OSCEs Crash Course Flashcards
(35 cards)
Orthopaedic Emergencies
1) Compartment syndrome
2) Necrotising fasciitis
3) Open fracture
4) Cauda Equina Syndrome
Things to mention on Xray
1) Patient biodata - skeletally mature?
2) What view - request orthogonal view, Is it weight bearing
3) What limb - is the no. of joints sufficient?
4) Fracture where - exact part, intra/extra-articular
5) Fracture pattern - transverse, spiral, oblique, comminuted
6) Displacement - translated, angulated, rotated, shortened, distracted (lengthened)
7) Special names (eponyms) + classifications
What is AMPLE history?
Allergies
Medications
Past medial history
Last meal
Events leading to presentation
Used for trauma Hx taking
Definition of open fracture
Fracture that communicates with external environment
Classification of open fracture? Used when?
Gustilo-Andersen
Used only AFTER debridement
5 Ps of compartment syndrome
Pain (out of proportion), pallor, paresthesia, paralysis, pulselessness
Pulselessness can be last to present because it takes a lot of pressure to occlude an artery
How to check compartment syndrome in unconscious patient?
Stryker needle
Delta pressure = diastolic - compartment pressure
Delta pressure <30mmHg = compartment syndrome
What is the result of severe muscle ischemia after compartment syndrome?
Volkmann’s ischemic contracture
Management of compartment syndrome
1) Escalate to senior
2) Remove all compressive dressings
3) Analgesia according to WHO
4) Pre-op prep
5) Emergency FASCIOTOMY
Difference between fasciotomy & fasciectomy
otomy - cut open, for compartment syndrome
ectomy - remove fascia, for nec fasc
Pre-op prep
Pre-op bloods: GXM, FBC , Renal panel, coagulation panel
Pre-op labs: ECG, CXR
Keep pt NBM
Hallmark features of nec fasc
Swollen, erythematous
Ecchymoses
Haemorrhagic bullae
Pain out of proportion
Pt in sepsis
Investigations for nec fasc
Clinical management - should NOT wait for MRI to confirm diagnosis then start treatment
Lab: pre-op bloods + ESR/CRP + lactate + BLOOD CULTURE
Radio: Xray for subcutaneous emphysema, Urgent MRI to see fluid tracking fascia planes
Management of nec fasc
1) Fluid resus if pt in septic shock
2) IV broad spectrum antibiotics
3) Escalate to senior
Definitive mgmt
1) Emergency fasciectomy/amputation
2) Debridement of nonviable tissue
Causes of cauda equina syndrome
Compression of cauda equina (L2 and below) - acute loss of lumbar plexus function
COMMON: central PID
others: abscess, tumour, haematoma, trauma, late stage spondylolisthesis
Presentation of cauda equina syndrome
Saddle anaesthesia
Bowel/bladder dysfunction (urinary retention)
Lower limb weakness (both legs)
Radiating pain (both legs)
Knee OA xray features
WEIGHT BEARING XRAY
loose bodies
loss of joint space - usually medial first
osteophytes
subchondral sclerosis
subchondral cysts (never see dont say)
REQUEST LONG LIMB FILM
- see genu varum
What classification for OA knee
Kellgren-Lawrence
OA symptoms
Mechanical pain
- worse on movement
- morning stiffness <30mins
Walk how long; climb stairs?
Associated: numbness, weakness, stiffness, systemic involvement?
Mgmt OA
Conservative: PT, weight loss, activity modification, analgesia, H&L (triamcinolone and lignocaine in SG)
Surgical: HTO, unicompartment arthroplasty, TKR
RA Xray features
Symmetrical loss of joint space (panarthritis)
Can develop secondary OA
RA symptoms
Inflammatory pain - relieved by activity, morning stiffness >1hr
Other signs:
- swelling >3 joints
- RA nodules
- Arthritis of MCP, PIP, wrist
Investigations for RA
Anti-CCP (cyclic citrullinated peptide)
ACL tear history
Injury mechanism - twisting, pop sound
Immediate swelling
Can weightbear? TRO fracture
Instability
Locking? TRO meniscus tear
