middle, or distal 1/3
| Or based on comminution - none (A), Butterfly (B), Proper comminution (C)
70
Presentation of a Shoulder Dislocation
Severe shoulder pain
Decreased RoM
Signs: Loss deltoid contour, Internally rotated and abducted is post disl., ant = abducted and external rotation
71
What is the most important aspect of Shoulder Dislocation Examination?
Neurovascular status - axillary n. and radial a. function prior to reduction
Regimental badge area, dorsal hand sensation and pulse
72
Ix for Shoulder dislocation
```
2 View Shoulder X-Ray - AP and Y view
To exclude fracture
Hill-sachs - Humeral head dents glenoid
MRI - Bankart
Anterior - 95% cases; Sit in front of acromion
Posterior - Lightbulb sign
```
73
Mx Shoulder Dislocation
Immobilise with sling/splint
Reduction (Closed before open)
Surgery > Conservative - if failed closed; fracture; Hill-Sach lesions or neurovascular injury; posterior dislocation
74
Most common joint dislocations
1 - Shoulder
| 2 - Elbow
75
Causes of an elbow dislocation?
Trauma - FOOSH
| Pulled elbow
76
Classification of elbow dislocation?
Posterior - 90%
| Anterior - 10%
77
Clinical features of an elbow dislocation?
```
Pain and swelling
Decreased RoM
Prominent olecranon process
Limb length discrepancy
Nerve injury - any of 3
Lost triangle of med/lat epicondyle and olecranon
```
78
How is an elbow dislocation diagnosed?
2 View X-Ray - AP/Lateral
Exclude fracture
Posterior fat pad sign if fracture present
79
Mx of an elbow dislocation?
No fracture - closed reduction & immobilise
| Fracture/instability - ORIF or closed in theatre setting
80
Epidemiology of a Distal Radial Fracture?
Bimodal peak incidence - 10-30, >65y
81
Aetiology of a Distal Radial Fracture?
High energy trauma in males (FOOSH)
Osteoporotic-related, low energy trauma
Fall on dorsi-flexed hand = Colles'
Fall on palmar-flexed = Smith's
82
Classification of Distal Radial Fractures?
```
Colles' = Dorsal angulation and shortening distal fragment
Smith's = Volar angulation and shortening distal segment
```
83
Clinical Features of a Distal Radial Fracture?
```
Tender, soft swelling at wrist
Decreased RoM
Deformity
Colles' = Dorsal displacement and dinner fork deformity (Z)
Smith's = palmar kink
```
84
Ix of a Distal Radial Fracture?
3 view X-Ray - AP, Lateral and Oblique
| Examine joint above and below
85
3 DDx of a Distal Radial Fracture?
Scaphoid
Greenstick
Monteggia
Galeazzi
86
Most commonly fractured carpal bone?
Scaphoid - Middle 1/3
87
Mechanism of injury in Scaphoid Fracture?
FOOSH + hyperextended and radially deviated wrist
88
Clinical Features of a Scaphoid Fracture?
```
Wrist pain and swelling
Pain over anatomical snuff box and scaphoid tubercle
Pain on telescoping thumb
Slight decreased RoM
Painful pinching/grasping
```
89
Ix of a Scaphoid Fracture?
4 views - Scaphoid views
| PA, lateral, 45, oblique
90
Significance of a normal X-Ray in a Scaphoid Fracture?
1/4 undetectable - immobilise and re-assess in 2/52
91
Mx of a Scaphoid Fracture?
Pain management
Undetectable, re-exam in 2 weeks
Immobilise: with a thumb spica or plaster
Surgery indications: Open fracture, evidence osteonecrosis or highly displaced
Surgery: Screw fixation
92
Complications of a Scaphoid fracture?
Proximal AVN - blood supply enters distally
| Subsequent non-union/delayed union; post-traumatic arthritis
93
What is a Bennet's fracture?
Most common thumb injury
| Intra-articular fracture at base of 1st metacarpal with CMC subluxation
94
Mx of a Bennet's fracture?
Closed manipulation and immobilisation
| If fails - K wire
95
What is the cause of a Boxer's fracture?
Striking solid object with closed fist - impact on 5th knuckle/metacarpal
96
Mx of a Boxer's fracture?
Conservative
Splinting
Surgical: Make fist - if fingers overlap - surgery as means rotation or shortening
97
Mx of phalangeal fractures?
Conservative: Buddy tape or splint
Surgical: Closed reduction, percutaneous pinning or ORIF
98
What is the position of safety (phalangeal fracture)?
Flexed MCPs and extended PIP (crocodile hand)
99
What is the function of the position of safety (hand)?
Safe immobilisation of hand and prevent contracture formation
100
RFx for a NOF?
```
OP
Elderly
Impaired co-ordination
Low Vit D
Smoking
Alcohol
Muscle Weakness
```
101
Classification of a NOF?
```
Intra-capsular:
- Displaced
- Non-displaced
Extra-capsular:
- Intratrochanteric
- Subtrochanteric
```
102
What is the significance of an intra-capsular NOF?
AVN - blood to femoral head disrupted
103
What are the clinical features of a NOF?
Groin pain
Inability to weight bare
Shortened and externally rotated hip
104
Ix for NOF?
MRI = gold standard
CT = 2nd best
Diagnosed on X-Ray - 2 views - AP/Lateral
If ?pathological fracture - X-Ray femur
105
When should a NOF be taken to theatre?
Within 48h unless medical cause that requires reversal - 36h
106
When would conservative Mx be offered in NOF?
Not fit for anaesthetic
107
Who is involved in post-op Mx of NOF?
```
PT
OT
Social work
Family
Orthopod
Geriatrician
```
108
What is the Mx of an extracapsular NOF?
DHS (preferred) or IM nail
109
What is the Mx of an intracapsular NOF?
Old - hemi
| Young - Total
110
3 Criteria for Hip replacement
Medically fit
No cognitive impairment
Mobilise outdoor with sticks or less
111
Complications of a hip replacement
General: AVN, VTE, infection
Hemi: Leg length discrepancy
DHS: failure of metalwork
112
How to prevent NOF?
Adequate OP prophylaxis
Falls risk assessment
Falls training - remove trip hazard, wear good shoes
113
RFx for OP?
```
Elderly
Female
Post-menopausal
Steroid use/PPI
Alcohol, smoking and malnutrition
```
114
What does a DEXA scan do?
Calculates BMD and gives answer as T-Score
115
Grade T-Scores
-1 to -2.5: Osteopenia
| < -2.5: OP
116
Causes of a pelvic fracture?
High energy: bike accidents, crashes, crushes - unstable
| Low energy: Osteoporotic falls - stable
117
Clinical Features of a pelvic fracture?
```
Pelvic pain
Worse on compression iliac crest
Leg length discrepancy
Instability
Tilted pelvis
Haematoma
```
118
How to test for pelvic instability?
Hands on both ASIS - apply downward pressure - Springy resistance AKA organs
119
Common co-presenting injuries to pelvic fracture?
Urethral injury
Bladder injury
Neurovascular injury
120
Ix for pelvic fracture?
Pelvic X-ray - AP inlet and outlet views
CT in stabilised patients
Angiography in haemorrhages
Retrograde urethrogram - only suprapubic catheter in people with pelvic fracture
121
Mx of pelvic fracture?
```
Resus and stabilisation
Application of pelvic binder
Conservative: bed rest and PT
Surgery: for unstable and open fractures
- Stabilise and fix with ORIF/ external fixation
```
122
Complications of pelvic fracture?
Haemorrhagic shock
Intra- and retroperitoneal bleeding
Abdo compartment syndrome (>7mmHg)
123
Hip Dislocation
Posterior 90%
- Associated with femoral head fractures
- Causes: Dashboard injury, Forces against internally rotated, adducted and flexed hip
- Presentation: Hip pain, shortened, internally rotated and adducted hip
- Management: Closed reduction (decreases risk osteonecrosis), ORIF if closed fails
- Complications: Sciatic and perineal n. injury
Anterior 10%
- Blow to posterior hip
- Lengthened, externally rotated hip
- Complications: Femoral n. injury
124
Femoral n. injury S&S
Sensory loss and paresis over anteromedial lower limb
| Decreased hip flexion and knee extension
125
Why are knee dislocations under reported?
They self reduce
Being obese RFx
126
Causes of a knee dislocation?
High energy - RTA; dashboard and crush injuries
| Obesity + walking - low energy
127
Clinical features of a knee dislocation?
Knee pain and instability
Deformity
Dimple sign - medial fem condyle pokes through medial capsule
Vascular injury - immediate reduction (popliteal)
128
Ix for a knee dislocation?
AP and Lateral + 45 degree oblique if ?fracture
| May also have avulsion fracture/ asymmetrical joint space
129
Mx for a knee dislocation?
Conservative: Closed reduction + Vasc assessment
Most require theatre stabilisation
Surgical: ORIF / External fixation (compartment) + Ligament repair
130
Causes of Femoral Shaft Fractures?
High impact trauma - RTA
| Low impact trauma - Fall from standing (<1m)
131
Clinical Features of a Femoral Shaft Fractures?
```
Painful, swollen and tense thigh
Haematoma
Reduced RoM
Shortening
Distal NV deficits
FAT EMBOLI - Change mental status, SoB, Hypoxia, Petechiae
```
132
Ix of Femoral Shaft Fractures?
Plain X-Ray unless suspect pathological
133
Mx of Femoral Shaft Fractures?
Emergency - skin traction and long-leg post splint
| Definitive - IM rod with interlocking nail or External fixation then an IM nail
134
Classification for Tibial Plateau Fracture?
Schatzker Classification
135
Most common long bone Diaphyseal Fracture?
Tibial
136
3 kinds of Tibial Fracture?
Proximal/Plateau
Shaft
Distal
137
Classification of Tibial Fractures?
Isolated
Combined tib/fib
Plateau
138
Clinical Features of Tibial Fractures?
Fracture signs - Pain, swelling, reduced RoM
| Tibial Plateau have high risk open fracture and compartment syndrome
139
Why do Tibial Fractures have high risk open fracture?
Min soft tissue
140
Why do Tibial Fractures have high risk compartment syndrome?
Surrounded by all 4 of the anterior, lateral, deep and superficial
141
Ix for Tibial Fracture?
X-Ray - knee and ankle
2 views
Lipohaemarthrosis fat fluid level (plateau)
Aspiration - haemarthritic material with fatty spots (in osteochondral plateau fracture)
Consider MRI - ligamentous/ meniscal injury
142
Mx for Tibial Fracture?
Conservative: Fibula - Splint; Prox tibia - Hinged knee brace; Shaft - Long-leg cast
Surgical: If open or displaced - irrigation, debridement, ORIF/Ex Fixation
143
Complications of Tibial Fracture?
Compartment syndrome - kept for overnight watch
Fat embolism
Peroneal n. injury - foot drop
144
Cause of Ankle Fractures
Supination or pronation - twisted ankle
145
Classification of Ankle Fractures
Weber - According to level of fibula fracture, related to level of syndesmosis
Weber A - Below (intact)
Weber B - At level of (?injury)
Weber C - Above (Injury - ruptured syndesmosis and torn interosseous membrane)
146
What is a Maisonneuve fracture?
Weber C (Ruptured syndesmosis and torn interosseous membrane) + Medial malleoulous fracture + deltoid ligament tear
147
How can ankle fractures be classified by stability?
Isolated medial/lateral malleolous --> Stable
Posterior Medial Malleolous --> Unstable
Bimalleolar - Unstable
Trimalleolar (Med/Lat/Post medial) - Unstable
148
What is Volkmann's triangle?
Avulsion fracture from posterior tibia (medial)
149
What is a Pilon fracture?
Fracture of distal tibia and part of talocrural joint
| Associated with fibular fracture
150
Clinical Features of an Ankle fracture?
Pain
Swelling
Haematoma
Tenderness over malleoli, syndesmosis or posterior ankle joint
Skin abnormalities - discolouration, bruising, tenting
151
Mx of Ankle Fractures
RICE - Rest, Ice, compression, elevation
Emergency - Reduction, backslab (sedate)
Weber A- Ankle support brace
Weber B - Operative fix if evidence of talar shift
Weber C - Operative fix (reposition, ORIF, or ex fix)
152
What is Talar Shift?
When talus no longer aligned with tibial articular surface on a mortice view
153
What is most common injury of foot?
Metatarsal fracture (5th most common, 2nd due to stress)
154
Causes of metatarsal fracture?
Crush injury
155
Clinical features metatarsal fracture?
Pain
Inability to weight bare
Tenderness
156
Important factors in metatarsal fracture?
Evaluation of soft tissue injury
Malrotation and overlapping
Monofilament for neurovascular status
157
Mx of a metatarsal fracture?
Goals - maintain foot arches, restore alignment
Conservative: Stiff toed shoes if weight baring tolerated
Surgery: If displacement - pinning (percutaneous or ORIF)
158
Associated conditions with metatarsal fractures?
Stress fractures
| Lisfranc fracture
159
What is a Lisfranc injury?
Tarso-metatarso fracture dislocation
| Disruption between articulation between cuneiform and 2nd metarsal head.
160
Cause of Lisfranc?
MVA
Fall from heigh
Athletic injuries
(High energy)
161
Clinical features of a Lisfranc?
```
Severe pain
Inability to weight bear
Medial plantar bruising
Mid foot swelling
Tenderness over TMT joint
Intability tests
```
162
What are the instability tests for Lisfranc injuries?
Metatarsal squeeze test
| Dorsal subluxation
163
Talar dislocation.
Rare.
High energy.
Medial - locked in supination.
164
How can you classify rotator cuff disorders?
Greater tuberosity
Supraspinatus - Abduction (before deltoid, 15 degrees)
Infrarpinatus - ex rotation
Teres Minor - ex rotation
Lesser tuberosity
Subscapularis - int rotation
165
What is the pathology of calcifying tendotinits?
Calcium deposits most commonly in supraspinatus tenson
166
Clinical features of calcifying tendonitis?
Asymptomatic
Acute or chronically painful shoulder
Worse with activity
167
Investigations for calcifying tendonitis?
X-ray shows calcium deposits in the tendon
168
Management of calcifying tendonitits?
Majority resolves with conservative management
169
What is chronic tendonitits?
AKA Impingement Syndrome
| Tendon is compressed against the coracoacromial arcj
170
Clinical features of impingement?
Gradual onset
| Pain with overhead activities
171
Management of impingement?
Conservative - physio, NSAIDs, subacromial steroid injection
Operative - subacromial decompression +/- tendon repair
172
How does a biceps tendon rupture present?
Usually rupture of long head of biceps
Popeye sign with muscle contraction
Visible bulge in the middle of biceps due to retraction of ruptured tendon
173
What are the 3 stages of adhesive capsulitis?
Painful phase - night pain, gradual onset
Frozen phase - progressive decreased ROM, esp ER
Thawing phase - progressive increased ROM and pain
174
Clinical Features of adhesive capsulitis?
Reduced RoM - ex Rotation
175
Ix adhesive capsulitis?
X-ray - exclude other Dx
176
Mx adhesive capsulitis?
Analgesia
Steroid injections
PT
Consider arthroscopy for resistant cases
177
Mx for Hip OA
THR/Hemi
178
Two kinds of knee replacement?
Constrained
| Non-constrained - TKR
179
RFx for Hip AVN
```
Irradiation
Trauma
Haematological malignancy
Decompression sickness
Alcoholism
Steroids
```
180
Clinical Features in <6m with DDH
Barlow and Ortolani
181
Clinical features of DDH 6-18m
Asymmetrical gluteal folds
| Inability to abduct hip
182
Clinical features DDH >18m
Waddling trendelenberg gait
| Leg length discrepancy and pain
183
Ix DDH
< 4m - USS
| >4m - X-ray
184
Mx DDH
<6m - Brace/Pivlik harness
| >6m - Closed reduction and spica cast
185
Cause of Quads tendon rupture
Contraction of quads when knee partly flexed and foot planted
186
Clinical Features of Quads tendon rupture
Pain and swelling knee joint
Palpable gap tendon
Inability to flex knee
187
Mx Quads tendon rupture
Surgical suturing
188
Causes Patella tendon rupture
Trauma to infrapatellar region
189
Clinical Features of Patella tendon rupture
Pain, swelling, palpable gap
| High riding patella
190
Mx of Patella tendon rupture
Partial tears - immobilise
| Complete tears - suture
191
Clinical Features of Meniscal tear
Clicking, locking, popping
Effusion
Medial > Lateral
192
How to differentiate meniscal tear from ligament damage
```
Pop = Ligament
Lock = meniscus
```
193
Mx Meniscal tear
RICE
NSAIDs
PT
Arthroscopy
194
Knee ligament Causes and RFx
ACL >PCL
Females
Audible pop
195
Knee ligament Mx
RICE
Arthroscopy
Knee brace and crutches
196
What is the unhappy triad?
ACL, Medial meniscus, Medial collateral
197
Cause of Achilles tendon rupture?
Sudden plantar flexion with forced dorsi flexion
| Occurs intermittently active individuals
198
Clinical features of Achilles tendon rupture?
Loud pop
Feel of being kicked back of legs
Simmons test negative
199
Mx Achilles tendon rupture?
Non-op: serial casting with foot in full equinous then start stretching
Op: Tendon repair
200
3 DDx Mechanical back pain
Disc protrusion - nucleus moves against annulus fibrosis
Disc herniation - annulus fibrosis torn and extrudes
Disc sequestration - bit of nucleus breaks off and compresses spinal n
201
Clinical features mechanical back paion
```
Acute onset severe back pain
Radiates legs and arms
Stabbing/electric shock-like
Loss deep tendon reflexes - LMNL
Short walks and changing position helps
```
202
Ix Mechanical back pain
MRI
Straight leg raise - Sciatica
Neck compression test - cervical spine radiculopathy
203
Mx Mechanical back pain
Conservative: PT, local heat, NSAIDs
Surgical: Decompression, discectomy
204
Mx Malignant Spinal Cord Compression (MSCC)
```
Contact MSCC Team
Rehab and transition home
Steroids
RTx
Decompressive surgery
```
205
Cause of Discitis?
Strep Pyogenes
206
Clinical Features of Discitis?
Back or neck pain not relieved by rest
Worse at night
Extension contracture protective posture
207
Early signs of NF?
Diffuse redness
Swelling
Extreme tenderness
208
Late signs NF?
Crepitus
Purple discolouration
Loss of sensation
209
Cause of NF?
Polymicrobial
Group A strep - Pyogenes
S aureus
210
Mx NF
ITU
Broad spectrum Abx
Extensive debridement
211
Complications NF
```
Sepsis
DIC
AKI
Severe necrosis
Amputation
```
212
What are Incomplete fracture in paeds?
Fractures where fracture line absent or doesnt cross width of bone - intact of periosteum on one side
3 Types:
Torus - Disruption of cortex on side of compressive force (presents as bulge) - cast/splint
Greenstick - Disruption of cortex on side tension, intact on side on compression - cast or reduce
Bowing - No disruption of cortex but angulation
