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Orthopaedics Flashcards

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1
Q

What is the diaphysis?

A

The shaft

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2
Q

What are the risk factors of OA?

A

Increasing age
Female gender (twice as common)
Obesity
Developmental dysplasia of the hip

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3
Q

What are the features of OA of the hip?

A

chronic history of groin ache following exercise and relieved by rest
red flag features suggesting an alternative cause include rest pain, night pain and morning stiffness > 2 hours
the Oxford Hip Score is widely used to assess severity

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4
Q

What should you give to patients with lower back pain?

A

NSAIDS are now recommended first-line for patients with back pain. This follows studies that show paracetamol monotherapy is relatively ineffective for back pain
proton pump inhibitors should be co-prescribed for patients over the age of 45 years who are given NSAIDs
NICE guidelines on neuropathic pain should be followed for patients with sciatica

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5
Q

What stabilises the ankle joint.

A

Tibiofibular syndesmosis
The syndesmosis is an essential part of the ankle jointand its stability, preventing splaying of the tibia and the fibula

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6
Q

What Ix would you want to do for a person with suspected ankle fracture?

A

Bedside tests- observations, BM, pregnancy test, ECG
Blood tests - FBC, U and Es and LFTS (prophylactic anticoagulation), clotting screen if someone is on anticoags to see what their clotting time is before surgery
Imaging- ankle XR (weight beading when possible, AP and lateral and mortise views), ankle CT is used in complex fractures
Special tests

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7
Q

What is a talar shift?

A

Widening of the medial clear space
It is associated an increased risk of post traumatic arhritis
It may not be evident on non weight bearing films
Talar shift is a clear sign of instability

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8
Q

What is the classification system used for ankle fractures?

A

Weber classification, based on the level of the fibular fracture in relation to the syndesmosis.

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9
Q

What is weber A, B, C Classifications?

A 
A= below the level of syndesmosis 
B= at the syndesmosis
C= above the level of syndesmosis
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10
Q

What is a maisonneuve fracture?

A

It is where there is ankle injury but the energy may pass upward and fracture the fibula, therefore in an ankle fracture you should always examine the knee with potential xray depending on clinical findings

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11
Q

What is the management of weber A fracture?

A

Weight bear with walking boot

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12
Q

How do you treat weber B fractures?

A

May need surgical fixation, although some will be appropriate for cast immobilisation

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13
Q

What do you do for a weber C fracture?

A

ORIF

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14
Q

What is close contact casting?

A

May be used as an alternative to surgical fixation

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15
Q

What would your approach be to an ankle fracture?

A

Analgesia- conscious sedation, opiates, gas and air
Reduce and cast (backslab)
Backslab allows the ankle to swell at the front
Re assess and check neurovascular status
Repeat xray
NBM (if really unstable and you think they will be going to theatre and elevate)
Senior review

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16
Q

When may you consider closed contact casting?

A

In patients who are elderly or co-morbid (e.g. diabetes mellitus, peripheral neuropathy) closed contact casting (CCC) should be considered for definitive management. Complications associated with surgery (e.g. infection) are eliminated though there appears to be a higher risk of mal-union with CCC.

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17
Q

What is a colles fracture?

A

An extra articular fracture of the metaphsyeal region of the radius with dorsal angulation of the distal fragment and impaction

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18
Q

What normally causes a colles fracture?

A

Fall onto outstretched hand (FOOSH)

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19
Q

What is a Smiths fracture?

A

This is reverse of Colles, refers to fracture of the distal radius with volar angulation of the distal fragment. Tends to be inherently less stable than fractures with dorsal angulation

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20
Q

What are the presentation of wrist fractures?

A

Fractures of the distal radius are acute injuries, patients will present with pain, swelling and reduced function of the affected joint.
Symptoms

Pain
Reduced range of movement
Signs

Boney tenderness
Swelling
Deformity
All patients should have a full assessment (and documentation) of the limbs neurovascular status. Complete a full-body assessment for associated injuries.

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21
Q

What investigations do you need to do for Colles?

A

The diagnosis of a wrist fracture may be made clinically and confirmed by a wrist radiograph.
Bedside

Observations
Urine dip
ECG
Bloods

FBC
U&Es
CRP
Bone profile
Vitamin D
Group & save
Clotting screen
Imaging

Wrist X-ray: PA and lateral films.
CT: allows accurate delineation of the extent of the fracture and any intra-articular involvement (not routinely required).
MRI: allows assessment of soft tissue injuries (not routinely required).

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22
Q

How do you manage wrist fracture?

A

Under 65- surgery will typically be considered. If closed reduction is possible then K wire fixation is generally preferred to ORIF

Over 65- in more elderly pts, non operative management will be considered as definitive management, where there is instability, significant deformity or neurological compromise then surgery will be considered.

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23
Q

What are the complications of wrist fracture?

A

Early

Median nerve neuropathy
Ulnar nerve neuropathy
Extensor pollicis longus or flexor pollicis longus rupture
Compartment syndrome
Medium to late
Osteoarthritis
Non-union / mal-union
Complex regional pain syndrome
Metalwork infection
Metalwork irritation
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24
Q

What does cauda equia normally present with?

A

Compression of the cauda equina (L1-S5) of the spinal nerves
It usually presents with bilateral leg weakness and paraesthesia
Also associated with bladder and bowel dysfunction

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25
What does lumbar disc herniation present with?
Lumbar disc herniation is incorrect this usually presents with reduced power and sensation in the affected leg. This is due to nerve root compression compressing both motor and sensory nerve fibres. A positive straight leg raise test is indicative of the condition.
26
The sciatic nerve divides into the tibial and common peroneal nerves Injury often occurs at the neck of the fibula What are the characteristics of a common peroneal nerve lesion?
Most characteristic feature is foot drop Other features.. - weakness of foot dorsiflexion - weakness of foot eversion - weakness of extensor hallucis longus - sensory loss over the dorsum of the foot and the lower lateral part of the leg - wasting of the anteror tibial and peroneal muscles
27
What are the clinical features of degenerative disc disease?
Depemds on the region and severity Potential signs include local spinal tenderness of contracted parasoinal muscles, hypomobility, painful extension of back or neck All cases require a complete neurological exam When the disc degeneration progresses to cause instability, the pain may become more severe and include radicular leg pain or paraesthesia. Pain may be reproduced by passively raising the extended leg (positive Lasegue sign). Further disease progression may demonstrate signs of worsening muscle tenderness, stiffness, reduced movement (particularly lumbar region), and scoliosis.
28
Pain after replacement?
Osteomyelitis Dislocation of the prosthesis Loosening of the prosthesis
29
What is the name for bunion?
Hallux valgus
30
What are the symptoms of hallux valgus caused by?
Pressure on the medial aspect of the first metetarsal head
31
What is cervical spondylosis?
Osteophytes in the vertebral foramen
32
Causes of limp in child? | < 4years old
``` NAI Juvenile idiopathic arthritis Transient synovitis (after an illness) NAI Leukaemia ```
33
Causes of hip pain in child 4-10 years?
Perthes Osteomyelitis SA Leukaemia
34
Hip pain in 10-16 years?
Slipped femoral epiphysis Avulsion fractures Osteomyelitis/ septic arthritis
35
What would you see on Xray of perthes?
Flattening of the femoral head
36
What is the management of perthes?
To keep the femoral head within the acetabulum: cast, braces If less than 6 years: observation Older: surgical management with moderate results Operate on severe deformities
37
What is enthesopathy?
Disorder or tendon/ ligament insertion
38
What is tendosynovitis?
Tendon sheath synovitis
39
What are the features of epicondylitis?
Gradual Onset pain | Pain is worse with activity and relieved by rest
40
What is lateral epicondylitis? What are the risk factors? What are the signs on examination? What is the management?
Also called tennis elbow It is inflammation of the lateral epicondyle Pain worse with movement, gradual onset, normal passive ROM Risk factors= obesity, smoking, carpal tunnel, tendionpathies On examination you get pain with resisted wrist extension (cozens test) and supination Treatment= NSAIDS, splints, physio Medical= steroid injection if tx resistant Surgical option= release incision
41
What is medical epicondylitis? What are the risk factors? What are the signs on examination? What is the management?
Inflammation of the common flexor pronator tendon and ulnar collateral ligament Risk factors= manual work and sports Pain with wrist flexion and pronation +/- carpal tunnel
42
What is de quervains tenosynovitis? Where is the pain? What is the treatment?
Inflammation of the synovial sheaths of thumb tendons (external pollicus brevis and abductor pollicus longus) The pain is worse of thumb flexion and ulnar deviation (finkelsteins test) Swelling around sytloid process of radius Management is with Rest, splinting, NSAIDS Localised corticosteroid injections Surgical release of tendon tunnel, if sx persist
43
When do you refer tendor tears?
Only refer for imaging/ secondary care if no improvement if 12 weeks or traumatic injury
44
What are the risk factors for frozen shoulder What are the stages What is the treatment
``` Risk factors= Female Diabetes >40yrs Following surgery/injury Thyroid Immobility ``` Stages Pain then freezing then resolution (resolves in 1.5 to two years) NSAIDS and physio +/- steroid injections
45
What are the causes of impingement syndrome? | What is the management?
Causes= subacromial bursitis, suprasoinatus tendonitis, acromioclaviculae arthritis Management is with NSAIDs, physio, steroid injections, and removing bony tissues
46
What is the treatment of biceps tendon rupture?
It depends if the pt is young and active If young and active then you can do surgery If old or not active then you can do RICE
47
What are the two types of patellar bursitis, how do you treat?
``` Infrapatellar = clergymans knee Suprapatellar= housemaids knee ``` Avoid kneeling, incision and drainage if infected
48
What is plantar fasciitis? | How does it present?
Overuse injury causing inflammation of the plantar fascia Stabbing pain under heal (worse wirh first steps after prolonged resting) Associated w/ prolonged standing/running, poor trainers/ hard ground, flat feet, obesity, middle aged + female
49
What does subcalcaneal bursitis present with? | What is the treatment?
A dull ache under the heel which worsens throughout the day | Again treatment is RICE, NSAIDS, comfortable footwear and orthoptics
50
What is associated with an ACL tear?
Medial meniscus damage
51
What are the causes of meniscal damage of the knee | How do you diagnose it?
Degenerative tears Acute tears due to twisting injury Diagnosis is with mcmurrays test, may do an x ray to rule out fracture and osteoarthritis, MRI is diagnostic
52
What is the management of meniscal problems?
``` Arthroscopic repair (if sx are serious or it is a younger patient) Conservative tx (if degenerative tear/OA)- activity modification, physio, NSAIDS ```
53
How do you diagnose ligamental damage to knee?
ACL/PCL= replacement with hamstring or patellar tendon graft (dont tend to heal on their own) Collateral ligaments= immobilisation with knee brace and phsyio
54
What are the red flags of back pain that require MRI?
``` New onset in <22y/o or >55 years Constant night pain Progressive motor weakness Thoracic back pain Saddle anaesthesia Bladder or bowel incontinence Recent infection Hx of trauma or cancer ```
55
What is radiculopathy, what are the sx? | What is myelopathy, what are the sx!?
Radiculopathy is where the nerve roots are pinched as they exit the spine Causes pain, paraesthesia, weakness in a dermatomal distribution You also get LMN signs (hyporeflexia, hypotonia) Myelopathy is where the spinal cord is compressed and it causes pain, paraestgesia, weakness BILATERALLy and other neurological symptoms You get UMN signs (hypereflexia, hypertonia, spasticity)
56
What is cervical spondylosis?
Cervical radiculopathy which is caused by age related degenerative changes to the spine It is caused by osteophyte development which pinch nerve roots as they leave the spinal canal
57
What are the symptoms of spondylosis? How do you diagnose it? What is the management?
Pain in neck (radiating down as a dull ache or toothache) —> brachial neuralgia Tingling and numbness in one dermatome +/- weakness in one arm Usually a clinical diagnosis Management is mostly self limiting (6-12 weeks), rest, physio, Analgesia (NSAIDS or neuropathic - TCAS), hard collar for immobilisation
58
What nerve would be damaged in a humeral fracture?
Radial nerve
59
How do you treat acromioclavicular joint dislocation?
Surgical fixation
60
What is the most likely presentation of arterial embolus?
Pain out of keeping with clinical findingsb
61
What nerve is damaged if there is paraesthesia of the whole dorsum of foot?
Superficial fibular
62
What nerve is compromised if you have paraesthesia of the first web space?
Deep peroneal
63
What do you see in posterior dislocation of the hip?
Leg shortening and internal rotation
64
What is the most common cause of osteomyelitis? | How do you treat it?
Staph aureus Need to do MRI to Ix Management is fluclox for 6 weeks
65
What is meralgia paraesthetica?
Compression of lateral cutaneous nerve | Get burning sensation of antero lateral aspect of thigh

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