Orthopaedics

Question 1

What is cervical spondylosis?

Answer 1

Degenerative changes of the cervical spine - annular fibrosis and bony spurs
Narrows spinal canal and intervertebral foramina
Neck and arm pain, paraesthesia

Question 2

What is whiplash?

Answer 2

Sudden neck extension with rebound flexion

Protective muscle spasm causes pain and stiffness

Question 3

What are some causes of impingement syndrome?

Answer 3

Supraspinatus tendinopathy
Calcifying tendinopathy
ACJ-osteoarthritis

Question 4

What are the features of rupture of long head of biceps?

Answer 4

Discomfort occurs after lifting or pulling

‘Ball’ appears in the muscle on elbow flexion

Question 5

What are the phases of adhesive capsulitis?

Answer 5

1. Painful phase - less than a year
2. Frozen phase 6-12 months
3. Thawing phase - 1-3 years

Question 6

What is olecranon bursitis?

Answer 6

Traumatic bursitis following elbow pressure
Pain and swelling behind olecranon
Check for skin cellulitis

Question 7

What are the features of subluxation of the radial head?

Answer 7

Typically 1-4 year old lifted by the arm
Radial head slips out of anular ligament
Arm is held slightly flexed and twisted inwards

Question 8

What are the features of Dupuytren’s contracture?

Answer 8

Progressive painless fibrotic thickening of the palmar fascia
Skin puckering and MCP joint flexion
Consider fasciectomy

Question 9

What are some causes of Dupuytren’s contracture?

Answer 9

Genetic
Smoking
Diabetes
AEDs

Question 10

What is De Quervian’s disease?

Answer 10

Stenosing tenosynovitis of 1st extensor compartment, APL and EPB as the cross the radial styloid

Question 11

What is scoliosis and what are the symptoms?

Answer 11

Lateral spinal curvature with secondary vertebral rotation

Pain, cosmesis issues, poor lung function

Question 12

What are some features of discitis?

Answer 12

Fever, night pain, specific tenderness
Raised ESR
50% staphylococcal

Question 13

What is Pott’s disease?

Answer 13

Spinal TB
Focal tenderness, kyphosis and stiffness
Do CXR to check for pulmonary TB

Question 14

What are some symptoms of transient synovitis?

Answer 14

Viral prodrome
Child systemically well
Acute onset limp and reduced movements

Question 15

What is Perthes disease?

Answer 15

Avascular necrosis of the femoral head
Gradual onset limp and pain
Can cause early onset OA

Question 16

What are some features of SUFE?

Answer 16

Boys over 10
Increased risk in obesity and hypothyroidism
Do frog leg lateral hip x-rays

Question 17

What are some signs of developmental dysplasia of the hip?

Answer 17

Asymmetrical leg length
Asymmetrical skin folds
Buttock flattening

Question 18

What is Osgood-Schlatter disease?

Answer 18

Tibial tuberosity apophysitis
10-15 year olds
Physical overuse

Question 19

What are hammer toes?

Answer 19

Extended MTPJ
Hyperflexed at PIPJ
Extended at DIPJ
Toes look curled

Question 20

What are claw toes?

Answer 20

Extended MTPJ
Hyperflexed at PIPJ
Flexed at DIPJ

Question 21

What are some features of osteosarcoma?

Answer 21

Can be primary (metaphases of long bone) or secondary e.g. Paget’s, radiation
Bone destruction and new bone formation on imaging
HRCT chest to look for metastases

Question 22

What is Ewing’s sarcoma?

Answer 22

Malignant round cell tumour of long bones

Affects adolescents

Question 23

What are some red flags for bone tumours?

Answer 23

Non-mechanical bone or joint pain
Nocturnal pain
Bony swellings
Pathological fractures

Question 24

What is osteochondroma?

Answer 24

Benign painful mass associated with trauma

XR - bony spur arising from cortex

Question 25

What is osteogenesis imperfecta?

Answer 25

Inherited disorder of type 1 collagen | Joint laxity, fragile low-density bones

Question 26

What are the different types of osteogenesis imperfecta?

Answer 26

1. Mildest, commonest, AD, blue sclera, hearing loss 2. Lethal perinatal form, recessive, dwarfism 3. Severe form, recessive, fractures and birth, spinal and limb deformity 4. Moderate, AD

Question 27

What are the complications of joint replacements?

Answer 27

``` VTE Dislocation Infection Limb length discrepancy Nerve palsy ```

Question 28

When should a c-spine x-ray be performed?

Answer 28

``` Neuro exam shows focal deficit Spine tenderness Alteration in consciousness Intoxication Distracting injury ```

Question 29

What are some risk factors for poor fracture healing?

Answer 29

``` DM Recent trauma Smoking Osteoporosis Steroids ```

Question 30

What are the four stages of fracture management?

Answer 30

Reduction Stabilisation Maintain NV supply Rehabilitation

Question 31

What should be done for an open fracture?

Answer 31

1. IV antibiotics 2. NV status assessment - impaired do urgent surgery 3. Debridement within 24 hours 4. Photograph 5. Cover wound in saline soaked gauze 6. Splint the limb 7. Definitive stabilisation and wound cover within 72 hours

Question 32

What are some immediate fracture complications?

Answer 32

Bleeding Organ injury Nerve/skin/vessel injury

Question 33

What are some local later fracture complications?

Answer 33

Skin necrosis Pressure sores Infection Delayed or non-union

Question 34

What are some general later fracture complications?

Answer 34

Fat embolism PE Pneumonia Arthritis

Question 35

What is the immediate management of compartment syndrome?

Answer 35

Remove any constrictive dressings Elevate to level of heart Analgesia and fluids Fasciotomy

Question 36

What is the order of structures in the antecubital fossa from lateral to medical?

Answer 36

Radial nerve Biceps brachii Brachial artery Median nerve

Question 37

What are some features of supracondylar fractures?

Answer 37

Happen in paeds Pain, swelling and inability to move elbow Can damage median nerve Heal in around 4 weeks

Question 38

What are some features of schaphoid fractures?

Answer 38

Often result from fall onto outstretched hand | Tenderness over anatomical snuff box

Question 39

What are the signs of NOF?

Answer 39

External rotation, adduction and shortening of affected leg