Orthopaedics Part 2 Flashcards
(78 cards)
1
Q
What is De Quervain’s tenosynovitis?
A
- sheath containing extensor pollicis brevis and abductor pollicis longs tendons inflamed
- females 30-50yo
2
Q
Features of De Quervain’s tenosynovitis:
A
- pain on radial side of wrist
- tenderness over radial styloid process
- abduction of thumb against resistance painful
- Finkelstein’s test
3
Q
What is Finkelstein’ test?
A
- pull thumb in ulnar deviation and longitudinal traction
- pain over radial styloid process along length of extensor pollicis brevis and abductor pollicis longus
4
Q
Management De Quervain’s tenosynovitis:
A
- analgesia
- steroid injection
- immobilisation with thumb splint
- surgical treatment sometimes
5
Q
What is discitis and what are the features?
A
- infection in intervertebral disc space
- can lead to serious complications such as sepsis or epidural abscess
- back pain, pyrexia, riggers, sepsis
- neurological features: e.g. changing lower limb neurology, if epidural abscess develops
6
Q
Causes of discitis:
A
- bacterial: staph aureus most common
- viral
- TB
- aseptic
7
Q
Diagnosis and Treatment of discitis:
A
- MRI has highest sensitivity
- CT guided biopsy may be required
- 6-8 weeks IV Abx
- identify organism with positive culture with bloods or CT guided
8
Q
Further investigation required when someone has discitis:
A
assess for endocarditis e.g. with trans thoracic echo or transesophageal echo
9
Q
In whom is dupuytren’s contracture most common?
A
older male patients with 60-70% positive family history
10
Q
Specific causes of dupuytren’s contracture:
A
- manual labour
- phenytoin treatment
- alcoholic liver disease
- diabetes mellitus
- trauma to hand
11
Q
Management of Dupuytren’s contracture:
A
consider surgical treatment when metacarpophalangeal joints cannot be straightened and thus the hand cannot be placed flat on the table (fasciectomy)
can recur and risks neuromuscular damage
12
Q
Features of lateral epicondylitis (tennis elbow):
A
- pain localised to lateral epicondyle
- worse on resisted wrist extension with albow extended or supination of forearm with elbow extended
- episodes 6 months - 2 years
- acute pain 6-12 weeks
13
Q
Features of medial epicondylitis (golfer’s elbow):
A
- pain and tenderness localised to medial epicondyle
- aggravated by writs flexion and pronation
- numbness/tingling in 4th and 5th finger due to ulnar nerve involvement
14
Q
What is radial tunnel syndrome and what are the features?
A
- compression of posterior interosseous branch of radial nerve
- result of overuse
- symptoms similar to lateral epicondylitis
- pain 4-5cm distal to lateral epicondyle
- worsened by extending elbow and pronating forearm
15
Q
What is cubital tunnel syndrome and what are the features?
A
- compression of ulnar nerve
- initially intermittent tingling in 4th and 5th finger
- worse when elbow on firm surface for extended periods
- later numbness in 4th and 5th finger with weakness
16
Q
What is olecranon bursitis?
A
swelling over posterior aspect of elbow - pain, warmth, erythema (middle aged males)
17
Q
What is a Smith’s fracture?
A
- reverse Colles
- volar angulation of distal radius fragment (garden spade deformity)
- by falling backwards onto palm of outstretched hand or falling with wrists flexed
18
Q
What is a Bennett’s fracture?
A
- intra-articular fracture of first carpometacarpal joint
- impact on flexed metacarpal, caused by fist fights
- x-ray: triangular fragment at ulnar base of metacarpal
19
Q
What is a Monteggia’s fracture?
A
- dislocation of proximal radioulnar joint in association with an ulna fracture
- fall on outstretched hand with forced pronation
- needs prompt diagnosis to avoid disability
20
Q
What is Galeazzi fracture?
A
- radial shaft fracture with associated dislocation of distal radioulnar joint
- direct blow
21
Q
What is a Pott’s fracture?
A
- bimalleolar ankle fracture
- forced foot eversion
22
Q
What is a Barton’s fracture?
A
- distal radius fracture (Colles/Smith) with associated radoiocarpal dislocation
- fall onto extended and pronated wrist
23
Q
Fat embolism in respiratory system features:
A
- early persistent tachy
- tachypnoea, dyspnoea, hypoxia 72 hours post injury
- pyrexia
24
Q
Fat embolism in dermatological system features:
A
- red/brown impalpable petechial rash
- subconjunctival and oral haemorrhage/petechiae
25
Fat embolism in CNS features:
- confusion and agitation
| - retinal haemorrhages and intra-arterial fat globules on fundoscopy
26
Treatment fat embolus:
- prompt fixation of long bone fractures
- DVT prophylaxis
- general supportive care
27
Fracture types:
- oblique
- comminuted
- segmental
- transverse
- spiral
28
Gustilo and Anderson classification system:
1: low energy wound <1cm
2: greater than 1cm wound with moderate soft tissue damage
3: high energy wound >1 cm with extensive soft tissue damage
3A: adequate soft tissue coverage
3B: inadequate soft tissue coverage
3C: arterial injury
29
Management of fractures:
- immbolise including proximal and distal joints
- monitor neuromuscular status
- tetanus prophylaxis
- IV broad spec antibiotics for open injuries
- debride thoroughly if open
- open fractures constitute an emergency and should be lavage within 6 hours
30
What is a ganglion?
- cyst arising from joint or tendon sheath
- most commonly around back of wrist and 3 times more common in women
- often disappear spontaneously after several months
31
What is greater trochanteric pain syndrome?
- trochanteric bursitis
- repeated movement of fibroelastic iliotibial band
- most common 50-70yo
- pain over lateral hip/thigh
- tenderness on palpation of greater trochanter
32
What is Dupuytren's contracture?
- fixed flexion of hand
- underlying ontractures of palmar aponeurosis
- progresses slowly ad painlessly
33
What is the aim of carpal tunnel syndrome surgery?
- decompression
| - division of flexor retinaculum
34
What are Osler's nodes?
- painful, red, raised lesion on hands and feet
| - deposition of immune complexes
35
What are Bouchard's nodes?
- hard, bony outgrowths or gelatinous cysts
- proximal interphalangeal joints
- osteoarthritis
- formation of calcific spurs of articular cartilage
36
What are Heberden's nodes?
- middle age
- chronic swelling of affected joints or sudden painful onset of redness, numbness and loss of dexterity
- symptoms usually subside
- permanent bony outgrowth
37
Types of hip dislocations:
- posterior: 90%, affected leg is shortened, adducted and internally rotated
- anterior: affected leg abducted and externally rotated, no leg shortening
- central dislocation
38
Management of hip dislocation:
- ABCDE
- analgesia
- reduction under general anaesthetic within 4 hours to reduce the risk of avascular necrosis
- long term management: physiotherapy to strengthen muscles
39
Complications of hip dislocations:
- sciatic or femoral nerve injury
- avascular necrosis
- osteoarthritis
- recurrent dislocation: due to damage of supporting ligaments
40
Prognosis of hip dislocation:
- 2-3 months for hip to heal after traumatic dislocation
| - prognosis best when hip is reduced less than 12 hours post injury
41
Features of hip fracture:
- pain
- shortened and externally leg
- non-displaced or incomplete neck of femur fractures may be able to weight bear
42
What is an intracapsular hip fracture:
from edge of femoral head to insertion of capsule of hip joint
43
What is an extra capsular hip fracture:
trochanteric or subtrochanteric
44
Garden system of hip fracture classification:
- type I: stable fracture with impaction in valgus
- type II: complete fracture but undisplaced
- type III: displaced fracture, usually rotated and angulated but still has boney contact
- type IV: complete boney disruption
45
In which hip fractures is blood supply disruption most common?
types III and IV
46
Management of undisplaced intracapsular hip fracture:
internal fixation or hemiarthroplasty if unfit
47
Management of displaced intracapsular hip fracture:
- arthroplasty (total hip replacement or hemiarthroplasty)
- total is favoured if patients were able to walk independently, are not cognitively impaired and are medically fit for anaesthesia
48
Management of extra capsular hip fracture:
- dynamic hip screw
| - if reverse oblique, transverse or subtrochanteric: intramedullary device
49
What is development dysplasia of the hip?
- often picked up on newborn examination
- Barlow's test, Ortolani's test positive
- unequal skin folds/leg length
50
What is transient synovitis (irritable hip):
- typical age group: 2-10 years
- acute hip pain associated with viral infection
- commonest cause of hip pain in children
51
What is Perthes disease:
- degenerative condition affecting hip joints of children (4-8yo)
- avascular necrosis of femoral head
- 5 times more common boys
- 10% bilateral
- limp, stiffness, reduced range of movement
52
X ray findings of Perthes disease:
- early changes including widening of joint space
| - later changes include decreased femoral head size/flattening
53
How does a slipped upper femoral epiphysis present?
- 10-15yo
- more common in obese and boys
- displacement of femoral head epiphysis postern-inferiorly
- bilateral in 20%
- may present following trauma or more commonly chronic
- knee or distal thigh pain
- loss of internal rotation of leg in flexion
54
What is juvenile idiopathic arthritis:
- arthritis occurring in someone who is less than 16yo for more than 3 months
- pauciarticular JIA refers to cases where 4 or less joints are affected
- 60% of JIA
55
Features of JIA:
- joint pain and swelling (knees, ankles, elbows)
- limp
- ANA may be positive - associated with anterior uveitis
56
What is an iliopsoas abscess?
collection of pus in iliopsoas compartment
57
Primary causes iliopsoas abscess:
- haematogenous spread of bacteria
| - staphylococcus aureus most common
58
Secondary causes of iliopsoas abscess:
- Crohn's
- Diverticulitis, CRC
- UTI, GU cancers
- vertebral osteomyelitis
- femoral catheter, lithotripsy
- endocarditis
- IV drug use
59
Mortality rates of iliopsoas abscess:
- primary: 2-4%
| - secondary: 19-29%
60
Features iliopsoas abscess:
- fever
- back/flank pain
- limp
- weight loss
61
Clinical examination iliopsoas abscess:
- supine with knee flexed and hip mildly externally rotated
- place hand proximal to patient's ipsilateral knee and ask patient to lift thigh against your hand - pain due to contraction of poses muscle
- lie patient on normal side and hyperextend the affected hip - pain as muscle is stretched
62
Investigation and management of iliopsoas abscess:
- CT abdomen
- Abx
- percutaneous drainage
- surgery if failure to drain or presence of another intra-abdominal pathology which requires surgery
63
What is iliotibial band syndrome?
- common cause of lateral knee pain in runners
- 1 in 10 runners
- tenderness 2-3cm above the lateral joint line
64
Management of iliotibial band syndrome:
- activity modification and iliotibial band stretches
| - if not improving - physiotherapy
65
What is the unhappy triad?
commonly seen following lateral blow to knee:
- anterior cruciate ligament
- medial collateral ligament
- meniscus
66
How is the ACL commonly damaged and what tests are positive?
- from twisting injuries (sports)
- anterior drawer test: knee at 90 degrees
- Lachman test: knee at 30 degrees
67
What damage commonly results in PCL injury and tests?
- following dashboard injuries
- hyperextension
- tibia lies on back of femur
- paradoxical anterior draw test
68
What damage commonly results in MCL injury and what test?
- skiing and following valgus stress
- causes abnormal passive abduction of knee
- leg forced into valgus via force outside leg
69
How common is lateral collateral ligament injury?
isolated injury uncommon
70
How can the menisci be damaged and symptoms?
- twisting injuries
- locking and giving way
- rotation sporting injuries
- delayed knee swelling
- recurrent pain and effusions common (often following minor trauma)
71
Presentation of ruptured ACL:
- loud crack
- pain and rapid joint swelling (haemoarthrosis)
- poor healing
72
Chondromalacia patellae:
- teenage girls following injury to knee e.g. dislocation patella
- typical history of pain going downstairs or at rest
- tenderness, quadriceps wasting
73
How does dislocation of patella come about?
- most commonly due to trauma or severe contraction of quadriceps with knee stretched in valgus and external rotation
- genu valium, tibial torsion and high riding patella risk factors
- skyline x-ray views of patella required
- osteochondral fracture in 5%
- 20% recurrence rate
74
2 types of fracture of patella:
- direct blow to patella causing undisplaced fragments
| - avulsion fracture
75
Tibial plateau fracture:
- elderly
- knee forced into valgus or virus, but knee fractures before ligaments rupture
- varus affects medial plateau and if valgus, lateral plateau depressed fracture
- classified using Schatzker system
76
Test for meniscal tear:
Thessaly's test: weight bearing at 20 degrees at knee flexion, patient supported, positive if pain on twisting knee
77
What is infra patellar bursitis associated with?
- also Clergyman's knee
| - kneeling
78
What is prepatellar bursitis associated with?
- housemaid's knee
| - upright kneeling
