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Surgery > Orthopaedics > Flashcards

Orthopaedics Flashcards

(153 cards)

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1
Q

Fractures - early local complications

A

Compartment syndrome
Nerve injury
Vascular injury
Infection

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2
Q

Non-union - patient factors

A 
Smoking
Alcohol abuse
Increasing age
Steroids
Diabetes
Chronic renal failure
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3
Q

Non-union - fracture factors

A

Higher energy fracture
Open fractures
Infection
Bone loss

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4
Q

Anterior shoulder dislocation

A

Mode:fall on abducted and externally rotated arm
Neurovascular: axillary nerve, brachial plexus

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5
Q

Humoral shaft fracture

A

Neurovascular: radial nerve

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6
Q

Supracondylar fracture

A

Neurovascular: anterior interossus, median nerve

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7
Q

Monteggia fracture-dislocation

A

Ulnar shaft fracture, radial head dislocation

Neurovascular: posterior interossus, radial nerve

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8
Q

Distal radial fracture

A

Neurovascular: median nerve

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9
Q

Posterior hip dislocation

A

Neurovascular: sciatic nerve

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10
Q

Knee dislocation

A

Neurovascular: common peroneal nerve

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11
Q

Volkmann’s ischaemic contracture

A

Permanent flexion contracture of the hand at the wrist, claw-like deformity of the hand and fingers.
Passive extension of fingers is restricted and painful.
Result from undiagnosed compartment syndrome.

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12
Q

Neer’s classification

A

Proximal humeral fracture
Parts: humeral head, greater tuberosity, lesser tuberosity, shaft.
Displacement: >45 angulation, >1cm displacement

1 part: fracture lines 1-4 parts, non-displaced
2 part: fracture lines 2-4 parts, 1 displaced
3 part: fracture lines 3-4 parts, 2 displaced
4 part: fracture lines >4 parts, 3 displaced

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13
Q

Gartland classification

A

Supra-condylar fractures
Type I: undisplaced fracture
Type II: angulated fracture with intact posterior cortex
Type III: posteriorly displaced distal fragment, no cortical contact

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14
Q

Galeazzi fracture-dislocation

A

Distal radial fracture, distal radioulnar joint dislocation

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15
Q

Colles’ fracture

A

Distal radial fracture with dorsal angulation “dinner fork”

Mode: fall onto extended wrist

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16
Q

Smith’s fracture

A

Distal radial fracture with volar displacement

Mode: fall onto flexed wrist

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17
Q

Barton’s fracture

A

Distal radial fracture with partial fracture of radial head involving articular surface

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18
Q

Garden classification

A

Intracapsular femoral neck fracture

Stage 1: undisplaced, incomplete (incl valgus impacted fractures)
Stage 2: undisplaced, complete
Stage 3: complete fracture, incompletely displaced
Stage 4: complete fracture, completely displaced

Stage 3&4 higher risk of AVN

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19
Q

Schatzer classification

A

Tibial plateau fracture

Type I: wedge shape, pure cleavage of lateral plateau, 4mm depression
Type IIIa: lateral depression of lateral plateau
Type IIIb: central depression of lateral plateau
Type IV: depression of medial plateau, no fracture
Type V: involving both plateau regions
Type VI: fracture through metadiaphysis of tibia

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20
Q

Fractures - systemic complications

A

Fat embolism
DVT/PE
Sepsis
Complications of immobility

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21
Q

Complications of immobility

A

Respiratory tract infection - basal atelectasis
UTI
Pressure sores
Disuse osteoporosis and joint stiffness

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22
Q

Fat embolism - risk factors

A

Lower limb diaphysis fractures
Multiple fractures
Closed fractures
Young patients

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23
Q

Fat embolism - clinical features

A 
Tachypnoea - inflammatory response of lung parenchyma
Dyspnoea
Confusion/agitation
Petechial rash
Tachycardia
Fat in urine, retina, sputum

Low O2, low CO2, low platelets, diffuse bilateral lung infiltrates

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24
Q

Gustilo and Anderson classification

A

Open fractures, for prophylactic antibiotic regime

Types 1: wound 1cm, minimal soft tissue injury, minimal comminution
Type 2: wound 1-10cm, moderate contamination and soft tissue injury
Type 3a: extensive soft tissue damage, massive contamination, soft tissue coverage adequate
Type 3b: extensive soft tissue damage with periosteal stripping and bone exposure, massive contamination, soft tissue coverage inadequate
Type 3c: associated with arterial injury requiring limb salvage

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25
Perthe's disease
Idiopathic AVN of the femoral head in children
26
Ankylosing spondylitis
Chronic inflammatory autoimmune disease affecting spine and sacroiliac joints in young males. Features: seronegative spondyloarthropathy, "bamboo" spine
27
Paget's disease
Abnormal bone architecture from abnormal osteoclastic and osteoblastic activity. Bone pain with raised ALP
28
Osteopenia
Decreased bone mass. | Unaffected Ca, PO, PTH. Normal ALP
29
Osteopetrosis
Thick dense "marbled" bone. | Unaffected Ca, PO, PTH. Elevated ALP
30
Osteoporosis
Brittle and fragile bone. Risk factors: postmenopause, steroids. Treatment: bisphosphenates
31
Ewing's sarcoma
Malignant round cell tumour in diaphysis of long bone or pelvis in children. X-ray: large soft tissue mass with onion-peel sign
32
Osteosarcoma
Cancerous bone tumour, can arise secondary from Paget's disease.
33
Osteoclastoma
Giant cell tumour, common in young adults and affects epiphysis of long bones. Osteolytic, slow growing tumour, pathological fractures, soap bubble appearence.
34
Musculocutaneous nerve | C5-6
Motor: Coracobrachialis Biceps brachii Sensory: Lateral cutaneous nerve (lateral forearm)
35
Median nerve | C6-7
``` Motor: Brachialis Pronator teres Flexor carpi radilalis Palmaris longus Flexor digitorium superficialis Thenar muscles Lumbricals (2&3) ``` Sensory: Lateral 3.5 fingers
36
Medial cutaneous nerve | T1
Sensory: | Medial aspect of arm
37
Ulnar nerve | C8-T1
``` Motor: Flexor carpi ulnaris Flexor digitorium profundus (4&5) Palmar interossei Dorsal interossei Palmar brevis Hypothenar Lumbricals (4&5) Adductor pollicis ``` Sensory: Medial aspect of forearm Medial 1.5 fingers
38
Axillary nerve | C5-6
Motor: Deltoids Sensory: Lateral upper arm
39
Radial nerve | C5-C8
Motor: Triceps brachii Brachioradialis Extensor carpi radialis longus Sensory: Medial upper forearm (superficial radial nerve) Lateral dorsum of hand
40
Posterior interosseous nerve (radial) | C7-8
``` Motor: Extensor carpi radialis brevis Extensor carpi ulnaris Extensor digiti minimi Extensor digitorium ``` ``` Supinator Extensor indicis Abductor pollicis longus Extensor pollicis longus Extensor pollicis brevis ```
41
Anterior interosseous nerve (median) | C5-T1
Motor: Flexor policis longus Pronator quadratus Flexor digitorium profundus (2&3)
42
Tibial nerve | L5-S1
Motor: Ankle plantar flexion Knee flexion Great toe flexion Sensory: Sole of foot
43
Superficial peroneal | L5-S1
Motor: Ankle eversion Sensory: Dorsum of foot
44
Deep peroneal | L5-S1
Motor: Ankle dorsiflexion and inversion Great toe extension Sensory: 1st web space
45
Sural nerve | S1-2
Sensory: | Lateral foot
46
Saphenous nerve | L3-4
Sensory: | Anteromedial ankle
47
UL Neuro Screen
"Thumbs up" = PIN/radial (abductor pollicis longus) "OK sign" = AIN/median (flexor digitorium profundus) "Spread fingers" = ulnar (dorsal interosseus)
48
Open reduction - indications (NO CAST)
``` Non-union Open fracture Neurovascular compromise intra-Articular fracture Salter-harris 3,4,5 polyTrauma ```
49
Fractures - late local complications
``` Non-union Malunion Osteomyelitis Post-traumatic OA Avascular necrosis Joint stiffness/adhesive capsulitis ```
50
Orthopaedic emergencies (VON CHOP)
``` Vascular compromise Open fracture Neurological compromise Compartment syndrome Hip dislocation Osteomyelitis/septic arthritis Pelvic fracture (unstable) ```
51
Compartment syndrome - features
Pain with passive stretch Pain with active contraction of compartment Swollen, tense compartment Suspicious history (tibial shaft, pediatric supracondylar, forearm)
52
Compartment syndrome | 5 P's
``` Pain: out of proportion for injury, not relieved by analgesics, increased with passive stretch Pallor Paresthesia Paralysis Pulselessness ```
53
Anterior hip dislocation
Mechanism: posteriorly directed blow to knee with hip abducted Features: shortened, abducted, externally rotated
54
Posterior hip dislocation (more common)
Mechanism: force to knee while hip flexed and adducted Feature: shortened, adducted, internally rotated
55
Osteomyelitis x-ray
``` Soft tissue swelling Lytic bone destruction Periosteal reaction (seen 10 days post infection) ```
56
Septic joint
Organisms: Staph species, N. gonorrhoea Factors: previous surgery/injury to joint, joint disease, IVDU, IA steroids
57
Anterior shoulder dislocation (more common)
Mechanism: abducted arm, external rotation, blow to posterior shoulder Features: slight abduction, externally rotated, unable to internally rotate, "squared off" shoulder.
58
Anterior shoulder apprehension test + relocation
Gentle shoulder abduction and external rotation to 90, humeral head pushed anteriorly Posteriorly directed pressure relieves apprehension
59
Hill-Sach lesion
Compression fracture of posterior humeral head against glenoid rim. Reverse Hill-Sachs in posterior dislocation.
60
Bankart lesion
Avulsion of anterior glenoid labrum from glenoid rim. | Reverse Bankart in posterior dislocation.
61
Sulcus sign
Subacromial indentation with distal traction on humerus, inferior shoulder instability
62
Posterior shoulder dislocation
Mechanism: adducted, internally rotated, flexed arm (seizure, alcohol, electrocution) Features: adducted and internally rotated arm, external rotation blocked, anterior shoulder flattening
63
Posterior shoulder apprehension test
Apply posteriorly force on flexed, adducted, internally rotated arm. For posterior instability
64
Supraspinatous
Insertion: Greater tuberosity Nerve: Suprascapular Function: Abduction
65
Infraspinatous
Insertion: Greater tuberosity Nerve: Suprascapular Function: External rotation
66
Teres minor
Insertion: Greater tuberosity Nerve: Axillary Function: External rotation
67
Subscapularis
Insertion: Lesser tuberosity Nerve: Suprascapular Function: Internal rotation, adduction
68
Corocoid process attachment
Short head of biceps Coracoid brachialis Pectoralis minor
69
Painful arc syndrome
Compression of supraspinatous tendon, subacromial bursa. Pain with abduction >90 degrees
70
Rotator cuff tears
Night pain and difficulty sleeping on affected side Pain worse with active movement Weakness and loss of ROM Tenderness over greater tuberosity
71
Jobe's test
Supraspinatous 90 degree abduction, 30 degree forward flexion, internal rotation so thumb at ground
72
Lift-off test
Subscapularis Internal rotation so hand on back
73
Posterior-cuff test
Infraspinatous and teres minor External rotation, elbow at 90 degrees
74
Neer's test
Rotator cuff impingement Passive shoulder flexion with thumb down, pain between 130-170 degrees
75
Hawkins-Kennedy test
Rotator cuff impingement Shoulder flexion at 90 degrees, passive internal rotation
76
Frozen shoulder (adhesive capsulitis)
Gradual onset diffuse shoulder pain Decreased active and passive ROM Pain worse at night Increased stiffness as pain subsides (6-12 months)
77
Lateral epicondylitis
"tennis elbow", inflammation of extensor tendon inserts
78
Medial epicondylitis
"golfer's elbow" inflammation of flexor tendon inserts
79
Scaphoid fracture
Mechanism: FOOSH, impaction of scaphoid onto distal radius Features: pain in wrist movement, tenderness in anatomical snuff box, no displaced.
80
Compression fracture - spine
Anterior column = stable
81
Burst fracture - spine
Anterior, midline = unstable High energy axial loading + flexion
82
Flexion dislocation - spine
Middle, posterior = unstable MVA, lap belt only
83
Fracture dislocation - spine
Anterior, middle, posterior = unstable
84
Compression test (C-spine)
Compression on head worsens radicular pain
85
Distraction test (C-spine)
Traction on head relieves radicular symptoms
86
Valsalva test (C-spine)
Increased intrathecal pressure and causes radicular pain
87
C5
Motor: deltoid, biceps, wrist extension Sensory: axillary nerve, rhomboids Reflex: biceps
88
C6
Motor: biceps, brachioradialis Sensory: thumb and index Reflex: biceps, brachioradialis
89
C7
Motor: triceps, wrist flexion, finger extension Sensory: middle finger Reflex: triceps
90
C8
Motor: interossei, digital flexors Sensory: ring and little fingers Reflex: finger jerk
91
Swimmer's view
Lateral view with arm abducted 180 degrees to evaluate C7-T1
92
Lateral flexion/extension view
Evaluate subluxation of C-spine
93
Straight leg raise
Radicular pain radiating down posterior/lateral leg to knee
94
Lasegue maneuver
Dorsiflexion of foot during straight leg raise, exacerbates pain
95
Femoral stretch test
Prone, passive flexing of knee and extending of hip exacerbates radicular pain
96
L4
Motor: quadriceps, tibialis anterior Sensory: medial malleolus Reflex: knee Test: femoral stretch
97
L5
Motor: extensor hallucis longus, gluteus medius Sensory: 1st dorsal web, lateral leg Test: straight leg raise
98
S1
Motor: peroneus longus + brevis, gastrocnemius + soleus Sensory: lateral foot Reflex: ankle Test: straight leg raise
99
Red flags for BACK PAIN
``` Bowel/bladder dysfunction Anesthesia (saddle) Constitutional symptoms/malignancy Khronic disease Paresthesias Age >50 IV drug use Neuromotor deficits ```
100
Mechanical back pain - disc
Back pain Flexion aggravation Gradual onset Weeks-months duration
101
Mechanical back pain - facet
Back pain Extension, standing, walking aggravation More sudden onset Days-weeks duration
102
Direct nerve root compression - spinal stenosis
Leg pain Exercise, extension, walking, standing aggravation Congenital or acquired onset Acute episodes (spinal claudication) on chronic history
103
Direct nerve root compression - root compression
Leg pain Flexion aggravation acute leg +/- back pain onset More constant pain (lateral disc herniation) or intermittent pain (central disc herniation
104
Back Pain - differentials
Degenerative (disc, facet, ligament) Peripheral nerve compression (disc herniation) Spinal stenosis (congenital, osteophyte, central disc) Cauda equina syndrome Others (neoplastic, infectious, metabolic, trauma, spondyloarthropathies, referred)
105
Spondylolysis
Defect in pars interarticularis with no movement of vertebral bodies, "collar" break in "Scottie dog" on oblique x-ray. Acitivity related back pain
106
Spondylolisthesis
Defect in pars interarticularis causing forward slip of vertebrae Congenital, degenerative, traumatic
107
Pelvic fracture classification
A: Stable avulsion fracture Rotationally and vertically stable A1: fracture not involving pelvic ring A2: minimally displaced fracture of pelvic ring ``` B: Open book Rotationally unstable, vertically stable B1: open book B2: lateral compression - ipsilateral B3: lateral compression - contralateral ``` ``` C: Unstable vertical fracture Rotationally and vertically unstable C1: unilateral C2: bilateral C3: associated acetabular fracture ```
108
Shenton's line
Radiographic line along upper margin of obturator foramen extending along the inferiormedial side of femoral neck. Disruption indicates subcapital fracture
109
Thomas test
Flexion of both knees and hips and eliminate lumbar lordosis, straighten out affected leg with other flexed. Fixed flexion contracture, apparent limb shortening seen in OA
110
Knee history (CLIPS)
``` Clicking Locking Instability Pain Swelling ```
111
Anterior/posterior draw test
ACL and PCL tears
112
Lachmann test
ACL tear | Hold knee at 20 degrees flexion, sublux tibia anteriorly on femur
113
Posterior sag test
PCL tear
114
Pivot shift sign
ACL tear | Knee extended, apply valgus force and flex knee
115
Collateral ligament stress test
MCL and LCL tear Palpate for knee joint opening
116
Meniscal tear
Joint line tenderness Crouch compression test McMurray test
117
McMurray test
Meniscal tear Knee in flexion, palpate joint line. LM - internal rotation, varus stress and extend knee MM - external rotation, valgus stress and extend knee
118
O'Donoghue's Unhappy Triad
ACL rupture MCL rupture Meniscal damage
119
Patellar dislocation
Risk factors: young, female, obesity, high-riding patella, knock-knees, increased Q angle, shallow intercodylar groove, tight lateral retinaculum. Knee catches or gives way on walking, weak knee extension, positive patellar apprehension test
120
Patellar apprehension test
Examiner laterally displaces patella
121
Patellofemoral Syndrome
Softening/eroision of articular cartilage in medial aspect of patella. Features: deep aching anterior knee pain, exacerbated by prolonged sitting, stair climbing, sitting, sensation of instability,
122
Anterior draw foot
Lateral ligament injury Displace foot anteriorly against fixed tibia
123
Talar tilt
Foot inverted, angle of talar rotation evaluated by x-ray
124
Ottwa ankle rules
X-ray required if: Pain in malleolar zone AND bony tenderness over posterior aspect of medial/lateral malleolus OR Inability to weight bear immediately after injury or in ED
125
Danis-Weber classification
Ankle fracture A: infrasydesmosis (pure inversion injury) Avulsion of lateral malleolus below plafond/torn calcaneofibular ligament B: trans-syndesmotic (external rotation and eversion) Avulsion of medial malleolus or rupture deltoid ligament, spiral fracture of lateral malleolus starting at plafond C: supra-syndesmotic (pure external rotation) Avulsion of medial malleolus or torn deltoid ligament, posterior malleolus avulsion with posterior tibio-fibular ligament, fibular fracture above plafond
126
Ankle ligaments
Medial: deltoid ligament Lateral: anterior talofibular, calcaneofibular, posterior talofibular
127
Talar fracture
Mechanism: axial loading, hyperdorsiflexion Distal to proximal blood supply, high risk of AVN with displaced fractures
128
Calcaneal fracture
Mechanism: axial loading | Loss of Bohler's angle (20-40 degrees), varus heel
129
Achilles tendon rupture
Features: palpable gap, apprehensive toe off, weak plantar flexion, Thompson test
130
Thompson test
Achilles tendon rupture Squeezing calf muscle to elicit passive plantar flexion of foot
131
Plantar fascilitis (heel spur syndrome)
Mechanism: repetitive strain, aslo associated with obesity, DM, arthopathies Radiological: heel spurs
132
Bunions (hallux valgus)
Valgus alignment of 1st MTP, painful bursa over medial side of 1st metatarsal head
133
Ottawa foot rules
X-ray required if: Pain in midfoot zone AND bony tenderness over navicular or base of 5th metatarsal OR Inability to weight bear both immediately after injury and in ED
134
Salter-Harris classification
Epiphyseal injury Straight: transverse through growth plate Above: through metaphysis and along growth plate Low: through epiphysis to plate and along growth plate Through: through epiphysis and metaphysis Ram: crush injury of growth plate
135
Slipped capital femoral epiphysis
Type 1 Salter-Harris at proximal hip. Common in adolescent, male, obese, hypothyroid. Positive Trendelenburg sign, Whiteman's sign (flexion with obligate external rotation at hip), bilateral involvement in 25%.
136
Developmental dysplasia of hip
Ligament laxity, muscular underdevelopment, abnormal shallow slope of acetabulum roof. Painless. Tests: Barlow's, Ortolani's, Galeazzi's
137
DDH - 5 F's of predisposition
``` Family history Female Frank breach First born leFt hip ```
138
Barlow's test
DDH | Flex hips and knees at 90 degrees, grasp thighs, fully adduct thighs and push posteriorly
139
Ortolani's test
DDH | Reduce hips with fingertips from Barlow's test by abducting hips
140
Galeazzi's sign
DDH | Knee ar unequal heights when hips and knees flexed
141
Legg-Calve-Perthes Disease
Self limited AVN of femoral head, 4-10 yos | Features: child with hip pain and limp, tender over anterior thigh, flexion contracture
142
Osgood-Schlatter Disease
Repetitive stress on tibial tuberosity by patella tendon, minor avulsion Features: tender over tibial tuberosity, pain on resisted leg extension, anterior knee pain on jumping
143
Congenital talipes equinovarus
Talipes: talus inverted and internally rotated Equinus: ankle is plantar flexed Varus: heel and forefoot are in varus (supinated)
144
Scoliosis
10-14 yo | Causes: idiopathic, congenital, neuromuscular, postural
145
Benign bone lesion - radiology
No periosteal reaction Thick endosteal reaction Well developed bone Intraosseous and even calcification
146
Malignant bone lesion - radiology
Acute periosteal reaction: Codman's triangle, onion skin, sunburst Broad border between lesion and normal bone Varied bone formation Extraosseous and irregular calcification
147
Osteoid osteoma
20-30's yo, tibia and femur common. Features: severe intermittent pain, mostly night, relieved by NSAIDs Radiology: small, round translucent nidus surrounded by dense sclerotic bone
148
Osteochondroma
20-30's yo, most common benign tumour, metaphysis of long bone Feature: slow growing Radiology: cartilage capped bony spur "mushroom"
149
Ewing's sarcoma
5-20 yo, metaphysis of long bone Features: pain, mild fever, erythema, swelling, anaemia Radiology: moth eaten appearence with onion-skinning Rx: resection, chemotherapy, radiation
150
Osteosarcoma
20's, elderly with history of Paget's disease Features: progressive pain, night pain, decreased ROM Radiology: periosteal reaction (Codman's triangle or sunburst) Rx: complete resection, bone scan, metastases
151
Chondrosarcoma
Primary 70% or secondary 30% (malignant degeneration of pre-existing cartilage tumour) Features: progressive pain, mass Radiology: medullary cavity, irregular "popcorn" calcification
152
Multiple myeloma
Most common primary malignant tumour of bone in adults Features: bone pain, compression/pathological fractures, renal failure, infections, systemic, hypercalcaemia with pancytopenia. Radiiological: punched out lesions Rx: chemotherapy, radiation
153
Bone metastases
``` Breast Prostate Thyroid Lung Kidney ```

Surgery (5 decks)

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