Trauma and orthopaedics

Question 1

What is debridement?

Answer 1

Surgical removal of dead, damaged or infected tissue

Question 2

What is a scarf osteotomy?

Answer 2

This is a Z shaped surgical division of the 1st metatarsal to correct a bunion (hallux valgus).

Question 3

Name 3 types of arthroplasty

Answer 3

Total joint arthroplasty, hemiarthroplasty, unicompartmental

Question 4

Define: arthrotomy

Answer 4

opening a joint

Question 5

Define: osteotomy

Answer 5

cutting/dividing a bone

Question 6

Define: osteosynthesis

Answer 6

joining bone

Question 7

Define: arthroplasty

Answer 7

Refashioning a joint

Question 8

Define: exostectomy

Answer 8

smoothing a bone

Question 9

Name the parts of the long bones

Answer 9

Physis= growth plate in children
Epiphysis= joint side of the physis
Metaphysis= widened flare of the bone on the shaft side of the physis
Diaphysis= shaft of the bone

Question 10

What is a classic cause of an insufficiency fracture?

Answer 10

Osteoporosis

Question 11

What could cause a pathological fracture?

Answer 11

Tumour, infection, metabolic

Question 12

How long should it take for an adult lower limb fracture to heal?

Answer 12

12 weeks

Question 13

How long should it take for an adult upper limb fracture to heal?

Answer 13

6 weeks

Question 14

What are the 3 main stages of fracture management?

Answer 14

Reduce, stabilise, rehabilitate

Question 15

What are the stages of bone healing?

Answer 15

Trauma, haematoma, inflammation, callus formation, consolidation, remodelling

Question 16

Name some early complications of fractures

Answer 16

Blisters, swelling, compartment syndrome, complications of treatment, associated other injuries, sepsis from major trauma, thrombo-embolism, fat embolism/ARDS

Question 17

Name some late complications of fractures

Answer 17

Deformity, delayed/mal/non-union, post-traumatic osteoarthritis, avascular necrosis (femoral neck, scaphoid, talus), chronic pain.

Question 18

How do you treat compartment syndrome?

Answer 18

Fasciotomy

Question 19

How do we classify sprains?

Answer 19

Ligaments:
Grades I (minimal tear, fibre stretching),
II (partial tear)
III (complete tear).
Muscles:
Grades I (small tear, minimal bleeding),
II (significant number muscle fibres torn, bleeding),
III (complete tear).

Question 20

What are the 2 types of referred pain?

Answer 20

1) Radicular, from nerve root compression (along dermatomal distribution).
2) Somatic, pain originating elsewhere (hard to localise).

Question 21

What is the first sign that someone is in shock?

Answer 21

Fast respiratory rate

Question 22

What are the signs of shock?

Answer 22

Tachycardia, hypotension, increased RR, low pulse pressure, CNS disturbance/altered mental state, decreased urine output.

Question 23

Where do you put a chest drain?

Answer 23

5th intercostal space, mid-axillary line

Question 24

Where do you put a wide bore cannula to drain the pleura in an emergency? (Needle thoracocentesis)

Answer 24

2nd intercostal space, mid-clavicular line

Question 25

What is anthalgic gait?

Answer 25

Limp- gait caused by pain (minimal time stepping on the painful side to avoid loading weight)

Question 26

What is the definition of a fracture?

Answer 26

A soft tissue injury associated with a break in the continuity of the cortex of the underlying bone

Question 27

What would you see on a gout X-ray?

Answer 27

Periarticular erosion

Question 28

What are tophi?

Answer 28

Deposits of uric acid crystals in joints, cartilage or bones

Question 29

What are the two types of fracture reduction?

Answer 29

Open and closed

Question 30

What is a back slab?

Answer 30

Plaster along the back of the affected limb held in place with bandages.

Question 31

What are the two types of traction that can be applied to fractures?

Answer 31

Skin traction and skeletal traction

Question 32

List possible causes of arthritis

Answer 32

``` Congenital Degenerative Post traumatic Septic Inflammatory Endocrine Haematological Neurological ```

Question 33

What are the four main surgical methods of managing arthritis?

Answer 33

Debridement Osteotomy Replacement Ablation

Question 34

Define arthrodesis

Answer 34

Fusion of a joint

Question 35

When would you do an arthrodesis?

Answer 35

If the joint cannot be replaced. It relieves pain.

Question 36

What sign might you see in ischaemia in the upper limb?

Answer 36

Volkmann ischaemic contracture

Question 37

What is a Bankart lesion?

Answer 37

Injury to the anterior inferior glenoid labrum due to anterior shoulder dislocation.

Question 38

What is a Hill-Sachs lesion?

Answer 38

Fracture of the posterolateral aspect of the humeral head due to impaction against the anterior inferior glenoid during anterior shoulder dislocation.

Question 39

What lesions may occur in posterior dislocation of the shoulder?

Answer 39

Reverse Bankart lesion | Reverse Hill-Sachs lesion.

Question 40

What is sail sign (of the elbow)?

Answer 40

A radiological sign that suggests an occult fracture. Caused by displacement of the fat pad around the elbow.

Question 41

What is a Monteggia fracture?

Answer 41

Fracture of the proximal 1/3 of the ulna and volar dislocation of the proximal radius.

Question 42

What is a Galeazzi fracture?

Answer 42

Fracture of the middle or distal 1/3 of the radius with diastasis of the distal radio-ulnar joint (shortening and dislocation of the ulna).

Question 43

What is a Colles' fracture?

Answer 43

Fracture of the distal radius with dorsal angulation of the distal fragment.

Question 44

What is a Smith's fracture?

Answer 44

Fracture of the distal radius with volar angulation of the distal fragment (similar to Colles', but angulation is volar not distal).

Question 45

What is the Terry Thomas sign/Madonna sign?

Answer 45

A radiological feature of scapholunate disloacation. There is an increase in space between the scaphoid and lunate on an AP wrist X-ray (~3 or 4mm minimum). This occurs due to ligamentous injury. Associated with wrist instabilities.

Question 46

What is Mallet finger, and what causes it?

Answer 46

The finger bends down at the DIP join due to disruption of the extensor tendon.

Question 47

What kinds of fractures need urgent treatment?

Answer 47

Open fractures Fracture dislocations Fractures with vascular or neurological consequences.

Question 48

What is an avulsion fracture?

Answer 48

Bony fragment torn off by a tendon or ligament.

Question 49

Which nerve supplies sensation to the dorsum of the foot?

Answer 49

Peroneal nerve

Question 50

Which 3 special tests are best for ACL injury?

Answer 50

Anterior drawer test, Pivot shift test (for instability) and Lachman's test (most sensitive).

Question 51

What clinical findings would you notice in an ACL injury?

Answer 51

Large haemarthrosis and quadriceps avoidance gait (not actively extending the knee)

Question 52

How would a patient with an ACL tear present?

Answer 52

Felt a "pop“, pain deep in knee, immediate swelling (70%) / hemarthrosis

Question 53

How would a patient with quadriceps tendon rupture present?

Answer 53

Often report a history of pain leading up to rupture consistent with underlying tendinopathy. Symptoms= pain, tenderness at site of rupture, palpable defect usually within 2 cm of superior pole of patella, unable to extend knee against resistance.

Question 54

How do we manage an acutely swollen knee (without fracture)? | acronym= RICE

Answer 54

Rest Ice pakcs Compression/splintage Elevation