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Y3 Surgery > T&O > Flashcards

T&O Flashcards

1
Q

Presenting an orthopaedic radiograph

A
  • Name and date of patient
  • What date and time
  • Which body part
  • Which side
  • What projection
  • Adequacy

Obvious finding first- fracture

This is an adequate PA radiograph of Mr Smith’s right wrist which shows…

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2
Q

Adequacy

A
  • Is all the body part intended to be xrayed included
  • Is the exposure okay
  • Is it aligned well?
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3
Q

What projection is the wrist?

A

Wrist is always PA

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4
Q

Parts of the bone

A
  • Diaphysis
  • Metaphysis
  • Physis (growth plate)
  • Epiphysis
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5
Q

What is the apophysis?

A

Part of the bone where a tendon inserts to

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6
Q

How can we further explain diaphyseal fractures?

A

Proximal, middle and distal thirds

or at the junction of the middle and distal 1/3

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7
Q

What further information do you need to mention with a metaphyseal fracture?

A

Whether it is extra-articular or intra-articular
Does the fractures extend to the joint?

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8
Q

What are the types of fracture?

A

Simple
- Transverse
- Oblique (bend)
- Spiral (torsional)

Comminuted

Open (road traffic, fall from height)

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9
Q

What is a greenstick fracture?

A

Incomplete fractures more commonly seen in children

Softer, more elastic and cartilaginous

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10
Q

What are the types of displacement?

A

STAR

Shortening
Translation- commonly given as a percentage
Angulation
Rotation

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11
Q

What does the term off-ended mean with displacement?

A

The term off-ended is used by some orthopaedic surgeons and radiologists to describe a long bone fracture that is displaced by more than the width of the bone. An off-ended fracture is often shortened due to muscle contraction.

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12
Q

What is the polo mint mnemonic?

A

Try breaking a polo sweet in one place….impossible!
There will always be two breaking points.

So if there is a # in one, there’s got to be a fracture in the other

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13
Q

Apex posterior?

A

Apex is posterior
Re-cavatum derofmity

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14
Q

Apex anterior?

A

Pro-cavatum

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15
Q

What does HBL stand for on an x-ray?

A

Horizontal beam lateral
The patient was not standing- lying flat.

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16
Q

What line would be straight on an x-ray?

A

Blood
Fluid level- nothing in nature is straight.

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17
Q

What else leaks from a bone in a fracture

A

Bone marrow- fat and blood.
Fat settles on top- blood which is more dense settles on the floor.
Important to know which direction the image has been taken.

HBL- fluid level we are looking for.

Lipohemoarthrosis.

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18
Q

On an x-ray, how do you know if a fracture is open?

A

Air- subcutaneous emphysema
Highly suggestive of an open fracture
Need to examine the leg to definitively say.

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19
Q

What is the most common nerve block used in neck of femur fractures?

A

Iliofascial nerve block

Fascia iliaca compartment is an area of potential space that lies between the posterior surface of the fascia iliaca, and the anterior surface of the iliacus and psoas muscle

Local anaesthetic injected into this potential space affects the femoral, obturator and lateral femoral cutaneous nerves

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20
Q

Why is a closed reduction under general anaesthetics important in a dislocation?

A

The risk of avascular necrosis is high after 4 hours

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21
Q

What is the blood supply to the ACL and PCL?

A

Branches of the middle genicular which is a branch of the popliteal artery

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22
Q

What does McMurray’s test assess?

A

The meniscus

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23
Q

How do you assess lateral meniscus damage?

A

McMurray’s test
Internally rotating the tibia applying varus pressure to the knee, carefully extend the knee

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24
Q

How do you assess medial meniscus damage?

A

McMurray’s test

Flex to extend the knee
External rotation of the tibia and valgus pressure on the knee.

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25
Q

How can tibial plateau fractures be classified?

A

Schatzker classification

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26
Q

What antibiotic increases risk of achilles tendinopathy?

A

Fluoroquinolones e.g Ciprofloxacin

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27
Q

What are the 3 phases of adhesive capsulitis?

A

Painful, stiff and thawing

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28
Q

What is De Quervain’s tenosynovitis?

A

Swelling and inflammation of the tendon sheaths in the wrist. It primarily affects two tendons (abductor pollicis longus and extensor pollicis brevis)

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29
Q

What is the test for De Quervain’s?

A

Finkeistein’s test

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30
Q

What are the signs of L5/S1 paracentral disc prolapse

A
  • Impairment of ankle plantar flexion
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31
Q

What is characteristic of lumbar canal stenosis?

A

Relief on walking uphill due to the freeing up of space between the vertebrae involved.

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32
Q

What is Lhermitte’s phenomenon?

A

Intermittent electric shock pain in the limbs upon neck flexion- sign of cervical myelopathy.

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33
Q

What is the test to detect antibodies against salmonella?

A

Widal

Commonly seen in sickle cell anaemia

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34
Q

What is the most common primary mallignant tumour in children and adolescents?

A

Osteosarcoma

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35
Q

How do you classify radial fractures?

A

Salter-Harris

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36
Q

What is the UHL prophylaxis for joint replacements?

A

IV Co-amoxiclav followed by 2 further half doses at 8hr intervals.

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37
Q

What is the classification for open fractures?

A

Gustilo-Anderson

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38
Q

What management steps can you do in an open fracture?

A
  • Give broad spectrum antibiotics
  • Tetanus vaccination
  • Remove gross debris from the wound
  • Dress the wound in saline-soaked gauze
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39
Q

What are early and late complications of an open fracture?

A

Early
Neurovascular injury- 6ps, foot drop
Compartment syndrome

Late
Osteomyelitis- tenderness at the side, swelling and erythema, unable to weight bear
Surgical site infection- pus from the wound site, erythema, tenderness

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40
Q

What nerve is damaged if you can’t perform the OK sign?

A

Anterior interosseous nerve

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41
Q

What is the motor deficit in an ulnar nerve lesion?

A

Adduction of the thumb
Froment’s sign

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42
Q

What is the motor deficit with median nerve?

A

Abduction of the thumb

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43
Q

What is the motor deficit with the radial nerve?

A

Extension of the IPJ of the thumb

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44
Q

What is the hook test?

A

Ask the patient to flex their arm
Hook your finger under the biceps tendon distally.
Feel for laxity

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45
Q

What is the sylvian fissure?

A

Separates the frontal and parietal lobes from the temporal lobe

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46
Q

What two medications can be used in a subarachnoid hemorrhage?

A

Keppra (Levertiracetam) prevents seizures after a brain bleed by calming overactive brain cells. Nimodipine widens blood vessels in the brain to improve blood flow and prevent complications like stroke after a subarachnoid hemorrhage.

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47
Q

What is the time frame for all #NOF to be treated?

A

36 hours

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48
Q

What is the time frame for all #NOF to be seen by a geri-ortho?

A

48 hours

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49
Q

What are the 4 types of consent forms?

A

Consent form 1 is for adults and those patients having anaesthetic Consent form 2 is for paediatrics Consent form 3 is for procedures without sedation
Consent form 4 should be used when the patients lack capacity and should be completed by the professional doing the procedure.

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50
Q

What is the nottingham hip fracture score?

A

The Nottingham Hip Fracture Score is a tool used to predict mortality risk in patients who have sustained a hip fracture. It takes into account various factors such as age, sex, cognitive impairment, pre-fracture mobility, and pre-existing medical conditions to estimate the likelihood of death within 30 days of the fracture. It helps clinicians in making treatment decisions and planning post-operative care for hip fracture patients.

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51
Q

What is lumbar spinal stenosis?

A

Lumbar spinal stenosis is a condition in which the central canal is narrowed by tumour, disk prolapse or other similar degenerative changes.

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52
Q

What is the best investigation for spinal stenosis?

A

MRI

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53
Q

What is the treatment for spinal stenosis?

A

Laminectomy

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54
Q

In the 4AT score, what signifies delirium?

A

A score of 4 or more
We therefore developed a short test called the 4 ‘A’s Test (4AT). The four ‘A’s stand for Arousal, Attention, Abbreviated Mental Test – 4, and Acute change.

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55
Q

Why do patients have to be NBM before surgery?

A

Prevention of Aspiration: NBM (Nil by Mouth) status before surgery reduces the risk of aspiration, where food or fluids enter the lungs instead of the stomach. Aspiration can lead to serious respiratory complications such as pneumonia.

Safety during Anaesthesia: Being NBM ensures the stomach is empty, reducing the likelihood of regurgitation and subsequent aspiration under anaesthesia. An empty stomach also minimises the risk of complications like vomiting during surgery, which can compromise airway management.

Optimal Surgical Conditions: A clear stomach allows for safer and more efficient surgical procedures, as it reduces the likelihood of abdominal distension and associated complications. It also facilitates better visualization of surgical sites, enhancing the surgeon’s ability to perform the procedure effectively.

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56
Q

If you suspected a problem with the biceps, what actions would you test?

A

Flexion and supination

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57
Q

What is the most common cause of delirium in patients?

A

Pain

Then constipation

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58
Q

How do you classify radial head fractures?

A

Mason types

Type 1
- Non-displaced or minimally displaced fracture <2mm

Type 2
- Partial articular fracture with displacement >2mm or angulatio n

Type 3
- Comminuted fracture and displacement

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59
Q

How do you treat a mason type 1 fracture?

A

Treated non-operatively, with a short period of immobilisation with sling (less than 1 week) followed by early mobilisation

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60
Q

How do you treat a mason type 2?

A

If no mechanical block then can be treated as per a type 1 injury; if a mechanical block is present, then may need surgical intervention

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61
Q

What is an example of a plane joint?

A

Carpal bones
Tarsal bones
Facet joints of the spine

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62
Q

What is an example of a condyloid joint?

A

Atlanto-occipital joint at the base of the skull
Radiocarpal joint

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63
Q

What is an example of a saddle joint?

A

The first carpometacarpal joint at the base of the thumb.

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64
Q

What is an example of a hinge joint?

A

The knee and elbow

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65
Q

What is an example of a pivot joint?

A

The atlanto-occipital joint

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66
Q

If you suspect a patella fracture, what action should you ask the patient to do to see whether they need surgery?

A

SLR

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67
Q

What are questions you should ask when taking a fragility fracture history/presenting a patient?

A
  1. Did they lose consciousness in the fall
  2. Did they have any palpitations?
  3. What was their mobility like before? wheelchair, zimmer etc.
  4. Smoking history
  5. Menopausal history
  6. Co-morbidities, hypertension, obesity, diabetes
  7. Medications? Steroids?
  8. Are they on any blood thinning medication?
68
Q

If someone had a heart valve replacement surgery, what do you need to ask about anticoagulation?

A

If it was a mechanical valve- they will be on warfarin

If it was a bovine/tissue valve- the will not.

69
Q

What antibiotics do you give as prophylaxis before surgery?

A

IV teicoplanin and gentamicin

70
Q

What will be significant in a ligament rupture?

A

Massive swelling

71
Q

What structure in the knee is most important in stabilizing the fracture?

A

The ACL

72
Q

What is the main complaint of people with a ruptured ACL?

A

Weakness on internal rotation of the knee

73
Q

What should you not do in a knee examination?

A

Sit on the patient’s knee when doing the anterior drawer test- use your knee instead.

73
Q

How should you test the ACL?

A

Flex the knee- takes out the action of the IT band.

Drawer, lachmans

73
Q

What is the dial test?

A

Tests posterolateral instability
PCL

74
Q

Describe the 5 stages of fracture healing?

A
  1. Haematoma
    Granulation tissue, bleeding at the fracture site.
    The hematoma serves as a scaffold for the influx of inflammatory cells and growth factors necessary for the healing process.
  2. Inflammatory reaction
    Inflammatory cells, such as neutrophils and macrophages, migrate to the fracture site to clear away debris and bacteria, and to release cytokines and growth factors that stimulate the proliferation of other cells involved in the healing process. This phase typically lasts for several days.
  3. Soft callus (1 week)
    Fibrous tissue and cartilage
  4. Consolidation (hard callus)
    Woven bone becomes organized into lamellar bone
  5. Remodelling
    Lamellar bone remodelled to original outline of bone. Osteoclasts resorb excess bone at the fracture site, while osteoblasts deposit new bone in a process known as bone remodeling.
75
Q

What factors contribute to nonunion and malunion of fractures?

A

Factors contributing to nonunion and malunion include poor blood supply to the fracture site, inadequate immobilization, infection, excessive motion at the fracture site, poor nutritional status, smoking, and certain medical conditions such as diabetes and osteoporosis.

76
Q

What are bone morphogenetic proteins (BMPs) and bone grafting, and how do they influence fracture healing?

A

Bone morphogenetic proteins (BMPs) are growth factors that play a crucial role in bone formation and repair. They can be used therapeutically to promote bone healing, either through direct application or as part of bone grafting procedures. Bone grafting involves transplanting bone tissue to the fracture site to provide structural support and promote healing.

77
Q

How does smoking affect fracture healing?

A

Smoking negatively impacts fracture healing by impairing blood flow, reducing oxygen delivery to tissues, delaying inflammatory response, inhibiting bone formation, and increasing the risk of infection. It significantly increases the likelihood of nonunion and complications following fractures.[

78
Q

Why would you use a back slab instead of a cast?

A

Back slabs accommodate swelling better than casts.
They allow easier inspection and monitoring of the injured limb.
Back slabs can be easily adjusted or removed for reassessment.
They provide immediate pain relief after reduction.
Back slabs are quick and easy to apply in the A&E setting.

79
Q

When is an anterograde intramedullary nail preferred?

A

Typically used for diaphyseal tibial fractures.

  • The tibial canal is wider at its top, making it easier to use larger nails for anterograde nailing, providing better stability.
80
Q

When is a retrograde intramedullary nail preferred?

A

Often preferred for certain ankle fractures, particularly those involving the distal tibia or tibial plafond.

  • Retrograde nailing is better for fractures at the bottom of the tibia because it allows easier reduction and alignment of fracture fragments from a distal to proximal direction.
81
Q

What is an investigation that is crucial in cauda equina?

A

Post-void bladder scan

82
Q

Outline the blood supply to the femoral head, mentioning the primary arteries involved and their respective branches.

A

Medial Femoral Circumflex Artery (MFCA)

Origin: Typically from the deep branch of the profunda femoris artery.
Branches:
Ascending branch: Supplies superior femoral head.
Descending branch: Supplies inferior femoral head.
Lateral Femoral Circumflex Artery (LFCA)

Origin: Arises from the deep branch of the profunda femoris artery.
Branches:
Ascending branch: Supplies greater trochanter and contributes to femoral head.
Descending branch: Supplies lateral femoral head.
Retinacular Arteries

Formed by MFCA and LFCA branches.
Encircle femoral neck, contributing to femoral head supply.

83
Q

What is a hip fracture?

A

Fracture of the neck of femur
Not a fracture of the femoral shaft or the femoral head

84
Q

How do you define intra-capsular fractures?

A

From the subcapital region of the femoral head to basocervical region of the femoral neck, immediately proximal to the trochanters

85
Q

How do you define inter-trochanteric?

A

which are between the greater trochanter and the lesser trochanter

86
Q

Where will patients complain of pain with fractured neck of femurs?

A

Pain in the groin
Also pain with osteoarthritis.

87
Q

Fall history

A

Why did the patient fall?

Trip- pro-dromal symptoms, palpitations, chest pain, SOB
- LOC

Co-morbidities
- CVS, resp/neuro/cognitive, renal- anticoagulation, head medication, previous fragility fractures

Social
- Where do they live? Who do they live with? Pre-fall level of mobility, family support and advanced directives.

88
Q

How do you define sub-trochanteric?

A

Which are from the lesser trochanter to 5cm distal to this point

89
Q

Why do patients with an intracapsular fracture require joint replacement rather than fixation?

A

Retinacular arteries are torn
Won’t be able to restore the blood flow to the femoral head once it has fractured.
Avascular necrosis
The fracture won’t heal due to a lack of blood supply.

90
Q

Examine patients with a fall

A
  • Baseline observations
  • Respiratory
  • CVS
  • Neuro- GCS/AMTS
  • Then hip!
91
Q

What do you look for on a pelvis x-ray?

A
  • Shenton’s line (inferior and posterior)
  • Google
92
Q

How do you know the leg is extended due to the lesser trochanter?

A

The lesser trochanter becomes further into view
Normally a poster-medial structure.

93
Q

How do you fix an intertrochanteric fracture? (Extra-capsular)

A

Dynamic hip screw

94
Q

How would you describe sciatic pain?

A

Specific radicular pain- going down the legs

95
Q

What are the two different types of claudication?

A

Vascular and neurogenic (spinal stenosis)

96
Q

What will someone tell you in the history of spinal stenosis?

A

Leaning forwards (pushing a trolley)- opening up the space in their spinal canal.

97
Q

What is posterior cord syndrome characterized by?

A

Posterior cord syndrome (PCS) is characterized by loss of vibration and proprioception sensation, and the posterior spinal artery supplies reflexes below the level of the lesion as the posterior column pathway.

98
Q

What nerve exits between C7 and T1?

A

C8
8 cervical nerves
7 cervical vertebral bodies

99
Q

What nerve exits between C4 and C5?

A

C5

100
Q

Between L5 and S1, what would a central disc prolapse affect?

A

S1 (traversing nerve root)

101
Q

Between L5 and S1, what would a paracentral disc prolapse affect?

A

L5 (exiting nerve root)

102
Q

What are the causes of thoracic spinal pain?

A

Infection/tumor
It is very uncommon to have thoracic pain- lumbar is more common

103
Q

How do you do a spinal cord de-compression?

A
  • Transect the ligamentum flavum
  • The word laminectomy literally means - excision of lamina. However in most cases, involves excision of the supraspinous ligament and some or all of the spinous process.
104
Q

Inx for T&O

A

Bedside
- Observations
- Urine dip
- Joint aspirate

Bloods
- FBC
- CRP
- ESR
- UE
- Uric acid
- RF (comes and goes, multiple joints)
- Anti-CCP

Imaging
- X-ray of the joint
- CXR (seeded an infection from elsewhere)
- Joint USS
- Joint MRI

105
Q

Differentials for painful joint

A

Infective
- Septic
- Osteomyelitis
- Bursitis
- Cellulitis

Inflammatory
- Bursitis
- RA
- PA
- RA

Tumor
- Metastasis
- Benign tumor
- Malignant tumor

Trauma
- Fracture
- Haemarthrosis
- Soft tissue injury

106
Q

Steps before managing septic arthritis

A
  1. Joint aspirate
  2. Blood culture
  3. IV antibiotics (always say I would give bacteria as per trust guidelines)
  4. Wash out
  5. Analgesia
  6. Splinting if helpful for comfort

Bacteria isn’t very good at penetrating joints

107
Q

Most common bacteria in joint infections in younger adults

A

Neisseria gonorrhea (20%)

108
Q

Most common bacteria found in sickle cell patients

A

Salmonella

109
Q

Most common bacteria found in dog and cat bites

A

Pasteurella

110
Q

Complication of septic arthritis

A

Inflammatory cells dissolve cartilage- arthritis
Limb amputation
Death
Osteomyelitis
Growth arrest
Recurrence- quite difficult to get rid of it in a wash

111
Q

Fibrosing ankylosis

A

Scarring of soft tissue around a joint- makes it very stiff

112
Q

Complication of septic arthritis in children

A

Growth arrest- damage growth plate

113
Q

Common ankle sprain injury with a normal xray

A

Lateral collateral ligaments

114
Q

Management of an ankle sprain

A

RICE
Walking boots
Physiotherapy
Analgesia

115
Q

Risk factors for osteomyelitis

A
  • IVDU
  • Previous surgery
  • Diabetes
  • Wound
  • Open fracture
  • Endocarditis
  • Malnutrition
  • Renal failure
  • Immunocompromised
116
Q

What is Pott’s disease?

A

Potts disease is an infection of the vertebral body and intervertebral disc by Mycobacterium tuberculosis. Patients will present with back pain +/- neurological features, with associated low grade fever and non-specific infective symptoms.

The infection will initially start in the intervertebral disc before spreading to the para-discal regions, typically affecting the thoraco-lumbar region of the spine.

MRI imaging is the gold-standard investigation for suspected cases. Most cases will require a prolonged course of anti-TB medication, however surgical intervention may be required for abscess drainage in the case of extensive spinal destruction.

117
Q

What do you do if the skin looks very cellulitic?

A

Avoid joint aspiration- you are seeding

118
Q

What are the x-ray signs of osteomyelitis?

A
  • Osteopenia
  • Bone lysis
  • Periosteal reaction (onion skin)
  • Loss of trabecula appearance
119
Q

When do x-ray signs tend to develop?

A

8 weeks- need enough bone lysis for it to show

120
Q

Why is MRI the most specific for osteomyelitis?

A

MRI is the most specific imaging modality for osteomyelitis due to its superior soft tissue contrast, multiplanar imaging capability, sensitivity to early changes, and ability to detect associated complications.

121
Q

How do you manage osteomyelitis?

A
  • IV antibiotics
  • IV fluids
  • IV analgesia
  • Splinting
122
Q

What are the three main ways that bacteria spreads?

A
  • Direct innoculation
  • Haematogenous
  • Contiguous
123
Q

Why are you pre-disposed to gout with CKD?

A

In chronic kidney disease (CKD), the kidneys may not effectively remove uric acid from the body, leading to higher levels of uric acid in the bloodstream, which increases the risk of gout, a condition caused by the buildup of uric acid crystals in the joints.

124
Q

What arthritic changes do you get with gout?

A

Punched out erosions

125
Q

Pseudogout crystals

A

Blue (postitive birefringent)

126
Q

Gout crystals

A

Yellow (negatively birefringent)

127
Q

How long does gout take to settle down?

A

Couple of months

128
Q

X ray change with pseudogout?

A

Chondrocalcinosis

129
Q

Shoulder position with anterior shoulder dislocation?

A

Squaring of the shoulder
Internally rotated, adducted

ACJ dislocation- another good differential

130
Q

What is a positive empty can test?

A

Pain and weakness

131
Q

First line imaging for a supraspinatus tendon rupture?

A

Ultrasound

132
Q

How do you manage supraspinatus tear with elderly people, chronic changes

A

Physio- poor repair

133
Q

How would you manage a supraspinatus tear in a younger patient?

A

Arthroscopiclaly, stitches through it

134
Q

How can you get a better look at a joint on an MRI scan?

A

Dye in the joint- extravasation of the dye if there is a hole

135
Q

What is a segond fracture?

A

A Segond fracture (bony avulsion of the lateral proximal tibia) is pathognomic of ACL injury.

136
Q

What is the gold standard investigation for an ACL rupture?

A

MRI

137
Q

When do you examine the knee after an ACL rupture?

A

After about 2 weeks once the swelling has gone down, swelling causes a pseudo-support.

138
Q

ACL rupture management

A

Posteriomedial area of lateral femoral condyle to anterior intercondylar tibia

  • 2 weeks assessment of ligaments
  • Knee brace for comfort
  • MRI
  • Physiotherapy
  • Consider surgical repair or reconstruction
139
Q

3 year old boy with hip pain history

A
  • Was hip screening normal
  • Was the birth normal?
  • Trauma
  • Fever, have they been off feeding? Wet nappies, bowels changed
  • Recent infections (transient synovitis) don’t always know why it happens, can be precipitated by a viral infection, inflammation around the joint

Main thing is to rule out septic arthritis- Kocher criteria

140
Q

What criteria do you use for septic arthritis in children?

A

Kocher
Most common cause of paediatric hip pain
3-10 year olds
Surveillance
4/4= 100% they have septic arthrits

141
Q

What sign is seen on examination of a patella/quadriceps tendon rupture?

A

Extensor lag (can’t SLR)
Gap in the patella tendon

142
Q

Patella sitting too high or low?

A

If the patella is sitting too high (equivalent to the patellar tendon being too long) then this is called patella alta. If the patella is sitting too low (i.e. a short patellar tendon) then this is patella baja (sometimes referred to as patella infera).

143
Q

How would you manage a patella/quadriceps tendon repair?

A

Splint them in extension
Surgery

144
Q

How do you manage a bursitis?

A

Able to deal conservatively

145
Q

What is the surgical outcome vs conservative outcome like in achilles tendon rupture?

A

The same
Equinus boot
Chronic or open injuries consider reconstruction/repair

146
Q

What are the most likely primary tumors for malignant bone tumors?

A

Metastatic spread from other cancer types is the most common cause of bone cancer, the most common primary sites being renal, thyroid, lung, prostate, and breast.

147
Q

What is the most common site for bony metastases?

A

The spine

148
Q

After a shoulder dislocation, how long do you keep the arm in a sling for?

A

2 weeks- sling around the back
Assess axillary nerve
Assess rotator cuff

149
Q

How to remember nerve roots and reflexes?

A

A helpful way of remembering nerve roots and reflexes is ‘S1+S2 I tie my shoe (ankle reflex)
L3+L4 I kick the door (knee jerk reflex), C5+C6 I grab some sticks (biceps reflex)
C7+C8 I lay them straight (triceps reflex).

150
Q

Summary of a knee examination

A
  • Comment on range of motion on active movement
151
Q

Posterior sag sign

A

PCL injury

152
Q

Anterior drawer test

A
  • Two thumbs on the tibial tuberosity
  • Quality of end point- end of the muscle contraction
  • Amount of anterior translation of the tibia
153
Q

Lachman’s

A
  • Stabilise the femur with thumb
  • Pull on the tibia
154
Q

What does the valgus stress test evaluate

A

MCL

155
Q

What does the varus stress test evaluate

A

LCL

156
Q

Why do you put your hand under someone’s back for the Thomas’ test?

A

For someone with a fixed flexion deformity of the hip, the only way they will bring their leg up is to hyperflex their back.

157
Q

Joint aspiration for an effusion

A
  • Quick gram stain done in A&E
  • MCS
  • Blood cultures
  • Crystal analysis
158
Q

What are two management options for osteoarthritis apart from analgesia?

A
  • Mobility aids
  • Physiotherapy
  • Steroid joint injections
  • Weight loss
159
Q

What is compartment syndrome defined as?

A

Compartment syndrome happens when the compartmental pressure raises over 30 mmHg, which will lead to compression of the capillaries, veins and ultimately arteries and also compression of the nerves running in that compartment.

Compartment syndrome is managed by taking the patient to theatre and performing an urgent decompression

160
Q

How to remember the difference between galeazzi and monteggia fractures?

A

MUGGER

MU
- Monteggia and ulnar
- Ulnar fracture (with radial head dislocated)

MonteggiAA
A is proximal
proximal fracture

GeR
- Galezzi and radius
- Radius is fractured with dislocation of radioulnar joint

GaleazZi
Z is distal
Distal fracture

161
Q

What is the difference in appearance of Paget’s disease and osteoporosis on x-ray?

A

Paget’s will look brighter- expand the cortex
Osteoporosis- bone will look thinner

162
Q

What is the imaging of choice for cauda equina?

A

WHOLE spine MRI

163
Q

How does osteosarcoma presesnt

A

Single lesion

Osteosarcoma can exhibit both lytic and sclerotic features. Typically, it is a mixed lesion that shows areas of bone destruction (lytic) and abnormal new bone formation (sclerotic). The radiographic appearance often includes a combination of these characteristics, leading to a “sunburst” pattern or Codman’s triangle due to periosteal reaction.

164
Q

What is the earliest sign of dupuytren’s contracture?

A

Palmar nodule

Y3 Surgery (7 decks)

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