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T&O Flashcards

1
Q

Classification system for intracapular neck of fracture

A

The garden classification

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2
Q

Relevence of ligamentum arteriosum in NOF fracture

A

There is blood supply in the early days of life from the ligamentum arteriosum to the femoral head - which lies within the ligamentum teres

however this dramatically reduces in size in later life, and is of negligible importance in adults

Meaning if circumflex femoral a. damaged then there will be avascular necrosis

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3
Q

What is a Skeletal survey ?

A

Series of radiographs, performed systematically to cover the entire skeleton or the anatomic regions appropriate for the clinical indications.

e.g. paeds when suspicion of NAI, multiple myeloma etc.

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4
Q

Classification system for ankle fractures

A

Weber classification

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5
Q

Management of ankle fractures

A
  1. All ankle fractures –> promptly reduced to remove pressure on the overlying skin and subsequent necrosis

If Non-displaced medial malleolus, weber A, Weber B without talar shift or unfit for surgery:
- conservative management

If displaced bimalleolar/trimalleolar fractures, Weber C, Weber B with talar shift or open fractures:
- Open reduction and internal fixation

May need external fixation first if swelling too extensive for cast/inscision

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6
Q

What is the talar shift (ankle fracture)

A

Displacement of the talus in relation to the articular surface of the distal tibia and malleolar end segment

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7
Q

What is varus deformity

A

Bone distal (above) a joint is angled inwards, towards body midline

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8
Q

What is valgus deformity

A

Bone distal (away) to a joint is angled outwards, away from body midline

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9
Q

Serious complication after talar fracture

A

Avascular necrosis - talus is reliant predominantly on extraosseous arterial supply, which is highly susceptible to interruption

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10
Q

Tarsal bones

A

Calcaneus (most common to fracture)
Talus (2nd most common to fracture)
Navicular
Cuboid
Cuneiforms

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11
Q

Hawkins classification

A

Is for talar bone fracture, aids management planning and can determine risk of avascular necrosis

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12
Q

What is Lisfranc injury

A

Injury to the tarsometatarsal (lisfranc) joint between the medial cuneiform and base of 2nd metatarsal

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13
Q

Features suggestive of a Acetabular labral tear

A

hip/groin pain
snapping sensation around hip
there may occasionally be the sensation of locking

Labral tears may occur following trauma (most commonly in younger adults) or as a result of degenerative change (typically in older adults).

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14
Q

What is a maisonneuve fracture

A
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15
Q

What is the most sensitive investigation for avascular necrosis (AVN) of the hip?

A

MRI of hip

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16
Q

Causes of avascular necrosis of the hip

A

Long-term steroid use
Chemotherapy
Alcohol XS
Trauma

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17
Q

Characteristic features of avascular necrosis of the hip

A

Initally asymptomatic
then
Pain in anterior groin region

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18
Q

First line analgesic for back pain

A

NSAIDs

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19
Q

What is an abnormal intracompartmental pressure measurement? and what measurement is diagnostic of compartment syndrome?

A

Pressure > 20mmHg = abnormal
>40mmHg = diagnostic

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20
Q

Fractures high risk of compartment syndrome

A

Supracondylar fracture
TIbial shaft frature

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21
Q

Features of acute limb ischaemia (the 5 Ps)

A

Pain - disproportionate to injury
Pallor
Pulselessness
Perishingly cold
Paralysis

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22
Q

Features of compartment syndrome

A

Severe pain (disproportionate to injury)
Worsened by passively stretching muscle
Paraesthesia
Tense/pressure
+/- feature of acute limb ischaemia

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23
Q

Compartment syndrome investigations

A

Clinical diagnosis
Intra-compartmental pressure monitor (if there is clinical uncertainty)
Creatine kinase may aid diagnosis

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24
Q

Causes of acute limb ischemia

A

Embolism
Thrombosis
Trauma (incl. compartment syndrome)

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25
Classification system for acute limb ischaemia
Rutherford
26
Most common shoulder dislocation
Anterior
27
Cause for anterior shoulder dislocation
FOOSH
28
Cause for a posterior shoulder dislocation
Seizures and electric shocks (although anterior dislocations still more common in seizures) but can occur through trauma (a direct blow to the anterior shoulder or force through a flexed adducted arm)
29
Nerves vulnerable to injury in shoulder dislocation
Axillary and suprascapular
30
What are boney bankart lesions? What are soft bankart lesions?
Boney = Fractures of the anterior inferior glenoid bone, commonly seen in those with recurrent dislocations Soft = labrum tears from the glenoid
31
What are hill-sachs defects?
impaction injuries to the chondral surface of the posterior and superior portions of the humeral head, present in approximately 80% of traumatic dislocations
32
Meniscal tear - common mechanism of injury
Twisting injury - while knee is flexed and weight bearing Or can be degenerative disease
33
Features of meniscal tear
"tearing" sensation + intense sudden onset pain Knee may be locked in flexion Joint line tenderness Joint effusion Limited knee flexion
34
Specific test for meniscal tear
McMurrray's test - often prove very painful to the patient so many clinicians no longer advocate their use Thessaly's test - weight bearing at 20 degrees of knee flexion, patient supported by doctor, postive if pain on twisting knee
35
Investigations for meniscal tear
X-ray - initially to exclude fracture MRI = gold standard
36
Complications of Knee arthroscopy
DVT Damage to local structures (e.g. saphenous nerve and vein, peroneal nerve, popliteal vessels)
37
Mechanism of injury for ACL tear
twisting the knee whilst weight-bearing. result from a sudden change of direction twisting the flexed knee.
38
Specific tests to identify potential ACL damage
Lachman test (more sensitive) Anterior draw test
39
Features of ACL tear
Rapid joint swelling Significant pain Instability 50% of ACL tears have a meniscal tear ! (similar mechanism of injury)
40
Mechanism of injury in a medal collateral ligament tear
Trauma to the lateral aspect of the knee Direct blow in a valgus stress direction Non-contact can occur - e.g. skiing where there is a valgus stress with external rotation force
41
Features of medial collateral ligament tear
"pop" with immediate joint line pain Delayed swelling after a few hours (unless there is an associated haemarthrosis) Increased Laxity (valgus stress test)
42
Specific test to identify MCL injury
Valgus stress test A Grade II and III tear can be distinguished clinically on medial stress testing; Grade II is lax in 30 degrees of knee flexion but solid in full extension, whereas Grade III is lax in both these positions.
43
Nerve injury that can occur as a result of a Colles fracture
Median nerve injury --> acute carpal tunnel syndrome + weakness or loss of thumb/index finger flexion
44
Colles fracture deformity
Dinner for deformity Dorsally displaced distal radius
45
What is a colles fracture
extra-articular fracture of the distal radius with dorsal angulation and dorsal displacement
46
3 common distal radius fractures
Colles' (90%) Smiths's Bartons
47
What is a smiths fracture
volar angulation of the distal fragment of an extra-articular fracture of the distal radius (the reverse of a Colles fracture), with or without volar displacement.
48
What is a bartons fracture
intra-articular fracture of the distal radius with associated dislocation of the radio-carpal joint.
49
Which artery supplies the scaphoid
Radial artery
50
Contents of the anatomical snuffbox
Radial artery Superficial radial nerve Cephalic vein. Floor = scaphoid, trapezium, radial styloid
51
When after inital presentation should another X-ray of schapoid be taken
Repeat x-ray 10-14 days after If initial radiographs do not show evidence of a fracture however there is sufficient clinical suspicion, treat conservatively and re-image in two weeks
52
Imaging modality for osteomyelitis
MRI then consider a bone biopsy to determine causative organism
53
Organism involved in osteomyelitis
Staph. aureus is the most common cause except in patients with sickle-cell anaemia where Salmonella species predominate
54
Management of osteomyelitis
flucloxacillin for 6 weeks clindamycin if penicillin-allergic
55
Features of carpel tunnel syndrome
Pain, numbness, and/or paraesthesia - throughout the median nerve sensory distribution. Pain worse at night Sx temporarily relieved by shaking hand or hanging It over side of bed Palm spared -due to the palmar cutaneous branch of the median nerve branching proximal to the flexor retinaculum and passing over the carpal tunnel. Later stages - weakness of thumb abduction (due to denervation of thenar muscles) +/- wasting of thenar eminence
56
Specific clinical tests for carpel tunnel syndrome
Tinel's test Palen's test
57
DDx for carpel tunnel syndrome
Cervical radiculopathy (C6 nerve root involvement may produce pain/paraesthesia similar to CTS) Pronator teres syndrome - compression by pronator teres Flexor carpi radialis tenosynovitis
58
Management of carpal tunnel syndrome
Wrist spint (commonly worn at night) Corticosteroid injections NSAIDs Carpal tunnel release surgery
59
Contents of the carpal tunnel
Median nerve Flexor pollicis longus Flexor digitorum profundus Flexor digitorum superficialis
60
Clinical test for achilles tendon rupture
Simmons test - absence of plantar flexion on squeezing the calf of the affected leg
61
Most common cause for cauda equina syndrome
Central disc prolapse at L4/5 or L5/S1
62
What is the femoral stretch test?
Patient is prone, knee is passively flexed to the thigh and the hip is passively extended Positive = pain in anterior thigh Suggestive of a high lumbar radiculopathy L3/L4 nerve root compression
63
What is the sciatic stretch test?
raise one leg - knee absolutely straight - until pain is experienced in the thigh, buttock and calf. record angle at which pain occurs - a normal value would be 80-90 degrees L5/S1 nerve root compression
64
Cause of foot drop
compromise of common peroneal nerve (supplied by sciatic)
65
Classification system for tibial plateau fractures
Schatzker Classification
65
Arteries at risk in tibial shaft fracture
Peroneal Anterior / posterior tibial artery
66
Management of undisplaced tibial shaft fracture
Closed reduction + cast for 16 weeks (Sarmiento cast)
67
Managment of displaced tibial shaft fracture
Intramedullary nailing May need to start with external fixator while swelling reduces Particularly proximal or distal fractures, especially those which extend into the joint, may require open reduction internal fixation (ORIF) with locking plates.
68
Complications of a tibial shaft fracture
Compartment syndrome Ischaemic limb Open fracture
69
Classification of Open Fractures
Gustilo-Anderson classification
70
What is traction splinting used for? e.g. Kendrick traction splint
suspected or isolated fractures of the mid-shaft femur, acting to hold the femur in correct position against action of the large thigh muscle mass.

FINALS (19 decks)

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