Ortho

Question 1

Immediate Complications of fractures

Answer 1

Immediate:
General: Haemorrhage
Shock
Fat embolus

Specific: Neurovascular injury
Muscle/tendon/ligament injury
Compartment syndrome

Question 2

fracture complications Early <30days

Answer 2

General: DVT/pe
Infection/sepsis
UTI
pressure sores

Specific: local infection

Question 3

Fracture late complications

Answer 3

General:
DVT/PE
Infection/sepsis
UTI
Pressure sores

Specific:
Arthritis
Reflex sympathetic dystrophy
Non/malunion
Contractures
Avascular necrosis
growth disrurbance

Question 4

Causes of NOF fractures

Answer 4

Osteoporosis

Trauma

Question 5

Hx from NOF

Answer 5

Age
Comorbidity
Preinjury mobility
Current meds
Mental state
reason for fall
Social hx: relatives, stairs, etoh

Question 6

Mx of Extracapsular fracture

Answer 6

Dynamic hip screw

Question 7

Mx of Intracapsular fractures

Answer 7

Undisplaced (garden 1/2): Fix with screws/DHS

Displaced:
<55 -> open reduce and fix with screws
FU with arthroplasty if AVN in future.

> 65 -> fit and mobile (1 stick or less, no cognitive impairment): THR
Less fit-> Hemiarthroplasty

Question 8

Describe a fracture XR

Answer 8

Location
Pieces (simple/multifragment)
Pattern (transverse oblique, spiral)
Displacement (Shortening, translation, angulation, rotation)

Question 9

Gustilo anderson classification open fractures

Answer 9

1. <1cm
2. > 1cm minimal soft tissue damage
3. Extensive soft tissue damage

C. perfringens-gas gangrene
Benpen, clindamycin
Debridement

Question 10

Hip arthroplasty scars

Answer 10

Anterolateral - via abductors and superior gluteal nerve -> trendelenburg gait post op.

Posterior - higher risk of dislocation, sciatic nerve damage-> foot drop.

Question 11

Mx of osteoarthritis

Answer 11

Conservative: Lose weight
Physio

Medical: Analgesia: WHO pain ladder. check U+Es before NSAIds, and not old wo PPI
Steroid injections

Surgical: arthroscopic washout - knees, trim cartilage, remove loose bodies. 
Realignment osteotomy
Arthroplasty
Arthrodesis
Microfracture
Autologous chondrocyte implantation

Question 12

osteoarthritis definition and features

Answer 12

Degenerative loss of hyaline cartilage and new bone formation

Rfs: age, obesity, joint abnormality

Pain worse w movement, worse at end of day

Stiff after resting, lasts 30mins

deformity

decreased ROM, first lost is IR
exclude Rheum disease - FBC, ESR, ANA< Rhf

XR: LOSS D

Question 13

Garden Classification

Answer 13

Intracapsular NOFs

1. Incomplete/impacted injury w valgus distal angulation
2. complete, undisplaced.
3. Complete, partially displaced
4. Complete - totally displaced.

Question 14

Rheumatoid on XR

Answer 14

Soft tissue swelling
Periarticular osteopenia
Periarticular erosions
Severe deformity

Question 15

Complications of Hip arthroplasty

Answer 15

Immediate: Nerve injury
fracture
Cement reaction

Early:
DVT, infection - sepsis
dislocation

Late: loosening, leg length discrepancy, metallosis, revision.

Question 16

Salter classification

Answer 16

growth plate fractures

1. Straight across (top)
2. Above (metaphysis)
3. lower/Below (epiphysis)
4. Two/through (all)
5. Erasure /crush

Question 17

Complications of TKR

Answer 17

Immediate

• fracture
• cement reaction
• nerve injury - common peroneal - foot drop
• vascular injury - SFA, popliteal

Early

• DVT
• Infection

Late

• Maltracking
• loosening
• instablitity
• periprosthetic fractures
• reduced ROM

Question 18

True leg length

Answer 18

ASIS - medial malleolus
- shortened - NOF, hip dislocation, growth disturbance tib/fib (osteomyeleitis)
surgery, SUFE, Perthes

Question 19

Apparent leg length

Answer 19

Xiphistenum to medial malleolus

- Scoliosis of spine.

Question 20

Thomas test

Answer 20

FFD = OA/NOF

Question 21

Trendelenburg test

Answer 21

Abductor injury - OA, superior gluteal nerve injury, DDH

Question 22

Carpal tunnel causes

Answer 22

Idiopathic
Pregnancy, Hypothyroidism
Radial fracture
Inflammation (rheumatoid, gout)
Soft tissue swelling (lipoma, acromegaly, amyloid)
Toxic (alcohol, DM)

Question 23

Mx Carpal tunnel syndrome

Answer 23

Conservative: Wrist splint neutral position at night

medical: local steroid injections
surgical: decompression by division of flexor retinaculum

Question 24

Colles fracture

Answer 24

radius - distal dorsall displacement

Question 25

Smiths fracture

Answer 25

distal volar displacement

Question 26

Barton fracture

Answer 26

intraarticular fracture of distal radius

Question 27

Scaphoid fracture signs

Answer 27

Tender anatomical snuffbox Risk of AVN non union and arthritis

Question 28

Monteggia fractures

Answer 28

Ulna fracture and dislocation of proximal radial head

Question 29

Galeazzifracture

Answer 29

Radius fracture and dislocation of distal ulnar

Question 30

Complications of shoulder dislocation

Answer 30

Hill sachs - cortical depression in humeral head Bankart - glenoid labrum defect

Question 31

Disc herniation mx

Answer 31

Conservative - max 2 days bed rest - encourage activity and physio Med:analgesia diazepam (relaxant) facet joint injections Surg: Percutaneous Microdiscectomy Endoscopic discectomy Hemilaminectomy + discectomy.

Question 32

Causes of charcot foot

Answer 32

Central: syringomyelia Tabes dorsalis Peripheral -DM, peripheral nerve injury, leprosy.

Question 33

Ix NOF

Answer 33

ECG FBC U+E, clotting Cross match XR pelvis/hip

Question 34

Signs of NOF

Answer 34

Shortening of leg External rotation of leg Swelling of hip

Question 35

Initial mx of NOF

Answer 35

``` Analgesia IV fluids Skin traction Urinary catheter O2 prn NBM ```

Question 36

Initial mx femoral shaft fracture

Answer 36

``` Analgesia IV fluids FBC U+Es Cross match 2 units XR pelvis/femur Splintage affected limb Check pedal pulses Check evidence other injuries ```

Question 37

Tibial fracture mx

Answer 37

``` Analgesia Bloods: clotting, FBC, U+E. Splint NBM IV fluids ``` Internal/external fixation if not displaced/minimal -> manipulation/plaster immobilisation

Question 38

Mx achilles tendon rupture

Answer 38

Equinus cast

Question 39

Positive fromets sign Claw hand Extension of 4th and 5th fingers at MCPs, and flexion at interphalangeal joints.

Answer 39

Ulnar nerve injury distal to wrist flexor digitorum profundus intact, not countered by small muscles of hand.

Question 40

Features of adhesive capsulitis

Answer 40

``` frozen shoulder DM External rotation affected most active and passive affected painful freezing phase bilateral 20% 6m -2y NSAIDS, physio, steroids. ```

Question 41

Claudication buttocks and thighs atrophy of leg muscles impotence

Answer 41

Leriche syndrome -atherosclerosis of aorta iliac vessels Ix: Angiography, mX - stents

Question 42

wrist pain after FOOSH, normal XR hyperextended wrist radially deviated. loss of grip/pinch strength ``` Point tenderness over anatomical snuffbox. wrist effusion pain on telescoping thumb tender scaphoid tubercle. pain on ulnar deviation. ```

Answer 42

normal XR repeat XR 7-10days. Scaphoid # gradually worsening pain refer to Ortho, for MRI + surgery. XR: AP, Laterla. oblique with wrist pronated at 45 deg, ziter view - PA with wrist in ulnar deviation and beam angulated at 20deg. MRI MX: Immobilisation with futuro splint/below elbow backslab. referral to ortho , futher imaging MRI 7-10 days Undisplaced: cast 6-8w. displaced - surgery proximal pole - surgery