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Trauma + Orthopaedics > 1: Orthopaedic trauma > Flashcards

1: Orthopaedic trauma Flashcards

1
Q

What is compartment syndrome

A

Increase in pressure in a muscle fascial compartment leading to impaired tissue perfusion

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2
Q

What is the main cause of compartment syndrome

A

Fracture (75%)

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3
Q

What two fractures is compartment syndrome most commonly seen in

A
  • Tibial diaphysis

- Distal radius diaphysis

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4
Q

What else can cause compartment syndrome

A
  • Compression of the limb for several hours
  • Rhabdomyolysis
  • Burns
  • Iatrogenic
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5
Q

What may lead to continuous pressure on a limb

A

Crush Injury

Lying on limb for several hours (elderly/ drug abuse)

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6
Q

What may iatrogenically cause compartment syndrome

A

Too tight plaster cast. Hence why circumferential cases are not used in the first 2W

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7
Q

How will compartment syndrome present

A
  • Pain disproportionate to injury (physical symptoms)
  • Worse on passive stretching
  • Not relieved by analgesia, elevation
  • Compartment may feel full/tight
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8
Q

If compartment syndrome is missed how may it present

A

As an acute ischaemic limb

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9
Q

Explain the pathophysiology of compartment syndrome

A
  • There is a build up of pressure in a muscle compartment (contained by fascia)
  • This causes compression of veins, increasing flow of blood into interstitium causing further build-up of pressure
  • This pressure then compresses nerves causing symptoms in sensory/motor distribution
  • As pressure in the interstitum equals diastolic BP, it stops arterial blood flow into the compartment causing ischaemia
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10
Q

How should the diagnosis of compartment syndrome should be made

A

Clinically

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11
Q

If clinical uncertainty what may be used to identify compartment syndrome

A

Intra-compartmental pressure monitor

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12
Q

What should be done in initial management of compartment syndrome

A
  • Keep leg in neutral position
  • High-flow oxygen
  • IV crystalloid to maintain BP
  • Analgesia
  • Remove dressings
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13
Q

What should be done to manage compartment syndrome

A

Urgent fasciotomy

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14
Q

Explain wound care following urgent fasciotomy

A

Wound is left open for 48-72h. Any devitalised tissue is debrided. Wound is then closed

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15
Q

Why may renal function be monitored in compartment syndrome

A

Due to risk of renal damage from reperfusion injury or rhabdomyolysis

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16
Q

What are 4 complications of compartment syndrome

A
  • Ischaemia
  • Volkmann contracture
  • Gangrene
  • Rhabdomyolysis and renal failure
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17
Q

What is volkmann contracture

A
  • Permanent shortening of the fore-arm muscles due to ischaemic injury
  • Presents with claw-like hand
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18
Q

What fracture are Volkmann contractures most associated with

A

Supracondylar humeral fractures

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19
Q

What is septic arthritis

A

Infection of a joint

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20
Q

What is the most common cause of septic arthritis in healthy adults

A

S. aureus

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21
Q

What is the most common cause of septic arthritis in sickle cell disease

A

Salmonella

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22
Q

What is the most common cause of septic arthritis in sexually active young adults

A

N. Gonorrhoea

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23
Q

What are 6 risk factors for septic arthritis

A
  • Cellulitus
  • Diabetes
  • Immunosupressed
  • > 80y
  • pre-existing joint disease
  • prosthesis
  • IVDU
  • chronic renal failure
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24
Q

How will septic arthritis appear clinically

A
  • painful, erythematous swollen joint
  • unable to weight bare
  • pyrexial (60%)
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25
Q

What are two signs of septic arthritis

A
  • swollen, erythematous, warm joint

- painful on active and passive movement

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26
Q

Explain the pathophysiology of septic arthritis

A

Septic arthritis comes from bacteraemia which may be due to UTI, chest infection, cellulitis. The joint can be infected by direct inoculation or spreading from osteomyelitis

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27
Q

What can septic arthritis lead to

A

Irreversible cartilage damage causing OA

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28
Q

What investigations should be ordered in septic arthritis

A
  • FBC (WCC)
  • CRP + ESR
  • Joint aspiration
  • Blood cultures on two separate occasions
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29
Q

How should septic arthritis be managed

A
  • If septic initiate sepsis 6 protocol
  • Flucloxacillin for 4-6W. First 2W should be IV then switch to PO
  • Native joints require irrigation and debridement
  • Prosthetic joint = require wash out in theatre and revision of surgery
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30
Q

What are 2 complications of septic arthritis

A
  • OA

- Osteomyelitis

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31
Q

Define an open fracture

A

communication between fracture site and external environment

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32
Q

When should an open fracture be suspected

A

any limb where there is a wound in the same region as the fracture

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33
Q

Describe clinical presentation of open fracture

A
  • painful

- fracture with overlying wound punctum

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34
Q

What should be checked for all open fractures

A

Neurovascular status

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35
Q

What scoring system is used to evaluate open fractures

A

Gustilo-Anderson

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36
Q

What is Gustilo-Anderson 1 fracture

A

Laceration <1cm and clean. Low energy trauma,

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37
Q

What is Gustilo-Anderson 2 fracture

A

Laceration 1-10cm and clean wound. Low energy trauma

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38
Q

What is Gustilo-Anderson 3a fracture

A

Laceration >10cm
Adequate soft tissue coverage
Any high energy trauma

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39
Q

What is Gustilo-Anderson 3b fracture

A

Laceration >10cm
Inadequate soft tissue coverage
High energy trauma

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40
Q

What is Gustilo-Anderson 3c fracture

A

Any neuromuscular compromise

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41
Q

What teams are involved in

a. 3a fractures
b. 3b fractures
c. 3c fractures

A

a. orthopaedics
b. + plastic surgery
c. + vascular surgery

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42
Q

In 3c fractures what is used to predict the need for primary amputation

A

Mangled extremity scoring system (MESS)

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43
Q

What are 4 outcomes of open fractures

A
  • Infection
  • Soft tissue damage
  • Wound (skin) damage
  • Neurovascular compromise
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44
Q

What bloods may be performed in open fracture

A

FBC
Group + Save
Coagulation studies

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45
Q

What imaging may be performed in an open fracture

A

X-Ray

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46
Q

Explain 6 steps in the management of open fractures

A
  1. Stabilise the patient (life > limb)
  2. Reduce and splint
  3. IV Antibiotics
  4. Tetanus prophylaxis
  5. Wound photography
  6. Irrigation + debridement
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47
Q

What should be checked and documented before reduction and splinting of the limb

A

Neurovascular status

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48
Q

If an individual has not recently had their tetanus prophylaxis and has a very contaminated wound, what is given

A

IVIg

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49
Q

What should be done prior to debridement

A

Photograph the wound

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50
Q

What is debridement

A

Removal of devitalised tissue

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51
Q

When should debridement be performed

A
  • If evidence of contamination with sewage, marine or agricultural immediately
  • If not evidence of this in <24h
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52
Q

When should soft tissue coverage of the wound be considered

A

contact plastics within 72h

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53
Q

If there is vascular compromise due to the open fracture what should be done

A

immediately contact vascular surgeons for surgical exploration

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54
Q

What is caudal equina

A

compression of the cauda equina

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55
Q

What are the 3 groups of caudal equina

A
  1. Cauda equina syndrome with retention (CESR)
  2. Cauda equina syndrome incomplete (CESI)
  3. Cauda equina syndrome suspected (CESS)
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56
Q

What is the most severe form of caudal equina

A

Cauda equina with retention (CESR)

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57
Q

How will caudal equina with retention present

A
  • Back pain
  • Bilateral sciatica
  • Bilateral Loss of sensation and weakness in legs
  • Saddle anaesthesia
  • Loss of anal tone
  • Urinary retention, or incontinence
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58
Q

How will cauda equina syndrome incomplete present

A

Same as above, but with altered urinary sensation

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59
Q

What are 4 indicators of altered urinary sensation

A
  • Loss of desire to void
  • Poor stream
  • Loss of satisfaction
  • Need to strain
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60
Q

What is caudal equina suspected

A
  • Severe back pain

- Possible neurological signs

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61
Q

what is peak incidence of caudal equina

A

40-50y

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62
Q

what can cause caudal equina syndrome

A
  1. Disc herniation
  2. Trauma: fracture, spondylolisthesis
  3. Neoplasm (1’ or 2’)
  4. Infection: Pott’s disease, disci tis
  5. Ankylosing spondylitis
  6. Haematoma secondary to spinal anaesthesia
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63
Q

What are 5 cancers than spread to the vertebrae

A 
Breast
Lung
Thyroid
Kidney 
Prostate
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64
Q

Will cauda equina cause UMN or LMN signs and symptoms and why

A

LMN. As the cauda equina is made of LMN (which have left the cord)

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65
Q

What are the symptoms of cauda equina

A
  • Bilateral sciatica
  • Back pain
  • Saddle anaesthesia
  • Faecal/Urinary incontinence
  • Impotence
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66
Q

what are 5 signs of caudal equina syndrome

A
  • Saddle anasthesia
  • Lower limb anaesthesia
  • Hyporeflexia
  • Loss of anal tone
  • Bladder distention
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67
Q

Where does the spinal cord terminate

A

L1/L2

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68
Q

What level is the caudal equina

A

L1-S5

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69
Q

What does the cauda equina contain

A

LMN that control:

  • motor + sensory innervation to lower limbs
  • parasympathetic supply to the bladder
  • motor innervation to anal sphincter
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70
Q

What is gold-standard for cauda equina

A

MRI

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71
Q

What are 2 other investigations for caudal equina

A

post-void bladder scan

rectal exam

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72
Q

How is caudal equina syndrome managed

A
  • Urgent neurosurgical review (for surgical decompression)

- High dose corticosteroids

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73
Q

How are fractured neck of femurs classified

A

Depending on position of the fracture line relative to the joint capsule

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74
Q

What are the two groups of hip fractures

A
  • Intracapsular

- Extracapsular

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75
Q

What are the two types of intra-capsular fractures

A
  • Subcapital

- Basocervical

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76
Q

What is a sub capital fracture

A

fracture through head and neck

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77
Q

What is a basocervical fracture

A

fracture below femoral neck

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78
Q

What are the two types of extra-capsular fractures

A
  1. inter-trochanteric

2. subtrochanteric

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79
Q

What is a sub-trochanteric fracture

A

fracture <5cm distal to greater trochanter

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80
Q

What is an inter-trochanteric fracture

A

fracture between lesser and greater trochanter

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81
Q

What is the classification system used for intracapsular NOF fractures

A

Garden system

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82
Q

What is garden classification 1

A

Stable fracture with impaction in valgus

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83
Q

What is garden classification 2

A

Complete fracture with no displacement

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84
Q

What is garden classification 3

A

Complete fracture with displacement (angulation/rotation) but still with contact

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85
Q

what is garden classification 4

A

Complete bony disruption

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86
Q

which population are NOF’s common

A

Elderly

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87
Q

What is the aetiology of NOFs

A
  • Low energy trauma (elderly)

- High energy trauma

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88
Q

In which population do low energy injuries cause NOFs

A

Elderly

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89
Q

How will a NOF present

A
  • Severe pain
  • Unable to weight bare
  • Shortened and externally rotated leg
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90
Q

What blood vessel supplies the neck of femur

A

Medial femoral circumflex artery

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91
Q

Where does the medial femoral circumflex artery arise from

A

deep femoral artery

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92
Q

Why is the medial femoral circumflex artery vulnerable in NOF fractures

A

as it runs over the neck of femur

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93
Q

what is first-line investigation of a NOF fracture

A

Lateral and AP x-rays of the pelvic

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94
Q

what bloods may be ordered

A
  • FBC
  • U+E
  • Coagulation screen
  • G+S
  • CK
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95
Q

why may creatinine kinase be ordered

A

if the patient has been on the floor for an extended period of time their is risk of rhabdomyolysis

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96
Q

what other investigations are typically ordered in complete pre-operative assessment of an elderly patient

A

CXR
Urinalysis
ECG

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97
Q

Describe management of hip fracture

A
  1. ATLS
  2. Sufficient analgesia
  3. Surgical management
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98
Q

Which is more serious an intra capsular or extra capsular fracture and why

A

Intra-capsular fracture as there is a risk of disruption to the

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99
Q

How is a displaced intra-capsular fracture in someone <70y managed

A

Internal fixation

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100
Q

How is a displaced intra-capsular fracture in mobile >70y managed

A

Total hip arthroplasty

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101
Q

How is a displaced intra-capsular fracture managed if someone was immobile prior to or has other severe co-morbidities

A

Hemiarthroplasty

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102
Q

How is an undisplaced intra-capsular fracture managed in young patients with no-comorbidities

A

Internal fixation

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103
Q

How is an undisplaced intracapsular fracture managed in someone with co-morbidities including advanced organ specific disease

A

Hemiarthroplasty

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104
Q

How is an extra capsular fracture managed

A

Dynamic hip screw

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105
Q

How is a extra-capsular fracture managed if reverse, oblique, transverse or sub-trochanteric

A

Intramedullary Nail

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106
Q

What is used to manage a subtrochanteric fracture

A

Intramedullary Nail

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107
Q

What is a intramedullary femoral nail

A

A metal rod that is inserted in the medullary cavity of the femur

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108
Q

Who manages NOF in elderly patients

A

Orthogeriatricians

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109
Q

What is % mortality of hip fractures

A

30%

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110
Q

What is a pubic rams fracture

A

type A pelvic ring fracture

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111
Q

What can cause pubic rami fractures

A
  • High energy blunt trauma

- Low energy falls from standing

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112
Q

What are investigations of pubic rami fractures

A
  • AP pelvic x-ray

- CT

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113
Q

How are pubic rami fractures managed

A

ATLS

Surgically

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114
Q

What is a main complication of pubic rami fractures

A

Intraperitoneal or retroperitoneal blood loss

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115
Q

In which gender are ACL tears more common

A

Female

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116
Q

When do ACL injuries tend to occur

A

During landing a jump or direct contact

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117
Q

How will ACL injury present

A

Rapid swelling and pain

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118
Q

Why do ACL injuries present with rapid swelling

A

ACL is highly vascularised and therefore results in haemoarthroses

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119
Q

What are two signs of ACL injury

A

Positive Lachman test

Positive anterior draw test

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120
Q

What is the most sensitive test for ACL injury

A

Lachman test

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121
Q

What is the role of ACL

A

It prevents anterior translation of the tibia relative to the femur

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122
Q

What mechanism of injury results in the unhappy triad

A

Lateral blow to the knee

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123
Q

What injuries occur in the unhappy triad

A

ACL Tear
MCL Tear
Medial meniscus tear

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124
Q

How are ACL tears initially investigated

A

AP and lateral x-ray to look for bony injuries as a cause of joint effusion

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125
Q

What is gold-standard imaging for ACL injury

A

MRI

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126
Q

What is first line management for ACL tears

A 
(POLICE)
Protection 
Optimal Loading 
Ice 
Compression
Elevation
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127
Q

What are the two ways to manage ACL tears

A
  1. Conservative - involves rehabilitation to strengthen the quadriceps and canvas knee splint
  2. Surgical = arthroscopic surgery that reconstructs the ACL from tendon or artificial graft
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128
Q

What is a complication of ACL tear

A

secondary OA

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129
Q

In which gender are patella fractures more common

A

Male

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130
Q

What is the peak incidence of patella fractures

A

20-50y

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131
Q

What causes patella fractures

A

Direct trauma to the patella (eg. RTA)

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132
Q

How do patella fractures present

A
  • Palpable defect

- Unable to perform straight leg raises

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133
Q

Why may an individual with patella fractures not be able to perform straight leg raises

A

Due to weakness in knee extensors

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134
Q

What is first-line investigation for patella fractures

A

AP and Lateral view X-ray

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135
Q

What are the two management strategies for a patella fracture

A
  1. Conservative

2. Surgical

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136
Q

What are the indications for conservative management of patella fractures

A
  • Individual can perform straight leg raises

- Articular step is <2mm

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137
Q

What is conservative management of patella fractures

A

Brace for 4-6W

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138
Q

What are the indications for surgical management of patella fractures

A

K-wires for cerclage

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139
Q

What is surgical management for patella fractures

A

Unable to perform straight leg raises. Or, articular step >2mm

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140
Q

How can ankle fractures be classified anatomically

A
  • isolated medial malleolus
  • isolated lateral malleolus
  • bimalleolar
  • trimalleolar
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141
Q

What classification system is used for lateral malleolus fractures

A

Weber’s

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142
Q

What is weber’s classification used for

A

Fractures of the lateral malleolus

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143
Q

What is a weber’s A fracture

A

Below syndesmosis

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144
Q

What is a weber’s B fracture

A

Level of syndesmosis

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145
Q

What is a weber’s C fracture

A

Above syndesmosis

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146
Q

Dave presents with a fracture at the level of the syndesmosis, what Weber grade are they

A

Weber B

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147
Q

Tim presents with a fracture above the syndesmosis, what Weber grade are they

A

Weber C

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148
Q

Mike presents with a fracture below the syndesmosis, what Weber grade are they

A

Weber A

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149
Q

What is a maisonneurve fracture

A

Spiral fracture of the fibula that extends to the syndesmosis widening the ankle joint

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150
Q

in which gender do ankle fractures occur more

A

Young males or Overweight middle-aged females

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151
Q

how will ankle fractures present

A

Diffuse ankle pain
Unable to weight bare
Tenderness @ site of injury

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152
Q

what is a syndesmosis

A

fibrous joint between bones held together by ligaments

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153
Q

what is the main differential for an ankle fracture

A

ankle sprain

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154
Q

where is the syndesmosis between in the ankle

A

between tibia and fibula

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155
Q

what rules are used to determine if someone should receive an x-ray following ankle trauma

A

Ottawa Ankle Rules

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156
Q

why were the ottawa rules developed

A

To reduce unnecessary imaging

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157
Q

what do the ottawa rules state

A

That if an individual has pain over the malleolar region and one of the following they should receive an x-ray:

  1. Unable to walk 4-steps
  2. Pain on palpation of posterior edge or tip of medial malleolus
  3. Pain on palpation of posterior edge or tip of lateral malleolus
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158
Q

what investigation is performed if ankle fracture is suspected

A

AP and Lateral X-Ray

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159
Q

what is first line management of suspected ankle fracture

A

Reduce the fracture under analgesia

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160
Q

why are ankle fractures promptly reduced

A

To prevent overlying skin necrosis

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161
Q

what is then put on following reduction of the ankle fracture

A

Below-knee back slab cast

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162
Q

what should be done prior to putting on a below the knee back-slab cast

A
  1. Check Neurovascular status

2. X-ray post reduction

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163
Q

what are the two management strategies for ankle fracture

A

Conservative

Surgical

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164
Q

when is conservative management for ankle fracture indicated

A
  • Elderly patients

- Weber A or B fractures with no talar displacement

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165
Q

why do elderly patients undergo conservative management of ankle fractures

A

As their bones are weaker and do not hold compression plates well

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166
Q

when is surgical management for ankle fractures indicated

A
  • Young patients
  • Webers B or C
  • Open fracture
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167
Q

what is surgical management of ankle fracture

A

Compression plate

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168
Q

what is a long-term complication of ankle OA

A

Secondary OA

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169
Q

what is a stress fracture

A

cracks in the bone caused by repetitive use that are insufficient to cause a fracture themselves

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170
Q

what is a stress fracture also referred to as

A

hairline fractures

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171
Q

what causes metatarsal stress fractures commonly

A

sudden increase in marching or running

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172
Q

explain how metatarsal stress fractures will present clinically

A
  • gradual onset of dull foot pain which worsens on weight-bearing/use
  • tender to palpation
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173
Q

how are stress fractures diagnosed

A

clinically

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174
Q

why is an x-ray not used to diagnose stress fractures immediately

A

as stress fractures do not immediately show on x-ray. They only tend to show once they start to heal

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175
Q

What is management of stress fractures

A

Conservative:

  • Rest
  • Orthoses
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176
Q

What is the lisfranc joint

A

Second metatarsal

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177
Q

What is a lisfranc fracture

A

Fracture/dislocaiton between second metatarsal and medial cuneiform

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178
Q

What can cause Lisfranc injuries

A
  • RTA
  • Fall from height
  • Fall off the kerb
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179
Q

How will a lisfranc fracture present clinically

A
  • Severe pain
  • Inability to weight bear
  • Bruising over medial bottom of the foot
  • Collapsed foot arches
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180
Q

What is characteristic of lisfranc injury

A

bruising over medial plantar aspect

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181
Q

Where is the lisfranc ligament and what is its function

A

ligament that connects the second metatarsal and medial cuneiform. It maintains integrity of midfoot arch

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182
Q

How will a Lisfranc fracture present on x-ray

A

Widening between second meta-tarsal and medial cuneiform

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183
Q

What are the two management strategies for lisfranc injury

A
  1. Conservative

2. Surgical

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184
Q

How are lisfranc fractures managed conservatively

A

Cast for 8W

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185
Q

How are lisfranc fractures managed surgically

A

ORIF

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186
Q

What is a complication of lisfranc fractures

A

Compartment syndrome of the medial foot

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187
Q

In which gender are achilles tendon ruptures more common

A

male

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188
Q

What is the peak incidence of achilles tendon ruptures

A

30-50y

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189
Q

What can cause Achille’s tendon rupture

A
  • Trauma during athletic sports

- Achilles tendonitis

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190
Q

what are two risk factors for achilles tendon rupture

A

Fluroquinolones

Glucocorticoids

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191
Q

how will achilles tendon rupture present

A
  • Sudden ‘snap/pop’ at the time of injury

- Sudden-onset severe pain at the achilles

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192
Q

what test will be negative in achilles tendon rupture

A

Simmond’s test

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193
Q

what is the achilles tendon

A

It is a tendon formed from the convergence of the gastrocnemius and soleus

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194
Q

where is rupture of the achilles tendon most common and why

A

5cm from the calcaneus - as this is a vascular watershed area

195
Q

how is achilles tendon rupture diagnosed

A

clinically

196
Q

what may US be used for

A

identify swelling

197
Q

what may MRI show

A

differentiate between partial and complete tear

198
Q

what are two management strategies for achilles tendon rupture

A
  1. Conservative

2. Surgical

199
Q

when is conservative management of achilles tendon rupture indicated

A
  • Older patients
  • Unfit for surgery
  • Relatively inactive
200
Q

what is conservative management of achilles tendon rupture

A

Analgesia
Gravity equinus cast
4W rest
Rehabilitation

201
Q

what are the indications for surgical repair of the achilles tendon

A
  • Young, active patients
  • Complete tear
  • Delayed healing with conservative measures
202
Q

What are the 3 directions the shoulder may dislocated

A
  1. Anterior
  2. Inferior
  3. Posterior
203
Q

What is the most common type of shoulder dislocation

A

Anterior (95%)

204
Q

What % of shoulder dislocations are

a. anterior
b. inferior
c. posterior

A

a. 95%
b. 1%
c. 4%

205
Q

what joint is most common to dislocate and why

A

shoulder (gleno-humeral) as the humeral head is too large for the glenoid fossa

206
Q

in which age group are shoulders most likely to dislocated

A

20-50y

207
Q

what gender has the highest incidence of shoulder dislocations

A

Male

208
Q

what causes anterior shoulder dislocations

A

trauma: extension and lateral rotation

209
Q

what typically causes posterior shoulder dislocations

A

un co-ordinated muscle contractions

210
Q

give 3 possible causes of posterior dislocations

A
  1. Epilepsy
  2. Electric shocks
  3. Lightening attacks
211
Q

what is a risk factor for anterior shoulder dislocation

A
  • Lax joint capsule

- Rotator cuff tear

212
Q

how will a shoulder dislocation present clinically overall

A
  • Sudden onset shoulder pain
  • Inability to move shoulder
  • Unable to palpate humeral head in glenoid fossa
213
Q

where will the humeral head be felt in anterior shoulder dislocation

A

BELOW the coracoid process

214
Q

how will the arm present in anterior shoulder dislocation

A

it will be abducted and externally rotated

215
Q

how will the shoulder look in posterior dislocation

A

flattening of the anterior shoulder with prominent posterior shoulder

216
Q

what is a good mnemonic to remember how the arm will looks in posterior shoulder dislocation

A

PADI

217
Q

how will the arm look in posterior shoulder dislocation

A

Posterior
ADducted
Internally rotated

218
Q

what nerve is there a risk of damage in anterior dislocations

A

Axillary.N

219
Q

how will damage to the axillary nerve present

A

Parasthesia over the lateral arm and inability to abduct the arm due to loss of motor control to the deltoid

220
Q

Why is there a high incidence of shoulder dislocations

A

as the humeral head is too large for the shallow glenoid fossa

221
Q

How are dislocations at the shoulder joint described

A

the glenohumeral joint is described in relation to the glenoid fossa

222
Q

Why do superior dislocations at the shoulder not occur

A

due to obstruction by the coraco-arcomio arch

223
Q

What movement causes anterior shoulder dislocations and why

A

extension and lateral rotation. as this forces the humeral head anteriorly and inferiorly - which is the weakest part of the joint capsule.

224
Q

What lesions may be seen in anterior shoulder dislocations

A

Bankart and Hill-Sachs lesions

225
Q

What is a hill Sachs lesion

A

compression fracture of postero-lateral humeral head against anteroinfeiror glenoid fossa seen in anterior dislocations

226
Q

What is a bankart lesion

A

detachment of anterior-inferior labrum with or without an avulsion fracture

227
Q

Where does the axillary nerve run and what does this mean for shoulder dislocations

A

around surgical neck of the humerus - therefore at risk of injury during dislocations and relocations.

228
Q

what is used to diagnose shoulder dislocation

A

lateral and AP x-ray of the shoulder

229
Q

what sign may be seen on x-ray in posterior dislocations

A

Lightbulb sign

230
Q

what is the lightbulb sign

A

On dislocation of the humerus it internally rotates causing the head to project from the glenoid fossa and look like a lightbulb anterior

231
Q

what % of anterior shoulder dislocations have hill Sachs lesions

A

40%

232
Q

what is a hill Sachs lesion

A

fracture of the postero-lateral humeral head

233
Q

what is a bankart lesion

A

avulsion fracture of the anterior-inferior glenoid labrum

234
Q

what other imaging modality may be used and why

A

MRI

235
Q

what are the two management approaches of shoulder dislocation

A
  1. Conservative

2. Surgical

236
Q

what are 3 indications for closed reduction of shoulder dislocation

A
  1. Anterior or inferior dislocation
  2. No fracture
  3. Posterior shoulder dislocation <6W ago
237
Q

what should be done after reduction and why

A

X-ray: to confirm position

Check neuromuscular status

238
Q

what are 3 indications for surgical management of dislocations

A
  1. Unsuccessful closed reduction
  2. Concomitant fracture
  3. Recurrent dislocation
239
Q

what is a major problem with shoulder dislocations

A

once the joint capsule is damaged there is a higher risk of re-dislocation

240
Q

what are 3 complications of shoulder dislocation

A
  1. Axillary nerve damage
  2. Brachial plexus damage
  3. Axillary artery/vein damage
  4. Rotator cuff tear
241
Q

how will axillary nerve damage present

A

Parasthesia over lateral shoulder and inability to abduct arm to 30’

242
Q

What is acromio-clavicular joint separation

A

Injury to acromio-clavicula joint with disruption of acromio-clavicular ligaments with or without disruption of coracoacromio ligaments

243
Q

What causes AC joint separation

A

Direct trauma to the AC joint

244
Q

How does AC joint separation present

A

Severe pain over the AC joint which may refer to the trapezius

245
Q

What is used to investigate AC joint separation

A

Lateral and AP x-ray

246
Q

What does management of AC joint separation depend on

A

The degree of displacement

247
Q

If separation is <200% what should be done

A

Sling for 1W

248
Q

if separation >200% what should be done

A

surgery: excise distal 1/3 clavicle and reconstruct ligaments

249
Q

What system is used to classify clavicular fractures

A

Allman

250
Q

What does the Allman classification system grade clavicle fractures based on

A

Location of the fracture along the clavicle - where the clavicle is divided into 1/3s

251
Q

What is type I Allman fracture

A

Fracture in the middle 1/3 of the clavicle

252
Q

What % of fractures are Allman Class 1 and why

A

75%. As the middle 1/3 of the clavicle is the weakest point

253
Q

Are class I fractures stable or unstable

A

Stable but often significant deformity is present

254
Q

What are class 2 Allman fractures

A

Fracture of lateral 1/3 of the clavicle

255
Q

What % of clavicular fractures are class 2

A

20%

256
Q

are class 2 fractures stable or unstable

A

unstable

257
Q

what are class 3 allman fractures

A

fracture in middle 1/3 of the clavicle

258
Q

what causes class 3 Allan fractures

A

often associated poly trauma

259
Q

why are class 3 fractures often associated with polytrauma

A

as mediastinum lies behind the medial 1/3 of the clavicle predisposing to pneumothorax and haemothorax

260
Q

Tim fractures medial 1/3 of the clavicle, what Allman class is this

A

Class 3

261
Q

Dave fractures middle 1/3 of the clavicle what Allman class is this

A

Class 1

262
Q

Josie fractures the lateral 1/3 of her clavicle, what Allman class is this

A

Class 2

263
Q

When is the peak incidence of clavicle fractures

A

Bi-peak:

  • Adolescents
  • > 60y
264
Q

Why doe clavicle fractures happen in over 60y

A

Due to weakened bone

265
Q

What are the two etiological mechanisms causing clavicle fractures

A
  • Direct Injury

- Indirect injury

266
Q

what is direct injury

A

Trauma to the clavicle

267
Q

what is indirect injury

A

Fall onto the shoulder

268
Q

how will a clavicle fracture present

A
  • Pain over the clavicle

- Worse on moving the arm

269
Q

what should be examined for in clavicle fractures and why

A
  • Neuromuscular injury: due to risk of damaging brachial plexus
  • Open wounds as the clavicle is subcutaneous and therefore is a risk of open fractures
270
Q

how will medial fragment in clavicle fracture present and why

A

pull upwards due to action of the SCM

271
Q

how is a suspected clavicle fracture investigated

A

AP and modified oblique x-ray

272
Q

what are the indications for CT scanning of clavicle fractures and why

A

Allman 3 fracture - due to unable to visualise on x-ray

273
Q

What is mainstay treatment of clavicle fractures

A

Conservative

274
Q

What are indications for surgical management of clavicle fractures

A
  • Open fracture
  • Comminuted
  • Does not heal with conservative management alone
  • > 100% displacement
275
Q

What surgery is performed for clavicle fractures

A

ORIF

276
Q

What is the average healing time for clavicular fractures

A

4-6W

277
Q

What is a complication of Allman 2 fractures

A
  • Brachial plexus injury

- Non-union

278
Q

What is a complication of Allman 3 fractures

A
  • Haemothorax

- Pneumothorax

279
Q

What is bicep tendon rupture

A

Injuries to the bicep causing complete or partial rupture of the tendon

280
Q

What are the two types of bicep tear

A
  1. Proximal biceps tear

2. Distal biceps tear

281
Q

What is a proximal biceps tear

A

Rupture at the origin of the long head of biceps brachii

282
Q

What % of biceps tears are proximal

A

95%

283
Q

What are distal bicep tears

A

Tear at the insertion point of the biceps brachii

284
Q

What % of biceps tears are distal

A

5%

285
Q

What is the most common type of biceps tendon rupture

A

Proximal biceps tendon rupture

286
Q

What may cause proximal biceps tendon rupture

A

Minimal trauma in presence of underlying disease

287
Q

What are 5 risk factors for proximal biceps tear

A
  • Elderly
  • Smoking
  • Glucocorticoids
  • Pre-existing shoulder disease
  • Over-head activities
288
Q

What causes distal biceps tear

A

Excessive eccentric loading of the biceps

289
Q

How will a proximal biceps tear present

A
  • Painless
  • No loss of function
  • May be palpable tenderness in intertubercular sulcus
  • Popeye sign
290
Q

What is popeye sign

A

Distal displacement of biceps belly on contraction

291
Q

how will distal biceps tear present

A
  • Sudden onset acute stabbing pain
  • Painful pop followed by weakness
  • Haematoma in middle region
  • Limited flexion and supination
292
Q

what movements does a distal biceps tear limit

A

Flexion and supination

293
Q

what test is used to look for distal biceps tear

A

Hook’s test

294
Q

what is the difference between clinical presentation of proximal and distal biceps muscles

A 
Distal = painful, LOF 
Proximal = painless, no LOF
295
Q

explain anatomy of biceps brachii

A

Biceps brachii has two heads. Long head attaches to supraglenoid tubercle of the scapula. Short head attaches to the coracoid process. Both then insert onto the radial tuberosity via bicipital aponeurosis

296
Q

how are biceps brachii tears diagnosed

A
  • Clinically

- MRI may be used to distinguish complete and partial tears

297
Q

how are proximal tears in biceps brachii managed

A

Conservative or surgically if highly active patient

298
Q

how are distal tears in biceps brachial managed

A

Surgical re-fixation

299
Q

when is surgical re-fixation of distal biceps brachii tears repaired

A

2-3W

300
Q

What is the age-distribution of olecranon fractures

A

young (high-energy) and old (low-energy)

301
Q

What may cause olecranon fractures

A
  • direct trauma

- fall onto outstretched hand

302
Q

How will olecranon fractures present clinically

A
  • elbow pain

- unable to extend the arm

303
Q

What is a sign associated with olecranon fractures

A
  • pain on palpating posterior elbow
304
Q

What should be checked in olecranon fractures

A
  • Neurovascular status

- For other injuries (as FOOSH can cause wrist fractures)

305
Q

What type of fracture is an olecranon fracture

A

Intra-articular

306
Q

What muscle inserts on olecranon

A

Triceps

307
Q

Why do olecranon fractures happen on falling onto an outstretched hand

A

FOOSH - causes sudden pull on the triceps may lead to fracture

308
Q

What imaging modality is used to investigate olecranon fractures

A

Lateral and AP x-rays

309
Q

What does the management of olecranon fractures depend on

A

Degree of displacement

310
Q

If displacement is less than 2mm, how should the olecranon fracture be managed

A

Conservative

311
Q

What is non-operative management of olecranon fractures

A

Immobilise at 60-90 degrees of flexion for 1-2W then start to move

312
Q

Which population is non-operative management of olecranon fractures increasingly used for

A

> 75y, regardless of displacement

313
Q

What is the criteria for operative management of olecranon fractures

A

> 2mm displacement

314
Q

When is tension band wiring used to repair olecranon fractures

A

if olecranon fractures are proximal to the coronoid process

315
Q

When is olecranon plating used to repair olecranon fractures

A

If olecranon fractures are distal to the coronoid process

316
Q

If there is an olecranon fracture distal to the coronoid process what should be used to repair it

A

Olecranon plating

317
Q

If the is an olecranon fracture proximal to the coronoid process what should be used to repair it

A

Tension band wiring

318
Q

Why is metal work typically removed later in olecranon fractures

A

Due to superficial nature of the injury

319
Q

What is the most common fracture at the elbow

A

radial head fracture

320
Q

What mechanism of injury causes a radial head fracture

A

fall onto outstretched hand - with the arm extended and pronated

321
Q

How will radial head fracture present

A
  • pain in elbow following FOOSH

- bruising and swelling of the elbow

322
Q

What are two signs of radial head fracture

A
  • tenderness on palpation over posterior elbow

- crepitus on supination and pronation

323
Q

What is an Essex-Lopresti Fracture

A

fracture of the radial head with dislocation at the distal radio-ulna joint

324
Q

Explain how radial head fractures occur

A

radial head is pushed against the capitulum of the humerus when there is axial loading of the fore-arum particularly when the arm is extended and pronated

325
Q

How are radial head fractures investigated

A

lateral and AP x-ray

326
Q

What sign may be seen in radial head fractures on x-ray

A

Sail sign

327
Q

What is sail sign

A

Elevation of anterior fat pad (appears as a sail) due to elbow effusion

328
Q

What system is used to classify radial head fractures

A

Mason system

329
Q

What is type I Mason fracture

A

There is no or <2mm displacement

330
Q

What is a type II Mason fracture

A

Partial articular fracture with >2mm displacement

331
Q

What is a type 3 Mason fracture

A

Comminuted fracture

332
Q

How is a type 1 Mason fracture repaired

A

Conservative management. 1W sling and early mobilisation.

333
Q

How is type 2 Mason fracture treated

A

Depends on mechanical blockage: either treated via ORIF or conservatively.

334
Q

How is type 3 mason fracture managed

A

ORIF

335
Q

What is a complication of radial head fractures

A

Secondary OA

336
Q

How can elbow dislocations be divided

A

simple + complex

337
Q

What is a
a. simple
b. complicated
elbow fracture

A

a. no associated fracture

b. associated fracture

338
Q

what is the main mechanism of injury of elbow dislocations

A

fall onto outstretched hand

339
Q

what type of dislocations are the majority of elbow dislocations

A

posterior dislocations

340
Q

what % of elbow dislocations are posterior

A

90%

341
Q

in which age group do elbow dislocations not tend to occur

A

Children - if child presents with elbow pain suspect supracondylar fracture

342
Q

how will elbow dislocations present

A
  • Painful and deformed joint
  • Swollen
  • Loss of function
343
Q

what is the terrible triad

A

Elbow dislocation with:

  • LCL injury
  • Radial head fracture
  • Coronoid process fracture
344
Q

what causes the terrible triad

A

Fall onto outstretched hand with rotational force causing a posterior-lateral dislocation

345
Q

what is the problem with terrible triad

A

Leads to a very unstable elbow and person is likely to have recurrence

346
Q

how are elbow dislocations diagnosed

A

AP and lateral x-rays

347
Q

how is elbow dislocation managed

A

closed reduction with sufficient analgesia

348
Q

if there is an elbow dislocation and fracture how should it be managed

A

ORIF

349
Q

What are 5 fractures affecting the radius

A 
Colle's 
Smith's 
Barton's 
Galeazzei's 
Monteggia's
350
Q

What is a Colle’s fracture

A

Fracture of the distal radius with dorsal displacement and angulation of the fragments

351
Q

When does a colle’s fracture commonly occur

A

FOOSH

352
Q

What is a smith’s fracture

A

Fracture of distal radius with dollar angulation of the distal fragment

353
Q

what cause’s a smith’s fracture

A

falling backwards onto outstretched hand or falling onto flexed wrists

354
Q

What is a Barton’s fracture

A

fracture of radius with associated dislocation of the radio-carpal joint

355
Q

What causes a Barton’s fracture

A

Fall onto extended and pronated wrist

356
Q

What is Monteggia’s fracture

A

fracture of ulna with dislocation of proximal radio-ulna joint

357
Q

What is Galeazzi’s fracture

A

fracture of ulna with dislocation of distal radio-ulna joint

358
Q

What is the most common wrist fracture

A

Colle’s (90%)

359
Q

Which age group does colle’s fracture tend to occur

A

Children (5-15) and Elderly People

360
Q

What is a major risk factor for colle’s fracture

A

Osteoporosis

361
Q

How will colle’s fracture present

A

Pain in the wrist following trauma

362
Q

What investigation is used to look for radial fractures

A

X-ray

363
Q

How are radius fractures managed

A
  1. Closed reduction under conscious sedation with Bier’s block. Then backstab case
364
Q

When is surgery required for radial fractures

A

Unstable fracture or signficantly displaced

365
Q

What are 2 complications of radial fractures

A

Mal-union: can lead to shorted radius compared to ulna causing pain and LOF

366
Q

In which gender are scaphoid fractures more common

A

Male

367
Q

What causes scaphoid fractures

A

High-energy trauma

368
Q

How do scaphoid fractures present clinically

A

Sudden-onset pain in the wrist with bruising

369
Q

What sign indicates scaphoid fracture

A

Pain on palpating the anatomical snuffbox

370
Q

How does the scaphoid received its blood supply

A

From dorsal brach of the radial nerve

371
Q

Explain why scaphoid fractures are serious

A

dorsal branch of the radial nerve passes form the proximal pole of the of the scaphoid to the distal pole. This means if blood supply is disrupted at the proximal pole (due to fracture) there is de-nervation of distal pole and can lead to avascular necrosis

372
Q

What is first line investigation for scaphoid fracture

A

x-ray (order scaphoid series)

373
Q

What is a scaphoid series of x-ray

A

Lateral
AP
Oblique

374
Q

What is the problem with scaphoid fractures on x-ray

A

Scaphoid fractures are NOT always visible on x-ray immediately

375
Q

If a high suspicion of scaphoid fracture, but x-ray is negative, what should you do

A

Immobilise the first an repeat the x-ray in 10-14d

376
Q

when may an MRI wrist be ordered for scaphoid fracture

A

If very high clinical suspicion of scaphoid fracture, but both x-rays have returned negative

377
Q

what does management of scaphoid fracture depend on

A

degree of displacement

378
Q

is scaphoid fracture is displaced, how is it managed

A

percutaneous variable pitched screws

379
Q

if not displaced how is scaphoid fractures managed

A

strict immobilisation with thumb sica splint

380
Q

when may an undisplaced scaphoid fracture go through surgical treatment and why

A

if proximal pole fracture due to high risk of AVN

381
Q

what is the main risk with scaphoid fracture

A

avascular necrosis

382
Q

what increases the risk of scaphoid fractures

A

more proximal

383
Q

why do scaphoid fractures have a higher risk of non-union

A

due to poor blood supply

384
Q

What tendon is affected in Jersey Finger

A

Flexor digitorum profundus

385
Q

What is the mechanism of injury for FDP injury

A

forced extension of finger at the DIPs or damage to FDP at it s insertion on the ulna

386
Q

How will FDP injury present

A
  • swelling of the DIPS

- inability to flex the DIPS

387
Q

What finger is most commonly affected in ‘jersey finger’

A
  • ring (4th) finger
388
Q

what is used to repair jersey finger

A

Kessler’s technique for surgical repair

389
Q

where does FDS insert

A

MCP and PIPs

390
Q

what will FDS injury cause

A

inability to flex at PIPs

391
Q

what causes mallet finger

A

damage to extensor digitorum tendon

392
Q

how will mallet finger present

A

inability to extend at the DIPs

393
Q

where does FDP originate

A

ulna surface

394
Q

where does FDP tendon pass through

A

carpal tunnel

395
Q

what is the action of the FDP

A

it is the only muscle to cause flexion and the DIPS

Dips - fDp

396
Q

where does FDS originate

A

It has two heads - one originates from the medial epicondyle and other from the ulna

397
Q

what is the action of FDS

A

causes flexion at the PIPs and MCPs

398
Q

what is traumatic spinal cord injury

A

traumatic injury that results in spinal cord damage resulting in a permanent or temporary change to neurological function, including paralysis

399
Q

how can traumatic spinal cord injury be divided

A

incomplete and complete

400
Q

what is complete traumatic spinal cord injury

A

injury across the entire width of the spinal cord resulting in both loss of sensation + paralysis

401
Q

what is incomplete spinal cord injury

A

injury across part of the spinal cord, leading to partial loss of sensation or movement below the level of injury

402
Q

what system is used to classify spinal injuries

A

AO Spine Injury Classification

403
Q

What causes traumatic spinal cord injury

A

Falls (40%)
RTA (35%)
Sports Injuries (12%)

404
Q

what can be used to classify the degree of injury to the spinal cord

A

American Spinal Injury Association classification

405
Q

What is ASIA A

A

Complete: transection across the entire width of the spinal cord causing loss of sensory and motor function

406
Q

What is ASIA B called

A

Sensory incomplete

407
Q

What does ASIA B entail

A

Motor function is not preserved below the level. Sensory function is preserved

408
Q

What is ASIA C called

A

Motor Incomplete

409
Q

What does ASIA C entail

A

Motor function is preserved. More than half of muscles have MRC grade <3

410
Q

What is ASIA D

A

Motor incomplete

411
Q

What dose ASIA D entail

A

Motor function is preserved. At least half of muscles have MRC grade <3

412
Q

What is ASIA E

A

Sensory and Motor Function are preserved

413
Q

What are the 2 mechanisms by which trauma causes injury to the spinal cord

A
  1. Initial acute impact

2. Compression of spinal cord

414
Q

What does initial acute impact cause

A

Initial impact causes contusion of the spinal cord

415
Q

What causes compression of the spinal cord

A

Displaced rigid structures (eg. IV disc) increase pressure which may block venous return and cause oedema. Oedema can compromise arterial supply resulting in ischaemia. Ischaemia to the spinal cord causes a pattern of injury termed gliosis

416
Q

How can spinal cord injury be classified

A
  1. Primary

2. Secondary

417
Q

What are primary injuries

A

Destructive forces that damage neural structures

418
Q

What are secondary injuries

A

Vascular, cellular and biochemical events that occur following injury which may worse the primary injury

419
Q

How is suspected spinal trauma managed

A

ATLS approach

420
Q

What is the ATLS approach

A

C, A-E

421
Q

how is the cervical spine immobilised

A

using a 3-point immobilisation technique

422
Q

how is suspected cervical spine injury investigated for

A
  • CT scan in adults

- MRI in children

423
Q

what criteria is used to determine if individuals need a CT scan

A

Canadian Cervical C Spine Rules

424
Q

what is used to investigate thoracolumbar trauma

A
  1. X-ray: if SCI with no neurological symptoms

2. CT: if abnormal x-ray or neurological signs

425
Q

What is canadian cervical C spine rules used for

A

to determine who needs imaging of the spine following trauma

426
Q

what does the Canadian cervical C spine rules divide individuals into

A

High risk + Low risk

427
Q

what are the 3 criteria for high risk in Canadian C spine rules

A
  1. > 65y
  2. Dangerous Injury Mechanism
  3. Parasthesia in upper extremities
428
Q

if high risk, how should the patient be managed with Canadian C spine rules

A

Immediate imaging prior to mobilisation

429
Q

which patients are low risk

A

If no high-risk features

430
Q

how should low risk patients in the Canadian C spine rules be managed

A

Do not need radiologic assessment prior to mobilising the spine

431
Q

if imaging is not required what is done

A

assess range of motion in the spine

432
Q

once cervical spine is stabilised what should be tested

A

regular neuromuscular assessments

433
Q

what is osteomyelitis

A

infection of the bone marrow

434
Q

what is vertebral osteomyelitis a form of

A

haematogenous spread of pathogen

435
Q

what pathogen commonly causes vertebral osteomyelitis

A

staphylococcus aureus

436
Q

which pathogen is the main cause in individuals with sickle cell disease

A

salmonella

437
Q

what 5 conditions may predispose to osteomyelitis

A
  • diabetes
  • sickle cell anaemia
  • IVDU
  • HIV
  • Alcohol excess
438
Q

how does vertebral osteomyelitis present clinically

A

Back pain worse on activity and at night. Not relieved by rest

439
Q

explain pathophysiology of vertebral osteomyelitis

A

Pathogens can spread haematogenously causing infection of the vertebrae

440
Q

how is vertebral osteomyelitis investigated

A
  • FBC (WCC)
  • CRP, ESR
  • X-Ray
  • MRI
  • CT-guided needle aspiration
441
Q

what is the problem with x-rays for vertebral osteomyelitis

A

Often signs of infection are not visible until 2W after

442
Q

what is the best imaging modality for vertebral osteomyelitis

A

MRI

443
Q

how is vertebral osteomyelitis managed

A

IV antibiotics

444
Q

what is discitis

A

Infection of vertebral disc

445
Q

how will discitis present

A
  • back pain

- general features: riggers, fever, sepsis

446
Q

what does neurological features in discitis indicate

A

epidural abscess

447
Q

what is the most common cause of discitis

A

staphylococcus aureus

448
Q

aside from bacterial, what else can cause discitis

A
  • viral
  • TB
  • aseptic
449
Q

what imaging modality is used for discitis

A

MRI

450
Q

what other investigation is used for discitis and why

A

CT-guided aspiration. Be able to obtain a culture to determine antibiotic sensitivity

451
Q

how is discitis managed

A

IV antibiotics for 6-8W

452
Q

what else should patients with discitis be assessed for and how

A

Endocarditis - via trans thoracic or trans transoesophageal ECHO

453
Q

what is the most common cause of spinal cord compression

A

metastatic cancer

454
Q

what cancers typically metastasise to the spine

A 
Breast
Lung
Thyroid
Kidney 
Prostate

: haematogenous, myeloma

455
Q

what are 3 other causes of spinal cord compression

A
  • Infection
  • Trauma
  • Disc prolapse
456
Q

what trauma can cause spinal cord compression

A

Vertebral fracture

457
Q

how does infection result in spinal cord compression

A

Abscess formation can compress the spinal cord

458
Q

why are disc prolapses a rare cause of spinal cord compression

A

Most common site of disc prolapse is L4-L5. This causes caudal equina compression and not spinal cord compression. As the spinal cord terminates at L1

459
Q

explain risk factors for spinal cord compression

A

Any pathology which results in narrowing of the spinal canal increases the risk of compression

460
Q

what conditions increase risk of spinal cord compression

A
  • RA
  • Ankylosing spondylitis
  • Degenerative conditions
  • Hypertrophy of ligamentous flavum
  • Osteophyte formation
461
Q

how will spinal cord compression present

A
  • Back pain exacerbated by increase in pressure and lying down
  • loss of sensation and proprioception
  • bilateral or unilateral weakness
462
Q

what do autonomic signs in spinal cord compression indicate

A

late phase

463
Q

what are 3 autonomic features in spinal cord compression

A
  • constipation
  • bowel incontinence
  • urinary incontinence
464
Q

will the signs of SCC be UMN or LMN

A

UMN

465
Q

why are signs of SCC UMN

A

as there is compression within the spinal cord (which contains upper motor neurons)

466
Q

what are the UMN signs seen in spinal cord compression

A

Hyper-reflexia and hypertonia below the lesion. At the level of the lesion there will be a loss of tone and reflexes as the lower motor neurone in the ventral horn is compressed causing a LMN deficit

467
Q

what is first-line investigation for for SCC

A

MRI spine

468
Q

what are the NICE guidelines for imaging for metastatic spinal cord compression

A

If an individual is diagnosed with metastatic cancer they should receive an MRI of the spine within 1W

469
Q

how is metastatic spinal cord compression managed

A
  • Immediate high dose corticosteroids

- Neurosurgical referral

470
Q

what is the best prognostic factor for spinal cord compression

A

Mobility at the time of treatment

471
Q

what is average survival rate for metastatic spinal cord compression

A

6 months

472
Q

what is a pathological fracture

A

fracture that occurs in abnormal bone

473
Q

what do pathological fractures commonly refer to

A

fractures secondary to malignancy

474
Q

what are other causes of pathological fractures

A
  • metabolic bone disease

- osteomyelitis

475
Q

what termed is used for fractures secondary to metabolic bone disease

A

insufficiency fractures

476
Q

what are 5 metastatic tumours that go to bone

A 
Breast
Lung
Thyroid
Kidney
Prostate
477
Q

what are 3 bone diseases that predispose to pathological fractures

A

Osteogenesis imperfecta
Osteoporosis
Paget’s disease

478
Q

what are 2 local benign conditions

A

Osteomyelitis

Solitary bone cysts

479
Q

what are 3 primary malignant tumours of the bone

A

Ewing’s sarcoma
Osteosarcoma
Chondrosarcoma

480
Q

if an individual has bone metastasis what scoring system is used to predict their risk of pathological fracture

A

Mirel’s scoring system

481
Q

what is the range of scores in mirel’s classification

A

4-12

482
Q

what does a mirels score >9 indicate

A

Prophylactic fixation should be done

483
Q

what does a mirels score <9 indicate

A

Treat with radiotherapy and continue cancer treatment

484
Q

what are the 3 most common sites for pathological fractures

A
  • Sub-trochanteric
  • Junction of humeral head to metaphysic
  • Vertebral body

Trauma + Orthopaedics (11 decks)

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