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Final Year Defintions > Orthopaedics > Flashcards

Orthopaedics Flashcards

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1
Q

Pathological fracture

A

fracture due to cancer.

There will be tumours evident within the bone which weaken it and cause the fracture, tumours can be primary or more commonly due to mets

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2
Q

Fragility fracture

A

fracture due to osteoporosis.

DEXA scan will show diffuse demineralisation

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3
Q

Burst fracture (definition, mechanism, consequence)

A

Type of compression fracture.

Caused by high-energy axial loading spinal trauma.

Results in disruption of the posterior vertebral body cortex with retropulsion into the spinal canal

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4
Q

TSF (Taylor Spatial Frame) - what is it, how does it work, what is it used for?

A

orthopaedic device (circular frame with various rods into the bone) used to externally fix severe fractures where the bones need realignment.

It is used when the wound is not appropriate for internal fixation.

It is continually adjusted to realign the bones and then eventually removed and the bone is internally fixed.

A very specialised procedure and an alternative to amputation

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5
Q

Most common cause of death following NOF surgery

A

pneumonia, heart failure

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6
Q

Back slab

A

A half cast - put on when there is risk of swelling

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7
Q

Peg fracture

A

Odontoid process fracture (aka peg or dens fracture) - fracture through the odontoid process of C2.

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8
Q

Is an intra trochanteric fracture intra or extra capsular? How do you repair it?

A

Extra capsular therefore can do a dynamic hip screw (DHS) because there is no compromise to head of femur blood supply

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9
Q

What is the Gardeners classification of NOF # ?

A

1 - incomplete fracture of NOF.
2 - complete fracture of NOF, no displacement. Clinical determination for DHS or THR
3 - complete fracture of NOF WITH PARTIAL displacement. Risk of necrosis. Total Hip Replacement
4 - complete fracture of NOF WITH COMPLETE displacement. Risk of necrosis. Total Hip Replacement

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10
Q

What are the 4 signs of OA on radiograph? (HINT: think LOSS)

A

Loss of joint space
Osteophytes
Subchondral scleorsis
Subchondral cysts

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11
Q

Fracture

A

A fracture is loss of continuity of the cortex of the bone +/- soft tissue injury

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12
Q

List the clinical signs of a fracture

A 
Pain
Swelling
Crepitus
Deformity
\+/- adjacent structural injury
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13
Q

Outline the 3 stages of fracture healing

A

1) Reactive phase (first 48 hours) - bleeding into fracture site and inflammation forming granulation teaching

2) Reparative phase (first 2 weeks) -
- proliferation of osteoblasts and fibroblasts resulting in callus formation
- consolidation of the women bone forming lamellar bone

3) Remodelling phase (from 1 week) - remodelling of lamellar bone to cope with mechanical forces

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14
Q

What is the average healing time for an uncomplicated fracture?

A

3 weeks

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15
Q

What constitutes an uncomplicated fracture?

A

Closed, paediatric, metaphyseal, upper limb

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16
Q

What constitutes a complicated fracture?

A

Adult, lower limb, diaphyseal, open

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17
Q

What i the average healing time for a complicated fracture?

A

> 6 weeks

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18
Q

Stress fracture

A

Fracture due to bone fatigue due to repetitive strain

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19
Q

List the “6 As” of open fracture management

A 
Analgesia
Asses 
Antisepsis - swab, irrigation, cover
Alignment 
Anti-tetanus 
Antibiotics
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20
Q

What is the most severe complication of an open fracture?

A

Infection with clostridium perfringes which can cause wound infection, gas gangrene, shock, renal failure and death

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21
Q

List the general complications of fractures

A

Tissue damage - haemorrhage, shock, infection, rhabdomyolysis, fat emboli

Anaesthesia - anaphylaxis, aspiration

Prolonged bed rest - pneumonia, UTI, pressure sores, muscle wasting, DVT, PE

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22
Q

List the specific complications of fractures (HINT: split into immediate, early and late)

A

Immediate - neurovascular damage, visceral damage

Early - compartment syndrome, infection, fat embolism, ARDS

Late - problems with union, AVN, growth disturbance (children), post-traumatic osteoarthritis, regional pain syndromes

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23
Q

Name a neurovascular complication following a humeral shaft fracture (name the nerve and the pathology)

A

Radial nerve –> waiters tip

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24
Q

Name a neurovascular complication following an elbow dislocation (name the nerve and the pathology)

A

Ulnar nerve –> claw hand

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25
Name a neurovascular complication following an hip dislocation (name the nerve and the pathology)
Sciatic nerve --> foot drop
26
Define compartment syndrome
when the pressure in one of the muscle compartments increases to the amount that it obstructs blood flow
27
What pressures are (a) suggestive and (b) diagnostic of compartment syndrome?
(a) 20 mmHg | (b) 40 mmHg OR within 30 mmHg of BP
28
Name the three classifications of problems with fracture union
Delayed union Non-union Malunion
29
List the causative factors of problems with fracture union (HINT: think "5 Is")
``` Infection Ischaemia Increased interfragmentary strain Interposition of tissue between fragments intercurrent disease (eg: malignancy) ```
30
Define malunion of a fracture
Fracture has healed in an imperfect position resulting in poor appearance and/or function
31
Define AVN following a fracture
Death of bone due to deficient blood supply
32
Which three sites are most at risk from AVN following a fracture?
Femoral head Scaphoid Talus
33
What are the signs of AVN on XR?
Sclerosis | Deformity
34
What are the two main causes of a #NOF?
Osteoporosis with minor trauma | Major trauma
35
List the risk factors of osteoporosis (HINT: think A SHATTERED)
``` Age Steroids Hyperthyroid / hyperparathyroid Alcohol and cigarettes Thin (BMI < 22) Testosterone low Early menopause Renal failure / liver failure Erosive bone disease (eg: RA) DM / dietary (low calcium, low vitamin D) ```
36
What will you see on examination in a #NOF?
Affected leg is shortened and externally rotated
37
With regards to shoulder examination - which findings are positive in adhesive capsulitis (frozen shoulder)?
Decreased external rotation (<30 degrees on both passive and active movement)
38
With regards to shoulder examination - which findings are positive in impingement syndrome?
Positive Hawkin's test
39
With regards to shoulder examination - which findings are positive in rotator cuff injuries?
Positive Jobes test Painful / limited external rotation Painful / limited internal rotation
40
Name the muscles that make up the rotator cuff - list their function
Supraspinatus - abduction Infraspinatus - external rotation - Teres minor - external rotation Subscapularis - internal rotation
41
Explain how you would test each rotator cuff muscle
Supraspinatus - ABduction against resistance (passive abduction tests deltoid) Infraspinatus - external rotation against resistance whilst isolating joint at elbow Teres minor - external rotation - as above Subscapularis - internal rotation: hand behind back and get patient to push against hand
42
Which direction does the arm move with horiztonal ABduction of the shoulder?
AWAY from midline
43
Which direction does the arm move with horizontal ADduction of the shoulder?
TOWARDS midline
44
Which fractures are most likely to cause compartment syndrome?
``` Tibial fractures Supracondylar fractures (elbow) ```
45
What are the Ottowa Rules for ankle XR
XR the angle if there is pain in malleolar zone PLUS (a) tenderness along posterior tib/fib OR (b) unable to weight bear
46
List some conditions associated with Dupuytren's contracture (HINT: think BAD FIBRES)
Bent penis (peryronies disease) AIDS Diabetes ``` Family history Idiopathic Booze (alcoholic liver disease) Reidel's thyroiditis Epilepsy Smoking ```
47
Define osteoarthritis
Degenerative joint disorder in which there is progressive loss of hyaline cartilage and new bone formation at the joint surface
48
What is Lesague's sign?
Back pain on straight leg raise - sign of disc prolapse
49
Define: spondylolistehsis
Displacement of one lumbar vertebra on another
50
Describe the presentation of acute cord compression
bilateral back and radicular pain LMN signs are compression level UMN signs below compression Sphincter disturbance
51
Describe the presentation of acute cauda equina
Alternating radicular pain (legs) Saddle anaesthesia Loss of anal tone Incontinence
52
List some causes of AVN
Fracture Dislocation Perthes disease and other developmental joint pathologies Systemic disease - sickle cell, DM, pancreatitis, Gaucher's, HIV/AIDS Drugs - steroids
53
What is the difference between osteomyelitis and septic arthritis?
Osteomyelitis = infection of the bone | Septic arthritis = infection of the joint
54
List XR changes with osteomyelitis
Decreased bone density Sub-periosteal reaction Sequestrum
55
Which organisms are most commonly responsible for osteomyelitis?
S aureus | Streptococcus
56
Which organisms are most commonly responsible for septic arthritis?
S aureus | Gonococcus
57
Which primary tumours most commonly metastasise to bone?
``` Thyroid Lung Breast Kidney Prostate ```
58
How are bony mets usually treated?
Radiotherapy
59
Name three primary malignant bone tumours
Chondrosarcoma - tumour of the cartilage Osteosarcoma - tumour of the bone (metaphysis) Ewing's sarcoma - tumour of the bone (diaphysis)
60
What age group do the following bone tumours present in most commonly? (a) Chondrosarcoma (b) Osteosarcoma (c) Ewing's sarcoma
(a) Adults > 40 (b) Adolescents (c) Children
61
What forms the carpal tunnel?
Flexor retinaculum and carpal bones
62
What does the carpal tunnel contain
all the flexor tendons and the median nerve
63
What does the median nerve supply? (HINT: think LOAF)
Lumbricals Opponens pollicis Abductor pollicis brevis Flexor pollicis brevis Essentially - lumbricals + thenar muscles
64
Which muscles supplied by the median nerve make up the thenar eminance? (HINT: think OAF)
Opponens pollicis Abductor pollicis brevis Flexor pollicis brevis
65
List some of the causes of carpal tunnel syndrome
Primary - idiopathic Secondary - pregnnacy, hypothyroidism, acromegaly, inflammatory joint disease (gout, RA), soft tissue swelling (eg: lipoma), diabetes, EtOH
66
Outline the pathology of carpal tunnel syndrome
Compression of the median nerve due to reduced space within the carpal tunnel
67
Explain a POSITIVE trendelenberg's test
If there is abductor weakness, pelvis will drop to the contralateral side on leg raise Eg: L abductor weakness causes R drop - this is felt in the examiners L hand (so if you feel drop in your left hand, the patient has a L sided weakness)
68
What causes an apparent leg length discrepancy?
Spinal or hip pathology
69
What causes a true leg length discrepancy?
Difference in length of long bones
70
What is Thomas' test looking for?
Fixed flexion deformity
71
What is the most common cause of a fixed flexion deformity?
Osteoarthritis
72
List the complications of hip arthroplasty (HINT: split into immediate, early and late)
Immediate - nerve injury, fracture, cement reaction, haemorrhage Early - DVT, infection, dislocation Late - loosening, infection, leg length discrepancy, revision
73
List the complications of knee arthroplasty (HINT: split into immediate, early and late)
Immediate - fracture, cement reaction, vascular injury, haemorrhage, nerve injury Early - DVT, deep infection Late - loosening, peri-prosthetic fractures, decreased ROM, instability (ACL is sacrificed during surgery)
74
List some differentials for knee locking
Meniscal tear Cruciate ligament injury Loose body
75
Outline the presentation of an ACL tear
Associated with declaration or rotational movement Inability to continue with activity / sport Hearing a pop / feeling a tearing sensation Haemarthrosis within 6 hours Instability / sensation of giving way
76
List the most common cause of the following gait abnormalities: (a) antalgic (b) trendenlenberg (c) parkinsonian (d) broad based (e) high stepping (f) spastic
(a) antalgic = pain (b) trendenlenberg = weak abductors (c) parkinsonian = PD (d) broad based = cerebellar (e) high stepping = common peroneal nerve injury (f) spastic = UMN, eg: stroke
77
List some differentials for popliteal swelling
``` Popliteal aneurysm Bakers cyst Enlarged bursae Skin pathology (eg: lipoma) Neruoma ```
78
What is a Baker's cyst?
Posterior herniation of knee joint capsule

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