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Ortho elective Flashcards

(53 cards)

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1
Q

What are the key aspects of an orthopaedic/MSK examination?

A

Look
Feel
Move
Special test

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2
Q

What aspects may you comment on during inspection in a clinical examination?

A

Bruising
Scars
Deformity
Shortening
Swelling
Wasting

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3
Q

What is grade 0 muscle power?

A

No power

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4
Q

What is grade 5 muscle power?

A

full and normal muscle power

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5
Q

What is grade 3 power?

A

Enough to move limb against gravity

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6
Q

What is grade 2 power?

A

Enough to move limb without gravity

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7
Q

What is grade 4 power?

A

enough to move limb against gravity and provide some resistance

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8
Q

How may you eliminate scapulothoracic movement when assessing the GH joint?

A

Face palm downwards

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9
Q

What deformity may be present when inspecting a patient with a previous supracondylar fracture?

A

Gunstock deformity

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10
Q

What type of gaits are there?

A

Antalgic gait (pain)

Scissor gait (crosses over due to adductor spasm e.g. Cerebral palsy)

Drop foot gait (ankle dorsiflexion weakness due to Common peroneal nerve palsy)

Hemiplegic gait (flexor spasm)

Trendelenburg gait (abductors weak)

Painful foot gait (shuffling gait)

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11
Q

What is the primary difference between the Lachman and the anterior drawer test?

A

The Lachman test involves the knee being only partially flexed

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12
Q

What is the term for a flat foot?

A

Pes planus

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13
Q

What is the term for an arched foot?

A

Pes cavus

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14
Q

What is a synovial joint?

A

Communication of two joints which is lined by synovium, secreting synovial fluid. Articular ends of bones are lined with hyaline cartilage.

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15
Q

Name the types of joint?

A

Synovial joints

Cartilaginous joints (primary cartilaginous or secondary ‘symphyses’)

Fibrous joints

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16
Q

What types of bones exist?

A

Long bones
Flat bones
Short bones
Accessory ossicles

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17
Q

What is the apophyses?

A

Scale of growing bone

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18
Q

Give an example of the apophyses.

A

Olecranon
Acromion
Calcaneum

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19
Q

Outline some key aspect of bone perfusion.

A

Nutrient artery supplies bone marrow and periosteal vessels

Circulus vasculosus (vessel ring) around joint supplies collateral circulation at large ends of long bones

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20
Q

What are the two types of cartilage?

A

Hyaline
Type 2 collagen arranged in arcades with ECM consisting of PGs and other collagen types

Fibrocartilage
Elastic due to elastin and collagen

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21
Q

Give an example of how joint loading may be altered in disease.

A

Joint loading and the subsequent trabeculae pattern reflects the load of weight through a joint.

In hip disease, the antalgic gait may shift the centre of gravity closer towards the joint, leaning towards the affected side will prevent the abductors on the hip from working as hard and engaging the hip, reducing pain

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22
Q

Why may a periprosthetic fracture occur?

How has this attempted to be overcome?

Study These Flashcards
A

Bones and their implants are of different stiffness thus a stress riser may be created and in time, result in a fracture.

Isoelastic implants have been created

23
Q

What is a stress riser?

Study These Flashcards
A

Bones with areas of differing stiffness may be susceptible to fracture

24
Q

How may an implant be fixed to bone?

Study These Flashcards
A

Interference fit (tight fit)

Screws (mechanically)

Bone cement

Bone ingrowth

25
How does bone heal?
1) Inflammatory phase: blood, macrophages and bone cells 2) Reparative phase (callus formation): Osteoblasts deposit and osteoclasts resorb (seen 7-10 days post fracture) 3) Remodelling phase: external forces sensed by osteocytes and shaped by cycle of osteoclasts and osteoblasts
26
Describe the electrical activity of bone.
Bone is piezoelectric, emitting a current when deformed. The convex side has a positive charge relative to the concave side under compression. Important to note this when using screws and plates as differing piezoelectric properties may alter ability of bone to remodel
27
What is the difference between an autograft and an allograft?
Autograft = from the same patient Allograft = from a different patient
28
How may a bone be lengthened?
Hormonally Mechanically - Callotasis; Physeal distraction
29
What are the physical signs of a fracture?
Abnormal movement Crepitus Deformity Bruising Pain on stress Impaired function Swelling Tenderness
30
How long does it take for bones to heal?
8 weeks; x2 in lower limb
31
What are the types of impaired bone healing?
Delayed union Malunion Non-union (hypertrophic and atrophic)
32
How would you classify a fracture?
Open vs closed Morphology: transverse/oblique/spiral/comminuted/crush/greenstick/buckle Displaced vs non-displaced
33
What are the mechanisms of action for fractures?
Direct force Indirect force Pathological Fatigue (stress fractures)
34
How do you classify growth plate fractures in children?
Salter-Harris classification SALTR Straight across (epiphyseal slip) Across (fracture through epiphyseal line) Lower (below the physis) Through (through the epiphyses) cRushed (obliteration of epiphyseal plate)
35
List the potential early complications of a fracture
Wound infection Fat embolism Shock lung Chest infection DIC Exacerbation of generalised illness Compartment syndrome
36
List potentials late complications of a fracture.
Deformity Poor healing (malunion; non-union; delayed union) OA Aseptic necrosis Reflex sympathetic dystrophy
37
What are the clinical features of complex regional pain syndrome?
Skin sensation ∆ Skin colour change Abnormal movement Thought to be due to damage to sensory fibres sensing temperature change a painful stimuli thus hyperalgesia
38
What types of injuries to a joint can occur?
Subluxation Dislocation Fracture dislocation
39
What is the difference between subluxation and dislocation?
Subluxation is partial with some joint space contact cf dislocation is complete thus no joint contact
40
What is the difference between a sprain, partial rupture and complete rupture of a ligament?
Sprain is a partial tear but stability maintained Partial rupture is a partial tear with stability compromised A complete rupture is loss of both stability and continuity of the ligament
41
How may a blood vessel be damaged in a trauma?
Division (completely ruptured) Stretched (soft tissue injuries indirectly impact vessel) Spasm (blood vessel contracts and relaxes) Crushing (direct trauma compresses intima)
42
What are the potential nerve injuries exhibited in trauma?
Neurapraxia (outside pressure with transient loss of function) Axonotmesis (loss of function due to compression but incomplete) Neurotmesis (division of the nerve with no neural continuity)
43
How may muscle be damaged in a trauma?
Crushing (direct force) Laceration Ischaemia Ectopic ossification (haematoma leads to bone deposition)
44
What is the demographic of ankle fractures?
Bimodal Young (15-24) Elderly (75-84)
45
What are the most common locations of ankle fractures?
Isolated malleolar = 70% Bimalleolar = 20% Trimalleolar = 10%
46
What type of joint is the ankle joint?
Hinge joint
47
What is the range of motion of the talocrural joint?
Dorsiflexion = 10 degrees (30 degrees when knee is flexed) Plantarflexion = 30 degrees
48
Which fibres make up the medial collateral ligament of the ankle?
4 components to the 'delta' ligament: - Tibionavicular (Anterior) - Tibiocalcaneal (Intermediate) - Anterior tibiotalar (Deep) - Posterior tibiotalar (Posterior)
49
Which fibres make up the lateral collateral ligament of the ankle?
3 components: - Anterior tibiofibular ligament - Posterior tibiofibular ligament - Calcaneofibular ligament
50
When operating on the ankle using an anterior approach, which structures may be damaged?
Anterior tibial artery Deep peroneal nerve Both course over anterior ankle between EDL and EHL
51
When operating on the ankle using a posterior approach, which structures may be damaged?
Posterior tibial artery Tibial nerve These course posterior to medial malleolus between FDL and FHL tendons If posterolateral approach, may damage superficial perineal nerve and sural nerve
52
What are the biomechanics of the medial collateral ligament of the ankle?
Restrains anterolateral talar displacement
53
Which ankle fracture variants are you aware of?
Bosworth Maisonneuve LeFort-Wagstaffe Tillaux-Chaput

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