Orthopaedics Flashcards
(87 cards)
1
Q
What is meant by a pathological fracture
A
Fracture through an abnormal bone e.g. osteoporosis, tumour/mets, osetemalacia, Pagets disease
2
Q
How many points are allocated to each aspect of GCS
A
Eyes 4
Voice 5
Motor 6
3
Q
Describe GCS assessment of eyes
A
1 - wont open
2 - open to pain
3 - open to voice
4 - spontaneously open
4
Q
Describe the GCS assessment of voice
A
1 - no voice 2 - incomprehensible 3 - inappropriate 4 - confused 5 - orientated
5
Q
Describe the GCS assessment of motor
A
1 - none 2- abnormal extension (decerebrate) 3 - abnormal flexion (decorticate) 4 - flexion to withdraw from pain 5 - moves to localise pain 6 - obeys commands
6
Q
Early complications of a fracture
A
DVT/PE Avascular necrosis Wound infection Osteomyelitis Compartment syndrome
7
Q
Late complications of a fracture
A
Mal-union, Non-union Delayed union Infection Stiffness Instability
8
Q
Delayed union of a fracture is classed as non-union how long after the injury?
A
6 months
9
Q
Risk factors for incomplete bone healing
A
Joint instability Infection Segmental fracture Areas of low blood supply - scaphoid, distal tibia, 5th MTP DM Smoker HIV Steroids
10
Q
What are the 6 Ps of critical limb ischaemia
A
Pain Pallor Pulseless Paralysis Paraesthesia Perishingly cold
11
Q
Signs/symptoms of a fracture
A
Pain, swelling, tenderness Mobile at fracture site Loss of limb function Neurovascular compromise distally Crepitus
12
Q
What are the 3 types of nerve injury from fractures
A
Neuropraxia
Axonotmesis
Neurotmesis
13
Q
Management of a fracture
A
Wound care and analgesia
- Reduction (closed/open)
- Stabilisation/fixation (internal/external)
- Rehabilitation
14
Q
What are the 2 broad types of hip fracture
A
Intracapsular
Extracapsular
15
Q
Describe the Garden classification of intracapsular hip fractures
A
1 - undisplaced + incomplete
2 - undisplaced + complete
3 - partly/incompletely displaced
4 - completely displaced
16
Q
Management of Garden hip fractures type 1 and 2
A
Dynamic hip screw (internal fixation)
17
Q
Management of Garden hip fractures type 3 and 4
A
Hemi/total arthoplasty
18
Q
When describing fractures what are the 3 main questions you need to think about
A
Which bone
Which bit of that bone
How is it broken
19
Q
When describing how a bone is broken what descriptive categories can you use
A
Complete/incomplete Transverse/spiral/oblique Non-displaced/angulated/displaced Distracted/impacted Simple/segmental/comminuted Open/closed
20
Q
OA affects mostly which joints
A
Hip, knee, hand, spine, shoulder
21
Q
Secondary causes of OA
A
Metabolic: gout/pseudogout, haemochromatosis, Wilsons
Neuropathic: DM, syphilis
Anatomical: slipped epiphysis, Perthes disease
Traumatic: injury, fracture, surgery
Inflammatory arthritis
22
Q
Clinical features/symptoms of OA
A
Pain and stiffness that gets worse with activity
Sometimes swelling
Giving way/locking
Decreased ROM
Bony deformities - heberdens nodes, bouchards nodes, squaring of the thumb base
Crepitus
Joint line tenderness
23
Q
Heberdens nodes affect which joint
A
DIP
24
Q
Bouchards nodes affect which joint
A
PIP
25
X-ray findings of OA
Loss of joint space
Subchondral sclerosis
Subchondral cysts
Osteophytes
26
Management of OA
```
Conservative: weight loss, exercise, physio
Analgesia - NSAIDs + paracetamol + PPI
Intra-articular steroid injections
Orthoses
Surgery
```
27
Bone density T score for osteopenia
-1 to -2.5
28
Normal bone density T score
Over -1
29
Osteoporosis bone density T score
Less than -2.5
30
Risk factors for osteoporosis
```
Female
Low BMI
Maternal FH
Steroid use
Aromatase inhibitors
Smoking
Alcohol
```
31
Diseases that can cause osteoporosis
Hyperthyroidism
Hyperparathyroidism
Cushings
Vitamin D deficiency
32
Management of osteoporosis
Falls prevention
Bisphosphonates (Alendronic acid)
Ca/Vit D replacement
33
Differentials of childhood leg pain
```
Transient synovitis of the hip
Perthes disease
Slipped upper femoral epiphysis
Developmental dysplasia of the hip
Juvenile idiopathic arthritis
Tumour
Referred pain - malignancy, testicular, appendix
NAI
Joint sepsis/osteomyelitis
```
34
Classic findings of a fractured neck of femur
Classically the affected leg is shortened, ABducted and externally rotated
Exacerbation of pain on palpation of the greater trochanter
Pain is exacerbated by rotation of the hip
35
Typical presentation and management of transient synovitis of the hip
Boy aged around 5
Acute mild/moderate hip pain and limp following recent URTI or gastroenteritis
Limited movement, positive leg roll, sometimes abducted and externally rotated
Usually resolves after 7-10 days, management is supportive with analgesia and activity restriction
36
What is Perthes disease
Decreased blood supply to femoral epiphysis --> avascular necrosis, remodelling, deformity, secondary OA
37
Typical presentation of Perthes disease
Boys aged around 5
| Painless limp, usually unilateral, decreased ROM, short stature, pain worse with activity, asymmetrical limb length
38
Typical presentation of slipped upper femoral epiphysis
Adolescent/puberty
Associated obesity, hypothyroidism or metabolic disorder
Pain, limp, external rotation upon flexion of the hip
Restricted range of movement
39
Typical presentation of developmental dysplasia of the hip
Newborn girls
Hip subluxation/dislocation
Asymmetrical leg folds, asymmetrical hip abduction, delayed crawling
40
Back pain differentials
```
Mechanical
Disc herniation
Spinal stenosis
Fracture
Discitis/osteomyelitis/spinal abscess
Malignancy
Inflammatory arthropathy
Cauda equina syndrome
Referred: peptic ulcer, AAA, pyelonephritis
```
41
At what level does the spinal cord end and cauda equina start
T12/L1
42
Sciatic nerve root levels
L4 + L5
| S1,2,3
43
Back pain red flags
```
Thoracic pain
Leg weakness
Incontinence
Fever
Saddle anaesthesia
History of cancer
```
44
Typical presentation of spinal stenosis
Neurogenic claudication - Leg/back pain, weakness, numbness bought on by walking
45
Differential diagnosis of shoulder pain
```
Subachromial impingement
Bursitis
Referred pain from neck
Rotator cuff tear
RA
OA
Frozen shoulder
```
46
Typical symptom complaint of shoulder impingement
Pain and weakness with overhead movements
47
Risk factors for bursitis
```
Occupation with repetitive mechanical stress
Nearby joint infection
OA
RA
Gout/pseudogout
```
48
Typical symptom complaint of bursitis
Localised pain, worse with movement, over months and has flare ups
49
Risk factors for frozen shoulder
```
Female
Shoulder injury or surgery
DM
Thyroid disease
Previous frozen shoulder
```
50
Describe the 4 typical stages of frozen shoulder (adhesive capsulitis)
1 - lateral shoulder pain, worse at night, only slight reduction to range of movement
2 - pain and ROM get worse
3 - pain only on extremes of movement but loss of ROM really bad
4 - negligible pain but profound loss of ROM
51
How long does frozen shoulder typically take to resolve
18-24 months
52
How long after intra-articular steroid injections do you have to wait before you could have implant/prosthesis surgery
3 months
53
What are the muscles of the rotator cuff
Supraspinatus
Infraspinatus
Subscapularis
Teres minor
54
What action does the supraspinatus muscle facilitate
Abduction of the shoulder
55
What action does the subscapularis muscle facilitate
Internal rotation of the shoulder
56
The infraspinatus muscle and teres minor facilitate which movement
External rotation of the shoulder
57
Which nerve supplies the supraspinatus muscle
Suprascapular nerve
58
Which nerve supplies the subscapularis muscle
Upper and lower subscapular nerves
59
Which nerve supplies the infraspinatus muscle
Subscapular nerve
60
Which nerve supplies teres minor
Axillary nerve
61
What does pain upon the Hawkins-Kennedy test suggest
Supraspinatus impingement
62
What are the two tests for shoulder impingement
Hawkins-Kennedy
| Scarf test
63
What are the three tests for the rotator cuff
Empty can test
External rotation against resistance
Gerber's lift-off test
64
Which muscle does Gerbers lift off test assess
Subscapularis
65
Which muscles does external rotation of the shoulder against resistance assess
Infraspinatus and teres minor
66
Which muscle does the empty can test assess
Supraspinatus
67
Low arc pain on abduction of the shoulder suggests what
Supraspinatus impingement
68
High arc pain on abduction of the shoulder suggests what
ACJ injury/pathology
69
Loss of shoulder external rotation is common in which disease process
Frozen shoulder
70
Winging of the scapula suggests damage to which nerve
Long thoracic nerve
71
Typical clinical features of meniscal tears
```
Knee pain worse on weight bearing or activity
Joint line tenderness
Restricted knee extension
Locked knee
Clicking/popping/locking of knee joint
Intermittent joint effusion
```
72
What special test in examination can assess for knee meniscal tears
McMurray's test
73
What aspects of the history can be used to differentiate meniscus tear from knee ligament injuries
Meniscal tears - axial loading and rotation with fixed foot or degenerative changes are mechanism of injury. You get delayed slow onset effusion. There is palpable popping/clicking/locking of the knee with maneuvers
Knee ligaments - varus or valgus stress is mechanism of injury. Rapid onset effusion. Absent popping sensation.
74
Features of L3 nerve root compression
Sensory loss over anterior thigh
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test
75
Features of L4 nerve root compression
Sensory loss anterior aspect of knee
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test
76
Features of L5 nerve root compression
Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test
77
Features of S1 nerve root compression
Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test
78
Describe the femoral stretch test
This is a test for irritation of higher nerve roots - L4 and above.
The patient is positioned lying face downwards, and with the knee flexed, the hip is lifted into extension. Lumbar root irritation tension may cause pain to be felt in the front of the thigh and the back.
79
An elderly man with bone pain, raised ALP but normal Ca and PO4 is typical of which diagnosis
Pagets disease
80
If a FRAX score shows intermediate risk what should you do
Arrange a bone mineral density scan
81
Describe a Colle's fracture
Fall onto extended outstretched hand
Classical Colles' fractures have the following 3 features:
1. Transverse fracture of the radius
2. 1 inch proximal to the radio-carpal joint
3. Dorsal displacement and angulation of distal fragment
82
Describe a Smiths fracture
Palmar angulation of distal radius fragment (Garden spade deformity)
Caused by falling backwards onto the palm of an outstretched hand or falling with wrists flexed
83
Describe Bennetts fracture
Intra-articular fracture of the first carpometacarpal joint
Impact on flexed metacarpal, caused by fist fights
X-ray: triangular fragment at ulnar base of metacarpal
84
Describe Monteggia's fracture
Dislocation of the proximal radioulnar joint in association with an ulna fracture
Fall on outstretched hand with forced pronation
Needs prompt diagnosis to avoid disability
85
Describe Galeazzi fracture
Radial shaft fracture with associated dislocation of the distal radioulnar joint
Direct blow
86
Describe Pott's fracture
Bimalleolar ankle fracture
| Forced foot eversion
87
Describe Barton's fracture
Distal radius fracture (Colles'/Smith's) with associated radiocarpal dislocation
Fall onto extended and pronated wrist
