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FRCR 2A (Crack The FRCR 2A) > 2. MSK (Trauma/Acquired) > Flashcards

2. MSK (Trauma/Acquired) Flashcards

1
Q

Stress fracture - definition

A

Abnormal stress on normal bone

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2
Q

Insufficiency fracture - definition

A

Normal stress on abnormal bone

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3
Q

Bone healing - features (2)

A

Takes 6-8 weeks usually (months for tibia).
Osteolytic phase precedes new bone formation.

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4
Q

Scaphoid fractures - trivia (3)

A

Most common carpal bone fracture.
70% occur at the waist.
Avulsion fractures most common at distal pole.

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5
Q

Scaphoid fracture -complications (4)

A

Proximal fractures most prone to AVN and non-union.
Blood supply is distal to proximal, so proximal pole is most prone to AVN.
First sign of AVN is sclerosis (dead bone can’t turnover).
AVN appearance on MRI is disputed. Most reliable sign is dark on T1.

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6
Q

SLAC wrist - definition/cause (2)

A

Scapho-lunate advanced collapse.
Occurs due to scapho-lunate ligament injury.

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7
Q

SNAC wrist - definition/cause (2)

A

Scaphoid Non-union Advanced Collapse.
Occurs due to scaphoid fracture.

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8
Q

SLAC/SNAC wrist - anatomy/complications (4)

A

Scaphoid wants to rotate in flexion, prevented by scapho-lunate ligament.
If this ligament is injured, the radial scaphoid space will narrow and the capitate will migrate proximally.
Radio scaphoid joint is therefore the first to develop degenerative changes.
Capitate migrates proximally, eventually leading to DISI

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9
Q

SLAC wrist Rx (2)

A

Depends on occupation of pt and their needs.
- Wrist fusion: Max strength, loss of ROM
- Proximal row carpectomy: Maintain ROM, loss of strength

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10
Q

Carpal dislocation - spectrum (8)

A

Scapholunate dissociation:
- SL >3mm, clenched fist view exaggerates this.
- Chronic SL dissociation leads to SLAC wrist.
Perilunate dislocation
- capitate is dorsally displaced, scaphoid and lunate correctly positioned
- 60% associated with scaphoid fractures.
Midcarpal dislocation
- Lunate is ventrally dislocated & capitate dorsally dislocated. Scaphoid is correct.
- Associated with triquetriolunate interosseous ligament disruption and with triquetrial fracture
Lunate dislocation
- lunate ventrally dislocated, scaphoid and capitate OK
- Happens with dorsal radiolunate ligament injury

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11
Q

DISI deformity (5)

A

Dorsal intercalated segmental instability.
Associated with Radial Sided Injury (Scapholunate side).
Lunate becomes free of stabilising force of scaphoid, and can rock dorsally.
SL injury is common, so this is common.
Causes widening of the SL angle (>60 degrees).

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12
Q

VISI deformity (5)

A

Volar intercalated segmental instability.
Associated with ulnar sided injury (Lunotriquetrial side).
Lunate no longer stabilised by lunotriquetrial ligament, and gets tilted volar by the scaphoid.
LT injury less common, so this is less common.
Causes narrowing of the SL angle (<30 degrees)

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13
Q

Bennett vs Rolando fractures (3)

A

Both fractures of base of first metacarpal.
Rolando is comminuted, Bennet is not.
Dorsolateral dislocation of Bennett fracture is caused by pull of the Adductor Pollicis Longus tendon.

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14
Q

Gamekeeper’s thumb (3)

A

Avulsion fracture of base of first proximal phalanx, with ulnar collateral ligament (UCL) disruption.
Stener lesion - adductor tendon gets caught in the torn edges of the UCL. Displaced ligament won’t heal and needs surgery.
Yo-yo appearance on MRI.

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15
Q

Carpal Tunnel Syndrome (4)

A

Median nerve distribution (thumb to radial aspect of 4th digit), often bilateral and may have thenar muscle atrophy.
Enlargement of median nerve on USS.
Usually due to repetitive trauma.
Also associated with dialysis.

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16
Q

Guyon’s canal syndrome (3)

A

Entrapment of ulnar nerve as it passes through Guyon’s canal (formed by pisiform and hamate).
Classically caused by handle bars (handle bar palsy).
Fracture of hook of hamate can also damage ulnar nerve.

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17
Q

Elbow/forearm fractures trivia (3)

A

Radial head fractures commonest in adults.
Supracondylar fractures commonest in kids (Sail sign, posterior is positive).
Capitulum fractures are associated with posterior elbow dislocation.

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18
Q

Essex-lopresti fracture

A

Radial head fracture with anterior dislocation of the distal radial ulnar joint.

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19
Q

Monteggia fracture

A

Proximal ulnar fracture with anterior dislocation of the radial head.

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20
Q

Galeazzi fracture

A

Radial shaft fracture with anterior dislocation of the ulna at the distal radial ulnar joint.

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21
Q

Cubital tunnel syndrome (3)

A

Due to repetitive valgus stress.
Ulnar nerve passes beneath the cubital tunnel retinaculum at the epicondylo-olecranon ligament or Osbourne band.
Can be due to tumour, haematoma, or accessory muscle, classically anconeus epitrochlearis (accessory anconeus).

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22
Q

Shoulder dislocation - types (3)

A

Anterior - by far most common
Posterior - Uncommon, usually seizure or electrocution
Inferior - Uncommon, Arm sticking above head, 60% nerve injury, usually axillary

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23
Q

Anterior shoulder dislocation - imaging (3)

A

Hill Sachs - posterolateral humeral head impaction fracture (best seen on internal rotation view)
Bankart - Anterior glenoid rim fracture (bony) or anterior inferior labrum tear
Greater tuberosity avulsion fracture (10-15% of over 40s)

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24
Q

Posterior shoulder dislocation - imaging (4)

A

Reverse Hill Sachs (aka trough sign) - anterior humeral head impaction fracture
Reverse bankart - Posterior glenoid rim
Rim sign - no overlap between glenoid and humeral head.
Arm may be locked in internal rotation on all views

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25
Q

Proximal humerus fracture (2)

A

Old lady falling on stretched arm.
Neer classification (how many parts humerus is in), 3 or 4 parts tend to do worse.

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26
Q

Shoulder replacement - types & when used (4)

A

Depends if rotator cuff is intact and if glenoid fossa is intact.
Cuff and Glenoid intact - resurfacing or hemi-arthroplasty
Cuff deficient, glenoid intact - Hemi-arthroplasty or reverse total arthroplasty
Cuff intact, glenoid deficient - total shoulder arthroplasty
Cuff and glenoid deficient - reverse shoulder arthroplasty

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27
Q

Complications of shoulder replacement (4)

A

Total shoulder arthroplasty - commonest complication is loosening of glenoid component.
- Can also get “Anterior escape”, anterior migration of humeral head after subscapularis failure
Reverse total shoulder arthroplasty - Posterior Acromion Fracture from excessive deltoid tugging (Reverse relies heavily on deltoid as it doesn’t need intact rotator cuff

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28
Q

Femoral neck fractures - trivia (anatomy) (2)

A

Medial is classic stress fracture location.
Lateral is classic bisphosphonate fracture location.

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29
Q

Hip dislocation (3)

A

Commonly associated with dashboard injuries.
Posterior dislocation much more common than anterior.
Posterior dislocation usually associated with fracture.

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30
Q

Anterior & posterior column of the hip (3)

A

Acetabulum supported by 2 columns of bone, which come together to form an inverted Y.
Iliopectineal line = anterior column, Ilioischial line = posterior column.
Both column fractures divide the ilium proximal to hip joint, meaning no articular surface of the hip attached to the axial skeleton, which is a problem.

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31
Q

Corona mortis (2)

A

Anastamosis of inferior epigastric and obturator vessels sometiems lies on the superior pubic ramus.
This can be injured during lateral dissection, sometimes used to repair hip.

32
Q

Hip fracture and AVN (2)

A

Displaced intracapsular fracture increases risk of AVN (vascular supply comes from circumflex femorals).
Degree of displacement corresponds with degree of AVN risk.

33
Q

Avulsion injury - trivia (2)

A

Seen more in kids than adults (because tendons are stronger than bones in kids).
Isolated lesser trochanter avulsion - suspect pathologic fracture.

34
Q

Avulsion at iliac crest caused by

A

Abdominal muscles

35
Q

Avulsion at ASIS caused by

A

Sartorius

36
Q

Avulsion at AIIS caused by

A

Rectus femoris

37
Q

Avulsion at Greater Trochanter caused by

A

Gluteal muscles

38
Q

Avulsion at ischial tuberosity caused by

A

Hamstrings

39
Q

Avulsion at pubic symphysis caused by

A

Adductor group

40
Q

Snapping hip syndrome (4)

A

Clinical sensation of snapping or clicking on hip flexion and extension
3 types:
External (most common) - Iliotibial band over greater trochanter
Internal - iliopsoas over iliopectineal eminence or femoral head
Intra-articular - labral tears/joint bodies

41
Q

Femoroacetabular impingement (FAI) (3)

A

Painful hip movement, caused by deformities of the hip/femoral head.
2 types - pincer impingement and cam impingement
Commonest location for acetabular labral tear = anterior superior.

42
Q

Pincer type FAI (3)

A

Over-coverage of the femoral head by the acetabulum
Seen in middle aged women
Cross over sign - anterior acetabular rim crossing over the posterior rim

43
Q

Cam type FAI (3)

A

Bony protrusion on the antero-superior femoral head-neck junction.
Seen in young men.
Pistol grip deformity of the femur.

44
Q

Sacral insufficiency fracture - causes (6)

A

Commonest: postmenopausal osteoporosis.
Also seen in:
- Renal failre
- RA
- Radiation
- Mechanical changes pos hip arthroplasty
- Long term steroid use

45
Q

Sacral insufficiency fractures - imaging (2)

A

Often occult on plain film.
Honda sign (H shaped increased uptake) on bone scan

46
Q

Segond fracture (3)

A

Lateral tibial plateau fracture.
Associated with ACL tear.
Occurs with internal rotation.

47
Q

Reverse segond fracture (4)

A

Medial tibial plateau fracture.
Associated with PCL tear.
Occurs in external rotation.
Associated with medial meniscus injury.

48
Q

Arcuate sign (2)

A

Avulsion of proximal fibula (insertion of arcuate ligament complex).
90% associated with cruciate ligament injury (usually PCL).

49
Q

Deep intercondylar notch sign (2)

A

Depression of lateral femoral conduly (terminal sulcus), secondary to impaction injury.
Associated with ACL tears.

50
Q

Patella dislocation (3)

A

Almost always lateral, medial patello-femoral ligament is injured.
Characteristic appearance on MRI:
- Classic contusion pattern.

51
Q

Patella Alta - causes (7)

A

Patella tendon rupture leads to unopposed upward pull from quads tendon, causing patella alta.
Classically associated with SLE.
Also seen in:
- elderly
- trauma
- athletics
- RA
“Bilateral patellar tendon rupture” = Chronic steroids

52
Q

Patella Baja (2)

A

Quads tendon rupture leads to unopposed downward pull, leading to Patella Baja.

53
Q

Tibial plateau fractures (3)

A

Most commonly due to axial loading.
Lateral way more common than medial (Medial is usually seen WITH lateral too).
Schatzker type 2 (split, depressed lateral fracture) is commonest.

54
Q

Pilon fracture (4)

A

a.k.a. tibial plafond fracture.
Commonly due to axial loading, talus driven into tibial plafond.
Comminution and articular impaction.
75% also get distal fibula fractures

55
Q

Tibial shaft fracture (2)

A

Commonest long bone fracture.
Many ways to repair it surgically.

56
Q

Tillaux fracture

A

Salter Harris 3 through the anterilateral aspect of the distal epiphysis.

57
Q

Triplane fracture

A

Salter Harris 4, vertical component through epiphysis, horizontal through physis, oblique through metaphysis.

58
Q

Maisonneuve fracture - definition/pathology/trivia (3)

A

Unstable fracture involving medial malleolus and/or disruption of the distal talofibular syndesmosis.
Forces begin distally (tibiotalar joint) and ride up syndesmosis to proximal fibula.
Does NOT extend into the hindfoot.

59
Q

Maisonneuve fracture - imaging (2)

A

Ankle with widened mortis on XR.
Look further up for proximal fibular shaft fracture.

60
Q

Cassanova fracture (3)

A

Bilateral calcaneal fractures - look for compression or burst fractures of the spine.
Occur due to axial loading.
Peroneal tendons can become entrapped within lateral calcaneal fractures.

61
Q

Bohler’s angle (2)

A

Line drawn between anterior and posterior borders of calcaneus on lateral view.
Normal >20 degrees. <20 concerning for fracture.

62
Q

Jones fracture (3)

A

Fracture of base of 5th metatarsal, 1.5cm distal to tuberosity.
Rx: Non-wt bearing cast
may need internal fixation due to risk of non-union.

63
Q

Avulsion fracture of 5th MT

A

More common than Jones #.
Classically dancer with lateral foot pain.
Can be 2ndary to tug from lateral cord of plantar aponeurosis or peroneus brevis.

64
Q

Stress fracture of 5th MT

A

High risk fracture, hard to heal

65
Q

Lisfranc injury (5)

A

Commonest dislocation of the foot.
Lisfranc joint is the articulation of the tarsals and metatarsal heads.
Lisfranc ligament connects medial cuneiform to the 2nd metatarsal base on the plantar aspect.
Rupture of ligament results in one of 2 parrrerns:
- Homo-lateral: Every MT moves lateral
- Divergent: 1st MT moves medial, others move lateral.

66
Q

Lisfranc injury - trivia (3)

A

Cannot exclude on non-wt bearing film.
Associated fractures most common at base of 2nd MT (Fleck sign - bony fragment in the LisFranc space between 1st MT and 2nd MT, associated with avulsion of LisFranc ligament).
Fracture non-union and post traumatic arthritis are complications of missed fractures.

67
Q

Stress fracture vs insufficiency fracture

A

Stress fracture = abnormal stress on normal bone
Insufficiency fracture = normal stress on abnormal bone

68
Q

Compressive side vs tensile side (5)

A

Relates to femoral neck and tibia.
Compressive side fractures are constantly being pushed together, hence they do well as they heal well.
Tensile side fractures are constantly being pulled apart, hence they do poorly.
Femoral neck: tensile = lateral.
Tibia: tensile = anterior

69
Q

Femoral stress fracture (3)

A

Compressive (medial) more common
usually seen in younger people along inferior femoral neck.
Tensile (lateral) more common in old people

70
Q

Tibial stress fracture (5)

A

Commonest site of stress fracture in young athletes.
Most common on compressive side (posterior medial)
Most common in proximal or distal third.
Less common on tensile side (these favor mid shaft).
“Dreaded black lines” as they often don’t heal.

71
Q

SONK (5)

A

Spontaneous osteonecrosis of the knee.
Type of insufficiency fracture.
Classically old ladies, sudden pain after rising from seated.
Can be seen in younger people, after meniscal surgery.
Favours medial femoral condyle (area of max weight bearing).

72
Q

Navicular stress fracture (2)

A

Runners on hard surfaces.
Navicular is high risk of AVN.

73
Q

March fractures

A

Metatarsal stress fracture, classically seen in military recruits.

74
Q

Calcaneal stress fracture (3)

A

Calcaneus is most fractured tarsal bone.
Usually intra-articular (75%).
Stress fracture with fracture line perpendicular to trabecular lines.

75
Q

High risk stress fractures (7)

A

low likelihood of uncomplicated healing with conservative management.
Femoral neck (tensile)
Transverse patella
Anterior tibial fracture (midshaft)
5th metatarsal
Talus
Tarsal navicular
Sesamoid great toe

76
Q

Low risk stress fractures (5)

A

High likelihood of uncomplicated healing with conservative Rx
Femoral neck (compressive),
Longitudinal patella
Posteriomedial tibial fracture
2nd and 3rd metatarsal
Calcaneus

FRCR 2A (Crack The FRCR 2A) (55 decks)

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