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Orthopaedics Flashcards

(60 cards)

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1
Q

Osteoarthritis signs hands

A

Heberden’s nodes (in the DIP joints)

Bouchard’s nodes (in the PIP joints)

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2
Q

VTE prophylaxis post joint replacement

A

28 days post elective hip replacement

14 days post elective knee replacement

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3
Q

Most common prosthetic joint infection organism

A

Staphylococcus aureus

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4
Q

Prosthetic Joint Infections mx

A

joint irrigation, debridement or complete replacement.

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5
Q

compound fracture

A

skin is broken and the broken bone is exposed to the air

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6
Q

stable fracture

A

sections of bone remain in alignment

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7
Q

pathological fracture

A

bone breaks due to an abnormality within the bone

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8
Q

Fractures specific to children

A

Greenstick and buckle fractures typically occur in children

Salter-Harris fractures only occur in children (adults do not have growth plates).

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9
Q

Colle’s fracture

A

transverse fracture of the distal radius

posteriorly (upwards), causing a “dinner fork deformity”

fall onto an outstretched hand (FOOSH).

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10
Q

scaphoid fracture

A

sign of a scaphoid fracture is tenderness in the anatomical snuffbox

scaphoid has a retrograde blood supply, with blood vessels supplying the bone from only one direction. This means a fracture can cut off the blood supply, resulting in avascular necrosis and non-union.

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11
Q

fall onto an outstretched hand (FOOSH) fractures

A

Colle’s fracture

scaphoid fracture

Smith’s fracture

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12
Q

Bones with vulnerable blood supply

A

scaphoid bone

the femoral head

the humeral head

the talus, navicular and fifth metatarsal in the foot.

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13
Q

Ankle fracture classification

A

Weber classification

Type A – below the ankle joint – will leave the syndesmosis intact

Type B – at the level of the ankle joint – the syndesmosis will be intact or partially torn

Type C – above the ankle joint – the syndesmosis will be disrupted

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14
Q

Pathological fracture cancers

A 
Po – Prostate
R – Renal 
Ta – Thyroid
B – Breast
Le – Lung
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15
Q

first-line medical treatments for reducing the risk of fragility fractures

A

Calcium and vitamin D

Bisphosphonates (e.g., alendronic acid)

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16
Q

Principles of Fracture Management

A

Mechanical alignment

Relative stability

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17
Q

Methods to achieve mechanical alignment

A

Closed reduction via manipulation of the limb

Open reduction via surgery

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18
Q

Methods to achieve relative stabiliy

A 
External casts (e.g., plaster cast)
K wires
Intramedullary wires
Intramedullary nails
Screws
Plate and screws
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19
Q

fat embolism syndrome diagnosis

A

Gurd’s criteria
Gurd’s major criteria:

Respiratory distress
Petechial rash
Cerebral involvement

Many Gurd’s minor criteria, including:

Jaundice
Thrombocytopenia
Fever
Tachycardia

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20
Q

fat embolism syndrome

A

supportive while the condition improves.

The mortality rate is around 10%.

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21
Q

Hip fracture categorisation

A

Intra-capsular fractures

Extra-capsular fractures

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22
Q

Intracapsular hip fracture categorisation

A

Garden classification

Grade I – incomplete fracture and non-displaced
Grade II – complete fracture and non-displaced
Grade III – partial displacement (trabeculae are at an angle)
Grade IV – full displacement (trabeculae are parallel)

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23
Q

Non-displaced vs displaced management

A

Non-displaced can fix femoral head by internal fixation

If displaced, may mean blood supply compromised - sp head of femur must be replaced

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24
Q

Extra-capsular management

A

Intertrochanteric fractures - dynamic hip screw/sliding hip screw.

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25
Hip Fracture Presentation
Shortened, abducted and externally rotated leg
26
Reverse oblique/ transverse / Subtrochanteric fractures mx
intramedullary nail/device
27
Compartment syndrome presentation
P – Pain “disproportionate” to the underlying injury, worsened by passive stretching of the muscles P – Paresthesia P – Pale P – Pressure (high) P – Paralysis (a late and worrying feature)
28
Compartment syndrome management
Needle manometry to measure pressure Escalating to the orthopaedic registrar or consultant Removing any external dressings or bandages Elevating the leg to heart level Maintaining good blood pressure (avoiding hypotension) Emergency fasciotomy debride any necrotic muscle tissue
29
Compartment syndrome definition
pressure within a fascial compartment is abnormally elevated, cutting off the blood flow to the contents of that compartment.
30
acute osteomyelitis: abx mx
6 weeks of flucloxacillin, possibly with rifampicin or fusidic acid added for the first 2 weeks Alternatives to flucloxacillin are: Clindamycin in penicillin allergy Vancomycin or teicoplanin when treating MRSA
31
Acute osteomyelitis mx
Surgical debridement of the infected bone and tissues | Antibiotic therapy
32
potential signs of osteomyelitis on an x-ray
``` Periosteal reaction (changes to the surface of the bone) Localised osteopenia (thinning of the bone) Destruction of areas of the bone ```
33
osteomyelitis presentation
Fever Pain and tenderness Erythema Swelling
34
osteomyelitis Mechanisms
Haematogenous osteomyelitis direct contamination
35
osteomyelitis most common causative organism`
Staphylococcus aureus
36
Sciatica nerve roots
L4 – S3 - greater sciatic foramen - divides into the tibial nerve and the common peroneal nerve. at the knee
37
Sciatica mx
Amitriptyline Duloxetine advanced: Epidural corticosteroid injections Local anaesthetic injections Radiofrequency denervation Spinal decompression
38
Rotator cuff muscles
S – Supraspinatus – abducts the arm I – Infraspinatus – externally rotates the arm T – Teres minor – externally rotates the arm S – Subscapularis – internally rotates the arm
39
Underlying causes of bilateral carpal tunnel syndrome
rheumatoid arthritis, diabetes, acromegaly or hypothyroidism
40
Special tests for carpal tunnel syndrome
Phalen’s test | Tinnel’s test
41
Surgical management of carpal tunnel
flexor retinaculum incision for tension relief
42
Adhesive capsulitis | (frozen shoulder) aetiology and symptoms
(frozen shoulder) Common in middle-age and diabetics Characterised by painful, stiff movement Limited movement in all directions, with loss of external rotation and abduction in about 50% of patients
43
Supraspinatus tendonitis
Rotator cuff injury Painful arc of abduction between 60 and 120 degrees Tenderness over anterior acromion
44
cubital tunnel syndrome description
compression of the ulnar nerve and can present with tingling/numbness of the 4th and 5th finger
45
De Quervain's tenosynovitis presentation
pain on movement of the thumb/wrist. The radial styloid may be hardened and thickened.
46
Radial tunnel syndrome presentation
tingling/numbness/pain along the back of the hand and forearm.
47
Oblique fracture
Fracture lies obliquely to long axis of bone
48
Comminuted fracture
>2 fragments
49
Segmental fracture
More than one fracture along a bone
50
Transverse fracture
Perpendicular to long axis of bone
51
Spiral fracture
Severe oblique fracture with rotation along long axis of bone
52
Open vs Closed fracture classification system
Gustilo and Anderson classification system
53
Gustilo and Anderson classification system
1 Low energy wound <1cm 2 Greater than 1cm wound with moderate soft tissue damage 3 High energy wound > 1cm with extensive soft tissue damage 3 A (sub group of 3) Adequate soft tissue coverage 3 B (sub group of 3) Inadequate soft tissue coverage 3 C (sub group of 3) Associated arterial injury
54
Lateral pain in keen runners
iliotibial band syndrome
55
locking and swelling of the knee joint
Osteochondritis dissecans
56
anterior knee pain worsened by going up or down stairs
Patellofemoral pain syndrome
57
pain in the lateral cutaneous nerve of the thigh distribution
Meralgia parasthetica
58
Triad of symptoms for fat embolism
Gurd's criteria Respiratory Neurological Petechial rash (tends to occur after the first 2 symptoms)
59
Ottowa knee rules
Inability to weight bear both immediately and during the consultation for four steps (inability to transfer weight twice onto each lower limb regardless of limping). Inability to flex the knee to 90 degrees. Tenderness of the head of the fibula. Isolated tenderness of the patella (no bone tenderness of the knee other than the patella). Age 55 years or older.
60
Weber Classification for fibula fracture
Type A is below the syndesmosis Type B fractures start at the level of the tibial plafond and may extend proximally to involve the syndesmosis Type C is above the syndesmosis which may itself be damaged

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