others

Question 1

risk factors DDH? age?

Answer 1

infant

female, macrosomia, oligo hydramnios, first child, family history

Question 2

investigations DDH

Answer 2

clinical - clunking, asymmetrical skin folds
Barlow and ortolani
galeazze test 
USS <4m
xray >4m

Question 3

management DDH

Answer 3

pavlik harness <6m
CR + spica cast >6m

OR + spica cast 6-18m
osteotomy + OR + spica cast 2y

Question 4

symptoms of compartment syndrome

Answer 4

disproportionate pain - pain out of keeping
paraesthesia
paresis
muscle contracture
limb pallor
loss of sensation

Question 5

what is compartment syndrome?

Answer 5

build up of pressure within a closed space (myofascial compartment)
blood flow to muscles and nerves are cut off

Question 6

management of compartment syndrome

Answer 6

urgent fasciotomy within 1h

Question 7

causes of Cauda Equina syndrome

Answer 7

compression of the spinal nerve roots
lumbar disc herniation 
spinal vertebral fracture
metastases
infection

Question 8

symptoms of Cauda equina

Answer 8

bilateral sciatica
leg weakness
saddle anaesthesia 
urinary / fecal incontinence
sexual dysfunction

Question 9

examination findings Cauda Equina

Answer 9

LMN signs - hypotonia, areflexia, muscle weakness, poor anal tone, saddle anaesthesia
ABDOMEN - palpate bladder

Question 10

investigations cauda equina

Answer 10

MRI

Question 11

management cauda equina

Answer 11

ABCDE
insert catheter
surgical decompression - laminectomy, discectomy

Question 12

osteoporosis definition

Answer 12

> 2.5 sd below mean for young adult

Question 13

examination of osteoporotic patient

Answer 13

inability to weight bear 
external rotation of limb
shortened limb
pain on limb rotation
bruising (extra capsular #)

Question 14

important nerve to examine in hip fracture

Answer 14

sciatic nerve

motor function of Ankle, dorsiflexion of great toe

Question 15

extra capsular femoral fracture stable?

Answer 15

yes, blood supply maintained

Question 16

intracapsular femoral fracture stable?

Answer 16

no, bloood supply disrupted

risk of AVN / non union

Question 17

risk with intracapsular femoral head fracture

Answer 17

AVN

non union

Question 18

management subtrochanteric fracture

Answer 18

cephalomedullary nail

IM / gamma nail

Question 19

management intertrochanteric humeral head fracture

Answer 19

DHS dynamic hip screw

Question 20

complications of any hip surgery

Answer 20

pain, bleeding, stiffness, infection
peri prosthetic fracture
anaesthetic risks - CVA, MI, respiratory depression
DVT / PE

Question 21

complications of THR / hemiarthriplasty

Answer 21

mal union
dislocation
leg length discrepancy
sciatic n. damage

Question 22

commonest cause of Paediatric hip pain

Answer 22

transient synovitis

Question 23

commonest cause of septic arthritis

Answer 23

s aureus
N gonorrhoea (12-18)
gonorrhoea sometimes presents with septic arthritis!!!

Question 24

spread of septic arthritis?

Answer 24

haematogenous
direct inoculation
spread from osteomyelitis
spread from soft tissue infection

Question 25

investigations in septic arthritis

Answer 25

aspiration gold standard temperature bloods - ESR, CRP, WBC aspirate!!!!!!!! + USS (before Abx) blood cultures

Question 26

what criteria is used in septic arthritis?

Answer 26

``` KOCHER criteria unable to weight bear temp >38.5 WBC >12 ESR >40 ``` CRP >12 also indicative

Question 27

management septic arthritis

Answer 27

emergency washout in theatre IV Abx 6 weeks - cefuroxime / cefotaxime repeat washout

Question 28

main differential of septic arthritis

Answer 28

transient synovitis

Question 29

what is transient synovitis

Answer 29

irritable hip | irritation of synovium

Question 30

what does USS show transient synovitis

Answer 30

hip effusion!

Question 31

causes of transient synovitis

Answer 31

recent infection eg URTI allergy trauma

Question 32

differentiate between transient synovitis and septic arthtisi

Answer 32

KOCHER - temp, ESR, WBC, CRP, USS aspiration

Question 33

blood supply to femoral head in paediatrics vs adults?

Answer 33

artery of ligament Teres (peads) | retinaculum vessels in adults

Question 34

risk factors perthes

Answer 34

male family history 3-12

Question 35

perthes presentation

Answer 35

``` unilateral or bilateral decreased ROM - int rotation and abduction intermittent hip or groin pain NO history of trauma painful gait ```

Question 36

classification of PERTHES

Answer 36

herring lateral pillar classification

Question 37

management of perthes

Answer 37

conservative physio brace - abduction traction

Question 38

what is SUFE

Answer 38

femoral head slips backwards | slippage of epiphysis relative to femoral neck

Question 39

risk factors SUFE

Answer 39

``` male 12-15 obese endocrine disorder rapid growth during adolescence ```

Question 40

test in SUFE

Answer 40

faber test | flexion, abduction and external rotation of hip causes pain

Question 41

classification of SUFE

Answer 41

- slippage - weight bearing - southwick angle classification

Question 42

what is salter Harris classification

Answer 42

fracture through growth plate

Question 43

imaging in SUFE

Answer 43

AP | frog leg lateral (Lowenstein)

Question 44

treatment of SUFE

Answer 44

in situ pinning | prophylactic pinning of other hip

Question 45

x ray findings in SUFE

Answer 45

widened physis decreased epiphyseal height Kleins line head shaft angle of southwich