Orthopaedics

Question 1

Complications due to a fracture:

Answer 1

Rhabdomyolysis, Sepsis, VTE

Question 2

Fracture General Management:

Answer 2

The 4 R’s:

1. Resuscitation
2. Reduction
3. Restriction
4. Rehabilitation

Question 3

Factors which delay fracture healing?

Answer 3

Diabetes (poor blood supply)

Vascular Insufficiency

Malnutrition

Disorders of Vit.D and calcium or phosphate metabolism

**Think of things that affect vascualture/bone metabolism**

Question 4

6 P’s of acute peripheral ischaemia

Answer 4

The six Ps of acute ischemia include

pain

pallor

poikilothermia

pulselessness

paresthesia

paralysis

Question 5

Gas gangrene is caused by which organism?

Answer 5

Clostiridum Perfringens

Question 6

Surgical procedure for cauda quina (contraindicated in metastatic disease):

Answer 6

Laminectomy

Question 7

Type 1 necrotising fasciitis is a ____ infection.

Answer 7

Polymicrobial

Question 8

Type 2 necrotising fasciitis is a _____ infection.

Answer 8

Monomicrobial

(usually Strep A infection)

Question 9

Which intracompartemental pressure is diagnostic of compatment syndrome?

Answer 9

> 40 mmHg

Question 10

Colles Fracture is a ____ displacement of the distal radius.

Answer 10

Dorsal

Question 11

Hand signs associated with osteoarthritis?

Answer 11

Heberdens (DIP) Bouchards (PIP) Remember Emily’s fingers have Heberdens

Question 12

Transient synovitis is generally preceded by a _____ 1-2 weeks before the onset of pain and limp.

Answer 12

Viral infection (particularly upper respiratory tract infections)

Microscopy, culture and sensitivity of the joint aspirate will distinguish between TS and septic arthritis, as bacteria within the joint space confirms septic arthritis.

Transient synovitis (sin-oh-vie-tis), commonly called irritable hip, is the most common cause of limping in children

Question 13

Perthes disease is avascular necrosis of the femoral head in children aged ____.

Ischaemia in Perthes disease presents with gradual onset limp and hip pain. Pain can also be referred to the knee. Pain from transient synovitis would be similar, but would only last around ____ weeks; pain persisting for ____ weeks should raise suspicion for Perthes disease.

Answer 13

4-8 yrs

2 weeks

>4 weeks

Question 14

Osteoid Osteoma is a benign tumour in children that is classicaally relieved by ____.

Answer 14

NSAIDs

• and do not need escalating analgesia

Question 15

Ewing’s is the second most common malignant bone tumor in children, comprising 10-15% of childhood bone cancers. Ewing’s tumors have characteristic _____ cells

Answer 15

small round blue

Question 16

____ is the most common type of bone tumour in children and commonly occurs in the bones around the knee, as it often originates from the ____.

Answer 16

Osteosarcoma

Metaphysis

Question 17

____ and ____ are the most common malignancies of bone tissues in children. Add

Answer 17

Osteosarcoma and Ewing’s sarcoma

Osteosarcoma, the more common of the two types, usually presents in bones around the knee. Ewing’s sarcoma may affect bones of the pelvis, thigh, upper arm, or ribs.

Question 18

SUFE often presents with ____ pain alone.

On flexing the knee the childs hip will _____

Answer 18

Knee

externally rotate (called obligatory external rotation)

Question 19

Osteogenesis imperfecta is a genetic disorder varying in severity characterised by ____ formation in bones, leading to fragile bones which are prone to fractures. It is also commonly associated with eye, hearing and dental abnormalities.

Mnemonic - ___ :

Answer 19

Inadequate collagen

BITE

B = bones

I = eyes

T = teeth

E = ears

Question 20

Menisci are primarily made up of type ___ collagen. There is a medial and lateral meniscus in the knee.

Answer 20

2

Question 21

_____ classification is used to determine severity of open fracture IN THEATRE following debridement.

Answer 21

Gustilo-Anderson

Question 22

Compartment syndrome 3 Pains:

Answer 22

PAIN- out of proportion

PAIN - not relieved by storng opiates

PAIN- on passive flexion

NB - 5Ps of peripheral vascular compromise is a late sign!

Question 23

Pelvic Sphlanchnic Nerves ____ - ____ are responsible for the ____ innervation of the bladder. They thus are responsible for ____ and detrusor contraction, but also provide involuntary control to the ____ urethral sphincter.

Answer 23

S2-S4 (pelvic nerve)

Parasympathetic

Urge reflex

External

Question 24

The most important adage to remember for the surgical management in traumatic orthopaedic complaints is ‘____– ___– ____’.

Answer 24

“Reduce - Hold - Rehabilitate “

Question 25

Frozen shoulder is also known as ________.

It affects 2% to 5% of the population. It is slightly more common in women than in men, and is most common in people between ____ and ____ years of age.

Recent history of traumatic shoulder injury, prior surgery to affected shoulder, _____ , _____, and previous history are all risk factors.

Mainstay of treatment is _____ and _____. Evidence shows that non-steroidal anti-inflammatory drugs and injected corticosteroids may also be beneficial.

Refractory cases may require a surgical capsular release. This can be performed reliably and satisfactorily with arthroscopic techniques.

Answer 25

Adhesive capsulitis

40 - 70 years

diabetes mellitus

thyroid disease

Steroid injection/NSAIDs (pain phase - 1yr)

physiotherapy and observation (stiffness phase - 1 yr)

Remember external rotation is the primary loss of function in adhesive capsulitis.

*Remember roofer patrick in gp warrington - type 1 diabetic*