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Orthopaedics Flashcards

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1
Q

Which blood vessels are at risk of damage in intracapsular hip #

A

Retinacular arteries from the femoral artery

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2
Q

Name the main hip abductors

A

Gluteus minimums and maximis

Tensor fasciae lattea

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3
Q

What is the main action of gluteus maximums?

A

Extension and external rotation

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4
Q

Describe the appearance of a -ve Trendelenberg test. What is the clinical significance?

A

Normal = pelvis falls on the side of the stance leg

Abnormal = pelvis rises on the side of the stance leg —> abductor muscle paralysis

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5
Q

Name the main hip flexors

A

Psoas major and iliacus

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6
Q

Quad muscles innervated by the femoral nerve. What muscles make up the quad group?

A

Rectum femoris

Vastus lateralis, medialis and intermedious

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7
Q

Hamstrings are supplied by sciatic nerve. What muscles make up hamstrings?

A

Biceps femoris
Semimembranosus
Semitendinosis

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8
Q

The adductors are supplied by the obturator nerve. Name the adductor muscles

A

Adductor longus
Adductor brevis
Adductor Magnus
Gracious

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9
Q

Which meniscus is most likely to be torn? Why?

A

Medical meniscus is most likely to be torn as it is fixed. The lateral meniscus is mobile so tears are less likely

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10
Q

Role of medial meniscus?

A

To resist virus stress

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11
Q

Role of PCL?

A

To resist posterior subluxation of the tibia e.g. going down stairs - can also think of resisting anterior subluxation of femur

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12
Q

Role of lateral meniscus

A

To resist varus stress and external rotation of the knee

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13
Q

What is our average anatomical axis of the hip and knee?

A

6 degrees valgus —> knee and ankle aligned perfectly

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14
Q

Which nerve supplies the anterior compartment of the lower leg?

A

Deep peroneal (or fibular) nerve

E.g. tibialis anterior and extensor digitorum

Act to dorsiflex and invert the foot

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15
Q

Which nerve supplies the lateral compartment of the leg?

A 
Superficial perineal (fibular)
Act to evert the foot 
E.g. fibularus longus and brevis
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16
Q

Which nerve supplies the posterior compartment of the leg?

A

Tibial nerve
Acts to plantarflex the foot
E.g. gastrocnemius, soles, tibialis posterior etc

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17
Q

Which 2 structures contribute to the medial arch of the foot?

A

Posterior tibial and plantar fascia

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18
Q

Difference between hammer and claw toe?

A

Claw = flexion at proximal and distal interphalangeal joint

Hammer = flexion at PIP but extension and DIP

Both due to an imbalance between flexors and extenders

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19
Q

Cartilage is made of water, collagen, proteoglycans and chondorcytes. What do chondrocytes do?

A

Make collagen

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20
Q

What is osteochondritis dissecans?

A

Subchondral bone becomes avascular —> cartilage +/- bone fragmenting
Usually medial epicondyle of femur in adolescence
Typically pain with swelling and locking after exercise
Treat conservatively, with pinning or removal of fragment

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21
Q

Good surgical option for builder with valgus alignment and early medical compartment OA?

A

Osteotomy

surgical cutting of bone to alllow realignment

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22
Q

In a well selected patient, how long does a TKR last?

A

15-20 years

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23
Q

Don’t forget that 50% of ACL tears often have a meniscal tear too

A

Medial meniscus 10x more common that lateral

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24
Q

Why do radial meniscal tears not heal?

A

They involve the central surface of the meniscus - only the peripheral 1/3 has a blood supply

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25
Most likely diagnosis in a patient with an acute locked knee
Bucket handle meniscal tear Requires urgent surgery
26
MCL tear usually heals well. Brace, early motion and physio
ACL tear is more worrying. Repair does not work - needs reconstruction from graft e.g. patellar tendon or Achilles 1/3 compensate well 1/3 can avoid instability by avoiding actively 1/3 cannot compensate and get instability
27
What structures are relatively likely to be damaged in a knee dislocation?
1) Common peroneal nerve 2) Popliteal artery —> potential for compartment syndrome
28
Patient can’t do a straight leg raise and there is a palpable gap on examination. Diagnosis and management?
Extensor mechanism rupture | Needs surgical repairs
29
Most likely knee injury after hitting dashboard in RTA?
PCL tear
30
Most likely knee injury from getting up from squat?
Meniscal
31
Diagnosis in footballer who twisted and heard a pop. Generalised pain and rotator instability?
ACL rupture
32
Recurrent catching and locking after sudden pain which occurred when getting up from squatting?
Meniscal tear
33
What 3 examination tests are done if suspected ACL tear?
1) Lachman (knee at 20 degree flexion) 2) Anterior drawer (knee at 90 degree flexion) 3) Pivot shift (knee externally rotated)
34
LOSS on x-ray
Loss of joint space Osteophytes Subchondrol sclerosis Subarticualr cysts
35
+ve McMurray test. Likely diagnosis?
Probably a meniscal problem
36
Position of a leg with an intracapsular hip fracture?
Shortened, externally rotated and adducted Need to do AP and lateral view
37
Intracapsular # occur within the joint capsule and as there is poor blood supply - malunion is common
Extracapsular fracture occur outwith the joint capsule so malunion is less likely
38
Management of intracapsular hip #
Undisplaced —> internal fixation and dynamic hip screw Discplaced —> hemiarthroplasty (exicse head and insert prosthesis)
39
Management of extra-capsular #
Usually a dynamic hip screw | femoral shaft # requires stabilisation and then insertion of intra-medullary nail
40
What does loss of Shenton’s line suggest?
Hip # | It is formed by the inferior edge of the superior pubic ramis and medial edge of femoral neck
41
What are the 5 types of hip # ?
Intra-capsular: - subcapital - transcervical - basicervical Extra-capsular: - intertrochanteric - sub-trochanteric
42
What is Garden’s classification?
Tool for assessing the severity of hip # 1 - incomplete or impacted 2 - complete 3 - partially displaced 4 - completely displaced
43
Remember a hip # is EXTRA bad so the leg is EXTERnally rotated
Hip dislocations are not too bad so the leg is internally rotated
44
Key things to mention when discussing a #
Site - e.g. shaft of femur Direction of # e.g. transverse/ oblique/ spiral Displacement - always describe in relation to distal bone fragment e.g. lateral displacement eith shortening and valgus angulation Soft tissue - open/ closed, NVB? Compartment syndrome?
45
What does comminuted # mean?
> 2 bone fragment s
46
In every patient with back pain you must ask about causes equina and any history of malignant
In every patient with back pain you must ask about causes equina and any history of malignant
47
Knee pain worse on walking up or down stairs?
Classically patellofemoral pain
48
Always look at medication list in a patient with gout. They may have just started a thiazide diuretic which often precipitates attacks
Always look at medication list in a patient with gout. They may have just started a thiazide diuretic which often precipitates attacks
49
Differential diagnosis of neck pain?
- mechanical - trauma - cervical spondylosis, prolapse or discitis - OA - bony mets
50
Features of complex regional pain syndrome?
Pain, hypersensitivity and autonomic dysfunction e.g. excess sweating Often following trauma Distal forearm and hand usually involved
51
Carpal tunnel = radial 3.5 fingers affected
Cubical tunnel = ulnar 1.5 fingers affected
52
Differential for widespread musculoskeletal pain
``` PMR Polymyositis Fibromyalgia RA Psoriatic arthritis Ank spon SLE Metabolic bone disease ```
53
Differential for ‘acute hot swollen joint’
``` Septic arthritis Gout RA Transient synovitis Haemarthrosis - common in patients on warfarin or with a bleeding disorder (if haemarthrosis is suspected, a clotting screen should be done and INR should be checked) ```
54
Differential for an unwell child with joint pain?
Septic arthritis | Idiopathic juvenile arthritis
55
How will a child with a SUFE typically stand?
With the affected leg in external rotation
56
What does Thomas’s test test for?
A fixed flexion disorder (the contralateral leg comes off the bed)
57
If you suspect a SUFE, which x-ray should you order?
Frog leg lateral x-ray
58
What are the hand manifestations of RA?
Swan neck deformity Boutonnière deformity Ulnar drift
59
In any skin lump/ swelling, consider it sinister if >5cm in diameter
In any skin lump/ swelling, consider it sinister if >5cm in diameter
60
List some causes of a secondary arthritis
``` Perthes SUFE AVN Trauma Previous infection RA ```
61
HLA DR4 is very important in the development of RA
HLA DR4 is very important in the development of RA
62
Rheumatoid factor is in serum of 80% of patients with RA
High levels —> severe disease and extra-articulate features
63
Which joints are typically affected by rheumatoid arthritis?
Small and medium sized joints in a symmetrical
64
Synovitis is the cardinal feature of RA. It usually affects the small joints of the wrist and hand except...
DIPJ -almost always spared
65
Extra-articular of RA
``` Rheumatoid nodules Teno synovitis/ bursitis Carpal tunnel - due to synovitis Lung nodules/ pulmonary fibrosis Eye - keratoconjunctivitis sicca, episcleritis, scleritis ```
66
What are the 2 serological tests associated with RA.
Rh factor | Anti- CCP
67
Name some biological therapies
Anti-TNF —> infliximab, adalimumab and etanercept (monoclonal antibodies) Other biologics —> ritixumab and abatacept
68
People with RA should be on a DMARD asap
Steroids are often given to relieve symptoms short term while the DMARD takes effect
69
What is the major side effect of ciclosporin, other than bone marrow suppression?
Renal disease —>>HT
70
In any fracture, what must you consider other than the actual bone?
1) Overlying skin 2) Distal blood supply - pulses? 3) Nerve involvement - weakness/ sensation
71
Describe the salter Harris classification of growth plate #
``` 1 = through growth plate only 2 = mainly epiphysis but part of metaphysis is also involved 3 = growth plate and epiphysis e.g. intra-articular 4 = though epiphysis, growth plate and metaphysis —> most severe 5 = crush injury —> unusual and only detected when bone growth stops later ```
72
Most common type of salter-Harris fracture
Type 2 | Through growth plate and epiphysis
73
Operative treatment i.e open reduction is always required for open fractures and displaced intra-articulate fracture
Operative treatment i.e open reduction is always required for open fractures and displaced intra-articulate fracture
74
Patient develops hypoxia and sudden onset SOB 2 days after femoral #. Differential?
PE | Fat embolus - never forget!
75
First step in management of an open #
``` ABCDE Cover in an iodine soaked swab Splint Start ABx prophylaxis e.g. IV co-amoxiclav (amoxicillin and clavulanic acid) Tetanus prophylaxis De-bride in theatre ASAP. ```
76
What must be considered if there is blood at the urethral meatus/ blood or boggy prostate on PR?
Pelvic fracture
77
Scaphoid # are notoriously tricky. You need to get a lateral (scaphoid) view. What are the complications?
``` Non-union Malunion AVN Reduced grip strength Increased risk o OA ```
78
Patient with FOOSH and pain in anatomical snuffbox. Suspected scaphoid # but x-ray normal. What to do?
Immobilise wrist and re-do x-ray in 2 weeks | If still normal but tenderness remains then do an MRI
79
Cole’s #
Fracture of the distal radius with dorsal displacement (dinner fork appearance) Most common in old ladies who fall and have osteoporosis
80
Names of bone ends and growth plates
``` Epiphysis = bone end e.g. beyond growth plate Physis = growth plate Metaphysis = between physis and diaphysis Diaphysis = bone shaft ```
81
Most likely mechanism for a posterior shoulder dislocation?
Epileptic shoulder
82
Views for shoulder dislocation?
AP and axillary
83
Which rotator cuff muscles insert into greater tuberosity?
Supraspinatous (Jobe’s -thumb down) | Infraspinatous and Teres minor (external rotation)
84
Which rotator cuff muscle inserts onto lesser tuberosity?
Subscapularis | Internal rotation - push against hand
85
Popeye sign
Ruptured biceps tendon
86
What are the 3 recognised stages of adhesive capsulitis?
Painful - often at night Frozen - reduced ROM, especially external rotation Thawing - progressive improvement in ROM
87
Galeazzia = radial shaft # with dislocation of DRUJ
Monteggia = proximal ulnar # with dislocation of radial head | remember its the ulnar head which forms the elbow joint
88
Bennet’s = intra-articulation # of the base of the thumb
Boxers # = 5th metacarpal neck fracture (little finger) | Always volar angulation
89
Remember trascervical is an intracapsular fracture
Basicervical is an extracapsular fracture
90
Positive anterior draw and Lachman’s test?
ACL rupture
91
The Danis-Weber classification is used for ankle fractures. Describe it
``` A = below syndesmosis B = at level of syndesmosis C = above syndesmosis ``` Ankle # need reduced in A&E Any degree of talar shift needs operative fixing
92
Commonest cause of Baker’s cyst?
OA
93
Bone bone which resolves with aspirin?
Osteoid osteoma | benign
94
Soap bubble appearance of bone tumour?
Giant cell tumour
95
Onion skin appearance of bone tumour?
Ewing sarcoma | t(11;22) translocation
96
Popcorn appearance of bone tumour?
Chondrosarcoma

Acute Care (4 decks)

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