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CST Interview > Orthopaedics > Flashcards

Orthopaedics Flashcards

(56 cards)

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1
Q

Bicep reflex

A

C5/C6

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2
Q

Tricep reflex

A

C6/C7

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3
Q

Abdominal reflex

A

T8 - T12

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4
Q

Knee reflex

A

L3/L4

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5
Q

Ankle reflex

A

S1/S2

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6
Q

Brachioradialis reflex

A

C5/C6

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7
Q

Grading of reflexes

A

0 = absent

1 = hypoactive

2 = normal

3 = hyperactive, no clonus

4 = hyperactive + clonus

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8
Q

Factors affecting fracture healing

A

Local trauma: soft tissue injury, tissue loss, sort tissue interposition, neurovascular injury, open fractures

Inadequate reduction and immobilisation

Infection

Location: metaphysics vs diaphysis

Metabolic

Age, NSAIDs, T2DM, Smoking

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9
Q

Perkin’s rule of fracture healing

A

Fracture of cancellous bone - metaphysical approx 6 weeks

Fracture of cortical bone - diaphysial approx 12 weeks

Fracture of tibia approx 24 weeks

Children, age plus 1 in weeks

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10
Q

Definition of delayed union

A

1.5x times normal fracture time

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11
Q

Definition of non-union

A

Failure of fracture at 2x expected healing time

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12
Q

Classification of non-union

A

Hypertrophic non-union
=excess mobility and stress
-large callus
-managed by fixation

Atrophic non-union
=poor blood supply

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13
Q

Osteomalacia

A

Reduced mineralisation of osteoid

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14
Q

Osteoporosis

A

Low bone mineral density
Low bone mass

Normal mineralisation

Prone to fractures

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15
Q

AO management of fracture principles

A

Fracture reduction to restore anatomical alignment

Fixation or stabilisation across fracture

Preservation of blood supply and soft tissues, utilisation of gentle reduction techniques

Early and safe mobilisation

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16
Q

Complications of plaster paris

A

Pressure areas

Venous thromboembolism

Loosening

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17
Q

Indications for internal fixation

A

Intra-articular fractures

Unstable fractures

Neurovascular damage

Polytrauma

Elderly in which bedrest would result in decline

Long bone fractures

Pathological fractures

Failed conservative stabilisation techniques

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18
Q

Management of factures of shaft of ulna and radius

A

Mechanism: fall on out-stretched hand

Undisplaced = above elbow cast
Displaced = open reduction and compressible plate fixation

Monteggia: proximal
Galeazzia: distal
Fracture dislocations are indication for open reduction and plating

FU x-ray at week 1 and week 2 to ensure reduction

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19
Q

Gartland Classification

A

Supracondylar fractures

Type I: undsiplaced

Type II: angulated or displaced but posterior cortex intact acting as a hinge

Type III: complete displacement

Type IV: completely displaced and unstable in flexion and extension

Mx: III or IV –> orthopaedic emergency and require K-wire fixation

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20
Q

Management of supracondylar fractures

A

Gartland classification II-IV are fixed with medial and lateral K-wires
AND above elbow casting

Gartland I: collar and cuff

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21
Q

Complications of supracondylar fractures

A

Vascular compromise from compression of brachial artery or vascular spasm
If transected - need interposition vein graft

Ischaemic contracture: Volkamn’s

  • contraction and fibrosis of forearm
  • avoided by early intervention

Neuropraxis

  • radial nerve
  • anterior interosseous nerve, branch of median nerve

Mal-union

  • gun-stock deformity
  • recurvatam more common in casting
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22
Q

Epicondyle fracture of humerus

A

Avulsion-type injuries of apophysis
-high associations with elbow dislocations

Fragment can be trapped in elbow joint
-indication for open fixation

Management: long-arm casting, unless trapped body

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23
Q

Lateral condyle fractures of the humerus

Study These Flashcards
A

Milcon classification
Type I: # of growth centre capitulum (Salter Harris IV)
Type II: # medial to growth centre and can involve trochlea (Salter Harris II)

Mx: fixation with K-wires or cannulated screws
-if not will be displaced by wrist extensors

24
Q

Assessment of the hand

Study These Flashcards
A

Motor innervation

  • OK sign = median nerve
  • Cross fingers = ulnar nerve
  • Extend wrist = radial nerve

Sensory innervation

  • Webbing between thumb and index finger on PALMAR surface = median nerve
  • Between distal little finger and distal ring finger on palmar/dorsal surface = ulnar nerve
  • Webbing between thumb and index finger on DORSAL surface = radial nerve
25
Testing radial innervation to the hand
Motor = wrist extension Sensory = Webbing between thumb and index finger on DORSAL surface of the hand
26
Testing median innervation to the hand
Motor = OK sign Sensory = Webbing between thumb and index finger on the PALMAR surface of the hand
27
Testing ulnar innervation to the hand
Motor = cross index and middle finger Sensory = distal little and ring finger
28
Complications of supracondylar fractures
Early - damage to brachial artery - damage to radial nerve (and median nerve) - damage to brachial vein - infection - haemorrhage Intermediate - compartment syndrome - infection - secondary haemorrhage Late - Volkman ischaemic contracture - Sudek's atrophy - Mal-union --> deformity - Non-union
29
Definition of Mal-union
Healing of a fracture in an abnormal position leading to shortening or deformity
30
Definition of Non-union
Arrest in fracture healing process
31
Gartland classification of Supracondylar Fractures
Type 1 = undisplayed or minimally displaced 1a: non-displased in two views 1b: minimal displacement, medial cortical buckling Type 2 = displaced but with INTACT cortex 2a: posterior angulation with intact posterior cortex 2b: rotatory displacement / straight displacement Type 3 = completely displaced 3a: no cortical contact 3b: soft-tissue interposition
32
Type 1 Gartland
Type 1 = undisplayed or minimally displaced 1a: non-displased in two views 1b: minimal displacement, medial cortical buckling
33
Type 2 Gartland
Type 2 = displaced but with INTACT cortex 2a: posterior angulation with intact posterior cortex 2b: rotatory displacement / straight displacement
34
Type 3 Gartland
Type 3 = completely displaced 3a: no cortical contact 3b: soft-tissue interposition
35
Holstein-Lewis Fracture
Fracture of the distal third of the humerus resulting in entrapment of the radial nerve.
36
Management of humeral shaft fractures
Sugar tongue casting for 1-2 weeks Then functional brace for up to 3 months Regular clinic follow-up
37
Presentation of slipper upper femoral epiphysis
Obese children M: 12 - 15 years F: 10 - 13 years Waddling gait Hip/knee pain Reduced internal rotation May be held in external rotation and shorten 20% are bilateral
38
Investigations for a slipper upper femoral epiphysis
Full joint examination of hip and knee AP plain radiograph and lateral / frog's leg pelvis veiws
39
Management of slipper upper femoral epiphysis
Acute: reduction and cannulated screw fixation Chronic: no reduction, cannulated screw fixation in-situ
40
Classification of slipper upper femoral epiphysis
Acute: <3 weeks Chronic >3 weeks Stable: able to WB Unstable: unable to WB
41
Complications of slipper upper femoral epiphysis
Avascular necrosis Chondrolysis Osteoarthritis Malunion, deformity Iatrogenic: subtrochanteric fracture if pinned too low
42
Definition of slipper upper femoral epiphysis
Displacement of epiphysis inferno-posteriorly through the growth plate
43
Risk factors for slipper upper femoral epiphysis
BMI Rapid growth Hypothyroidism Renal ricketts Pituitary deficiency Growth hormone deficiency Left > right Male > female
44
Diagnostic examination finding of SUFE
When hip is flexed --> external rotation limited ABduction Shortended, externally rotated
45
X-ray findings of SUFE
Widening of physics = pre-slip Klein's line: line from superior femoral neck should direct head, if it doesn't = slip
46
Presentation of hip dislocation
Post hip replacement Pain Reduced range of movement Internally rotated
47
Hip dislocation post arthroplasty
1-7% of hip replacements Occurs within 3 months Recurrence likely
48
Post arthroplasty films
Check no fracture in native bone, ruling out periprosthetic fracture Check for changes in angulation that may suggest loosening Check femoral component is in acetabulum
49
Management of hip dislocation
Needs relocation Under sedation or GA
50
Risk factors for hip dislocation
Patient factors - female > M 2:1 - weak hip musculature - age - obesity - alcohol - congenital developmental dysplasia of the hip Surgical approach - posterior approach much higher risk - revision surgery - capsular excision
51
Posterior vs lateral approach to hip
Posterior approach - higher rate of dislocation - lower sciatic nerve injury Lateral approach - less likely to dislocate - higher risk of sciatic nerve injury - more likely to bleed
52
4 compartments of the leg
Anterior compartment Lateral compartment Superficial posterior compartment Deep posterior compartment
53
Diagnostic criteria for compartment syndrome
= clinical diagnosis >30mmHg compartment pressure --> highly suggestive >40mmHg compartment pressure or <30mmHg of diastolic BP = diagnostic
54
Definition of compartment syndrome
Increased pressure in an osteofascial compartment leading to venous and lymphatic occlusion which progressed to limb threatening ischaemia
55
Management of compartment syndrome
Cast and dressings off Elevate limb Analgesia NBM IV fluids, reduce rhabdomyolysis Bloods inc group and save Reg on-call CEPOD Fasciotomy
56
Differential diagnosis of an acutely painful limb
Acute limb ischaemia DVT Compartment syndrome Missed fracture

CST Interview (11 decks)

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