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ORTHOPAEDICS Flashcards

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1
Q

What are the classic signs of a hip fracture?

A

shortened and externally rotated leg

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1
Q

What are the classic signs of a hip fracture?

A

shortened and externally rotated leg

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2
Q

What is the classification of hip fractures?

A

intracapsular (subcapital): from the edge of the femoral head to the insertion of the capsule of the hip joint

extracapsular: these can either be trochanteric or subtrochanteric (the lesser trochanter is the dividing line)

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3
Q

Describe the Garden classification of hip fractures.

A

Type I: Stable fracture with impaction in valgus (oblique displacement)

Type II: Complete fracture but undisplaced

Type III: Displaced fracture, usually rotated and angulated, but still has boney contact

Type IV: Complete boney disruption

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4
Q

Which types of hip fracture are most likely to disrupt blood supply?

A

Type III and IV

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5
Q

What is the management of an undisplaced intracapsular hip fracture?

A

internal fixation

hemiarthroplasty if unfit.

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6
Q

What is the management of a displaced intracapsular hip fracture?

A

total hip replacement

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7
Q

What is the management of stable extracapsular hip fractures?

A

dynamic hip screw

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8
Q

What is the management of an unstable extracapsular hip fracture?

A

Intramedullary device

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9
Q

What is the management of open fractures?

A
  1. IV broad spectrum antibiotics
  2. Debridement (and internal fixation devices avoided or used with extreme caution)

Open fractures constitute an emergency and should be debrided and lavaged within 6 hours of injury

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10
Q

Which classification system is used to distinguish open from closed injuries?

A

Gustilo and Anderson classification system

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11
Q

What is a comminuted fracture?

A

> 2 fragments

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12
Q

What is a segmental fracture?

A

More than one fracture along a bone

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13
Q

What is a transverse fracture?

A

Perpendicular to long axis of the bone

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14
Q

What is a spiral fracture?

A

Severe oblique fracture with rotation along long axis of bone

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15
Q

Which classification system is used to assess paediatric fractures?

A

Salter-Harris

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16
Q

What is a type I Salter-Harris fracture?

A

Fracture through the physis only (x-ray often normal)

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17
Q

What is a type II Salter-Harris fracture?

A

Fracture through the physis and metaphysis

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18
Q

What is a Salter-Harris III fracture?

A

Fracture through the physis and epiphyisis to include the joint

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19
Q

What is a Salter-Harris IV fracture?

A

Fracture involving the physis, metaphysis and epiphysis

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20
Q

What is a Salter-Harris V fracture?

A

Crush injury involving the physis (x-ray may resemble type I, and appear normal)

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21
Q

What is a greenstick fracture?

A

Unilateral cortical breach only

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22
Q

What is a Buckle fracture?

A

Incomplete cortical disruption resulting in periosteal haematoma only

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23
Q

What is a Toddler’s fracture?

A

Oblique tibial fracture in infants

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24
What are the Ottawa ankle rules?
These state that x-rays are only necessary if there is pain in the malleolar zone and: 1. Inability to weight bear for 4 steps 2. Tenderness over the distal tibia 3. Bone tenderness over the distal fibula
25
Describe the Weber classification.
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
26
What is the syndesmosis?
fibrous joint between two bones e.g. distal tibiofibular syndesmosis
27
What is the management of a Weber A fracture?
Allow weight bearing as tolerated in controlled ankle motion (CAM) boot
28
What are the risk factors for adhesive capsulitis?
Women | Diabetes
29
How long does adhesive capsulitis typically last?
6 months --> 2 years
30
How is movement affected in adhesive capsulitis?
external rotation is affected more than internal rotation active AND passive movement is affected
31
How is adhesive capsulitis diagnosed?
Clinically
32
What is the management of adhesive capsulitis?
NSAIDs Physiotherapy Oral corticosteroids and intra-articular steroids
33
What is seen on XR in avascular necrosis?
plain x-ray findings may be normal initially. Osteopenia and microfractures may be seen early on. Collapse of the articular surface may result in the crescent sign
34
Which imaging technique is most appropriate for avascular necrosis?
MRI
35
What is the management of avascular necrosis?
Joint replacement
36
What is 1st line management for trigger finger?
steroid injection
37
What is the imaging of choice in osteomyelitis?
MRI
38
What is Hornblower’s sign?
Inability to keep the arm externally rotated - teres minor pathology or axiliary nerve lesion
39
What are the four rotator cuff muscles?
S - supraspinatus I - infraspinatus T - teres minor S - subscapularis
40
What is indicated by a patient being unable to perform the lift-off test?
subscapularis muscle (e.g. tendonitis/tear) or a subscapular nerve lesion.
41
What is assessed in the Scarf test?
Acromioclavicular joint - pain suggests pathology e.g. osteoarthritis
42
What is the management of a rotator cuff injury?
Conservative - rest, analgesia, physio | Surgery - if young
43
What is the common name for lateral epiconylitis?
Tennis elbow
44
What are the features of tennis elbow?
pain and tenderness localised to the lateral epicondyle pain worse on resisted wrist extension with the elbow extended or supination of the forearm with the elbow extended
45
What are the features of golfer's elbow?
pain and tenderness localised to the medial epicondyle pain is aggravated by wrist flexion and pronation
46
What is cubital tunnel syndrome?
compression of the ulnar nerve. • initially intermittent tingling in the 4th and 5th finger • may be worse when the elbow is resting on a firm surface or flexed for extended periods later numbness in the 4th and 5th finger with associated weakness
47
What are the features of olecranon bursitis?
Swelling over the posterior aspect of the elbow. There may be associated pain, warmth and erythema. It typically affects middle-aged male patients.
48
What are the features of a Colles' fracture?
Distal radius fracture Dinner fork deformity FOOSH
49
Describe the features of Scaphoid fracture
Anatomical snuffbox tenderness FOOSH XR 80% sensitive
50
What is the management of a scaphoid fracture?
Futuro splint/back slab & refer to ortho Ortho - undisplaced = cast 6-8 weeks, displaced = surgical
51
Which bones are susceptible to avascular necrosis?
``` Femoral head Scaphoid Tallus Humeral head Navicular Fifth metacarpal (thumb) ```
52
What is a Smith's fracture?
Reverse Colles' fracture
53
What is a Bennet's fracture?
1st metacarpal fracture (thumb) | Fist fighting
54
What is a Monteggias fracture?
Ulnar fracture | Proximal radio-ulnar displacement
55
What is a Gelazzi fracture?
Ulnar fracture | Distal radio-ulnar displacement
56
What is a Pott's fracture?
Bimalleolar fracture of the ankle Forced eversion
57
What is a Barton's fracture?
Colles'/Smith's fracture | PLUS radiocarpal dislocation
58
Name some early complications of fractures
Damage to local structures (e.g., tendons, muscles, arteries, nerves, skin and lung) Haemorrhage leading to shock and potentially death Compartment syndrome Fat embolism (see below) Venous thromboembolism (DVTs and PEs) due to immobility
59
Name some late complications of fractures
``` Delayed union (slow healing) Malunion (misaligned healing) Non-union (failure to heal) Avascular necrosis (death of the bone) Infection (osteomyelitis) Joint instability Joint stiffness Contractures (tightening of the soft tissues) Arthritis Chronic pain Complex regional pain syndrome ```
60
What is a fat embolism?
Fat embolism can occur following the fracture of long bones (e.g., femur). Fat globules are released into the circulation following a fracture (possibly from the bone marrow). These globules may become lodged in blood vessels (e.g., pulmonary arteries) and cause blood flow obstruction.
61
How is fat embolism syndrome diagnosed?
Gurd's criteria: - Respiratory distress - Petechial rash - Cerebral involvement Minor: jaundice, thrombocytopenia, fever, tachycardia
62
How can osteomyelitis be classified?
Haematogenous | Non-haematogenous (spread from adjacent tissues)
63
What is the most common cause of osteomyelitis in patients with sickle-cell?
Salmonella
64
What is the most common cause of osteomyelitis?
S.aureus
65
Which abx is used for treating osteomyelitis?
Flucloxacillin 6 weeks

FINALS (26 decks)

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