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Orthopaedics Flashcards

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1
Q

What are the two main types of postoperative infection?

A

Superficial:

  • skin
  • subcutaneous tissue
  • occurs within 30 days

Deep:

  • to fascia and muscle
  • occurs within 30 days or 90 days if prosthetic
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2
Q

What are the most common organisms to cause postoperative infection in a hip arthroplasty?

A

Coagulase negative Staph

Staph Aureus

Strep - 9%

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3
Q

What are some risk factors for post opp infection in ortho?

A

Patient factors:

  • immunosuppressed
  • diabetic
  • malnourished
  • elderly

Trauma factors:

  • Trauma related injury
  • Open wounds
  • open fracture

Surgical factors:

  • long operating time
  • complicated surgery
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4
Q

How should post operative wound infections be managed?

A

Contact orthopaedic on call

Bloods:
- FBC 
- CRP 
- U&ES 
- G&S
\+/-
- blood cultures
  • Wound swaps
  • only commence antibiotics after wound swab and with senior ortho guidance.
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5
Q

Why is it so important to get swabs of wound or isolation cultures of in the infection prior to antibiotics starting?

A

The infections can be very difficult to treat. Especially in prosthetic joints, and require large amounts of antibiotics. As such getting the right antibiotics first time is helpful.

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6
Q

What is the predominant blood supply to scaphoid bone?

A

Dorsal Carpal Branch of the radial artery

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7
Q

What advice should be given to someone who has had a hip replacement, to avoid dislocation?

A

Don’t flex hips beyond 90 degrees

Avoid deep seats

Don’t sit crossed legged

Sleep on back for 1st 6 weeks

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8
Q

Name some x-ray signs seen with Pagets disease:

A

Skull:

  • Osteoporosis Circumscripta - areas of radiolucency in a circle
  • Cotton wool appearance
  • Tam O’Shanter sign - looks like person is wearing a hat

Pelvis:

  • Cortical thickening
  • Acetabular thickening

Long bones:

  • Blades of grass
  • Candle flame sign

Spine:
- squaring of the vertebrae

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9
Q

What signs on x-ray may be seen in osteomalacia?

A

Looser zones
- pseudofractures

Trefoil Pelvis

  • Lateral indentation of acetabulum
  • causes issues with cephalo-pelvis disproportion

Protrusio acetabuli
- medial indentation of the acetabulum

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10
Q

List some clinical findings seen in Ricket’s:

A

Skull:

  • Delayed fontanelle closure
  • Frontal bossing
  • Craniotabes

Chest:

  • Rachitic rosary/ Beading of the ribs (beads at costochondral joints)
  • Harrison’s grooves

Limbs:

  • Widening of wrists
  • Genu varum/ Valgus
  • Wind Swept look

Spine:
- Kyphosis

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11
Q

In osteoporosis what do you expect the blood results to show:

A

Calcium
- normal

Vitamin D
- normal

PTH
- normal

**this contrasts with osteomalacia in which you expect the opposite and PTH to be high

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12
Q

What is a urinary investigation that can be done into Paget’s disease?

A

Hydroxyproline

- break down of collagen

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13
Q

What is ulnar’s paradox?

A

The more proximal the lesion (i.e on the elbow) he lesser the deformity. Where as the more distal the lesions the worse the deformity

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14
Q

What are some common complications of a hip dislocation?

A

AVN - set in within 4 hours

Sciatic nerve pain

Recurrent dislocations

OA

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15
Q

List some core features of adhesive capsulitis:

A

Typically seen in diabetics.

  • reduction in all planes especially external rotation
  • active and passive movements are painful
  • worse in morning
  • varies between freezing phases and recovery phases
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16
Q

What is the management of cubital tunnel syndrome?

A

Soft Elbow Splints

Decompression surgery

  • cubital tunnel release, ligamental tunnel is removed and scar tissue is removed
  • anterior transposition of ulnar nerve
  • medial epicondylectomy

*steroid injections are not used to due risk of injury to the nerve

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17
Q

List some differentials for a stuck finger:

A

Dupuytren’s contraction

Posterior interosseous nerve palsy (radial nerve)

Locked trigger finger

Subluxed MCPs

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18
Q

List some differentials for radial side wrist pain:

A

De Quervain’s Tenovaginits

Radial fracture

Scaphoid fracture

Thumb CMC joint OA

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19
Q

Which population of people are affected more severely from RA?

A

Black Caribbean

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20
Q

In a joint aspiration in suspected septic arthritis/ swollen joint, what investigations are done on the sample?

A

Visual examination
- cloudy/ colour

Gram staining
Microscopy
Culture

Crystal examination

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21
Q

What drug is used in septic arthritis if allergic to penicillin?

A

Clindamycin

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22
Q

What are some of the co-moralities seen in Psoratic arthritis?

Study These Flashcards
A 
Cardiovascular disease - 30% 
Ischemia - 10% 
Lymphoma 3% 
Obesity - 30% 
Uveitis - 20% 
Osteoporosis
23
Q

What is another name for the straight leg test and when is it positive?

Study These Flashcards
A

Lasegue sign

At 30 degrees if painful = positive sign

24
Q

What x-rays should you order for a Lisfranc injury and what findings would you see on the x-ray?

Study These Flashcards
A

Weight baring foot x-ray
and
Stress foot- graph

Miss-alignment of 1st and 2nd rays.
medial border of the base of the 2nd won’t align with the medial cuneiform

25
Is a infected prosthetic joint drained to dryness like a native?
No. | This can be detrimental
26
What is the most important aspect to consider in management of a fracture:
Soft tissue injury - this should be done first to assess for bleeding or nerve damage. Following this: - reduction
27
What is the best investigation for assessing a intra-articular fracture?
CT Scan
28
What structures pass through the Carpal tunnel?
Median Nerve 4 x Flexor Digitorum Superficialis 4 x Flexor Digitorum profundus Flexor Pollicis Longus
29
What muscles does the median nerve supply and which is the most sensitive for assessing the degree of muscle weakness causes by the damaged to the median nerve?
Lateral (2) Lumbricals Opponens Pollicis Abductor Pollicis Brevis Flexor Pollicis Brevis * testing Abduction of the thumb is most sensitive - abduction is pointing the thumb away from the palmer plane *towards the sky if palms are facing up.
30
What is the management for Carpal tunnel syndrome?
``` NIght splints Steroid Injections (especially during pregnancy) ``` Carpal tunnel decompression surgery - divided longitudinally not transversely - prevent damage to structures
31
In cubital tunnel syndrome, what structures does the ulnar nerve pass between?
Two heads of the Flexor Carpi Ulnaris and Cubital Tunnel Retinaculum
32
What are the symptoms of cubital tunnel syndrome? and what is the management?
Reduced power in the nerve distrupution and sensation *Little finger abduction severely reduced Clawing of digits Hypothenar wasting Interosseous muscle wasting Treatment: - Night splints - Decompression surgery **steroid injections are not warranted due to risk of damaging the nerve
33
Trigger finger is caused by constriction and thickening of what structure? and how is it treated?
Thickening of the flexor tendon or A1 pulley - prevents extension of the finger treated: - night splints - Steroid injection - single injection - surgery on the A1 pulley
34
What disease is also known as Viking's disease and how does it inherit? and what is the pathology?
Dupuytren's contracture - Autosomal Dominant Proliferation of myofibroblasts on the palmar fascia producing nodules and cords.
35
What are the therapies available for Dupeytrens contracture?
Medical: - hand therapy - injectable collagenases to dissolve the fibrosis plaques Surgical: - Needle aponeurotomy - Fasciectomy - Dermofasciectomy - finger amputation
36
List some differentials for stuck fingers:
``` Dupeytrens contraction Palsy of the posterior interrouses nerve Subluxed MCPJs (often seen with RA) ```
37
List some differentials for radial sided wrist pain:
De Quervain's stenosing tenovaginitis Scaphoid fracture Radial styloid fracture Thumb OA Scaphotrapeziotrapezoid arthritis
38
What is the pathology of DE Quervain's stenosing tenovaginitis? and what is the diagnostic test. What is the treatment?
Stenosis of the 1st dorsal extensor compartment - Extensor pollicis brevis - Abductor Pollicis longus Test: - Finkelstein test - moving hand in an ulnar position to elecit pain Treatment: - Splinting - Steroid injection Surgical: - decompression of the 1st dorsal extensor compartment
39
What are the treatment options for a ganglion cysts?
leave alone Aspirate Surgically remove
40
List some differentials for lumps and bumps on the hands:
Ganglion cysts Giant cell tumour Heberden's nodes, Bouchard's nodes Enchondroma - often presents with pathological fracture - benign Skin lesions Gouty Tophi
41
What are some of the causes of Subacromial impingement syndrome?
Intrinsic: - muscle weakness - overuse of joint - degenerative disease External: - Hook shaped acromion (type III) - Glenohumoral instability
42
What tests can be done to examine for subacromial impingement syndrome?
Painful Arc - pain 60-120 degrees Neer's test Hawkin's test
43
What test can be done to assess for damage to the rotator cuff muscle, naming the specific muscles being exmained:
Empty cans test - supraspinatus External rotation - infraspinatus Hornblower sign - Tere's minor * affected side will raise significantly higher Belly press/ lift off - Subscapularis
44
Name the bones that are typically affected by avascular necrosis:
Head and neck of femur Scaphoid Talus
45
If an elderly patient has had flu like symptoms for the past month and weight loss, and currently has a painful lower back then what are your differentials?
Metastasis Osteomyelitis/ discitis Osteoporosis Mechanical back pain
46
What are some of the long term consequences of a hip replacement?
Chronic pain and stiffness Leg shortening Joist loosening requiring further surgery
47
What is the diagnostic test of choice for carpel tunnel syndrome?
Electromyography | - nerve conduction tests
48
Which clinical test can be done to establish weakness in the ulnar nerve, helping to differentiate between median nerve and ulnar nerve?
Froment's test | - testing strength of pincer grip
49
What are the two x-ray signs seen of osteosarcomas?
Codman's Triangle - as it pulls up over the periosteum Sun burst appearance
50
What features on an x-ray generally make a mass suggestive of malignancy?
Poor irregular borders Cortical destruction Soft tissue involvement
51
What staging criteria is used for bone tumours?
Enneking Stage System
52
What are some of the red flag symptoms of bone sarcoma?
Non- mechanical bone / joint pain Bone pain at night Pathological fracture Bone swellings
53
Which muscle contracts the DIPJ and which the IPJ of the hand?
DIPJ: Flexor Digitorum Profundus IPJ: Flexor Digitorum Superficialis

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