Surgery (Upper Limb and Trauma) Flashcards Preview

Year 2 - Musculoskeletal (DP) > Surgery (Upper Limb and Trauma) > Flashcards

Flashcards in Surgery (Upper Limb and Trauma) Deck (98):
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

Which of the following is not a feature of NAIs:
- Fractures in > 2 year olds
- Burns/Bruises
- Injuries on many body sites
- Increased ICP

Fractures in > 2 year olds