Orthopaedics Flashcards
(90 cards)
1
Q
signs of fracture
A
pain
swelling
crepitus
deformity
2
Q
management of fractures
A
- reduce (closed or open)
- hold (closed - plaster or traction, fixation - internal or external)
- rehab
3
Q
when do you do external fixation?
A
when extensive soft tissue injury/complex periarticular fracture
4
Q
general fracture complications
A
fat embolus
DVT
infection
prolonged immobility –> infections
5
Q
specific fracture complications
A
NV injury
muscle/tendon injury
non-union/mal-union
local infection
degenerative change
6
Q
OA management
A
conservative: analgesic, physio, walking aids, avoidance of exacerbating activity, injection
operative: replace, realign
7
Q
shoulder conditions - 15-45yo
A
dislocation, fracture
8
Q
shoulder conditions - 45-60yo
A
impingement
dislocation
ACJ OA
rotator cuff tears
fractures
9
Q
shoulder conditions - >60yo
A
glenohumeral OA
impingement
cuff tears
fracture
10
Q
hip conditions, 15-45yo
A
DDH
leg length discrepancy
impingement
11
Q
hip conditions, 45-60yo
A
OA
avascular necrosis
impingement
12
Q
hip conditions, >60yo
A
OA
post THR
13
Q
knee conditions, 15-45yo
A
patellofemoral maltracking
ACL/PCL
meniscal tears
fractures
14
Q
knee conditions, 45-60yo
A
OA
patellofemoral maltracking
ACL/PCL
meniscal tears
fractures
15
Q
knee conditions, >60yo
A
OA
16
Q
management of septic arthritis
A
immobilize joint in acute phase
physio onceover acute phase
17
Q
testing supraspinatus tendon
A
empty can test
18
Q
testing infraspinatus
A
external rotation against resistance
19
Q
testing teres meinor
A
horn blower test
20
Q
testing subscapularis
A
internal rotation against resistance
21
Q
4 stages to fracture healing
A
- reactive: first 48 hrs
reparative phase = 2 days to 2 weeks - proliferation: reparative phase part 1
- consolidation: reparative phase part 2
- remodelling: 1 week - 7 years
22
Q
managing open fractures
A
analgesia
assess: NV status, soft tissues, photograph
alignment: align fracture, splint
anti-sepsis
anti-tetanus
abx
23
Q
open fractures classification
A
Gustilo
24
Q
complication of fracture management
A
anaesthetic: anaphylaxis, damage to teeth, aspiration
intra-operative: bleeding, damage to local structures, tx failure
early post-op: compartment syndrome, infection, VTE, abx colitis
late post-op: scarring, function loss, neuropathy, pain
25
what are the fracture sites most associated with compartment syndrome?
suprachondylar fractures
tibial shaft fractures
26
what are the Ottawa knee rules?
<55yo
isolated patellar tenderness
cannot flex to 90 degrees
inability to weight bear >4 steps
27
what are the Ottawa foot tules?
malleolar zone pain +
1. lateral or medial mallelous tenderness
2. no weight bearing
mid foot pain +
1. 5th metatarsal base pain
2. unable to weight bear
3. navicular tenderness
28
risk factors for NOF fracture
SHATTERED
Steroids
Hyperthyroid/hyperparathyroid
Alcohol/smoking
Thin (BMI <22)
Testosterone low
Erosive bone disease
Renal failure
Early menopause
Dietary Ca low, DM
29
how do you classify degree of displacement of intracapsular NOF fracture/
Garden classification (grades I-IV)
30
what nerve is damaged by suprachondylar fracture?
median nerve damage
31
Colle's fracture definition
posterior displacement and angulation of distal radius fragment
32
Lisfranc injury
injury of foot
one or more of metatarsal bones are displaced from tarus
33
Subacromial impingement cause
supraspinatus tendon catches on acromion
34
management of subacromial impingement
cons: rest, physio
medical: NSAIDs, subacromial bursa steroid
surgical: athroscopic acromioplasty
35
partial vs complete rotator cuff tear
partial: painful arc
complete: shoulder tip pain, full range of passive movement but can't abduct arm. can abduct once past 90 degrees
36
what is adhesive capsulitis?
condition characterized by loss of active AND passive movement
no clear cause
37
lateral vs medial epicondyltiis
lateral: worse on wrist extension (Tennis)
medial: worse on wrist flexion (Golfers)
38
what is the cause of radial tunnel syndrome
posterior interosseous branch of radial nerve
symptoms similar to lateral epicondylitis (worse on wrist extension, decreased grip strength)
39
ix for carpel tunnel
EMG
40
ulnar nerve entrapment symptoms
pins and needles in 4th and 5th digit
claw hand
41
what causes De Quervain's tenosynovitis?
sheath containing extensor pollicis brevis and abductor pollicis longus tendons becomes inflamed
42
test used to investigate De Quervain's?
Finkelstein's test
43
management of Ganglions
50% disappear
aspiration +/- steroid and hyalurounic injection
surgical excision
44
knee locking differentials
obstructive causes:
meniscal/cruciate tear
osteochondritis dissecans
osteophytes
45
symptoms of torn meniscus in knee
delayed knee swelling
joint locking
recurrent pain/effusion
McMurray's test +ve
46
osgood schlatter's disease, what happens?
tibial tuberosity apophysis
patellar tendonitis
47
what special test for Chondromalacia patellae?
Clarke's test
pain on patellofemoral compression
48
Simmond's triad
for Achille's tendon rupture
1. Thomas's test does not elicit plantar flexion
2. Angle of declination (greater dorsiflexion of injured foot)
3. Gap in tendon path
49
features of Charcot foot
deformity
debris
density change
destruction
dislocation
50
features of Brown-Sequard syndrome
ipsilateral paralysis
ipsilateral loss of proprioception and fine touch
contralateral loss of pain and temp
51
indications for bisphosphonates
fragility fracture and age >75
fragility fracture and T score 65y and on/about to start long term steroids
52
when do you need to give immediate bisphosphonates to pt on/about to start long term steroids?
- >65
- < 65, do a DEXA, give if score < -1
53
2nd line treatment after bisphosphonate
SC denosumab
54
complications of TKR
immediate: vascular/nerve injury
early: DVT, prosthesis infection
late: loosening, instability from ACL
55
septic arthritis RFs
modifiable: crystal arthropathies
non-modifiable: age >90, RA, chronic renal failure, prosthetic joint
56
non-neoplastic bone tumours
fibrous dysplasia
simple bone cyst
57
muscles affected in Erb's palsy
abductors and external rotators paralysed
= waiter's tip
58
Fracture healing in general
1. Reactive phase (injury - 48hrs)
2. Reparative phase (2 days - 2 weeks)
3. Remodelling (1 week - 7 years)
59
Reactive phase
1. Bleeding into fracture site = haematoma
2. Inflammation = cytokine release to cause granulation tissue
60
Reparative phase
1. Proliferation of osteoblasts and fibroblasts = callous formation
2. Consolidation: woven bone to lamellar bone
61
X rays needed in a fracture
AP and lateral
Images of joint above and below fracture
62
Describing a fracture (PAID)
1. Demographics
2. Pattern: transverse, oblique, spiral, multifragmentary, avlusion
3. Anatomical: location
4. Intra / extra articular: dislocation or subluxation
5. Deformity (distal): translation, angulation, rotation, impaction
6. Soft tissues: open/closed, NV status, compartment syndrome
7. Amy specific classification
63
Methods of fracture reduction
Closed reduction
Open reduction (and internal rotation)
Traction (not common now )
64
Methods of restriction
Non-rigid (sling)
Plaster
Functional bracing
Ex-fix
Internal fixation
65
Late complications of fracture
Problems with union
AVN
Growth disturbance
Complex regional pain syndrome
66
Nerve damage and effect of anterior shoulder dislocation/numeral surgical neck
Axillary nerve
Numb axillary patch
Weak abduction
67
Nerve damage and effect of Humeral shaft fracture
Radial nerve
Waiters tip
68
Nerve damage and effect of elbow dislocation
Ulnar nerve
Claw hand
69
Nerve damage and effect of Hip dislocation
Sciatic nerve
Foot drop
70
Nerve damage and effect of Fracture of neck of fibula/knee dislocation
Fibular nerve
Foot drop
71
Union problems
1. Delayed union: union takes longer than expected
2. Non-union: fracture fails to unite
72
Causes of non union
Ischaemia
Infection
Inter current disease (malignancy/malnutrition)
73
Salter Harris Classification
SALT Crush
1. Straight across
2. Above (goes across and above growth plate)
3. Lower (goes across and below growth plate)
4. Through (straight through GP)
5. CRUSH
74
Management of low grade intracapsular hip fractures
ORIF with screws
75
Extracapsular management
ORIF with DHS
76
Management of unstable fractures
ORIF
77
Signs of shoulder impingement
Painful arc
Dec ROM
Weakness
78
Cause of shoulder impingement
Entrapment of supraspinatus tendon and subacromial bursa between acromion and greater tuberosity of humerus
79
Management of shoulder impingement
Rest/physio
NSAIDs
Injection
Acromioplasty
80
Signs of suorachondylar fracture of humerus
Elbow swollen and hand semi flexed
81
Management of suprachondylar fracture
Collar and cuff if no displacement
MUA and K wires if displacement
82
Weber classification of ankle injuries
A: below joint line
B: at joint line
C: above joint line
83
Problem with Weber B and C
Possible injury to syndesmosis so instability
84
Management of Weber fractures
A: boot
B/C: POP/ surgery
85
What is used in ACL repair ?
Autograft repair
Semitendinosus +/- gracillis tendon
86
What is spondyliothesis?
Displacement of one lumbar vertebrae on another
Usually L5 forward onto S1
87
Common causes of body mets
Bronchus
Thyroid
Breast
Kidney
Prostate
88
Commonest benign bone tumour
Osteochondroma
89
What is chondrosarcoma? Location? Appearance
Malignant cartilage tumours
Pelvis and axial skeleton
Popcorn calcification
90
X-ray changes on Osteosarcoma
Sunburst appearance
Cod man’s triangle
