fracture healing / infection

Question 1

most common organisms is osteomyelitis

Answer 1

staph aureus

Question 2

imaging modality of choice for avascular necrosis

Answer 2

MRI

Question 3

Salter haris classification of paeds fractures

Answer 3

LOOK THIS UP

Question 4

what is a Salter Harris fracture (paeds)

Answer 4

one that involves the growth plate

Question 5

what is the significance of the salter harris gradings

Answer 5

worse the fracture grading (5 is worse and indicated a crush injury), then the more likely it s that growth will be disturbed

Question 6

what is a greenstick fracture

Answer 6

unilateral cortical breach only

Question 7

most common organism in septic arthritis is

Answer 7

staph aureus

Question 8

key symptoms of septic arthritis

Answer 8

red, hot, swollen joint, reduced ROM and systemic signs

Question 9

IX for septic arthritis

Answer 9

FBC, U+E, CRP, blood cultures, joint aspiration and MC+S

Question 10

Abx for septic arthritis

Answer 10

IV flucloxacillin

Question 11

Complications of septic arthritis

Answer 11

sepsis, osteomyelitis, joint destruction

Question 12

first stage of fracture healing

Answer 12

haeamtoma formation and inflammation where bleeding stops and dead tissue removed (weeks 0-2)

Question 13

whats the second stage of fracture healing

Answer 13

soft callus formation (2-3 weeks)–>angiogenesis and granulation tissue makes a cartilaginous network

Question 14

what is the third stage of fracture healing

Answer 14

hard callus formation (3-6 weeks) where the cartilaginous network undergoes ossification

Question 15

how long does remodelling occur for in bone healing

Answer 15

8 weeks to 2 years

Question 16

what is second healing in bone

Answer 16

when there is the formation of a callus (This occurs when there is some movement at the fracture site)

Question 17

what is primary bone healing

Answer 17

where there is reestablishment of the cortex without formation of a callus (occurs when there is complete stability - screws/plates)

Question 18

what causes non union in bone healing

Answer 18

when there is inadequate stability or inadequate blood flow

Question 19

RF for non union in bone healing

Answer 19

smoking, age, DM

Question 20

what are the options in helping union of a bone

Answer 20

dietary supplements, bone stimulators (US waves which stimulate growth factors) or bone grafts

Question 21

what are BMPs

Answer 21

bone morphogenetic proteins which induce formation of bone and cartilage

Question 22

what are kanavels 4 signs of a tendon sheath infection

Answer 22

1) finger held in slight flexion
2) fusiform swelling
3) tenderness along the sheath
4) pain on passive extension

Question 23

what is a flexor tendon sheath infection

Answer 23

the flexor sheath where the finger tendons run get infected - can be proceeded by a penetrative injury. Emergency as causes a raised pressure with the sheath with compromises the finger

Question 24

Mx of a flexor tendon sheath infection

Answer 24

if presenting early can do hand immobilisation and IV abx but normally requires surgery with a flexor tendon sheath washout

Question 25

Complications of a tendon sheath infection

Answer 25

necrotising fasciitis

Question 26

how might avascular necrosis appear on xray

Answer 26

sclerosis and flattening of the femoral head

Question 27

things to comment on in a MSK xray

Answer 27

name, age, gender of patient
what the xray is imaging (this is an xray of the Left hip)
Comment on projection (AP)
Type of fracture eg oblique / transverse and whether it is displaced or not displaced

Question 28

definition of a comminuted fracture

Answer 28

> 2 fragments

Question 29

what is spondylodiscitis

Answer 29

infection of the disc and vertebrae normally with staph aureus

Question 30

Ix for spondylodiscitis

Answer 30

blood cultures as can get a bacteraemia and MRI

Question 31

Mx for spondylodiscitis

Answer 31

Abx for 6 weeks, spinal surgery input, immobilisation

Question 32

what is cervical spondylosis

Answer 32

age related wear and tear of the discs which causes pain and stiffness, may also cause radicular symptoms if the nerve roots become compressed

Question 33

RF of cervical spondylosis

Answer 33

neck trauma, age, congenital bony abnormalities

Question 34

what is cervical spondylosis a good differential for

Answer 34

PMR

Question 35

what is spondylolisthesis

Answer 35

where the proximal vertebrae displaces forward (due to fracture in the pars interarticularis)

Question 36

symptoms of spondylolisthesis

Answer 36

lower back pain that is worse on movement, tight hamstrings, pain in the legs that may extend down the thighs

Question 37

red flags of back pain

Answer 37

thoracic tenderness, pain that is not relieved by lying down, history of malignancy, systemic signs, <20 or >55,

Question 38

pathophysiology of compartment syndrome

Answer 38

raised intracompartmental pressure (due to bleeding, oedema, inflammation), veins compressed first and then arterial blood supply compromised

Question 39

presentation of lumbar stenosis

Answer 39

pain and claudication like pain but this is better going up hill

Question 40

Mx of lumbar stenosis

Answer 40

laminectomy

Question 41

Signs of psoas abscess

Answer 41

fever, back pain, limb

Question 42

RF for psoas abscess

Answer 42

crohns, UTI, diverticultiis, IVDU

Question 43

imaging of choice for a psoas abscess

Answer 43

CT abdomen

Question 44

what is firstline for back pain

Answer 44

NSAID (and stay physically active)