Flashcards in Surgery (Upper Limb and Trauma) Deck (98)
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1
How do we manage a sternoclavicular joint injury?
Physio
Injection
Excision (rarely)
2
True or false; The acromioclavicular joint is rarely injured?
False!! It is a very common injury
3
What condtion does an acromioclavicular joint injury often overlap with?
Impingement
4
What can cause a glenohumeral joint dislocation?
Cuff tear
Instability
Previous surgery
Idiopathic
5
What movement is often the first, and greatest, affected motion in a glenohumeral injury?
EXTERNAL rotation
6
What surgical options exist for treating a glenohumeral joint injury?
Total arthroplasty
Reverse arthroplasty
7
How can a rotator cuff tear result in OA?
1. Torn rotator cuff muscle
2. Deltoid pulls humeral head upwards
3. Abnormal forces on glenoid fossa
4. OA
8
During a reverse shoulder arthroplasty what are some of the surgical techniques carried out?
Increased lever arm of deltoid
Deltoid lengthened
Joint resurfaced
9
What does a reverse arthroplasty prevent?
Upward migration
10
What can OA of the radiocapitellar joint result in?
Osteophyte impingement
11
What does the radial head act as?
Secondary stabiliser
12
What three things can result in wrist instability?
1. Scapulolunate advanced collapse (SLAC)
2. Scaphoid non-union advanced collapse (SNAC)
3. Post-traumatic OA
13
How is wrist instability treated?
4 corner fusion
Proximal row carpalectomy
Total wrist arthrodesis
14
What can result due to base of thumb OA?
Subluxation of CMCJ
15
What causes an elevation in pain in base of thumb OA?
Pincing
16
What causes a swan-neck deformity?
OA:
- Volar plate of PIP becomes attenuated
- SMall ligament and limbrical tendons fall dorsally
17
What causes a Boutonnière deformity?
1. Extensor hood of PIP is attenuated
2. Extensor tendon moves from dorsal -> Volar
- PIP flexion -> Middle phalangeal head through hood
3. Extensor tendon slips around PIPJ
- DIP hyperextension
18
A patient with known OA presents with a painful lump near the end of her finger. She says it changes in size. On examination it is tender and there is a discharge. You notice it is causing some nail ridging.
Mucous cyst
19
What is the process of events resulting in trigger finger?
1. Tendon swelling
2. Irritation
3. More swelling
4. Tendon caught on A1 pulley
20
How can trigger finger be treated?
Conservative:
- Resolves spontaneously
- Splint
Tendon sheath injection:
- Steroid + LA
- Curative
- Repeat up to 3x
Surgery:
- Divide A1 pulley
21
What forms part of the 'Dupuytren's diasthesis'?
Lederhosen's (feet)
Peyronie's
22
How do we examine a suspected Dupuytren's patient?
Feel cords
Measure angles (if MCP/PIP involvement)
Table top test
23
What is paronychia?
Nail fold infection
24
What people are at risk of paronychia?
Children
Nail biters
25
How is paronychia treated?
Elevation
Antibiotics
Incision + drainage
26
How does a flexor tendon sheath infection present?
Extreme pain
Limited extension
Tracking up palm + arm
Tracking lymphangitis
27
How is a flexor tendon sheath infection treated?
Surgically:
- Wash out sheath
28
When and how do we treat a subungal haematoma?
If pressure is causing pain
Trephine -> Drills hole
29
What are the types of nailbed injuries?
Type 1 -> Soft tissue only
Type 2 -> Soft tissue + nail
Type 3 -> Soft tissue, nail + bone
Type 4 -> Proximal third of phalynx
Type 5 -> Proximal to DIPJ
30
How are nailbed injuries treated?
Types 1+2 -> Dressing only
Type 3 -> Repair nail bed + stabilise bone
Type 4 -> As above (If Ablate)
Type 5 -> Terminalise + V-Y flap (if tip unavailable)
31
What is a boxer's fracture?
Metacarpal fracture:
- Minimal displacement
- No rotation
- More distal
32
How do we treat a boxer's fracture?
Buddy strap to another finger
Early mobilisation
33
What can cause a mallet finger?
Extensor digitorum tendon rupture
Avulsion as tendon rips off part of distal phalynx
34
How does mallet finger present?
Resited finger extension
Tenderness
Bruising
35
How do we manage chronic mallet finger?
Dermatotenodesis
36
What is a Bennett's fracture?
Fracture of the base of 1st MC:
- Extends into 1st CMCJ
37
How do we treat a Bennett's fracture?
If very minor:
- Reduction and cast
1-3mm displacement:
- Closed reduction and pin fixation
>3mm displacement:
- ORIF
38
What is a escharectomy?
Remove of eschar following a full thickness burn:
- Thick, leathery, inelastic skin
39
What is tendonosis?
A chronic injury resulting in damage at a cellular level
40
Where do tendons arise from?
Lateral plate mesoderm
41
What is a tendons size and strength related to?
Muscle mass
Distance from insertion
42
What tendons to we not treat with injections and why?
Leg tendons
Increases the risk of rupture
43
What tendons are typically treated by decompression surgery?
Supraspinatus tendonitis
Subacromial
44
What tendons are typically treated by a synovectomy?
Wrist extensor tendons (in RA)
Tibialis posterior
45
What tends are surgically treated with a tendon transfer?
Tibialis posterior
EPL
46
A 51 year old painter and decorator presents with pain in his right shoulder. He has had difficulty sleeping and carrying out his day to day job as reaching up to paint is very painful and his arm tires out very quickly.
Rotator cuff impingement
47
What head of the biceps is most commonly injured?
Long head
48
What does the Popeye sign suggest?
Biceps tendon rupture
49
What can cause a biceps tendon rupture?
Overuse
Instability
Impingement
Trauma
50
What movements aggravate the anterior shoulder pain in a biceps tendinopathy?
Shoulder flexion
Forearm pronation
Elbow flexion
51
When is surgery considered in a biceps tendon rupture?
If it is a distal rupture
52
What can aggravate medial epicondylitis?
Wrist flexion
Pronation of forearm
53
What is medial epicondylitis also known as?
Golfer's elbow
54
What is medial epicondylitis associated with?
Ulnar neuropathy
Muscle weakness
55
What clinical test is useful in diagnosing lateral epicondylitis?
Mills test
56
What can predispose a patient to an extensor knee problem?
Trauma
Drugs
DM
57
In what situations will a fracture recover by primary bone healing?
Hairline fracture
Fixation with plate + screws
58
Explain the process of secondary bone healing
1. Gap fills with granulation tissue (fibroblasts):
- Angioblasts form blood vessels
2. Cartilage forms (soft callus)
3. Endochondral ossifcation (hard callus)
59
In what situations does secondary bone healing occur?
Colles fracture
POP
IM nail
External fixation
60
What are some skin signs of a high-energy comminuted fracture?
Skin swelling
Blisters
61
True or false; We can still operate if there are skin changes present over a fracture?
False:
- Wound will not close
62
What are the 5 types of fracture pattern and what causes them?
Transverse -> Twisting (Compression + Tension)
Oblique -> Sheer stress + axial loading
Spiral -> Twisting
Comminuted -> High energy/Poor bone
Segmental -> Unstable
63
How do we describe the angulation of a bone if fractured?
The direction the distal end of the bone is pointing (relative to its normal anatomical position)
64
If do ends of bone are not in contact after a fracture without and displacement or angulation, how do we describe it?
Distraction
65
What is shortening in regards to a fracture?
When the distal part of the bone overlaps with the proximal part
66
What part of the bone do we describe in a fracture?
The distal part
67
In what patients would we use traction to treat a fracture?
Kids
Elderly people who can't undergo surgery
68
What methods of internal fixation are usually employed?
K-wires/Cerclage wirse
Onlay devices:
- Plates
- Screws
Inlay devices:
- IM nail
69
How would we treat a simple, minimally displaced, extra-articular fracture that is in an acceptable alignment and is stable?
Splintage
70
If a bone position is unacceptable what must we do?
Reduce it
71
If there is an unstable fracture in a patient fit for surgery what do we do?
Operative stabilisation
72
How would we treat a high energy fracture with evidence of soft tissue injury?
AVOID ORIF
Indirect techniques:
- Nailing
- Ex-fix
73
What are the principles of treating an open fracture?
Antibiotics
Tetanus:
- Booster
- Ig (if never have vaccine)
Early debridement
Operative stabilisation
74
How do we treat compartment syndrome?
Fasciotomy
Operative stabilisation
75
If there is a vascular injury, how will we treat it?
Reduction
Stabilisation
Reassess circulation - Vascular surgery?
76
If there is a nerve injury how is it treated?
Open fracture:
- Explore
Closed fracture:
- Reduce fracture
- Recheck and observe
77
Approximately how much blood is lost in a femoral shaft fracture?
One litre
78
What complications can occur in a femoral shaft fracture?
Fat embolism
ARDS
79
What analgesia is supplied in a femoral fracture?
Femoral nerve block
80
What splint do we use for a femoral shaft fracture?
Thomas splint
81
In an unstable femoral shaft fracture, how is it treated?
IM nailing
82
What is the slowest healing bone in the body?
Tibia
83
What are some signs of a radial nerve injury in the context of a humeral shaft fracture?
Wrist drop
Loss of sensation in 1st web space
84
What tends to cause an olecranon fracture?
Avulsion:
- Triceps contraction -> Fall onto outstretched hand
85
What is a Galeazzi fracture?
Isolated radius fracture with distal radio-ulnar joint dislocation
86
What is a Monteggia fracture?
Isolated ulna fracture with radial head dislocation
87
Describe a Colles fracture?
FOOSH
Extra-articular
Dorsal angulation
Dorsal displacement
88
What are some complications of a Colles fracture?
Median nerve compression
EPL rupture
CRPS
Loss of grip strength
89
What is a Smiths fracture?
Fall onto back of hand:
- Extra-articular
- Volar displacement -> Wrist flexion deformity
- Volar angulation
(VERY UNSTABLE)
90
What is a Barton fracture?
Intra-articular
Volar/Dorsal rim fracture on lateral edge -> Carpus subluxation
91
What are some risk factors for femoral shaft fractures?
Osteoporosis
Smoking
Malnutrition
Excess alcohol
Neurological impairment
Impaired vision
92
What classification grades intracapsular femoral fractures?
Garden
93
What are some signs of a proximal femoral fracture?
Fall
Unable to bear weight
Shortening
External rotation
94
What is an x-ray feature of an intracapsular femoral fracture?
Shenton's line
95
Why do children suffer from greenstick fractures?
Thicker periosteum
96
What is a greenstick fracture?
One side broken, other side bent
97
What features of a history may suggest a NAI?
Doesn't match nature/severity of injury
Inconsistency/Vague
Accusations that child injured themselves intentionally
Delayed help
Child dressed inappropriately
98
