__Y6 Ortho

Question 1

Clinical signs of a fracture

Answer 1

Pain, deformity, swelling
Crepitus
Adjacent structural injury - nerve, vessels, ligaments, tendons

Question 2

Management of fractures summary

Answer 2

Reduce > Hold (metal/non-metal) > Rehabilitate (move, physio, use)

Question 3

Reduction options

Answer 3

Closed - manipulation or traction (skin or skeletal)

Open - mini-excision or full exposure

Question 4

Hold options

Answer 4

Closed - plaster or traction (skin or skeletal)

Fixation:

Internal - intramedullary nail/pins, extramedullary plate/screws/pins

External - mono/multiplanar

Question 5

Rehabilitate options

Answer 5

Use, move, strengthen, weight bear

Consider pain relief

Question 6

Complications of fractures

General and specific

Answer 6

General - DVT, infection, fat embolus, prolonged immobility (UTI, chest infection)

Specific - neurovasc/muscle/tendon injury, non-union or mal-union 
Local infection
Degenerative change/OA
Avascular necrosis
Growth disturbance
Compartment syndrome

Question 7

What do you FEEL for in ortho exam?

Answer 7

Pain, effusion, temperature (PET)

Question 8

What do you LOOK for in ortho exam?

Answer 8

Scars, swellings, deformities, redness

Question 9

Special tests in Knee exam

Answer 9

Collaterals
Cruciates
Cartilage (McMurray)

Question 10

Special tests in Hip exam

Answer 10

Trendelenburg
Thomas’ (fixed flexion deformity)
Tape (leg length discrepancy)

Question 11

Shoulder exam movements

Answer 11

Movements (active and passive) - ad/abduction, flex/ext, ex/int rotation

I - Impingement (Kennedy-Hawkins tests, arm and elbow 90 degrees, flap up and down + painful arc test)

S - Supraspinatus - empty beer can

I - Infraspinatus - lower external rotation vs resistance (arm at side, elbow bent 90)

T - Teres Minor - upper external rotation vs resistance (arm at 90 abduction, elbow bent 90)

S - Subscapularis - Gerber Lift-Off, place hand on lower back and ask them to push their hand off)

Question 12

Knee x-ray requests?

Answer 12

Both weight bearing and non-weightbearing

3 views - AP, lateral, sky-line

Question 13

X-ray signs of osteoarthritis

Answer 13

Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

(LOSS)

Question 14

Shoulder pain differentials

Answer 14

Subacromial impingement
Rotator cuff tear
Frozen shoulder (adhesive capsulitis)
OA, septic arthritis, gout, rheumatoid arthritis

Question 15

Hip pain differentials

Answer 15

Post-operative abductor weakness/rupture
Fixed flexion deformity
Leg length discrepancy
Loosened prosthesis/infection
OA
Radiating back pain

Question 16

Heberden’s nodes and Bouchard’s nodes

What are they and in what condition are they usually found?

Answer 16

Osteoarthritis

Heberden’s - bony prominence at DIP joints

Bouchard’s - at PIP joints

Question 17

Lab findings in rheumatoid arthritis

Answer 17

Anti-CCP,
+ve rheumatoid factor
Elevated CRP and ESR