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3rd yr clinical > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

What are the X-ray changes in osteoarthritis

A

LOSS
Loss of joint space
Osteophytes
Subarticular sclerosis (increased bone density along joint line)
Subchondral cysts (fluid holes in bone)

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2
Q

How long is VTE prophylaxis given for in joint replacements

A

28 days post hip
14 days post knee

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3
Q

What are the features of a colles fracture

A

Transverse fracture of the distal radius near the wrist

Posterior displacement causes dinner fork deformity

Fall onto an outstretched hand

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4
Q

What are the features of a scaphoid fracture

A

Fall on an out stretched hand

Tender anatomical snuffbox
Susceptible to avascular necrosis as it only has supply from blood vessels none direction

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5
Q

What bones are susceptible to avascular necrosis

A

Scaphoid, femoral head, humeral head, talus, navicular, 5th met

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6
Q

What is the Weber Classification of ankle fractures

A

Type A- below the ankle joint- syndesmosis intact - weight bear in air cast boot or a below the knee cast

Type B- Level of ankle joint - Syndesmosis intact or partially torn- below the knee cast

Type C- Above the ankle joint- syndesmosis disturbed- surgical fixation needed

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7
Q

What are some side effects of bisphophonates and what is an alternative drug to give

A

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

Can give denosumab

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8
Q

What is Gurds criteria for fat embolism

A

Gurd’s major criteria
Resp distress
Petechial rash
Cerebral involvement

Gurd’s minor
Jaundice
Thrombocytopenia
Fever
Tachy

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9
Q

What are the features of an intra-capsular hip fracture

A

Break in the femoral neck within the capsule of the hip joint

Affects the area proximal to the intertrochanteric line

Garden classification used
Grade 1- Incomplete fracture and non displaced
Grade 2- Complete fracture and non displaced
Grade 3- Partial displacement (trabecular are at an angle)
Grade 4- Full displacement (trabecular are parallel)

If non-displaced- intact blood supply to femoral head- less risk of avascular necrosis

Displaced will interrupt blood supply

In younger patients can do fracture reduction but in older offer hemiarthroplasty unless patient has high ADLs and good outcomes then offer a total hip replacement

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10
Q

What is the difference between hemiarthroplasty vs Total hip replacement

A

Hemiarthroplasty- replacing the head of the femur but leaving acetabulum in place

Total hip replacement- replace both head and socket

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11
Q

What are the features of extra-capsular fracture

A

Leave the blood supply to the femur in tact - don’t need to replace femur

Intertrochanteric fractures occur between the greater and lesser trochanter - treated with a dynamic hip screw

Subtrochanteric fractures- distal to the lesser trochanter- proximal to the shaft of the femur - intramedullar nail used

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12
Q

What are the features of a hip fracture

A

Groin/ hip pain radiating to knee
No weight bearing
Short, abducted and externally rotated leg

Disruption of shenton’s line is a key sign of neck of femur fracture

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13
Q

What are the features of compartment syndrome

A

Pressure in a fascial compartment

Acute or chronic

Acute- bone injuries or crush

5P’s
Pain- disproportionate to injury
Paraesthesia
Pale
Pressure
Paralysis

Needle manometry- measure compartment pressure

Emergency fasciotomy

Chronic compartment
Associated with exertion
Pressure falls during rest
Pain, numb, paraesthesia
Still needle manometry and fasciotomy

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14
Q

What are the features of osteomyelitis

A

Haematogenous contamination most common
Staph aureus

Risk factors
Open fractures
Ortho operations
Diabetes
PAD
IV drug use
Immunosuppression
Prosthetic joints

Presentation
Fever, pain tenderness, erythema, swelling

X-ray signs
-Periosteal reaction - change to bone surface
-Localised osteopenia (thin bone)
Destruction

Management
Surgical debridement
Antibiotic therapy

6 weeks of fluclox possibly with rifampicin or fusidic acid for the first 2 weeks

Fluclox alternatives- clindamycin or vans/ teicoplanin when treating MRSA

Chronic osteomyelitis needs 3 months of abx

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15
Q

What are the features of sarcoma

A

Soft tissue lump
Bone swelling
Persistent bone pain

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16
Q

How is sciatica managed

A

Do not use opioids
Use
Amitriptyline or duloxetine

17
Q

What are the features and causes of caudal equina

A

Herniated disc usually
Tumours (mets)
Spondylolisthesis
Abscess
Trauma

Red flags
Saddle anaesthesia, no bladder/ rectum sensation- incontinence , bilat sciatica reduced anal tone

Management
Emergency MRI
Lumbar decompression surgery

18
Q

How is metastatic spinal cord compression treated

A

This will present with UMNL signs whereas caudal equina compression will show LMWL signs

Back pain, motor and sensory signs
Oncological emergency rapid imaging

High dose dex
Analgesia
Surgery radio chemo

19
Q

What are the features of spinal stenosis

A

Gradual onset
If severe can present as caudal equina

Intermittent neurogenic claudication - similar to PAD so do an ankle brachial pressure index
Lower back pain, butt leg pain, leg weakness

Symptoms absent at rest/ when seated

Management
Exercise/ weight loss
Analgesia
Physio
Decompression

20
Q

What are the features of Achille’s tendinopathy

A

two types
Insertion tendinopathy- within 2cm of insertion on calcaneus
Mid portion tendinopathy- 2-6cm above insertion

Risk factors
Sports- bball, tennis, track
Inflam conditions
Diabetes
Raised cholesterol
Fluoroquinolone abx (ciproflox/ levoflox)

Pain/ ache in achilles
Stiff, tender, swelling, nodule on palpation

Calf squeeze rest- achilles tendon rupture

Management
RICE, physio, orthotics, Shock wave therapy, surgery

Do not give Steroid injections - risk of rupture

20
Q

What are the features of Osgood Schlatter disease

A

Inflam at the tibial tuberosity where patella inserts

10-15 yrs- more common in males

Multiple avulsion fractures as the patella ligament pulls pieces of bone

Tender lump
Hard lump at tibial tuberosity

Management
RICE
NAAIDs
Physio/ stretching

21
Q

What are the features of a Baker’s cyst

A

Pain/discomfort
Fullness
Pressure
Palpable lump
Restricted ROM

Lump bigger when standing full extended - disappears when knee flexed

Can rupture - pain, swelling and erythema

USS - 1st line
MRI can be used before surgery

No treatment usually of
RICE
Physio
USS aspiration
Steroid injections
Surgery

22
Q

What is morton neuroma

A

Abnormal nerve between 3rd and 4th Metatarsal
High heels/ narrow shoes make it worse

pain at front of foot
Lump in shoe
Pins and needles of distal toes

Metatarsal squeeze test causes pain
Painful click with Mudler’s sign- rubbing two toes together

RICE
Steroid injections
Weight loss
Insoles
Radiofrequency ablation
Sugery

23
Q

What are the features of frozen shoulder

A

Inflam an fibrosis in joint capsule of glenohumeral joint

Painful phase-pain worse at night
Stiff phase- active and passive- external rotation most affected
Thawing phase- gradual improvement and return to normal

Usually lasts 1-3 yrs in total

Clinical diagnosis of exclusion

Management
Analgesia
Physio
Intra-articular steroid injections
Hydrodilation

Surgery

24
Q

How can you tell a patient has supraspinatus tendinopathy

A

Positive empty can test- pain while resisting the movement as if they are emptying a can of water

25
Q

How can you tell a patient has Acromioclavicular joint arthritis

A

Tender AC joint palpation
Positive scarf test– pain wrapping arm across chest

26
Q

What do each of the rotator cuff muscles to

A

SITS
SuprAspinatus- Abducts the arm

Infraspinatus and Teres minor- externally rotate

Subscapularis
- internally rotates

27
Q

What are the features associated with posterior shoulder dislocation

A

Only happens in seizure or electric shock

28
Q

What are the features of an anterior dislocation of the shoulder

A

Humerus moves forward in relation to glenoid

Arm forced backwards whilst abducted and extended - reaching up and out to catch a high ball

Axillary nerve damage is a key complication- regimental badge anaesthesia

Management
Analgesia
Sedation
Closed reduction
Broad arm sling
Perhaps surgery
Post reduction X-ray

29
Q

What are the features of lateral epicondylitis

A

Tennis elbow
Outer elbow pain

Lateral epicondyle extends the wrist

Think of serving a tennis ball- arm supinated and wrist extending

30
Q

What are the features of medial epicondylitis

A

Golfers elbow
Inner elbow pain
Weak grip strength

Think of dropping a golf ball to the ground
Pronate the arm and flex the wrist

31
Q

What are the features of De Quervain’s tenosynovitis

A

Two tendons mainly affected
Abductor pollicis longus
Extensor pollicis brevis

Repetitive strain, pain on radial side of wrist

Bilateral associated with lifting up new born babies

Pain can radiate to forearm

Pain when patient makes a first and adducts (ulnar deivates) their wrist

RICE
Surgery to cut the retinaculum

32
Q

What are the features of trigger finger

A

Thickened tendon in a sheath
Most common in the MCP joint
Nodule on the tendon- locking of the finger in a bent position when trying to extend

Painful pop or click

40s and 50s
Women
Diabetes

Typically worse in morning

RICE
splitning Steroid injections
Steroids to release A1 pulley

33
Q

What are the features of Dupuytren’s contracture

A

Autosomal dom patter
Male
Manual labour
Diabetes
Epilepsy
Smoking and alcohol

Ring finger most often affected
Thick cord felt in palm of affected finger
Patient can’t put hands flat on a table

Needle fasciotomy to loose the cord

Can be caused by phenytoin

34
Q

What are the features of carpal tunnel syndrome

A

Compression of median nerve

Thumb index finger and lateral half of ring finger affected - sensory affected

Thenar muscles- motor affected

Risk factors
Repetitive strain
Obesity
Perimenopause
RA, Diabetes, acromegaly, hypothyroid

Gradual onset
Numb pain paraesthesia
Symptoms worse at night
Shake hand to relieve

Nerve conduction studies for investigation

Management
Rest
Wrist splints worn at night
Steroid injections
Surgery

35
Q

What are the features of Salter Harris fractures

A

Affects growth plates in children

S Type 1- straight across epiphyseal plate

A-Type 2 - Above the plate

L-Type 3- lower than the plate

T- Type 4- Transversing the plate

ER- Type 5 Erasing the plate

3rd yr clinical (22 decks)

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