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Finals Revision > Orthopaedics > Flashcards

Orthopaedics Flashcards

(103 cards)

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1
Q

What is a compound fracture?

A

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

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2
Q

What is a Colle’s fracture?

A

Transverse fracture of the distal radius
Distal portion displaces posteriorly (upwards)
‘dinner fork deformity’
Fall onto an outstretched hand FOOSH

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3
Q

What bones have vulnerable blood supplies?

A

Scaphoid
Femoral head
Humeral head
Talus, navicular and fifth metatarsal in the foot

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4
Q

What is the Weber classification?

A

For fractures of the lateral malleolus, described in relation to the distal syndesmosis (fibrous join between the tibia and fibular), which is essential for stability and function of the ankle joint

Type A - below the ankle joint - syndesmosis intact
Type B - at the level of the ankle joint - syndesmosis intact or partially torn
Type C - above the ankle joint - syndesmosis is disrupted

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5
Q

What cancers metastasise to bone?

A

Prostate
Renal
Thyroid
Breast
Lung

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6
Q

What are the key side effects of bisphosphonates?

A

Reflux and oesophageal erosions
Atypical fractures
Osteonecrosis of the jaw
Osteonecrosis of the external auditory canal

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7
Q

How do you prevent the side effects of bisphosphonates?

A

Taken on an empty stomach sitting upright for 30 mins before moving or eating to prevent this

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8
Q

What is an alternative to bisphosphonates when they can’t be used?

A

Denosumab

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9
Q

What is a fat embolism?

A

Fat globules released into the circulation following a fracture, often of the long bones
This can cause a systemic inflammatory response
Presents 24-72 hrs after
Use Gurd’s criteria for diagnosis

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10
Q

What is Gurd’s major criteria for fat embolism syndrome

A

Respiratory distress
Petechial rash
Cerebral involvement

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11
Q

What are the two types of hip fractures?

A

Intra-capsular
Extra-capsular

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12
Q

What are the two arteries that supply the femoral head?

A

Medial and lateral circumflex femoral arteries
Join the femoral neck just proximal to the intertrochanteric line

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13
Q

How do you know whether a fracture is intra-capsular or extra-capsular?

A

Break in the femoral neck, within the capsule
Area proximal to the intertrochanteric line

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14
Q

What is the Garden classification for intra-capsular neck of femur fractures?

A

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

Grade III and IV have disrupted blood supply

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15
Q

How do you decide between a hemiarthroplasty or a total hip replacement in avascular necrosis of the femoral head?

A

Hemiarthroplasty - for those with limited mobility or significant co-morbidities
Total hip replacement - patients who can walk independently

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16
Q

Which type of hip fracture can disrupt the blood supply to the femur?

A

Intra-capsular

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17
Q

How are non-displaced intra-capsular #NOF treated?

A

Internal fixation with screws

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18
Q

How are intertrochanteric fractures treated?

A

Dynamic hip screw through the neck into the head of the femur
Plate with barrel that holds the screw is screwed to the outside of the femoral shaft

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19
Q

How are subtrochanteric fractures treated?

A

Intramedullary nail - through the greater trochanter into the central cavity of the shaft of the femur

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20
Q

How do hip fractures present?

A

History of older patient with a fall
Pain in the groin or hip, which may radiate to the knee
Not able to weight bear
Shortened, abducted and externally rotated leg

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21
Q

What is Shenton’s line?

A

Seen on AP x-ray
One continuous curving line formed by the medial border of the femoral neck and continues to the inferior border of the superior pubic ramus.
Disruption = #NOF

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22
Q

What can cause compartment syndrome?

A

Bone fractures
Crush injuries

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23
Q

What are the 5 Ps of acute compartment syndrome?

A

Pain - disproportionate, worsened by passive stretching
Paraesthesia
Pale
Pressure - high
Paralysis (a late and worrying feature)

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24
Q

What can be used to measure compartment pressure?

A

Needle manometry

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25
What is the management for acute compartment syndrome?
Escalation Remove external dressings or bandages Elevating the leg to heart level Maintaining good BP Emergency fasciotomy
26
What are the features of chronic compartment syndrome?
Associated with exertion, improves with rest Pain, numbness and paraesthesia
27
What are the three types of canal stenosis?
Central stenosis - central spinal canal Lateral stenosis - nerve root canals Foramina stenosis - intervertebral foramina
28
What can cause the spinal canal to narrow?
Congenital Degenerative changes in the facet joints, discs and bone spurs Herniated discs Thickening of the ligaments lava or posterior longitudinal ligament Spinal fractures Spondylolisthesis (anterior displacement of a vertebra out of line with the one below) Tumours
29
How does lumbar central stenosis present?
Intermittent neurogenic claudication on standing or walking, worse standing straight Lower back pain Buttock and leg pain Leg weakness
30
What type of spinal stenosis causes sciatica?
Lateral stenosis and foramina stenosis
31
How do you differentiate between spinal stenosis and PAD?
In PAD, the peripheral pulses or the ankle-brachial pressure index are abnormal
32
What is the management for spinal stenosis?
Exercise and weight loss Analgesia Physiotherapy Decompression surgery if above fail (this has variable results)
33
What is a laminectomy?
Removal of part or all of the lamina from the affected vertebra.
34
What is a meniscal tear?
Knee injury involving the cartilage in the knee joint
35
What are the menisci of the knee?
Medial and lateral meniscus in between the femur and the tibia. Shock absorber Distribute weight Stabilise joint
36
How do meniscal tears often occur?
Twisting movements in the knee
37
What is the presentation of meniscal tear?
Pop sound or sensation Pain Swelling Stiffness Restricted range of motion Locking of the knee Instability of the knee 'giving way' Localised tenderness on the joint line Swelling Restricted range of motion
38
What is McMurray's test?
Lying supine, knee is flexed Internal rotation of the tibia and outward pressure to the inside of the knee, extend the knee - pain or restriction = lateral meniscal damage Vice versa for medial Not used due to risk of worsening tear
39
What is Apley Grind Test?
Patient prone with knee flexed to 90 degrees Downward pressure applied through the leg into knee, tibia is internally and externally rotated at the same time. Pain suggests meniscal damage. Not used due to risk of worsening tear
40
What are the Ottawa knee rules?
X ray of acute knee injury if any of the following: Age 55 or above Patella tenderness with no tenderness elsewhere Fibular head tenderness Cannot flex knee to 90 degrees Cannot weight bear
41
What is the gold standard investigation for meniscal tears?
Arthroscopy
42
What are the features of achilles tendinopathy?
Damage Swelling Inflammation Reduced function
43
What are the two types of achilles tendiopathy?
Insertion tendinopathy: within 2cm of insertion point of the calcaneus Mid-portion tendinopathy: 2-6cm above the insertion point
44
What are risk factors for achilles tendinopathy?
Sports Inflammatory conditions Diabetes Raised cholesterol Fluroquinolone antibiotics (e.g. ciprofloxacin and levofloxacin)
45
How does achilles tendinopathy present?
Gradual onset of pain/aching in achilles or heel Stiffness Tenderness Swelling Nodularity
46
How do you exclude achilles tendon rupture?
Simmonds calf squeeze test Prone/kneeling with feet hanging freely Intact achilles = plantar flexion Ruptured = none
47
Management of achilles tendinopathy
Rest Ice Analgesia Physio Orthotics Extracorporeal shock-wave therapy Surgery to remove nodules or adhesions
48
How does achilles rupture present?
Sudden onset of pain in the achilles or calf Snapping sound/sensation Feeling as though something has hit them in the back of the leg
49
What are the signs of achilles rupture?
Dorsiflexed when dangled Tenderness Palpable gap Weakness of plantar flexion Unable to stand on tiptoes Positive Simmonds' calf squeeze test
50
How do you manage achilles rupture?
Non surgical: specialist boot to immobilise the ankle and with foot in full plantar flexion of the ankle - gradually altered to move from full plantar flexion to a neutral position (6-12 weeks) Surgical is basically the same but with surgical reattachment of the achilles
51
What is the presentation of plantar fasciitis?
Gradual onset of pain on the plantar aspect/heel Worse with pressure and tender to palpation
52
Steroid injections can be used in plantar fasciitis, but what are they at risk of causing?
Pain Rupture Fat pad atrophy under the heel
53
What is the specialist management of plantar fasciitis?
Extracorporeal shockwave therapy Surgery
54
What can cause fat pad atrophy?
Age Inflammation due to repetitive impact
55
What are the symptoms of fat pad atrophy?
Pain and tenderness over the heel Worse with activity and barefoot on hard surfaces Very similar to plantar fasciitis - can be seen on US
56
What is Morton's neuroma?
Dysfunction of the nerve in the inter metatarsal space Irritation of the nerve relating to the biomechanics of the foot High heels or narrow shoes can irritate it further
57
What are the typical symptoms of Morton's neuroma?
Pain at the location of the lesion Sensation of a lump in the shoe Burning/numbness/pins and needles
58
What are the tests for Morton's neuroma?
Deep pressure on it Metatarsal squeeze test with pressure on the affected area Mulder's sign: painful click on manipulation of the metatarsal heads to rub the neuroma.
59
What is the management of Morton's neuroma?
Adapting activities Insoles Analgesia Weight loss Steroid injections Radiofrequency ablation Surgery
60
What is the medical name for bunions?
Hallux valgus
61
How are bunions managed?
Wide, comfortable shoes with bunion pads Surgery to realign the bones
62
What is seen on joint fluid aspiration in gout?
No bacterial growth Needles shaped crystals which are negatively birefrigent of polarised light Crystals are made of monosodium urate
63
Why should you not start allopurinol during an acute flare of gout?
Can worsen it
64
What is the medical name for frozen shoulder?
Adhesive capsulitis
65
What are the key risk factors for adhesive capsulitis (frozen shoulder)?
Middle age Diabetes Trauma,surgery or immobilisation (although it can occur spontaneously without any trigger)
66
What is the pathophysiology in adhesive capsulitis?
Inflammation and fibrosis in the joint capsule lead to adhesions, restricting movement
67
What are the phases in adhesive capsulitis?
Painful phase - shoulder pain worse at night Stiff phase - shoulder stiffness and affects both active and passive Thawing phase - gradual improvement in stiffness and return to normal. 6 months to a year in each phase but 50% have persistent symptoms
68
What differentials do you need to think about in adhesive capsulitis?
Supraspinatus tendinopathy Acromioclavicular joint arthritis Glenohumeral joint arthritis Septic arthritis Inflammatory arthritis Malignancy (e.g. osteosarcoma or bony metastases) If preceded by trauma or injury: Shoulder dislocation Fractures (E.g. proximal humerus, clavicle or scapula) Rotator cuff tear
69
What test is used to assess for supraspinatus tendiopathy?
The empty can test with pressure down on the arm and resistance
70
What tests are used to assess for acromioclavicular joint arthritis?
Tenderness to palpation of the AC joint Worse at extremes of the shoulder abduction about 170 degrees Positive scarf test
71
What is the management of adhesive capsulitis?
Continue movement, physio Analgesia Intra-articular steroid injecitons Hydrodilation injections to stretch the capsule Surgery can also be used to either forcefully stretch the capsule or to cut the adhesions
72
What are the four muscles of the rotator cuff?
SITS Supraspinatus - abducts the arm Infraspinatus - externally rotates the arm Teres minor - externally rotates the arm Subscapularis - internally rotates the arm
73
How does rotator cuff tears present?
Shoulder pain and weakness with specific movements
74
What is the management for rotator cuff tears?
Usually surgery unless unfit for surgery
75
What is subluxation?
Partial dislocation of the shoulder
76
What is the name of the socket in the shoulder joint?
Glenoid cavity of the scapula
77
What type of dislocation are the majority of shoulder dislocations?
Anterior dislocations - the arm is forced backwards whilst abducted and extended at the shoulder
78
What are posterior dislocations of the shoulder associated with?
Electric shocks and seizures
79
What associated damage can happen during shoulder dislocation?
Glenoid labrum (cartilage) tear Bankart lesions (anterior tears of the labrum) Hill-Sachs lesions - compression fractures of the posterolateral part of the head of the humerus Axillary nerve damage*** key - comes from C5 and C6 nerve roots Fractures of the humerus, scapula or clavicle Rotator cuff tears
80
What are the signs of axillary nerve damage?
Loss of sensation in the regimental badge area over the lateral deltoid Motor weakness int he deltoid and tires minor muscles
81
What do you need to assess in someone with a shoulder dislocation
Fractures Vascular damage (e.g. pulses, CRT, pallor) Nerve damage
82
What is the apprehension test?
Tests for shoulder instability, particularly in the anterior direction Patient lies supine Shoulder abducted to 90 degrees with elbow flexed to 90 degrees Shoulder slowly externally rotated As it approaches 90 degrees, the patient becomes anxious and apprehensive, even thought there is no pain
83
Why should you try to relocate the shoulder as soon as safely possible?
Muscle spasm occurs over time making it harder and increasing risk of neuromuscular injury during relocation
84
What happens in bursitis?
Thickening of synovial membrane and increased fluid production due to inflammation Inflammation can be caused by: friction/repetitive movements, leaning on elbow, trauma, inflammatory conditions, infections
85
How does olecranon bursitis present?
Young/middle aged man with an elbow that is: Swollen Warm Tender Fluctuant
86
What characteristics of an activity increase risk of repetitive strain injury?
Small repetitive activities Vibration Awkward positions
87
What are the symptoms of repetitive strain injury?
Pain, exacerbated by using the associated joints, muscles and tendons Aching Weakness Cramping Numbness
88
The tendon that inserts into medial epicondyle acts to do what?
Flex the wrist
89
The tendon that inserts into the lateral epicondyle acts to do what?
Extend the wrist
90
Lateral epicondylitis is often called what?
Tennis elbow
91
What is Mill's test?
Stretching the extensor muscles of the forearm while palpating the lateral epicondyle. Elbow extended, forearm pronated and wrist flexed. (showing off an engagement ring position) Testing for tennis elbow
92
What is Cozen's test?
Elbow extended, forearm pronated, wrist deviated in the direction of the radius, hand in a fist Pressure on the lateral epicondyle and resistance to the back of the hand while patient extends the wrist
93
What is the medical name for golfer's elbow?
Medial epicondylitis Pain often radiates down forearm and leads to weakness in grip strength
94
What is the golfer's elbow test?
Elbow extended, forearm supinated, wrist and fingers extended Pressure on the medial epicondyle
95
What is De Quervain's tenosynovitis?
Swelling and inflammation of the tendon sheaths in the wrist. Affects: Abductor pollicis longus tendon Extensor pollicis brevis tendon Type of repetitive strain injury
96
What is the presentation of Der Quervain's tenosynovitis?
Pain in the radial aspect of the wrist - radiating to the forearm - aching - burning - weakness - numbness - tenderness Bilateral is often due to new parents lifting up baby
97
What is the pathophysiology of De Quervain's tenosynovitis?
Repetitive movement of the tendon sheaths of APL and EPB tendons under the extensor retinaculum cause inflammation of the tendon sheaths
98
What is Finkelstein's test for De Quervain's tenosynovitis?
Patient makes a fist with thumb inside fingers Fist is abducted to ulnar sign
99
What is the medical name for trigger finger?
Stenosing tenosynovitis
100
What is the pathophysiology of trigger finger?
Thickening of the tendon or tightening of the sheath in finger tendons. Causes pain, stiffness, catching Often affects First annular pulley at the MCP joint - often by a nodule which gets stuck in the bent position
101
What is the presentation for trigger finger?
Painful and tender finger usually at MCP joint Doesn't move smoothly Makes a popping or clicking sound Gets stuck in flexed position Worse in mornign
102
What are the risk factors for trigger finger?
Middle age Women Diabetes
103
What is the management for trigger finger?
Splinting Steroid injections Surgery

Finals Revision (20 decks)

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