Orthopaedic medicine Flashcards
(243 cards)
1
Q
What are the two principal symptoms in orthopaedics?
A
pain stiffness
2
Q
which cell characterises acute disease?
A
polymorphic leucocytes
3
Q
which cell characterises chronic disease?
A
lymphocytes
4
Q
What is the difference between -otomy and -ectomy?
A
-otomy = open something up -etomy = remove something
5
Q
What is osteomyelitis?
A
bacterial infection resulting in inflammation of bone
6
Q
What is the difference between primary and secondary OA?
A
primary has unknown cause
7
Q
What is Perthes disease?
A
idiopathic osteochondritis of femoral head in children
- AVN occurs causes abnormal growth
- occurs in short, active boys
8
Q
Why are the lower limb joints subject to high loads?
A
muscles around the joint exert leverage several times body weight
eg. 3x body weight in hip during walking
9
Q
Explain normal walking
A
contract abductor muscles in the leg we step on
lift pelvis opposite way
other leg swings forward
10
Q
How does a walking stick help hip OA?
A
it reduces load on the hip by reducing abductor muscle activity carry stick in opposite hand lets shoulder girdle tilt the pelvis instead of the muscle tiling the pelvis
11
Q
what is arthrodesis?
A
surgical stiffening of a joint in a position of function. Essentially, a relatively stiff and very painful joint is cut out and the remaining raw bone ends are held together either by an external splint or screws until they heal with a bony bridge
12
Q
How can arthrodesis work in hip?
A
30° flexion and some abduction allows walking + sitting
13
Q
Name some negatives of hip arthrodesis
A
interferes with female sexual activity
strain on adjacent joints in long-term eg. opposite hip, lumbar spine and knee
a large joint is technically difficult to fuse
14
Q
In which body parts is arthodesis useful?
A
ankle and wrist
15
Q
what is an osteotomy?
A
surgical realignment of a joint to redirect forces
16
Q
who does osteotomy work for?
A
good in a joint deformity eg more wear due to bow-leg
- young people
- good ROM
- reasonable articular cartilage
17
Q
If someone has bad ROM is arthrodesis or osteotomy better?
A
arthrodesis
18
Q
is arthroplasty better in upper or lower limb? why?
A
lower because upper needs better ROM
19
Q
what function ROM is needed in the hip after arthroplasty?
A
10° extension 40° flexion few ° abduction
20
Q
what function ROM is needed in the knee after arthroplasty to get up and down stairs?
A
90° flexion stable in extension
21
Q
List general complications of arthroplasty
A
chest infection UTI DVT PE
22
Q
List specific early complications of arthroplasty
A
dislocation infection
23
Q
List specific late complications of arthroplasty
A
late infection loosening and wear
24
Q
4 requirements of joint replacement
A
functional ROM
stability
relief from pain
can withstand load
25
What joints are affected in rheumatoid arthritis?
Small joints affected symmetrically
* fingers (not DIP)
* wrists
* feet
* ankles
26
How does rheumatoid arthritis present?
chronic presentation that is more common in women
* severe pain
* swelling
* deformity
* stiffness worse in the morning
27
Give 2 surgical treatment for RA and who they are suitable for
synovectomy: early in disease, younger patient, retained movement but pain, good at wrist
excision arthroplasty: combined with synovectomy at wrist or elbow, good at removing pain but joint damaged so never full return to function
28
What sites are affected by post-traumatic AVN?
femoral head due to #fem neck
proximal scaphoid
proximal talus
29
what bones are affected by non-traumatic AVN?
lunate bone
femoral head
30
what is Caisson's disease?
AVN of the femoral head in chronic alcohol abuse, steroids, deep sea divers
31
How does AVN present ?
acute and often severe joint pain, which is made worse by movement, and to some degree relieved by rest.
With the passage of time symptoms become indistinguishable from osteoarthritis and then it may be treated as such.
32
What causes gout?
urate crystal deposition
* dehydration post-surgery
* chemotherapy
* over-use of diuretics
33
Which joints does gout commonly affect?
1. knee
2. first MTP (base of big toe)
34
what can pseudogout cause in the knee?
calicification of joint surfaces and menisci
35
How does presentation of acute septic arthritis differ between adults and children?
children very acute illness with a stiff, hot and tender joint
adults have a minor upset of a chronically abnormal joint --\> delay in recognition results in septicaemia and death
36
which organism causes
a) septic arthritis most commonly?
b) chronic septic arthritis?
c) acute septic arthritis in a young adult?
a) staphylococcus
b) TB
c) gonococcus
37
How does chronic septic arthritis present?
* chronic ill health
* weight loss
* considerable muscle wasting around the affected joint
* x-ray shows marked thinning of bone
38
Manage acute septic arthritis
surgical washout and IV antibiotics
39
how do meniscal lesions present
pain effusion locking/giving way
40
which meniscus is more likely to be damaged
medial
41
which type of meniscal lesion occurs in old age
cleavage lesion: a horizontal flap that allows in fluid --\> cyst
42
most common type of meniscal lesion
bucket handle tear
43
what MOI in meniscal lesion
twisting injury
44
How are meniscal lesions managed surgically?
ARTHROSCOPY
* try to preserve meniscus
* suture peripheral tears
* if tear in meniscus itself remove torn part as no capacity to heal
45
how do loose bodies present
injury causes osteochondral fragment to break off with an initial haemarthrosiswhich settles
later pain, locking, giving way, effusion
46
spontaneous loose bodies in adolescents is called
osteochondritis dissecans
47
MOI for cruciate ligaments
hyperextension/twist with anchored foot
48
PC cruciate injury
"pop" haemarthrosis --\> settles chronic injury
49
what causes patellar dislocation?
- congenital eg. Down's syndrome
- trauma
- malformed patella/femoral condyle results in maltracking which causes muscle spasm and spontaneous dislocation
50
what is maltracking patella
patella does not stay in its place on femur causing abrasion
51
treat minor patella maltracking
split vastus lateralis
52
treat recurrent, severe patella maltracking
plication (medial tightening of vastus medialis)
53
what do we call non-nervous tissue in the spine?
spondylitides
54
what surrounds nerve roots exiting from vertebral foramina?
facet joints intervertebral discs
55
How is referred pain in the leg distinguished from sciatica?
referred pain: back to buttock to leg (not below knee) sciatica: leg to foot
56
where does nerve root pain in cervical spine go to?
hand and forearm
57
what are localising signs?
loss of sensation or muscle weakness
58
what are the facet joints?
joint between articular processes of adjacent vertebrae
59
what is the pars interarticularis?
part between inferior and superior articular processes of the facet joint
60
how does lifting something with a straight back and holding it close to the spine prevent back sprain?
it causes less leverage and reduces spinal load
61
do we see signs of nerve compression in back sprain?
no
62
what is mechanical backache? what causes it?
recurrent sprains of unknown cause - may be due to spondylosis or primary OA
63
what is spondylosis?
degeneration of the intervertebral disc leading to increased loading of the facet joints and secondary OA
64
what is spondylolithesis?
slippage of one vertebrae relative to the one below it
65
how does spondylolithesis occur?
* congenital
* acquired following acute or fatigue # of pars interarticularis
66
how do you manage spondylolithesis if there is severe pain?
spinal fusion
67
what is spondylolysis?
of pars interarticularis without forward slippage. can cause pain
68
how does a prolapsed lumbar disc present?
acute leg pain (down to foot) +/- backache
can be after an episode of strain or spontaneous
69
Why does someone get a prolapsed disc?
abnormal intervertebral disc leads to prolapse of nucleus pulposis through annulus fibrosis
70
Which vertebrae are most commonly affected by prolapsed discs? What does this result in?
sacrum and 5th lumbar
sciatica as sciatic nerve exists from the above nerve root so pain is perceived in the sciatic nerve
71
How do we confirm what disc is affected in prolapsed disc?
myelography: inject radio-opaque die into spinal fluid and it wont go where prolapse is on xray
72
What is impinged when the nucleus puloposus herniates
a) backwards + laterally?
b) posteriorly?
a) nerve root
b) spinal cord
73
What is bony root entrapment?
bony overgrowth around vertebral foramina compresses nerve root
74
Why does bony root entrapment occur?
secondary to degenerative change eg primary OA or disc degeneration
75
Does bony root entrapment occur in response to a prolapsed disc?
no
76
Who is affected by bony root entrapment in the lumbar spine?
over 40 hx of mechanical back pain
77
What characterises spodylosis?
osteophytes growing around a degenerated disc
78
what is cervical spondylosis?
a degenerative disease of the cervical discs leading to secondary arthritic changes in the adjacent facet joints
79
Who does cervical spondylosis affect?
women over 40
80
How does cervical spondylosis present?
dull neck ache that refers to shoulders and upper arms tingling arms
81
Can cervical spondylosis progress?
yes it can progress to bony nerve root entrapment
82
How do you manage cervical spondylosis?
no localising signs = analgesia, NSAIDs, collar, physio
nerve root entrapment = fuse vertebrae
83
How can we differentiate between cervical spondylosis and cervical disc disease?
disc disease tends to have no history of cervical neck problems
84
What happens following cervical disc prolapse?
muscle spasm restricted movement
85
How do we manage cervical disc prolapse?
most will recover with
* rest, gentle traction, supporting collar
if marked localising sings / symptoms dont regress
* surgery to fuse vertebrae
86
Normal milestone for
a) sitting b) standing c) walking
a) 9 months
b) 1 year
c) 20 months
87
What is genu valgum?
knock knees - normal alignment
88
What is genu varum?
bow legs
89
Which of genu valgum and varum causes an increased gap at the feet?
genu valgum
90
What is the normal foot gap for children?
4cm
91
When do knock knees and bow legs tend to resolve?
by age 7
92
What are curly toes?
what toe is most commonly affected?
should they be operated on?
minor overlapping of toes
5th
discourage operating unless discomfort in shoes
93
Give some causes of intoeing
femoral neck anteversion tibial torsion abnormal forefoot
94
How does the femur develop
During the later stages of the normal development of the foetus, the leg rotates on the pelvis so that the acetabulum points almost backwards and the femoral head on the neck is orientated forwards.
95
What movements does a child with femoral neck anteversion do ?
* lots of internal rotation
* limited external rotation
96
When should femoral neck anteversion fix itself?
by age 10
97
What is tibial torsion?
how should it be managed?
where the bone is literally distorted or warped along its vertical axis
it is a normal variation and should be ignored.
98
What are the two types of flat feet?
rigid and mobile
* mobile is normal
* rigid may be due to underlying bony abnormality or RA
99
Which toe is particularly common to overlap?
5th toe
100
What age in childhood is knee pain common?
10-12
101
what is osgood-schlatter's disease? what is the mechanism behind it?
inflammation of the attachment of the patellar tendon to the growing tibial epiphysis due to excessive traction by the quadriceps
The cause is unknown but it may be an overuse injury as it is more common in very active children who are often involved in organised sport.
102
what can arthroscopy show in a girl with adolescent knee pain?
arthroscopy can shoe chondromalacia patellae (worn out patella)
103
what is the occurence of CDH
1/2 per 1000 live births
104
How is CDH screened?
at birth manoeuvres: one to dislocate and one to reduce a dislocated hip --\> positive if click/clunk screened again at 3,6,12 months
105
Signs of CDH
positive ortolani/barlow limb shortening asymmetrical skin creases limited abduction and a limp
106
how do you manage a) a click? b) a clunk?
a) refer to specialist at 3 months for x-ray b) treat from birth
107
how is early CDH treated?
splintage to put femoral head in acetabulum
108
how is late CDH treated?
not walking: gentle traction, open/closed manipulation, 3 months of splintage walking: major surgery to deepen acetabulum and reangulate femoral neck
109
what is the name for club foot?
talipes equinovarus
110
what does equinus mean?
plantarflexion
111
what are the two forms of club foot?
1. mild postural after breech birth
2. fixed form due to developmental abnormality of nerves and muscles
112
How is club foot managed?
manipulate at birth with 6 weeks splintage with Ponseti technique corrects hindfoot equinus then mid+forefoot varus
- severe cases may need surgery after this if correction incomplete
- follow up until feet stop growing
113
What are the two forms of spina bifida?
spina bifida occulta (minor bony abnormality, more common) spina bifida cystica (neural plate tissue open with little or no skin or bone cover)
114
What is a diastomatomyelia?
in what form of spina bifida does it occur?
tethering of spinal cord to higher lumbar vertebrae during growth
occulta
115
what is a meningocele?
when nerve tissue covered by a cyst
116
What is a meningomyelocele?
when nerve tissue is incorporated into a cyst
117
Which type of spina bifida may cause hydrocephalus?
cystica
118
what is cerebral palsy?
neuromuscular disorder with onset before 2‐3 years of age due to an insult to the immature brain before, during or after birth
119
how does spastic cerebral palsy present?
spaastic paralysis: some muscles to strong but uncoordinated, some weak and flacid missing milestones like walking lack of co-ordination and purpose of movement
120
Give an example of minor spastic cerebral palsy
how can this be treated
toe-walking in adolescence due to spastic calf muscles
--\> may need tendo-achilles lengthening
121
What MSK problems do people with cerebral palsy suffer from?
joint contractures, scoliosis and hip dislocation (non‐congenital).
122
How are MSK problems in CP managed ?
* careful physio
* baclofen and botox to reduce spasticity
* surgery to lengthen tight muscles, denervate them, move them
* hip surgery to help sit in a wheelchair
* splintage can make spasms worse
123
How is spina bifida managed?
surgery on feet to keep normal shape keep mobile till adolescence using splints + hand-held aids
124
Are orthopaedic problems more severe in spina bifida or cerebral palsy?
CP
125
What is scoliosis?
abnormal lateral curvature of the spine with a rotatory abnormality of the vertebrae
126
What is the underlying cause for scoliosis?
* most idiopathic
* neuromuscular disorder eg spina bifida
* congenital abormality of vertebrae
* tumour
127
is scoliosis painful?
it should not be painful - sometimes pain secondary to distress about condition
128
how does scoliosis occur?
abnormal lordosis leads to buckling and twisting of vertebral column due to muscles and gravity
129
Why would scoliosis warrant an operation?
progressive curve distressing to patient to allow to sit in wheelchair restrictive lung defect in severe cases
130
What does a limp from birth indicate?
? CDH or hip infection
131
What are imaging findings for perthes?
xray may be normal at first then fragment excess fluid on US
132
how do you manage perthe's?
leave minor cases alone
more severe may need splintage, osteotomy periods of traction
133
What are the long-term effects of perthe's disease in older children?
secondary OA
134
What age does perthe's disease present?
4-10 years
135
which two groups get a SUFE?
boys age 12 who are sexually immature girls age 14 who have had recent growthspurt
136
Where does SUFE tend to cause pain?
pain in the knee due to obturator nerve radiation
137
How do you manage a) minor SUFE? b) major SUFE?
a) pin hip b) gentle manipulation of head back on to neck --\> high risk of AVN
138
do you need to observe the other hip in perthes or sufe?
SUFE
139
when does osgood-schlatters present?
age 10-12
140
which gender are affected more by Perthes?
boys
141
What is an enthesis?
the short, fibrous origin of a muscle
142
Name 2 common sites of enthesopathy
1. Golfer's elbow: flexor muscles of forearm 2. Tennis elbow: extensor muscles of forearm
143
What is the prognosis for elbow enthesopathy
good esp if known cause - most resolve spontaneously
144
How do you manage severe or chronic enthesopathy?
anti-inflammatories steroid injection into point of max tenderness surgery to scrape origin off bone + decompress
145
What is neuropraxia?
compression/stretching injury to nerve
146
Which nerve is most commonly damaged by extrinsic causes?
common peroneal nerve as it winds around fibula
147
What nerves are commonly damaged by intrinsic causes?
median and ulnar nerves at the wrist ulnar nerve at the elbow posterior tibial nerve at the ankle
148
What symptoms should make you suspicious of nerve entrapment?
numbness or tingling
149
What symptoms are diagnostic of nerve entrapment?
weakness and real sensory loss
150
How do we manage nerve entrapment?
remove obvious cause surgical decompression
151
What is a bursa?
a small sac of fibrous tissue lined with synovial membrane and filled with fluid
152
What do bursae do?
acts as natural bearing to improve muscle and joint function by reducing friction where tendons and ligaments pass over bone
153
How does bursitis present?
chronic discomfort that might be exacerbated with movement or pressure swelling
154
How does an infected bursa present?
* tense swelling
* cellulitis
* malaise
155
How do you treat a) asymptomatic b) tender c) infected bursitis?
a) dont b) excise and treat cause c) incise and drain
156
What may painful, spasmodic flat feet indicate?
* infection
* chronic inflammatory disease
* impending rupture of tibialis posterior if acute
157
How do you manage painful flat feet?
medial heel lift --\> subtalar joint fusion (disturbs foot and ankle joint)
158
What is a bunion?
fluid-filled bursae around bony prominences
159
Where do bunions most commonly occur?
distal part of 1st metatarsal
160
What is a corn?
painful excessive skin
161
Why do bunions and corns form?
natural response to pressure that indicates underling abnormality
162
What is hallux valgus?
the turning away of the phalanges of the big toe from the mid-line, usually because of a deformity at the joint line.
163
What is hallux rigidus?
osteoarthritis of the first metatarsophalangeal joint.
164
Why does hallux rigidus occur in adolecents and how do you treat it?
osteochondral #
metatarsal bar which often fails then surgery
165
Describe surgical treatment of hallux rigidus
1. remove osteophytes and osteotomy of proximal phalanx
2. fusion
3. silicone spacer arthroplasty
( physio also useful)
166
when is hallux valgus seen alone and how is it treated?
in women with a short 1st metatarsal in varus
realign laterally and excise bony prominence
167
What is a claw foot? Why does it happen?
when muscles waste to make the bones and nails look prominent
occurs due to muscle weakness or deficiency eg spinal abnormality
168
What is hammer toe secondary to?
metatarsophalangeal joint disruption
169
What is metatarsalgia?
generally sore forefoot
170
What is morton's neuroma?
cutaneous nerves to the toes bcome trapped/irritated between metatarsal heads due to repetitive trauma
171
How does mortons's neuroma present?
dull, throbbing with sharp exacerbations tingling sideways compression causes click
172
Where does the plantar fascia span from?
os calcis to base of each toe
173
How does plantar fascitis present?
sore instep worse on rising and if sitting for hours minimal relief from walking
174
How do you treat plantar fascitis?
self-limiting condition with ways to relieve symptoms
* insoles and soft shoes
* local injection of steroids + local anaesthetic to point of tenderness
* surgery to strip fascia is questionable
175
What is sensory neuropathy?
a loss of sensation caused by disease or injury to sensory peripheral nerves.
176
How does achilles tendonitis present?
pain where the tendon inserts into os calcis
177
Who gets achilles tendonitis?
young athletes middle aged men
178
How do you treat achilles tendon rupture?
equinus plaster for 8 weeks or suture
179
What structures can contribute to shoulder pain?
* subacromial bursa
* supraspinatous tenson
* Acriomiocalvicular joint
* biceps tendon
* rotator cuff
180
What condition presents with tenderness under active movement with painful arc ?
supraspinatous tendon inflamamtion or subacromial bursitis
181
What pathology in the acriomioclavicular joint can cause shoulder pain?
degenerative change, and osteophytes in the acromio- clavicular joint
may lead to rupture of the supraspinatus muscle which is part of the rotator cuff. Such rotator cuff tears can become large rents and even small ones cause a lot of discomfort and pain.
182
What is frozen shoulder? who gets it?
little or no glenohumeral movement idiopathic or after trauma eg epileptic fit or electric shock
183
How long does frozen shoulder last?
18 months - 2 years
184
What is the periosteum?
the membrane covering the outside of the bone
185
signs of a fracture
pain deformity tenderness swelling discolouration loss of function crepitus
186
What determines the position of a) the proximal fragment? b) the distal fragment?
a) muscles b) gravity
187
How does a radioisotope scan work?
inject radioactive material into blood, it joins to phosphate and is taken up into bone increased at fracture site because it is more metabolically active
188
What is a spiral #?
occurs due to twisting injury low energy easy to heal as soft tissues ok
189
What is an oblique fracture?
buckling/ shearing force eg deceleration/ fall from height high energy --\> hard to heal
190
What is a transverse fracture?
bending force, cortex fails on one side in compression and other in tension. high energy --\> hard to heal
191
What is displacement?
is the distal bone fragment aligned wrong eg posterior/anterior, medial/lateral
192
What is angulation?
distal fragment points elsewhere eg posterior/anterior, valgus/varus
193
How can we relieve pain following fracture?
drugs: inject morphine or pethidine
splintage to steady #: encompass joint above and below
194
When is traction useful?
to help with muscle spasm femoral neck #
195
How much blood is lost in a) femoral #? b) pelvic #? c) tibial #?
a) 2-3 units b) 6 units c) 1 unit
196
How do you manage an open fracture?
surgery ASAP - may need to open wound and excise down to bone - most left open due to concern over skin closure
197
What are the two stages of fracture management?
reduction and holding
198
What must holding allow for?
keep # in place until united and consolidated (can weight bear)
199
name types of holding
casts internal fixation external fixation traction
200
describe how casting is done
place limb in cast at appropriate length immobilise joints above and below pressure at 3 points
201
What are some disadvantages of casting?
heavy can't re-examine muscle wasting due to immobilisation
202
What is a good alternative to casting?
functional braces - but these can only be applied after a few weeks once swelling and pain go down
203
When is external fixation useful?
high energy injury where there is soft tissue damage
204
Give types of internal fixation
apposition interfragmentary compression onlay device inlay device
205
What is apposition? give an example
holding a fracture in alignment so it can heal eg K wires
206
What is interfragmentary compression?
using screws and tension band wiring
207
what is an onlay device?
a rigid metal plate used to strengthen structures around joints and in upper limb long bones
208
Which types of internal fixation stop natural healing?
onlay device
209
What is an inlay device?
intramedullary
210
When are inlay devices not useful?
around joints
211
Give 3 types of traction
static: uses own body as pulley
balanced: takes pressure off body by using a weight
dynamic: allows joints to move using pulleys
212
How does traction work as a holding method?
* application of a relatively small weight to a limbexerts a pull along the axis of the broken limb.
* This pull of at most 5 kilograms stimulates muscles to contract. Muscles completely surround a bone, and this slight contraction (which is really an increase in muscle tone), is sufficient to hold a broken bone in the position achieved at reduction.
* effectively “massage” the aligned fracture ends until natural healing takes place.
213
Describe fracture healing at a) 0-2 weeks b) 2-6 weeks c) 6-12 weeks
a) swelling b) callus forms c) bone forms
214
How do bones heal?
with micromovement along the long axis of the bone at right angles to the break
215
Does rigid fixation speed up bone healing?
no it slows it down as no movement
216
How can low energy fractures be treated?
1. manipulation and casting 2. traction eg femur 3. internal fixation if early mobilisation
217
How should a displaced, intra-articular fracture be treated?
internal fixation screws to hold cancellous bone fragments as there is little soft tissue support
218
How should high energy injuries be treated?
external fixation as damage to blood supply
219
What does bone cancer occur secondary to?
thyroid kidney breast lung
220
Name 6 early complications that occur due to a fracture
* blood loss
* infection if open
* compartment syndrome
* renal failure
* soft tissue injury
* fat embolism
221
name 5 late complications that occur due to a fracture
* non-union
* delayed union
* mal-union
* growth arrest
* arthritis
*
222
name 5 early complicatios that occur due to fracture treatment
plaster disease renal stones immobility compartment syndrome infection
223
name 2 late complications that occur due to fracture treatment
mal-union infection
224
manage a) a stable fracture w infection? b) an unstable fracture w infection
a) drain + antibiotics b) external fixation, debridement + then bone graft later
225
How does fat embolism present?
men under 20 with long bone # 2-5 days after they have tachypnoea and confusion
226
Treat fat embolism?
high % o2 chest physio steroids
227
When does someone get renal failure following a #
major soft tissue damage person was trapped ischaemic limb in shock
228
What is a fascial sheath?
thick fibrous tissue surrounding a group of muscles
229
How does compartment syndrome happen?
causes bleeding and inflammation of adjacent compartment, inc pressure reduces blood flow and causes ischaemia
230
What is fracture/plaster disease?
muscle wasting stiffness skin sores
231
How long does normal healing take in a) upper limb b) lower limb compared to non-union?
a) 6 weeks then 10 weeks b) 12 weeks then 20 weeks
delayed union somewhere in between
232
Which bone is most commonly affected by non-union?
tibia
233
How is non-union treated?
* remove cause
* stabilise #
* autologous bone graft
234
What is malunion?
fixation of fracture in a bad position for function
235
How is malunion treated?
ORIF
236
Why does growth arrest occur following a #?
if it breaches the germinal layer of the epiphyseal growth plate
237
What are the radiological changes in AVN?
initially none
then bone dense as blood supply lost
238
treat TB
**2 RIPE 4 RI**
**- 2** months **R**ifampicin, **I**soniazid, **P**yrazinamide, **E**thambutol
- **4** months **R**ifampicin, **I**soniazid
239
Which knee ligament repairs spontaneously and which doesn't?
collateral repair as good blood supply
cruciate don't
240
What is osteochondritis?
fragmentation of bone and underlying cartilage
241
How can a sore, calcified supraspinatous tendon be treated?
injection
surgery
242
How to treat painful arc?
steroid injection into bursa or around tendon
243
What causes # to the shaft of long bones?
how are they treated
most are low energy injuries
treat with
1. casting and manipultation
use traction if this is difficult
internal fixation is justified if it allows for early mobilisation
