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MSK Phase 2 > # > Flashcards

# Flashcards

1
Q

Risk factors for NOF#

A 
Uncontrollable Risk Factors:
Being over age 50.
Being female.
Menopause.
Family history of osteoporosis.
Low body weight/being small and thin.
Broken bones or height loss.
Controllable Risk Factors:
Not getting enough calcium and vitamin D.
Not eating enough fruits and vegetables.
Getting too much protein, sodium and caffeine.
Having an inactive lifestyle.
Smoking.
Drinking too much alcohol.
Losing weight.
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2
Q

Why elderly have increased fall risk

A 
Medications
Dehydration
Cognitive impairment 
Reduced bone density
Neurovascular lesions
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3
Q

2 NOF# classes/types

A

Intracapsular

Extracapsular

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4
Q

Where do intracapsular NOF# happen

A

Subcapital
Transcervical
Basocervical

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5
Q

2 types of extracapsular NOF#

A

Inter tronchanteric (greater —> lesser trochanter)

Sub trochanteric (from lesser trochanter and down 5cm)

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6
Q

Which classification system is used to classify intra capsular fractures

A

Garden classification

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7
Q

What is the Garden Classification System for intracapsular NOF#

A
  1. Non-displaced incomplete #
  2. Non displaced complete #
  3. Partially displaced, complete #
  4. Full displaced, complete #
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8
Q

intracapsular femoral blood supply

A

Retrograde (distal to proximal) blood supply from medial circumflex artery

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9
Q

Medial circumflex artery is branch of

A

Profunda femoris

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10
Q

What can intracapsular NOF# lead to and how is it dealt with

A

Lead to AVN

Requires arthroplasty (replacement) not fixation

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11
Q

Clinical features of NOF#

A 
Pain in hip, groin or knee
Inability to weight bear
Reduced mobility or painful mobility 
Cannot perform straight leg raise
Leg shortened and externally rotated and abducted on inspection
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12
Q

Where is pain on NOF#

A

Hip
Thigh
Groin
Knee (in elderly)

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13
Q

Scans to inspect NOF#

A

Orthogonal view XR (AP and lateral views) of hip

Orthogonal view XR of pelvis

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14
Q

Why is an AP pelvis done in suspected NOF#

A

To assess hip for pre-op planning and the plating
Pelvis forms hip joint
Compare “normal” unaffected hip to fractured hip

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15
Q

Tests done for suspected NOF#

A
  1. FBC
  2. U+E
  3. Coag screen
  4. Group and save blood test

For elderly

  1. Urine dipstick
  2. CXR
  3. ECG
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16
Q

Initial management for NOF#

A 
Pain relief (use pain ladder)
IV fluids (for rehydration or to maintain hydration during starving)
Thrombi prophylaxis
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17
Q

Intracapsular undisplaced NOF# management

A

Conservative

Internal fixation

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18
Q

Management for displaced intracapsular NOF #

A

ORIF

Arthroplasty I.e. hemiarthroplasty or total hip replacement

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19
Q

Management for extracapsular NOF#

A

Traction
Intramedullary nail
Extramedullary nail

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20
Q

Management for inter trochenteric fracture

A

Dynamic hip screws

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21
Q

Indications for conservative management of NOF#

A

IMPACTION type intra-capsular undisplaced #
(RARELY DONE)

(impaction = 2 pieces of fractured bone driven into each other)

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22
Q

Indications for internal fixation of NOF#

A

Intracapsular undisplaced

Intracapsular minimally displaced

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23
Q

What is internal fixation of intracapsular NOF#

A

3 cannulated screws to stabilise broken bones

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24
Q

Difference between hemiarthroplasty and total hip replacement

A 
HA= only femoral head replaced with prosthesis
THR= Femoral head AND acetabulum replaced
25
Q

Indications for THR

A 
# in RA
# 2ndary to Malignancy
26
Q

Indications for Hemi

A 
# in elderly
# 2ndary to Paget's Disease / Met Bone Disease / OA
27
Q

What is traction of a NOF#

A

Use tapes/ pins attached to weights to pull and decompress hip joint

28
Q

What are the benefits of traction of NOF#

A

Relieves pain
Relaxes muscles
Restores mobility

29
Q

Indications for intramedullary fixation

A

Extracapsular #

30
Q

What is intramedullary fixation of NOF#

A

Titanium rod placed through medullary cavity of femur for stabilisation

31
Q

What is the indication for extramedullary fixation of NOF#

A

Extracapsular #

32
Q

What is extramedullary fixation of NOF#

A

DHS

3 parts:
Large screw in neck
Side plate
Bicortical screws

Lag screw slides through side plates

33
Q

What does DHS extramedullary fixation of NOF# allow

A 
#compression
Primary healing
Maintenance of neck/shaft angle of femur
34
Q

Complications of NOF#

A

AVN

Non union

35
Q

How long does the risk of AVN exist after surgery of NOF#

A

3 years

36
Q

What is needed to monitor for AVN in NOF#

A

Regular scanning using MRI (MRI better than XR)

37
Q

Type of fracture where non union is most common

A

Displaced

38
Q

Risk factors for distal radius #

A 
Age 
Female
Early menopause
Smoking
Alcohol
Prolonged steroid use

All related to osteoporosis

39
Q

Types of distal radius #

A

Colles
Barton’s
Smith’s

40
Q

Features of Colle’s #

A

Dorsal displacement
Extra articular # (not part of articulating joint)
Caused by FOOSH

41
Q

Features of Smith’s

A

Palmar/volar displacement
Extra articular #
Caused by fall on back of hand

42
Q

Features of Barton’s

A

Can be volar (more common) or dorsal displacement
Intra articular #
Radio-carpal joint dislocated (hallmark sign)

43
Q

Clinical features of distal radius #

A

Pain
Deformity & swelling
Paraesthesia / weakness (if neurological involvement)

44
Q

What should you check for on examination of suspecting distal radius #

A 
Neurovascular compromise
Nerve function
Limb perfusion (cap refill & pulses)
45
Q

Which nerves do you check for in neurological exam of distal radius #

A

Median
Ulnar
Radial

46
Q

How do you check motor and sensory function of median nerve in distal radius #

A

Motor: thumb abduction (make ‘C’ shape OR thumb to little finger aka thumb opposition OR rock part of “rock paper scissors)
Sensory: inside of index finger tip

47
Q

How to examine Motor and sensory function of ulnar nerve

A

Motor: scissors with palm facing down OR thumb adduction
Sensory: palm side of pinky finger tip

48
Q

Examine motor and sensory function of radial nerve

A

Motor: paper in “rock paper scissors” (extension of IPJ of thumbs)
Sensory: dorsal surface between thumb and 2nd finger

49
Q

How to test motor function of anterior interosseous nerve

A

Make “ok” sign

50
Q

Measurements that help with diagnosis of distal radius #

A

Radial height
Radial inclination
Radial tilt

51
Q

Ideal radial height

A

Less than 11mm

52
Q

Ideal radial inclination

A

22 degrees

53
Q

what should you evaluate when deciding eligibility for surgery of distal radius #

A 
Age
Occupation
Hand dominance 
Level of activity
Quality of bone
General medical condition
54
Q

Treatment options for distal radius #

A

Non operative: Cast of Paris

Operative: Surgical reduction ORIF

55
Q

Operative options for distal radius #

A

Manipulation under anaesthesia (MUA) and K wire
Volar locking plating
External fixation

56
Q

Which distal radius # is MUA & K wire best fit for

A

2 part, non comminuted fractures

comminuted= broken into more than 2 fragments

57
Q

Which distal radius # is volar locking plating best

A

Comminuted, shortened, osteoporotic #

Smith’s/ volar Barton’s #s

58
Q

Which fractures is external fixation best used for

A

Less commonly used

Good for high energy multi-fragmentary #s

59
Q

Complications of distal radius #

A 
Mal/non union 
Ulnar nerve damage
Carpel tunnel syndrome
OA
Compartment syndrome 
Infection

MSK Phase 2 (2 decks)

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