Flashcards in Orthopaedics Deck (20):
What are the causes of haemarthrosis?
Anterior cruciate tear (75%)
Spontaneous haemarthrosis (eg haemophilia)
What is the classical cause of an acutely locked knee?
Bucket handle meniscal tear
What are the two main considerations when someone with sickle cell disease presents with bone pain?
Bone infarction secondary to sickle cell crisis
What is the presentation of osteomyelitis?
Raised inflammatory markers
What kind of imaging is useful in patients with suspected osteomyelitis? What else is useful?
Technetium bone scan may detect signs after 3 days
MRI may identify sequestra, abscesses and sinus tracts
Fine-needle bone aspiration is definitive and can identify causative organism
Only detectable on Xray after 10 days
What is a slipped capital epiphysis?
Describe the pathological process.
What are the risk factors of this?
Refers to weakening or fracture of the proximal femoral epiphyseal growth plate
Continued shear stresses on the hip cause the epiphysis to move posteriorly and medially
Obesity, hypothyroidism and renal failure
What are the Ottawa rules?
Xray ankle/foot after injury if...
- Bone tenderness at the posterior edge or distal 6cm of the medial or lateral malleoli
- Bone tenderness at the base of the 5th metatarsal
- Bone tenderness over the navicular
- Unable to weight bear following injury and walk four step in the ED
What are the three kinds of slipped capital femoral epiphysis?
Acute - Normally secondary to significant trauma
Acute-on-chronic - Duration of symptoms >3w with sudden deterioration
Chronic - Symptoms >3w (commonest presentation)
What is Perthes disease (AKA Legg-Calve-Perthes disease)?
Avascular necrosis of the femoral head due to compromise of the tenuous blood supply
Usually present ages 4-10 with insidious onset
Supra condylar fracture?
Common childhood fracture
It is a fracture of the distal humerus proximal to the epicondylitis and is usually caused by a fall on an outstretched hand
Dislocation of the elbow?
Commonest dislocation in children (FOOSH) and second commonest in adults after shoulder
Normally posterior dislocation
Risk of ulnar nerve entrapment and slight risk to the median nerve and brachial artery
Radial nerve palsy
May occur with or without fracture to the humeral shaft
Patients typically present with wrist drop and loss of power grip
How can the lesion be localised in patients with wrist drop?
When in association with loss of active extension, it must be proximal (eg axilla)
If tricep is spared then must be distal to origin of the nerves to the triceps (eg fracture of the distal humerus)
Rupture of extensor policies longus tendon?
Fractures of the distal radius may result in rupture of the tendon of extensor policies long us because of its association with Listers tubercle
Patient will be unable to extend the inter phalanges joint of the thumb
What is a mallet finger?
What does it indicate?
Deformity resulting from an inability to extend the distal interphalangeal joint of the finger
Indicative of an injury to the insertion of extensor digitorum communist tendon
Presentation and sign?
AKA 'tennis elbow'
Presents with pain and tenderness over the common extensor origin
Commonly caused by overuse leading to a degenerative tear
Resisted wrist extension aggregates pain
What is important about the talus?
Has retrograde blood supply
Therefore fracture of the neck may lead to avascular necrosis of the body
What is Trendelenburg gait?
What is Trendelenburg's sign? Cause?
What must also be remembered?
Characteristic waddling gait of a patient with weakness or paralysis of the gluteus medius and minimus, which support the pelvis when the opposite leg is lifted off the ground
Dropping of the pelvis on the contralateral sign when the patient is asked to stand on one leg = lesion of the superior gluteal nerve
Also remember poliomyelitis involving the lower lumbar and sacral segments of the spinal cord
What is the Unhappy Triad of O'Donoghue?
Rupture of the medial collateral ligament, medial meniscus and anterior cruciate ligament
Due to vaglus strain on the knee joint