Ortho Revision Questions Flashcards by Hifza Khan

Management to avoid devleopment of chest infections in elderly patients who may have fallen

chest physiotherapy & analgesia

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squaring of the thumbs is a common feature in?

osteoarthritis

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Main causes of avascular necrosis of the hip

CHEMOTHERAPY
LONG TERM STEROID USE
excess alcohol
Trauma

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ACL injury mechanisms

direct blow to the back of the knee
excessive hyperextension

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Treatment for Pagets

Bisphosphonates

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Carpal Tunnel Treatment

6 weeks conservative management –> WRIST SPLINT +/- CORTICOSTEROID INJECTIONS

In severe cases - surgical decompression - flexor retinaculum division

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Management for Cauda Equina

Surgical Decompression

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Colles Fracture Features

DINNER FORK DEFORMITY
DISTAL RADIUS FRACTURE
DORSAL ANGULATION

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Smiths Fracture Features

GARDEN SPADE DEFROMITY
DISTAL RADIUS FRACTURE
PALMER ANGULATION

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Nerve affected in Meralgia Parasthetica

Lateral Femoral Cutaneous nerve

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Compartment Syndrome Investigation

Manometer

Normal - 0-10
Abnormal - 20-40
Diagnostic - 40 above

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Most Common Fracture that causes compartment syndrome

tibia / fibula TIBFIB

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T-score for bone density

-1 and above = normal
-1 - -2.5 = osteopenia
-2.5 and below = osteoporosis

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Osteomyelitis Management

surgical debridement & 6 weeks FLUCLOXACILLIN (with rifampicin / fusidic acid for the first 2 weeks)

*If penicillin allergy use clindamycin

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How soon should hip fractures be surgically treated?

within 48 HOURS

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Management of an intracapsular undisplaced hip fracture:

Internal Fixation

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Management of an intracapsular displaced hip fracture

Total Hip replacement to all patients providing they are:
1. able to walk independently out doors with no more than a walking stick
2. not cognitively impaired
3. are medically fit for anaesthesia & the procedure

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Extracapsular (stable intertrochanteric) Hip Fracture Management

dynamic hip screw

Extracapsular (reverse oblique / transverse / subtrochanteric) Hip Fracture Management

intramedullary device

–> should weight bear IMMEDIATELY after the operation. = reduces risk of VTE.

How soon should patients weight bear after hip fracture surgery?

immediately post op

Backpain 1st line treatment

NSAIDs

Osteoarthritis Management

Patient education via: weight loss, physiotherapy, occupational therapy, orthotics
Analgesia:

Oral paracetamol and topical NSAIDs
Oral NSAIDs - ibuprofen / naproxen (w/ ppi)
Opiates - codeine

How long should prophylaxis LMWH for VTE be given to patients following Knee replacement?

14 days

How long should prophylaxis LMWH for VTE be given to patients following hip replacement?

28 days

What is the most common reason for hip replacement revision surgery?

aseptic loosening

What is a potential complication of a total hip replacement?

Posterior dislocation - presenting with internal rotation and shortening of the leg

What structures are included in the anatomical snuffbox?

1. Radial artery 2. Superficial radial nerve 3. Cephalic vein

Scaphoid fracture main symptom

anatomical snuffbox tenderness

What is the most common nerve to be damaged in a colles fracture?

Median nerve

What are the Ottawa rules for ankle injuries?

The rules state that an ankle x-ray is only required if there is any pain in the malleolar zone and any one of the following findings: 1. Bony tenderness in the lateral malleolar zone. (From tip of lateral malleolus to include 6cm of posterior border of fibula) 2. Bony tenderness in the medial malleolar zone . (From tip of medial malleolus to include 6cm of posterior border of tibia) 3. Inability to walk 4 weight bearing steps immediately after the injury and in the ED.

What are some main side effects of bisphosphonates such as alendronic acid?

1. Gastrointestinal - reflux / oesophageal erosions 2. Osteonecrosis of the jaw 3. Osteonecrosis of the external auditory canal 4. Atypical fractures

What is Gurd’s MAJOR criteria for diagnosing fat embolisms?

CRP: 1. Cerebral involvement 2. Respiratory distress 3. Petechial rash

What is a late sign of cauda equina?

Urinary incontinentence

How can you differentiate between cauda equina and metastatic spinal cord compression?

Cauda equina presents with LMN signs: 1. Weakness / paralysis 2. Decreased reflexes - loss of tendon reflex 3. Decreased tone - flaccidity 4. Muscle wasting 5. Fasciculations

What are the Ottawa knee rules?

To determine if a patient requires an x-ray of their knee. The following should be present: 1. Aged 55 or above 2. Patella tenderness 3. Fibular head tenderness 4. Cannot flex knee to 90 degrees 5. Cannot weight bear - cannot take 4 steps (limps count)

Complications of discitis?

- sepsis - epidural abscess

Discitis Investigation

MRI

Causative organism of Discitis?

Staph. Aureus

Undisplaced scaphoid fracture Management

Cast for 6-8 weeks

RIB fracture management

1. ANALGESIA - NSAIDs, opioids, intercostal nerve blocks 2. Chest drain - if hemothorax / pneumothorax 3. Surgical management - if fracture has not healed even after 12 weeks

Diagnostic scan for rib fracture

CT scan of chest

Clubbed foot management

- Ponseti Method - Deformity corrected 6-10 weeks after birth - Night time braces should be used until the child is 4 years old