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Surgery finals > Hip and spine > Flashcards

Hip and spine Flashcards

1
Q

Describe the anatomy of the proximal femur

A

Head of femur
Neck of femur
2 trochanters- greater + lesser
-Between them is intertrochanteric line on Ant side

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2
Q

Describe the types of NOF and the clinical relevance

A

Broadly divided into
-Intracapsular: above the intertrochanteric line. Displaced vs non-displaced (Garden classification 1-4)
-Extracapsular: including or below the intertrochanteric line up to 5cm
Due to the blood supply to the femoral head (majority via circumflex arteries), intracapsular NOF risks avascular necrosis as it compromises blood supply. Therefore, these #s require different management

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3
Q

Describe the epidemiology + risk factors for NOF

A
  • Elderly
  • F > M
  • Osteoporotic
  • Frail/frequent falls
  • Multiple comorbidities eg. AF
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4
Q

Describe the presentation of NOF

A
  • Low energy fall +/- cardiac/syncopal episode
  • Hip/groin pain: constant, severe, exacerbated by movement, radiates to knee
  • Inability to weight-bear
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5
Q

Describe the signs of NOF on examination

A

-General: in pain, hypovolaemic
-Inspection: leg shortened + externally rotated, bruising, swelling
-Tenderness over the hip area
-Unable to SLR or weight-bear
+/- distal pulses or sensation

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6
Q

Describe the immediate management of suspected NOF

A

A to E approach

  • Examine hip + look for additional injuries
  • Analgesia ASAP (usually opioid)
  • Assess fluid status + resus if required
  • IV access + bloods: FBC, CRP, U+Es, clotting, G+S, glucose
  • ECG
  • Imaging: Xray hip AP and lateral views (or CT if traumatic) + CXR
  • Assess cognitive impairment eg. 4AT
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7
Q

Describe the overall management of confirmed NOF

A
  • Ortho referral
  • Make NBM
  • Analgesia regularly
  • IV fluids, IV antibiotics (prophylactic)

Conservative vs surgical management

  • Conservative not frequently offered, 6-8 wks bedbound
  • Surgical depends on type of fracture
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8
Q

Describe the types of surgical management of NOFs

A

Intracapsular:

  • Non-displaced: internal fixation w cannulated screws
  • Displaced: young- internal fixation, old-THR, unfit- hemiarthroplasty

Extracapsular:

  • Dynamic hip screw (trochanteric)
  • Intramedullary nail (subtrochanteric)
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9
Q

What are the important things to assess/consider in someone with hip fracture and why?

A
  • Type of fracture (influences Mx)
  • Cause of fall/injury (eg. arrhythmia? pneumonia?)
  • Cognitive impairment (cause, consent?)
  • Anticoagulation
  • Fitness for surgery eg. ECG, FBC, clotting
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10
Q

Describe the post-op management of hip fractures

A
  • Pain management
  • Monitor bladder + bowels
  • Wound care
  • DVT prophylaxis
  • Early mobilisation
  • MDT input with orthogeris: physio, OT, PT
  • Identify + treat underlying cause
  • Osteoporosis Mx eg. Vit D/Ca, DEXA, bisphos.
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11
Q

Describe the presentation of trochanteric bursitis

A
  • Gradual onset pain and swelling over lateral hip (greater trochanter)
  • Pain worse on movement, standing, lying on side
  • Stiffness
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12
Q

Describe the management of trochanteric bursitis

A

Conservative:

  • Rest + ice
  • Analgesia
  • Physio
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13
Q

Describe the complications of hip fractures

A
  • VTE
  • Avascular necrosis

Surgical/post-op:

  • Intra-op, anaesthetic
  • Non-union, failure of fixation
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14
Q

Describe the prognosis for hip fractures

A

10% die within 1 month, 30% within 1 year

Frequent loss of functional ability

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15
Q

Describe the classic presentation of transient synovitis

A

Child
Presenting w acute limp, hip pain, swelling + stiffness following viral infection
Not acutely inflammed eg red/hot

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16
Q

Describe the management of pubic rami fractures

A

Usually conservative, heal within 6-8 weeks

17
Q

What is disc prolapse?

A

Occurs when the nucleus pulposus herniates through the annulus fibrosis (inside of the disc through the outside eg. like jelly donut)

18
Q

Describe the presentation of disc prolapse

A
  • Low back pain: mechanical-achy, intermittent, exacerbated by movement, +/- radiation
  • Nerve root compression (radiculopathy) typically in L5 and S1 roots due to prolapse of L4/5 and L5/S1
19
Q

What is radiculopathy? What are some causes?

A

The clinical syndrome caused by nerve root compression
-Low back pain
-Pain in dermatomal distribution
-Shooting/tingling/numbness
-Decreased/absent reflexes
-Muscle weakness
Caused by narrowing/compression of the nerve root eg. disc degeneration, bony spurs, disc prolapse, tumour, stenosis. Overall, OA is typically responsible for these

20
Q

Describe the management of disc prolapse

A

Conservative:

  • Rest, heat, physio
  • Analgesia

Surgical:
-Discectomy, laminectomy

21
Q

Define spinal stenosis

A

Spinal stenosis is narrowing of the spinal canal

22
Q

Describe the aetiology of spinal stenosis

A

Typically caused by wear and tear (due to OA)

  • > specifically, facet joint OA
  • *Spondylosis

May also be caused by: iatrogenic (eg fusion), congenital, post-traumatic

23
Q

Define spondylosis. What are the potential consequences?

A

Spondylosis refers to degeneration of the spine eg. discs, facet joints
Spondylosis can lead to spinal stenosis and cord compression which present as myelopathy, radiculopathy, cauda equina syndrome etc.

24
Q

Describe the presentation of spinal stenosis

A

Presents with neurogenic claudication or radiculopathy
Claudication:
-Intermittent aching buttock/LL pain or heaviness when walking +/- numbness or tingling
-**Eased by leaning forward, worse on extension
-Progressively worsening

25
Q

Describe the signs of spinal stenosis on examination

A
  • Usually unremarkable
  • Stooped posture when walking
  • No major neuro deficits
  • Normal peripheral pulses
26
Q

What is the best imaging technique for spinal problems?

A

MRI

27
Q

Describe the management of spinal stenosis

A

Conservative:

  • Rest in acute episodes
  • Physio, heat, massage

Medical:

  • Course of NSAIDs
  • Transforaminal steroid injections
  • Chronic pain meds eg. gabapention

Surgical:
-If no improvement w medical. Decompression

28
Q

Define spondylosis, spondylolysis and spondylolisthesis

A

Spondylosis: generalised OA degeneration of the spine
Spondylolysis: stress fracture through the pars of the lumbar vertebrae
Spondylolisthesis: when a pars fracture ^ allows the affected vertebrae to slip anteriorly to the inferior vertebrae

29
Q

Describe the presentation of spondylolysis and spondylolisthesis

A

-May be asymptomatic
-Back pain common: worse on activity, radiates to bum
+/- myelopathy/radiculopathy in severe slips

30
Q

Describe the management of spondylolysis and spondylolisthesis

A

Conservative: often enough

  • Rest
  • NSAIDs
  • Physio, brace

Surgical:
-Spinal fusion

31
Q

Describe the aetiology of spinal fractures

A
  • Trauma
  • Osteoporosis
  • Tumours
  • Metabolic bone disease
32
Q

Where is the most common location for spinal fractures?

A

Lower thoracic spine, lumbar spine

Commonly thoracolumbar junction (trauma)

33
Q

Describe the types of spinal fracture and when they occur

A

-Compression: common in osteoporosis
-Fracture-dislocation: trauma
+ others

34
Q

Describe the presentation of spinal fracture

A

-Back pain: worse on movement, may radiate

+/- radiculopathy or myelopathy

35
Q

What does spinal decompression surgery mean? When is it used?

A

Any surgical procedure to relieve compression of the spinal cord/nerves eg. laminectomy, discectomy, foraminectomy
Used in conditions causing symptoms of compression:
-MSCC
-Spinal stenosis
-Spinal fracture
-Disc prolapse
-Spondylosis

36
Q

Describe the presentation of discitis

A

Low back pain: constant, non-mechanical, felt at night
Fever, unwell
Weight loss

RFs: IVDU, immunosuppression, DM

37
Q

Describe the investigations for discitis

A

Bloods: FBC, CRP, U+Es, LFTs, VBG, culture
Imaging: Xray lumbar spine, MRI

Surgery finals (16 decks)

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