Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Scott's Notes > Orthopaedics > Flashcards

Orthopaedics Flashcards

(110 cards)

Start Studying
1
Q

What are the different types of bone?

A

Woven - Disorganised bone that forms calluses

Lamellar - Mature bone which takes one of two forms:
Cortical: Dense outer layer
Trabecular: Porous central layer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

By which method do most bones form?

A

Endochondral ossification (mesenchyme -> cartilage -> bone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the phases and timings of fracture healing?

A 
Reactive phase (0-48hrs): 
Haematoma forms and local inflammation leads to granulation tissue formation

Reparative phase (2d-2w):
Proliferaiton of osteoblasts and fibroblasts which form cartilage and woven bone, which is then consolidated into lamellar bone

Remodelling phase (1wk-7y):
Remodelling of lamellar bone to cope with mechanical forces according to Wolff's Law
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the difference between a stress fracture and a pathological fracture?

A

Stress fractures are due to bone fatigue due to repetitive strain, e.g. marathon runners feet

Pathological fractures are due to normal forces applied to diseased bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

When radiographing a fracture, what images must be requested?

A

AP and lateral film of the fracture site, as well as images of the joint above and below the #

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How would you describe a fracture?

A

PAIDS

Pattern; transverse, oblique, spiral, multifragmentary, crush, greenstick, avulsion

Anatomical location

Intra/extra articular, dislocation or subluxation

Deformity (distal relative to proximal); Translation, angulation, rotation, impaction

Soft tissues; open or closed, neurovascular status, compartment syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the four ‘R’s of fracture management?

A

Resuscitate
Reduction
Restriction
Rehabilitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the principles of ‘Resuscitation’ in # management?

A 
ATLS
# usually in 2ary survey
Assess neurovascular status
Consider reduction and splinting before imaging
Manage pain and bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the 6As of open fracture management?

A 
Analgesia: M+M
Assess: NIV status, soft tissues
Antisepsis: wound swab, irrigation, dressing
Alignment
Anti-tetanus - check status
Abx: Fluclox + Benpen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the most concerning complication of an open fracture?

A

C. perfringens infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the methods of fracture reduction?

A

Manipulation/Closed reduction: under local/regional anaesthesia, use traction to disimpact and manipulation to align

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the principles of fracture restriction?

A

The interfragmentary strain hypothesis dictates that tissue formed at the # site depends on the strain it experiences. Fixation also reduces pain and increases functionality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the different methods of fracture restriction?

A

Non rigid - slings, elastic supports
Plaster
Functional bracing - joints free to move but bone shafts supported in cast segments
Continuous traction - e.g. collar and cuff

External fixation - useful in open #s, burns and tissue loss

Internal fixation - pins, plates, screws, IM nails. Perfect anatomical alignment which improve stability and aid early mobilisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the methods of # rehabilitation?

A

Physio
OT
Social services

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the possible complications following #?

A

General vs specific

General:
Tissue damage (haemorrhage, infection, rhabdomyolysis)
Anaesthesia (anaphylaxis, aspiration)
Bed rest (infections, pressure sores, muscle wasting, DVTs, reduced BMD)

Specific:
Immediate (NV damage, visceral damage)
Early (Compartment syndrome, infection, fat embolism ->ARDS)
Late (malunion, AVN, growth disturbance, post traumatic osteoarthritis, Complex regional pain syndrome, myositis ossificans)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How might an axillary nerve palsy form and present?

A

Following anterior shoulder dislocation -> Numb regimental badge area, weak abduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How might a radial nerve palsy form and present?

A

Following # humeral shaft ->waiters tip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How might an ulnar nerve palsy form and present?

A

Elbow dislocation-> Claw hand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How might a sciatic nerve palsy form and present?

A

Hip dislocation -> foot drop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How might a fibular nerve palsy form and present?

A

neck of fibula or knee dislocation -> foot drop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How does compartment syndrome present and how is it treated?

A

Pain on passive muscle stretching of a warm, erythematous, swollen limb with weak pulses

Rx by elevation, removal of bandage/cast and fasciotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the causes of delayed/non-union?

A

5Is

Ischaemia
Infection
Interfragmentary strain
Interposition of tissue between fracments
Intercurrent disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the different types of non-union?

A

Hypertrophic - rounded, dense bone

Atrophic - osteopoenic ends

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is myositis ossificans?

A

Formation of bone within muscle/soft tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is the presentation of complex regional pain syndrome type 1?
``` Presents weeks - months after injury in a neighbouring area to the #site Hyperalgia, lancing pain, allodynia Vasomotor Fx Skin is swollen or atrophic neuromuscular features ```
26
What are the grades of growth plate injury according to the Salter Harris Classification?
SALT CRUSH ``` Straight across Above Lower Through CRUSH ```
27
What are the risk factors for osteoporosis?
AGE + SHATTERED ``` Steroids Hyperpara/thyroidism Alcohol & cigarettes Thin Testosterone low Early menopause Renal/liver failure Erosive bone disesae Dietary calcium deficiency ```
28
What questions should you ask in a hip fracture pt?
``` Mechanism Osteo RFs Premorbid mobility Premorbid independence Comorbidities MMSE ```
29
How would you manage a hip fracture pt?
Resuscitate Analgesia NV status Image ``` Prep for theatre: ABCDEFG Anaesthetist Bloods CXR DVT prophylaxis ECG Films Get consent ```
30
What are the different types of hip fracture?
Intercapsular: Subcapital, transcervical, basicervical Extracapsular: Intertrochanteric/subtrochanteric
31
What is the Garden classification?
Used for intracapsular fractures (incomplete undisplaced, complete undisplaced, complete partially displaced, complete completely displaced)
32
What is the difference between a hemiarthroplasty and a total hip replacement/
Hemiarthroplasty involves only replacing the femoral head, while total hip replacement also replaces the acetabulum (/part of it)
33
What is the surgical management of intracapsular hip fractures?
<55 yos: ORIF 55-75yos: total hip replacement >75: hemiarthroplasty
34
What is the surgical management of extracapsular hip fractuers?
ORIF with dynamic hip screw
35
What is the prognosis following hip fracture?
30% mortality in 1 year 50% never gain full function Majority will have some residual pain/disability
36
What are the radiographic features of Colle's fracture?
Extra articular # of distal radius Dorsal displacement and angulation of distal fragment +-impaction
37
What are the specific complications of a Colle's fracture?
``` Median nerve injury Adhesive capsulitis Tendon rupture Carpal tunnel syndrome non/malunion Sudek's atrophy ```
38
What are the radiological features of a Smith's fracture?
Distal radius fracture with volar displacement and angulation of the distal fragment
39
If clinical Hx and exam suggest scaphoid fracture but X-ray normal, what should you do?
Treat anyway as #may only show after 10 days | Plaster cast
40
What is a Monteggia fracture?
of proximal 3rd of ulna shaft
41
What is a Galleazzi fracture?
of radial shaft between mid and distal 3rds
42
When might you see a posterior shoulder dislocation?
Direct trauma | Epileptic seizures
43
What is a Bankart lesion?
Damage to anteroinferior glenoid labrum
44
What is a Hill Sachs lesion?
Cortical depression of the posterolateral part of the humeral head following impaction against the anteroinferior glenoid rim. V common
45
What is the rate of dislocation recurrence following traumatic dislocation?
90% in 20 years
46
What is the pathology of Impingement syndrome/Painful arc?
Entrapment of the supraspinatus tendon and subacromial bursa between the acromion and greater tuberosity of the humerus
47
How does Impingement Syndrome present?
Painful arc between 60-120 degrees Weakness Reduced range of movement
48
What is the management of a painful arc?
Supportive - rest, physio Medical - NSAIDs, steroid injection Surgical - Arthroscopic acromioplasty
49
What is the presentation of adhesive capsulitis?
Progressive impairment of active and passive ROM Significantly reduced external rotation Shoulder pain esp at night
50
What is the classic sign of a rotator cuff tear?
Able to abduct actively following possive abduction to 90 degrees. Lowering past this point leads to a sudden drop
51
What structure is most commonly damaged in a supracondylar fracture?
Brachial artery
52
What demographic are supracondylar fractures most commonly seen in?
Children after FOOSH
53
What specific complications might occur following a supracondylar fracture?
Neurovascular injury to brachial artery, radial nerve, median nerve Compartment syndrome Gunstock deformity
54
How much blood should be Xmatched for the following fractures? Tibial Femoral
Tibial - 2 units | Femoral - 4 units
55
What are the specific complications following lower limb long bone fractures?
Hypovolaemic shock Neurovascular (sciatic nerve, superficial femoral artery) Compartment syndrome PE/ARDS from Fat emboli
56
What might the following features of a knee injury indicate? i) Swelling ii) Pain iii) Locking iv) Giving way
i) Haemarthrosis due to fracture or torn cruciates (80% ACL) ii) Meniscal or collateral tear iii) Meniscal tear iv) Ligament injury
57
What is the Unhappy triad of O'donoghue?
ACL tear Medial collateral tear Medial meniscus tear
58
What is the management of a ruptured ACL?
Conservative - Rest, physio strengthening quads and hammies Surgical - Autograft repair using semitendinosus +-gracilis held in place with screws
59
What is the definition of osteoarthritis?
Degenerative joint disorder where there is progressive loss of hyaline cartilage and new bone formation at the joint surface and its margin
60
What are the two main risk factors for OA?
Age | Obesity
61
Which joints does OA typically affect?
``` Hips Knees DIPS PIPS Thumb CMC ```
62
What are the symptoms and signs of OA?
``` Pain at end of day Stiffness after rest Joint deformity Reduced ROM Pouchards and Heberdips Fixed flexion deformity ```
63
What Xray changes are associated with OA?
``` Subchondral sclerosis Loss of joint space Osteophytes Deformity Subchondral cysts ```
64
What is the management of OA?
Supportive - Physio, weight loss, walking aids/home mods Medical - Para, NSAIDs, Tramadol, joint injections Surgical - Arthroscopic washout, arthroplasty
65
What is the presentation of the most common disc prolapse?
Most commonly affecting the L5 and S1 nerve roots, presenting with lumbago and sciatica. Signs include limited flexion/extension with free lateral flexion, pain on straight leg raise.
66
What does S1 root compression cause??
Weak plantarflexion and eversion with loss of ankle jerk and reduced sensation over sole of foot and back of calf
67
What is the commonest surgical procedure for disc prolapse?
Lumbar microdiscectomy
68
What is spondylolisthesis and where does it commonly affect?
Displacement of one lumbar vertebra over another, usually anterior displacement of L5 over S1.
69
What are the common causes of spondylolisthesis?
congenital malformation Spondylosis Osteoarthritis
70
How does spoondylolisthesis commonly present?
Usual onset in adolescence with pain worse on standing +- sciatica
71
What is the presentation of spinal stenosis?
Spinal claudication - aching buttoch and lower limb pain on walking usually rapid onset +-parasthesia. Pain eased by sitting forwards and worsened by spine extension.
72
What is the presentation of acute cord compression (Neurosurgical emergency)
Bilateral back and radicular pain LMN signs at compression level UMN signs at sensory level and below compression Sphincter disturbance
73
What is the presentation of acute cauda equina?
Radicular leg pain Saddle anaesthesia Loss of anal tone Bladder +-bowel incontinence
74
What is the management of acute cord/cauda equina compression?
Large prolapse - laminectomy/discectomy Tumour - Radiotherapy and steroids Abscesses - decompression and Abx
75
What is osteochondritis?
Idiopathic temporary softening of bone centre in adolescents due to necrosis followed by rehardening of bone in deformed position.
76
What are some examples of osteochondritic disorders?
``` Seheuermann's disease Kohler's disease Friedberg's disease Panners sidsease Perthe's disese ```
77
What are some examples of traction apophysitis?
Osgood Schlatter's Siding Larsen's disease (tibia) Sever's disease (Calcaneal)
78
What is osteochondritis dissecans, how does it present and what is the management?
When a piece of articular bone breaks off into the joint space. As well as pain and swelling, locking is a classical feature. Mx: Arthroscopic removal
79
How would you investigate and manage an acute osteomyelitis?
Ix: ESR/CRP, WCC, cultures, Xray (changes take 2 weeks to develop), MRI is sensitive and specific Mx: Vanc + cef empiriaclly, drainage, analgesia
80
What additional investigation might you for a septic arthritis that you wouldnt do for an osteomyelitis?
Joint aspirate MCnS
81
What are the complications of septic arthritis/
Osteomyelitis Post infective arthritis Ankylosis (fusion)
82
What are the commonest tumours which metastasise to the bone?
Breast, lung, prostate, thyroid, kidney
83
What is the typical presentation of fibrous dysplasia/
A young female presents with fractures of the long bones. Also affecting the ribs and skull.
84
What syndrome is fibrous dysplasia associated with, and what other features does it present with?
McCune Albright Precocious puberty in females Cafe au lait spots
85
When and where might you see a Shepherds crook deformity?
In a patient with fibrous dysplasia in the proximal femur
86
What is the commonest benign bone tumour and which joint does it typically affect?
Osteochondroma | Knee
87
What is the most common malignant cartilagenous neoplasm and how does it present?
Chondrosarchoma | Presents in older patients with a painful lump typically of the pelvis or axial skeleton
88
What are the Xray findings of a chondrosarcoma?
Popcorn calcification
89
Name three benign bone forming neoplasms
Osteoma Osteoid osteoma Osteoblastoma
90
Which benign bone neoplasm typically has pain which responds to aspirin?
Osteoid osteoma | Osteoblastomas are classically unresponsive to aspirin
91
What is the commonest primary malignant bone tumour and how does it typically presnet?
Osteosarcoma | Presents in male teenagers with warm painful bone typically at the knee
92
What are the Xray findings in osteosarcoma/
Pereosteal elevation leading to Codman's triangle
93
What is the classical presentation of Ewing's sarcoma/
<20 year old with a painful warm enlarging mass with systemic signs (Fever, anaemia, raised WCC) typically affecting long bone diaphysis
94
Ewings sarcoma X ray findings?
Onion skin periosteal reaction
95
Which nerve roots are affected in Erbs and Klumpkes palsies?
Erbs: C5,6 Klumpkes: C8, T1
96
What are the different presentations of a radial nerve injury?
at elbow/forearm: Loss of CMC extension, no sensory loss at humeral shaft: wrist drop, loss of sensation to snuff box Axilla (crutches/sat night palsy): paralysis of triceps and wrist drop
97
What are the features of an ulnar nerve palsy?
Intrinsic hand paralysis -> Claw hand Weak finger ab/adduction due to interossei paralyss Sensory loss over little finger
98
What is the ulnar paradox?
Lesions at the elbow cause less clawing than more distal lesions, as the flexor digitalis profundus is also denervated, meaning IP flexion is weakened.
99
What are the different presentations of median nerve injury?
Above ACF: Cant flex index IJPs, cant flex terminal thumb phalynx, loss of sensation in median distribution Injury at wrist: Typically affects abductor pollicis brevis CTS
100
What forms the carpal tunnel and what is its contents?
Formed by flexor retinaculum and carpal bones Contents: Tendons of flexor digitalis profundus and superficialis, flexor pollicis lungus and the median nerve.
101
Which hand muscles does the median nerve supply?
LLOAF Lateral lumbricals Opponens pollicis Abductor pollicis brevis Flexor pollicis brevis
102
What are the causes of carpal tunnel syndrome?
``` Primary idiopathic Pregnancy Oedema Radial # RA Gout Soft tissue swelling DM EtOH ```
103
What are the featuers of CTS?
Painful parasthesia of lateral 3.5 fingers worse at night or after repeated actions Relieved by shaking Clumsiness Reduced 2 point discrimination (irreversible damage) Thenar eminence wasting Tinels and Phalens +ve
104
What is the management of CTS?
``` Treat underlying pathology Wrist splints in neutral position Analgesia Steroid injections Surgical decompression by division of flexor retinaculum ```
105
Risk of CTS surgery?
Hypertrophic scar formation actually worsens symptoms
106
What associated features might be seen in Dupuytrens contracture?
BAD FIBRES ``` Bent penis AIDS DM FH Idiopathic (commonest) Booze Epilepsy (phenytoin) Reidels thyroiditis Smoking ```
107
What is the anatomical cause of trigger finger?
Tendon nodule catching on the proximal side of a tendon sheath trigggering manual extension
108
What is a Baker's Cyst and what is associated with?
Popliteal swelling between the medial head of gastrocnemius and semitendinosus muscle. Usually 2ary to OA May rupture causing calf pain and swelling
109
What is the commonest complication of hallux valgus/
Bunion at MTP
110
What is Morton's metatarsalgia?
Pain from pressure on an interdigital neuroma between the metatarsals. Pain radiates to the medial side of one to and lateral side of another.

Scott's Notes (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions