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Flashcards in Orthopaedics Deck (20):
1

What are the causes of haemarthrosis?

Anterior cruciate tear (75%)
Meniscal tear
Fracture
Spontaneous haemarthrosis (eg haemophilia)

2

What is the classical cause of an acutely locked knee?

Bucket handle meniscal tear

3

What are the two main considerations when someone with sickle cell disease presents with bone pain?

Osteomyelitis

Bone infarction secondary to sickle cell crisis

4

What is the presentation of osteomyelitis?

Pain
Fever
Tenderness
Inflammation
Raised inflammatory markers

5

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

6

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

7

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

8

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)

9

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

10

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

11

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

12

Radial nerve palsy

May occur with or without fracture to the humeral shaft

Patients typically present with wrist drop and loss of power grip

13

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)

14

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

15

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

16

Lateral epicondylitis?

Presentation and sign?

Cause?

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

17

What is important about the talus?

Has retrograde blood supply

Therefore fracture of the neck may lead to avascular necrosis of the body

18

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

19

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

20

What is a Maisonneuve fracture?

Fracture due to rotational eversional forces on the ankle

Fracture of the proximal shaft of the fibula with medial ligament rupture, interosseous membrane rupture and