Orthopaedic Emergencies

Question 1

What is the classification for open fractures?

Answer 1

Gustillo-Anderson

 Type I: < 1 cm
 Type II: 1-10cm
 Type III: > 10 cm or high energy

Question 2

List three complications of open fractures

Answer 2

 Soft tissue infection
 Osteomyelitis
 Tetanus
 Crush syndrome
 Skin loss
 Non-union
 Amputation

Question 3

State three aspects in the management of open fractures

Answer 3

• Control the bleeding
• Cover with sterile dressing (take medical pictures first so that dressing can remain in situ until theatre)
• Splint
• IV antibiotics
• Tetanus prophylaxis!!
• Assume any open wound over or near a joint extends to the joint until proven otherwise

Question 4

List two bacteria that cause septic arthritis

Answer 4

S aureus
beta hemolytic strep
Strep pneumoniae

Question 5

80% of septic arthritis cases are caused by which group of bacteria?

Answer 5

gram-positive aerobes

Question 6

Two causes of septic arthritis?

Answer 6

trauma
iatrogenic
haemtogenous spread
adjacent osteomyelitis
soft tissue infection

Question 7

List three clinical features of septic arthritis

Answer 7

 Rapid onset
 Joint pain
 Joint swelling
 Joint warmth
 Joint erythema
 Fever
 Decreased range of motion
 Pain with active and passive ROM

Question 8

List two aspects of the management of septic arthritis

Answer 8

Aspiration of Joint
IV antibiotics
Washout of joint- Arthroscopic or open

Question 9

Discuss three complications of septic arthritis

Answer 9

Degenerative joint disease
Soft tissue injury
Osteomyelitis
Joint fibrosis
Sepsis
Death
Joint destruction

Question 10

Define compartment syndrome

Answer 10

intra-compartmental pressure in a fascial compartment becomes elevated beyond the capillary perfusion pressure

Question 11

List three clinical features of compartment syndrome

Answer 11

Pain- out of proportion
Parasthesia
Pallor
Paralysis
Pulselessness
Pressure

Question 12

Above which intracompartmental pressure is compartment syndrome diagnosed

Answer 12

> 30 mmHg

Question 13

What is the most common organism to cause necrotising fasciitis?

Answer 13

group A strep

Question 14

Which part of soft tissue does nec fasc affect?

Answer 14

subcutaneous fascia

Question 15

What is the management of nec fasc?

Answer 15

surgical debridement
high dose broad spectrum antibiotics

Question 16

Discuss four aspects of clinical exam of suspected cauda equina

Answer 16

Palpation: spinal tenderness, bladder for retention
Neurovascular: myotomes, dermatomes, reflexes
DRE/genital exam: anal tone

Question 17

Is spinal tenderness indicative of cauda equina?

Answer 17

lower back pain and spinal tenderness is not a distinguishing feature

Question 18

Investigations for cauda equina

Answer 18

Pre and post voiding bladder scan
MRI lumbar spine

Question 19

What is the treatment for cauda equina

Answer 19

urgent surgical decompression within 23 hours
if malignancy then cord compression could be treated with radiotherapy

Question 20

State two complications of delayed presentation or decompression

Answer 20

urinary dysfunction- catherterisation
sexual dysfunction
chronic pain
persistent leg weakness
altered sensation