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Musculoskeletal > Injury + Surgery > Flashcards

Injury + Surgery Flashcards

1
Q

what is the pathogenesis of avascular necrosis of the femoral head?

A
  • increased venous pressure in femoral head

- pressure cuts off arterial supply

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2
Q

what are the 3 zones of cartilage?

A

superficial zone
transitional zone
deep zone

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3
Q

what is the orientation of the cartilage fibres in the superficial zone?

A

parallel to the surface

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4
Q

what is the orientation of the cartilage fibres in the transitional zone?

A

randomly orientated

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5
Q

what is the orientation of the cartilage fibres in the

A

perpendicular to the surface

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6
Q

what section of the cartilage must the damage reach for healing to occur?

A

the tidemark

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7
Q

what cartilage type is the hyaline cartilage replaced with during healing?

A

fibrocartilage

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8
Q

what is protrusio?

A

when the femur starts to protrude into the acetabulum itself

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9
Q

which is protrusio more common in- RA or OA?

A

rheumatoid arthritis

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10
Q

what is an osteotomy?

A

a controlled cut of the bone in order to realign or redistribute weight

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11
Q

what is a CAM bony feature of the hip joint? (abnormal)

A

a bigger bump of the femoral neck (no normal taper)

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12
Q

what is a pincer bony feature of the hip joint? (abnormal)

A

extra bone on the lateral side of the acetabulum

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13
Q

what is the surgical treatment of an asymptomatic pincer or CAM feature on a hip joint?

A

nothing

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14
Q

what is the surgical treatment of a symptomatic pincer or CAM feature on a hip joint?

A

shaving of the area of bone to reshape

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15
Q

what is the surgical management of early avascular necrosis?

A

decompression

drill a hole to let pressure escape

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16
Q

what are the 3 main non-surgical managements of an arthritic hip joint?

A

weight loss
analgesia
physiotherapy

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17
Q

when is proprioception more of an issue- hip or knee replacements?

A

knee replacements

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18
Q

compare hip arthritis pain to trochanteric bursitis pain?

A

hip arthritis pain: generalised achy pain, tender over groin

trochanteric bursitis: localised lateral hip pain, not tender over groin

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19
Q

why can only the peripheral 1/3 of a meniscus be expected to heal?

A

only the peripheral 1/3 has a blood supply

the rest of the meniscus is avascula

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20
Q

compare the medial and lateral menisci in terms of mobility?

A

medial menisci- fixed

lateral menisci- more mobile

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21
Q

which compartment does the knee mainly pivot on during flexion and extension?

A

medial compartment

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22
Q

due to the knee mainly pivoting on the medial compartment during flexion and extension, what way does the tibia slightly rotate during each movement?

A

flexion- slight internal rotation

extension- slight external rotation

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23
Q

why is the medial meniscus under greater stress than the lateral menisci?

A

because pivoting of the tibia mainly occurs on the medial compartment

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24
Q

which menisci is more likely to tear- medial or lateral?

A

medial menisci

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25
Q

what ligament in the knee is the main resistor of valgus stress?

A

medial collateral ligament

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26
Q

what ligament in the knee is the main resistor of varus stress?

A

lateral collateral ligament

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27
Q

what ligament in the knee is the main resistor of anterior subluxation of the tibia?

A

anterior cruciate ligament

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28
Q

what ligament in the knee is the main resistor of posterior subluxation of the tibia? (ie anterior subluxation of the femur)

A

posterior cruciate ligament

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29
Q

what ligament is the main resistor of excessive internal rotation of the tibia?

A

anterior cruciate ligament

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30
Q

what ligament is the main resistor of hyperextension of the knee?

A

posterior cruciate ligament

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31
Q

what ligaments are the main resistor of external rotation of the tibia?

A

posterolateral corner ligaments

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32
Q

what is the posterolateral corner made of

A

posterior cruciate ligament
lateral collateral ligament
smaller ligaments
popliteus

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33
Q

compare the medial and lateral collateral ligaments in terms of capacity to heal?

A

MCL- great capacity to heal

LCL- poor capacity to heal

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34
Q

what type of instability may a MCL rupture lead to?

A

valgus instability

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35
Q

what type of instability may a ACL rupture lead to?

A 
rotatory instability
(excessive internal rotation)
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36
Q

what type of instability may a PCL rupture lead to?

A

recurrent hyperextension
or
instability when descending staids

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37
Q

what type of instability may a posterolateral corner rupture lead to?

A

varus instability
and
rotatory instability [excessive external rotation]

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38
Q

when must a longitudinal tear in a meniscus be in order to heal?

A

peripheral

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39
Q

how do younger patients get meniscal tears?

A

trauma-
sporting injury (usually twisting)
getting up from squatting position

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40
Q

how do older patients get meniscal tears?

A

atraumatic spontaneous degenerate tears

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41
Q

what are 50% of ACL tears accompanied by?

A

meniscal tear

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42
Q

what is the investigation of choice for a suspected meniscal tear?

A

MRI

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43
Q

what main type of meniscal tears do not heal?

A

radial tears

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44
Q

when do you consider a arthroscopic menisectomy?

A

for meniscal tear with:

  • mechanical symptoms (eg painful catching or locking)
  • irreparable tears
  • failed meniscal repair
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45
Q

what type of menisci tear can give you an acute locked knee?

A

bucket handle tear

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46
Q

what is the treatment for acute locked knee due to a bucked handle tear?

A

urgent surgery

-arthroscopic repair

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47
Q

what will happen to the knee of a patient with acute locked knee if the knee remains locked?

A

fixed flexion deformity

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48
Q

if the acute locked knee is irreparable, what is the next step to unlock the knee and prevent further damage?

A

partial menisectomy

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49
Q

what type of patients is surgery for degenerative meniscal tears reserved for?

A

patients with mechanical symptoms

not solely for pain

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50
Q

what is the grading system of ligament injuries?

A

grade 1 - sprain, some fibres are torn but all macroscopic structures intact

grade 2 - partial tear, some fascicles disrupted

grade 3 - complete tear

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51
Q

what type of injuries cause MCL tears?

A

valgus stressing injuries

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52
Q

what is the main treatment of MCL tears?

A

bracing, early motion and physio

rarely require surgery

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53
Q

what type of injuries cause ACL tears?

A

twisting injuries

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54
Q

what type of injuries causes LCL tears?

A

varus stressing injuries

hyperextension injuries

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55
Q

what type of injuries cause PCL tears?

A

direct blow to anterior tibia

hyperextension injuries

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56
Q

what type of surgery is used for the treatment of an ACL tear?

A

ACL reconstruction with a graft

ACL repair doesnt work

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57
Q

what is the most commonly used graft for ACL reconstruction?

A

autograft from hamstringe tendon

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58
Q

how can physiotherapy help to stabilise ACL deficient knees?

A

builds up the surrounding muscles

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59
Q

what is the ACL rupture rule of thirds?

A

1/3 patients compensate and are able to function well (no surgery needed)
1/3 patients can avoid instability by avoiding certain activities (no surgery needed)
1/3 patients do not compensate and have freq instability or cannot gt back into high impact sport (surgery might be needed)

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60
Q

what is the role of surgery (ACL reconstruction) in ACL rupture?

A

consider when:

  • rotatory instability does not respond to physiotherapy
  • young adult/adolescent
  • patient keen on high impact sport
  • when a meniscal repair also has to be done
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61
Q

does ACL reconstuction affect future osteoarthritis risk?

A

if you rupture your ACL you will get osteoarthritic changes within 10 years, regardless of surgery

ACL reconstruction may even accelerate the osteoarthritic process

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62
Q

what nerve is commonly affected in LCL injury?

A 
common fibular (peroneal) nerve
[palsy]
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63
Q

what is the treatment for a complete LCL rupture?

A

urgent repair (within 2-3 weeks)

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64
Q

where does knee pain and bruising occur in a PCL rupture?

A

popliteal fossa

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65
Q

when does PCL require reconstruction?

A

if part of a multiligament knee injury

this is more common than isolated PCL ruptures

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66
Q

what are the 3 major complications of knee dislocation?

A
  • popliteal artery tear
  • nerve injury (common fibular)
  • compartment syndrom
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67
Q

what needs to be done ASAP with a knee dislocation?

A

emergency reduction

check neurovascular status

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68
Q

why do you only operate on a knee dislocation a few weeks after the trauma?

A

wounds don’t close so leave fracture blisters

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69
Q

what are the 4 main causes of weakened tendons that can lead to extensor mechanism rupture?

A
  • previous tendonitis
  • steroids
  • chronic renal failure
  • drugs (eg ciprofloxacin)
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70
Q

what is the main clinical test that indicates extensor mechanism rupture?

A

unable to perform straight leg raise

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71
Q

what is the treatment of extensor mechanism rupture?

A

surgical repair

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72
Q

what does a pop at the time of knee trauma suggest?

A

ACL rupture

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73
Q

what does a haemarthrosis (within an hour) within the knee joint suggest?

A

ACL rupture

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74
Q

what does an effusion (within a day) within the knee joint suggest?

A

meniscal or chondral injury

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75
Q

why can haemarthrosis cause generalised knee pain?

A

blood is an irritant to the knee capsule

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76
Q

why does ACL rupture cause a haemarthrosis?

A

because the ACL has a big blood vessel through it which can rupture

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77
Q

what does knee locking suggest?

A

bucket handle meniscal tear

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78
Q

what does localised pain on joint line suggest?

A

meniscal tear

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79
Q

what are the 4 main substances which comprise hyaline cartilage?

A

water
collagen
proteoglycans
chondrocytes

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80
Q

what type of strength do the proteoglycans provide the hyaline cartilage with?

A

compressive strength

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81
Q

what type of strength does the collagen provide the hyaline cartilage with?

A

tensile strength

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82
Q

how do the proteoglycans provide compressive strength to hyaline cartilage?

A

hydrophillic so attract water and expand like a balloon

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83
Q

what are the 2 main categories of articular cartilage defects?

A

traumatic

atraumatic

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84
Q

what are the 3 main subgroups of atraumatic articular cartilage defects?

A
  • osteochondritis dissecans
  • osteoarthritis
  • inflammatory arthritis
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85
Q

what is osteochondritis dissecans?

A

a joint condition causing necrosis of subchondral bone due to lack of blood supply
the bone and cartilage fragment can then break free and cause pain/hinder joint motion

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86
Q

who most commonly gets osteochondritis dissecans?

A

adolescence

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87
Q

what is the name of the surgical techniques used for a defect in the articular cartilage (that wont heal itself)?

A

cartilage regeneration techniques

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88
Q

what are the 4 main cartilage regeneration techniques?

A
  • drilling/ microfracture
  • osteochondral autograft/allograft
  • mosaicplasty
  • membrane-induced autologous chondrocyte implantation (MACI)
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89
Q

what is the purpose of drilling/ microfracture for the treatment of a defect in articular cartilage?

A

causes bleeding which stimulates stem cells to come in and differentiate into chondroblasts
(cartilage regeneration technique)

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90
Q

what is osteochondral autograft or allograft?

A

taking cartilage from other areas of the bodyfrom donors

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91
Q

what is mosaicplasty?

A

taking small fragments of cartialge from low-weight bearing surfaces and inserting them into the bigger section of defective cartilage

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92
Q

which of the cartilage techniques is used in the NHS?

A

microfracture

simplest and cheapest technique

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93
Q

compare the causes of shoulder pain of a young adult, middle aged adult or elderly adult?

A

young adult- instability
middle aged- rotator cuff tear or frozen shoulder
elderly- glenohumeral OA

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94
Q

what is impingement syndrome?

A

when the tendons of the rotator cuff muscles (especially supraspinatus) are compressed within the tight subacromial space during movement producing pain

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95
Q

why does a patient with impingement syndrome typically have a painful arc between 60 to 120 degrees of abduction?

A

painful as the inflamed area of supraspinatus tendon passes through the subacromial space

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96
Q

what are the 3 main causes of impingement syndrome?

A
  • tendonitis subacromial bursitis
  • acromioclavicular OA with inferior osteophyte
  • a hooked acromion
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97
Q

what are the 2 clinical tests for suspected impingement syndrome?

A

painful arc

Hawkins-Kennedy test

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98
Q

what is the first line treatment of impingement syndrome?

A

NSAIDs
analgesics
physio
subacromial steroid injections

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99
Q

if non-operative management of impingement syndrome is ineffective, what surgical management can be carried out?

A

subacromial decompression surgery

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100
Q

what is the non-operative management for rotator cuff tears?

A

physiotherapy and subacromial steroid injections

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101
Q

what is the operative management for rotator cuff tears?

A

rotator cuff repairs with subacromial decompression

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102
Q

why do rotator cuff repairs fail in a 3rd of patients?

A

the tendon is usually disease or retracted too far

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103
Q

why do middle aged patients commonly get rotator cuff tears?

A

because rotator cuff muscles can tear with minimal or no trauma as a consequence of degenerate changes in te etendons

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104
Q

what are the 3 muscles most commonly involved in rotator cuff tears, and which out of theses is the most common?

A

supraspinatus (most common)
subscapularis
infraspinatus

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105
Q

how are rotator cuff tears confirmed?

A

ultrasound or MRI

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106
Q

what is frozen shoulder?

A

when the capsule and glenohumeral ligaments become inflamed and so thicken and contract
(adhesive capsulitis)

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107
Q

what is the principle clinical sign of frozen shoulder?

A

loss of external rotation

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108
Q

what are the 3 conditions associated with frozen shoulder?

A

diabetes
hypercholesterolaemia
dupuytren’s disease

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109
Q

how long does frozen shoulder usually last?

A

18-24 months

pain first, then stiffness

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110
Q

what is acute calcific tendonitis?

A

calcium deposition in the supraspinatus tendon which causes acute severe shoulder pain

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111
Q

what can you see on xray of acute calcific tendonitis?

A

calcium deposition in the supraspinatus tendon just proximal to the greater tuberosity

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112
Q

how is acute calcific tendonitis managed?

A

pain relief- subacromial steroid and local anaesthetic injections
(condition is self-limiting)

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113
Q

what are the 2 types of shoulder instability?

A

traumatic

atraumatic

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114
Q

in traumatic instability of the shoulder what direction of dislocation mainly occurs?

A

anterior dislocation

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115
Q

in atraumatic instability of the shoulder what direction of dislocation occurs?

A

multidirectional

inferior, anterior or posterior

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116
Q

what type of patients get atraumatic instability of the shoulder?

A

patients with generalised ligamentous laxity

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117
Q

what surgical treatment can be done for a patient with a shoulder dislocation which didn’t stabilise? (ie now has instability)

A

bankart repair
(open or arthroscopic)
which reattaches the labrum and capsule to the anterior glenoid

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118
Q

what forms the carpal tunnel?

A

the carpal bones of the wrist and the flexor retinaculum

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119
Q

what nerve passes through the carpal tunnel?

A

median nerve

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120
Q

what is the cause of carpal tunnel syndrome?

A

median nerve compression in the carpal tunnel

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121
Q

why can rheumatoid arthritis cause secondary carpal tunnel syndrome?

A

synovitis causes reduced space which causes compression of the median nerve

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122
Q

why do conditions sch as pregnancy, diabetes, chronic renal failure and hypothyroidism cause secondary carpal tunnel syndrome?

A

fluid retention which causes compression of the median nerve

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123
Q

who is more affected by carpal tunnel syndrome-F or M?

A

females

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124
Q

fractures of the wrist/around the wrist can cause carpal tunnel syndrome, what particular fracture is especially likely?

A

colles fracture

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125
Q

what do patients with carpal tunnel syndrome present with?

A

parasthesia (tingling), loss of sensation or clumsiness in the median nerve innervated digits (thumb and radial 2.5 fingers)

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126
Q

what are the 2 tests which reproduce the symptoms of carpal tunnel syndrome?

A

tinel’s test

phalen’s test

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127
Q

what is tinel’s test?

A

percussing over the median nerve (or ulnar nerve)

if positive, this will reproduce the symptoms of carpal tunnel syndrome (or cubital tunnel syndrome)

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128
Q

what is phalen’s test?

A

holding the wrists hyper-flexed

if positive this will reproduce the symptoms of carpal tunnel syndrome

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129
Q

how do you confirm the diagnosis of carpal tunnel syndrome?

A

nerve conduction studies

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130
Q

what are the non-operative ways to manage carpal tunnel syndrome?

A

night splints to prevent flexion

corticosteroid injections

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131
Q

what is the surgical management of carpal tunnel syndrome?

A

carpal tunnel decompression

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132
Q

what does carpal tunnel decompression involve?

A

division of the transverse carpal ligament under local anaesthetic

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133
Q

what is the cause of cubital tunnel syndrome?

A

compression of the ulnar nerve in the cubital tunnel

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134
Q

what do patients with cubital tunnel syndrome present with?

A

paraesthesia in the ulnar 1.5 fingers and weakness of the muscles innervated by the ulnar nerve

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135
Q

what tests can be used for detecting cubital tunnel syndrome?

A

tinel’s test (of cubital tunnel)

froment’s test

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136
Q

what does Froment’s test assess?

A

weakness of the adductor pollicis

seen in cubital tunnel syndrome

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137
Q

why might there be compression of the ulnar nerve in the cubital tunnel?

A

due to a tight band of fascia forming over the roof of the tunnel (osborne’s fascia)
or
tightness at the intermuscular septum as the nerve passes between the two heads of flexor carpi ulnaris

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138
Q

how is he diagnosis of cubital tunnel syndrome confirmed?

A

nerve conduction studies

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139
Q

what causes lateral epicondylitis?

A

-repetitive strain
-degenerative enthesopathy
causing microtears in common extensor origin

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140
Q

what is an enthesopathy?

A

inflammation at the origin or insertion of a tendon or ligament into bone

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141
Q

what are the clinical features of lateral epicondylitis?

A

painful and tender lateral epicondyle

pain on resisted middle finger and wrist extension

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142
Q

what is the treatment of lateral epicondylitis?

A 
usually resolves with:
period of rest
NSAIDs
steroid injections
elbow clasp
(ultrasound therapy)
surgical treatment of refractory cases
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143
Q

what causes medial epicondylitis?

A

-repetitive strain
-degenerative enthesopathy
causing microtears in comon flexor origin

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144
Q

which is more common- medial or lateral epicondylitis?

A

lateral epicondylitis

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145
Q

why can steroid injections not be used in the treatment of medial epicondylitis?

A

risk of ulnar nerve injury when injectinf this area

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146
Q

what is the surgical treatment of RA/OA of the elbow which has failed non-operative management?

A

surgical excision of the radial head
or
total elbow replacement

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147
Q

what is the major con of total elbow replacement?

A

lifting weight restriction of 2.5kg

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148
Q

what are dupuytren’s contracture?

A

a proliferative connective tissue disorder where the specialised palmar fascia undergoes hyperplasia

normal bands form nodules and cords and progress to contractures

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149
Q

which joints are commonly affected in dupuytren’s contractures?

A

MCP and PIPs of ring finger and little finger

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150
Q

in dupuytren’s contractures, what type of cells proliferate and what abnormal substance do they produce?

A

myofibroblast cells

abnormal type 3 collagen (should be type 1)

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151
Q

who more commonly gets dupuytren’s contractures- M or F?

A

males

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152
Q

dupuytren’s contractures can sometimes be familial, what sort of inheritance is it?

A 
autosomal dominant
(with variable penetrance)
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153
Q

what condition can dupuytren’s contractures be a feature of?

A

alcoholic cirrhosis

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154
Q

what drug can dupuytren’s contractures be a side effect of?

A

phenytoin

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155
Q

what population with a chronic condition is dupuytren’s contractures seen more commonly in than the normal population? (ignoring other fibromatoses)

A

diabetics

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156
Q

up to what degrees of contracture in dupuytren’s contractures can be tolerated at the MCP and the PIP joints?

A

MCP can tolerate 30 degrees

PIP readily stiffens (any contracture here is usually an indication for surgery)

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157
Q

what are the indications of surgery for dupuytren’s contractures?

A
  • contractures interfering with function

- PIP joint involvement

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158
Q

what is the surgical treatment of dupuytren’s contractures?

A 
fasciectomy (removal of diseased tissue)
or
fasciotomy (division of cords)
or
amputation
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159
Q

what is trigger finger?

A

tendonitis of a flexor tendon causing a nodular enlargement distal to the A1 fascia pulley of the metacarpal neck

movement of finger causes clicking noise

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160
Q

why does movement of a trigger finger cause clicking?

A

clicks happen as the nodle catches on and then passes underneath the A1 pulley

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161
Q

why can a trigger finger lock in a flexed position?

A

nodule passes under the pulley but can go back through on extension

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162
Q

what is the treatment for trigger finger?

A

steroid injections

surgery for persistent cases (division of A1 pulley to allow tendon to move freely)

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163
Q

what is arthrodesis?

A

artificial ossification of two bones at a joint (fusion)

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164
Q

what is arthroplasty?

A

surgery to restore integrity of a joint

an artificial joint can be used, or bones might just be resurfaced

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165
Q

what surgical technique can be done to prevent tendon rupture in a RA patient?

A

tenosynovecomy (excision of synovial tendon sheath)

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166
Q

what is the surgical treatment for the rupture an extensor tendon to the wrist/fingers in a patient with RA?

A 
tendon transfer
joint fusions
(repair is not possible)
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167
Q

why do all total hip arthroplasty eventually fail?

A

due to loosening of the prosthetic components

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168
Q

what is revision hip replacement?

A

a re-do replacement after a hip replacement has failed

more complex than first time hip replacement

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169
Q

if avascular necrosis of the femur head is detected early (pre-collapse) what is the treatment?

A

decompression by drilling holes into the abnormal area

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170
Q

if avascular necrosis of the femur head is detected late (collapse) what is the treatment?

A

only option is total hip replacement

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171
Q

what injury does a direct blow to the anterior tibia with the knee flexed suggest?

A

PCL rupture

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172
Q

what confirms the diagnosis of a meniscal tear?

A

MRI

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173
Q

what is the treatment for a traumatic meniscal tear?

A
  • repair (doesn’t usually work)

- partial menisectomy

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174
Q

why should a degenerative meniscal tear not be treated with a menisectomy?

A

removal of meniscal tissue may cause increase stress on already worn surfaces

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175
Q

how can chronic MCL instbility be treated? (ie MCL hasn’t healed)

A

MCL tightening or reconstruction with tendon graft

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176
Q

why are regular checks of the foot circulation essential after a knee dislocation?

A

intimal tears can later thrombose

Vacular stenting or by-pass would be required

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177
Q

in a knee dislocation, what ligaments are torn?

A

ACL, PCL, MCL and LCL

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178
Q

after prolonged ischamia due to a knee dislocation, what may reperfusion result in? (and how can this be treated)

A

compartment syndrome

fasciotomy

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179
Q

what is the most likely extensor mechanism of the knee rupture in a patient under 40?

A

patellar tendon rupture

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180
Q

what is the most likely extensor mechanism of the knee rupture in a patient over 40?

A

quadriceps tendon rupture

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181
Q

why should steroid injections for tendonitis of the extensor mechanism of the knee be avoided?

A

high risk of tendon rupture

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182
Q

how do you determine whether the extensor mechanism of the knee is intact?

A

straight leg raise

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183
Q

what is the treatment of complete or substantial partial tears of the knee? extensor

A

surgical treatment (tendon repair or reattachment)

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184
Q

what is patellofemoral dysfunction?

A

a group of disorders of the patellofemoral articulation resulting in anterior knee pain

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185
Q

what is chondromalacia patallae?

A

softening of the hyaline cartilage around the patella

patellofemoral dysfunction

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186
Q

what exacerbates the anterior knee pain of pseudofemoral dysfunction?

A

going downhill

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187
Q

what does physiotherapy of pseudofemoral knee dysfunction aim to do?

A

rebalance quadriceps

strengthens vastus medialis

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188
Q

what type of locking does patellofemoral dysfunction cause?

A

pseudo-locking

knee acutely stiffens in flexed position

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189
Q

what direction does the patella almost always dislocate in?

A

lateral direction

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190
Q

what type of fluid builds up within the knee joint after patellar dislocation?

A

lipo-haemarthrosis

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191
Q

how does the risk of recurrent instability vary with age?

A

risk decreases as age increases

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192
Q

what is hallux valgis?

A

a deformity of the great toe where 1st metatarsal moves medially and big toe moves laterally

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193
Q

who is hallux valgis more common in- M or F?

A

females

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194
Q

why does a bunion form over the medial 1st metatarsal head in hallux valgus?

A

medial aspect of 1st metatarsal will end up rubbing on shoes resultin in inflamed bursa

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195
Q

what may happen to the second toe with hallux valgus?

A

1st toe may override it

ulceration and skin break down (due to rubbing)

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196
Q

surgical treatment of hallux valgus should be considered with caution, what is the treatment?

A

osteotomies to realign bones
and
soft tissue procedures to tighten slack tissues and release tight tissueshallu

197
Q

what is hallux rigidus?

A

OA of the 1st MTP joint

198
Q

what is the gold standard surgical treatment of hallux rigidus?

A

arthrodesis (fusion)

199
Q

what does arthrodesis of hallux rigidus prevent women doing?

A

wearing heels

200
Q

what is the surgical management of morton’s neuroma?

A

excision

201
Q

where do metatarsal stress fractures most commonly occur?

A

2nd metatarsal most commonly

followed by 3rd metatarsal

202
Q

what is the treatment for metatarsal stress fractures?

A

rest for 6-12 weeks in a rigid soled boot

203
Q

what is achilles tendonitis caused by?

A

repetitive strain or degenerative process (microtears)

204
Q

what is the treatment of achilles tendonitis?

A

rest, physio, heel raise, splint or boot

resistant cases may benefit from tendon decompression

205
Q

why should steroid injections not be administered around the achilles tendon?

A

risk of rupture

206
Q

what age groups does achilles tendon rupture tend to occur in?

A

middle aged or older groups

207
Q

what clinical signs are present in achilles tendon rupture?

A

weakness of plantar flexion
palpable gap in tendon
simmonds test positive

208
Q

what is simmonds test?

A

squeeze calf and ask patient to plantar flex
positive test if no plantarflexion
(achilles tendon rupture)

209
Q

what is plantar fasciitis caused by?

A

repetitive stress or degenerative

210
Q

what tendon do flat footed people have a higher risk of tendonitis of?

A

posteiror tibialis tendon

211
Q

what are the 3 most coommon causes of acquired flat foot?

A
  • posterior tibialis tendon rupture or stretch
  • RA
  • diabetic neuropathic joint destruction
212
Q

how is pes cavus treated?

A

if supple: soft tissue release and tendon transfer
if rigid: calcaneal osteotomy

severe cases may require arthrodesis

213
Q

explain claw toes?

A

hyperextension at MTPJ
hyperflexion at PIPJ
hyperflexion at DIPJ

214
Q

explain hammer toes?

A

hyperextension at MTPJ
hyperflexion at PIPJ
hyper extension at DIPJ

215
Q

what is the surgical treatment of claw or hammer toes?

A

tenotomy (division of overactive tendon)
tendon transfer
arthrodesis (esp of PIP joint)
toe amputation

216
Q

where does pain from achilles tendonitis present?

A

achilles tendon itself

insertion on calcaneus

217
Q

what is the Heston table top test?

A

where the patient is asked to place their palm flat on the table
failure to do so- fixed flexion contracture at MCPJs (quick screening tool for whether patient with dupuytren’s may benefit from surgical management)

218
Q

what are ankle fractures most commonly cause by?

A

twisting forces (commonly inversion or twisting on a planted foot)

219
Q

what Weber’s classification indicated the ankle fracture is definitely unstable?

A

Weber’s C

220
Q

what means an ankle fracture is unstable?

A

talar shift

221
Q

if an ankle fracture is stable (ie no talar shift) what is the treatment?

A

cast or boots

222
Q

if an ankle fracture has no talar shift but is a suspected fracture what is the treatment?

A

cast or boots and X-ray again in a week to see if talus has shifted

223
Q

what are the 2 types of giant cell tumour of the tendon sheath?
(and which is most common)

A

localised and diffuse

localised is more common

224
Q

what is the presentation of a giant cell tumour of the tendon sheath?

A

firm, discreet swelling on volar aspect of digits

225
Q

what is the managment of giant cell tumout of tendon sheath?

A

usually left alone

if functional issue- marginal excision

226
Q

what is the treatmend of acromioclavicular joint dislocation?

A

conservatively with NSAIDs, analgesics and steriod or local anaesthetic injections

227
Q

what is the mainstay of treatment of a frozen shoulder?

A

physio

228
Q

what part of the glenoid labrum is damaged in a SLAP tear?

A

superior labrum

229
Q

why do young people rarely get rotator cuff tears?

A

because normal, healthy rotator cuff muscles don’t tear (even with trauma)

230
Q

what is the difference between a painful arc and crescendo arc?

A

painful arc- pain on abduction from around 50- 120 degrees (no pain at the very top) : think rotator cuff impingement
crescendo arc- increasingly painful as you abduct : think ACJ pathology

231
Q

what biglaini grading is a hooked acromion?

A

biglaini grade 3

232
Q

as the biglaini grade increases what happens to the risk of impingement?

A

risk of impingemnet increases

233
Q

when are reverse arthroplastys used?

A

massive rotator cuff tears

234
Q

what is the purpose of a bankart repair?

A

fixes the defect in the glenoid labrum to prevent from recurrent dislocation

235
Q

which is always abnormal on x-ray of elbow- anterior or posterior fat pad?

A

posterior fat pad

236
Q

why can anterior and posterior fat pads of the elbow be displaced?

A

elbow joint effsion

237
Q

why is the growth plate of a bone prone to injury? (ie in children’s bone)

A

the growth plate is the weakest part of the developing bone

238
Q

what is a Salter-Harris fracture?

A

a fracture that involves the growth plate of a bone (physis)

239
Q

what is a hemiarthroplasty?

A

only replace one side of the joint

ie operate on humeral head, leave glenoid alone

240
Q

who tends to get radial buckle fractures?

A

children with soft bones

241
Q

who tends to get scaphoid fractures?

A

young males

242
Q

where is the most common area of the scaphoid to fracture?

A

the mid-scaphoid (waist)

243
Q

what is a bennett’s fracture?

A

a fracture of the base of the first metacarpal bone which extends into the carpometacarpal joint (nearly always associated with subluxation of the carpometacarpal joint)

244
Q

what is the most common fracture of the thumb?

A

a bennett’s fracture

245
Q

why can lower limb fractures appear sclerotic?

A

because they often involve axial force with bone impaction

246
Q

what direction do hips typically displace in?

A

posterior direction

247
Q

compare treatment of intra-capsular femoral fractures to extra-capsular femoral fractures?

A

intra-capsular: hemiarthroplasty (young person- reduction and screw fixation may help)
extra-capsular: internal fixation

248
Q

what space does the effusion accompanied by significant knee soft tissue tend to fill?

A

the suprapatellar space

249
Q

lipohaemarthrosis collecting within the suprapatellar recess of is a specific sign of what type of fracture?
(can be seen on x ray)

A

an intra-articular fracture

250
Q

what condylar side is most commonly fractured in a tibial plateau fracture?

A

lateral condyle fracture

251
Q

how do you treat swan-necking?

A

splintage

252
Q

when fusing a joint what is the main pro and what is the main con?

A
  • reduced pain

- reduced range of movement

253
Q

when fusing the wrist joint, what movements are taken away? (but what movements remain?)

A

flexion /extension removed

pronation and supination remain

254
Q

what type of movement is especially lost in glenohumeral joint OA?

A

external rotation

255
Q

what is a hemiarthroplasty?

A

only operate on one side of the joint

ie operate on humeral head, leave glenoid alone

256
Q

what is the most common operation for glenohumeral OA?

A

hemiarthroplasty

-resurfacing the humeral head

257
Q

what does a reverse arthroplasty allow the deltoid to do?

A

to initiate abduction (ie without the supraspinatus)

258
Q

what are the 4 main surgical strategies for the management of an arthritic joint?

A
  1. arthroplasty (joint replacement)
  2. excision or resection arthroplasty
  3. arthrodesis
  4. osteotomy
259
Q

why will a joint replacement eventually fail?

A

will eventually either loosen or the components will break down

260
Q

what can metal within the joint replacement cause?

A

can cause the formation of inflammatory granulomas (pseudotumours) which lead to muscle and bone necrosis

261
Q

what can polyethylene within the joint replacement cause?

A

an inflammatory response within the bone causing osteolysis which leads to loosening

262
Q

what can ceramics within the joint replacement cause?

A

shattering of the joint replacement

263
Q

what is the treatment of a deep joint infection if diagnosed within the first 2-3 weeks?

A

surgical washout and debridement
+ prolonged parenteral antibiotics

(in attempt to salvage joint)

264
Q

what is the treatment of a deep joint infection if diagnosed after 3 weeks’;

A

removal of infected implants and all foreign material
6 weeks with no joint and parenteral antibiotics
re-do joint replacement once infection is under control

265
Q

what is an excision or resection arthroplasty?

A

removal of bone and cartilage of one or both sides of a joint

266
Q

what do the vast majority of soft tissue inflammatory problems settle with?

A

rest, analgesia and anti-inflammatory medications

267
Q

what is surgical debridement?

A

removal of diseased tissue

268
Q

what is radiculopathy caused by?

A

compression or irritation of a nerve as it exits the spinal column

269
Q

why is a flexor tendon sheath infection a surgical emergency?

A

can cause loss of finger function (which could be permanent)

270
Q

what is the management of flexor tendon sheath infection?

A

wash out tendon sheath

271
Q

what is a laceration?

A

blunt wound with a break in the skin

272
Q

how do you relieve the pressure of a subungual haematoma?

A

heat a paper clip and use it to melt through the nail

273
Q

what finger is fractures in a boxers fracture?

A

little finger

274
Q

what is the treatment of a boxer’s fracture?

A

‘buddy strap’ + early mobilisation

275
Q

how do you make a rotational finger deformity more obvious?

A

ask patient to flex fingers

276
Q

what is the treatment for a mallet finger?

A

splint (prevents DIP from moving)

277
Q

why does holding the distal phalanx of the middle finger allow isolation of the FDS when flexing the index finger?

A

because FDP muscle bellies are all one, so holding the 3rd distal phalynx prevents the FDP being flexed

so flexing the index finger will only be flexing the FDS of that finger

278
Q

what is eschar?

A

thick, leathery, inlastic skin which can form after burns

279
Q

when would primary bone healing occur vs secondary bone healing?

A

primary- minimal fracture gap (less than 1mm)

secondary- gap at fracture site

280
Q

what are the 4 main steps of secondary bone healing?

A
  1. inflammation
  2. soft callus
  3. hard callus
  4. remodelling
281
Q

what 4 things are required for good secondary bone healing?

A
  • good oxygen supply
  • good nutrient supply
  • stem cells
  • a little movement or stress
282
Q

what type of non-union occurs in attempted secondary bone healing with a poor blood supply?

A

atrophic non-union

283
Q

what type of non-union occurs in attempted secondary bone healing with no movement?

A

atrophic non-union

284
Q

what type of non-union occurs in attempted secondary bone healing with too big a fracture gap?

A

atrophic non-union

285
Q

what type of non-union occurs in attempted secondary bone healing with tissue trapped in the fracture gap?

A

atrophic non-union

286
Q

what type of non-union occurs in secondary bone healing with excessive movement?

A

hypertrophiic non-union

287
Q

why may smoking severely impair fracture healing?

A

vasospasm

288
Q

what are the 5 basic fracture patterns?

A
  • transverse fractures
  • oblique fractures
  • spiral fractures
  • comminuted fractures
  • segmented fractures
289
Q

which pattern of fracture is most likely to shorten?

A

oblique fracture

290
Q

which 2 patterns of fracture are the most unstable?

A

comminuted fracture and segmental fracture

291
Q

what is a comminuted fracture?

A

fractures with 3+ fragments

292
Q

what type of energy injries cause comminuted fractures?

A

high energy injuries

293
Q

which patterns of fractures can interfragmentary screws potentially be used in?

A

oblique fractures

spiral fractures

294
Q

how is a segmental fracture satbilised?

A

with long rods or plates

295
Q

which type of fracture has a greater risk of stiffness, pain and post-trauma OA- intra-articular fracture or extra-articular fracture?

A

intra-articular fracture

296
Q

what fragment of fractured bone does displacement describe the direction of translation of?

A

displacement describes the direction of translation of the distal fragment

297
Q

what are the 4 main clinical signs of a fracture?

A
  • localised bony tenderness
  • swelling
  • deformity
  • crpitus
298
Q

what are the cardinal clinical signs of compartment syndrome?

A
  • increased pain on passive stretching of teh involved muscle
  • severe pain out with clinical context
299
Q

what artery is risked in knee dislocation?

A

popliteal artery

300
Q

what are the 4 main signs/symptoms of fracture healing?

A
  • resolution of pain and function
  • absence of point tenderness
  • no local oedema
  • resolution of movement at fracture site
301
Q

what are the 3 main signs/symptoms of non-union of a fracture?

A
  • ongoing pain
  • ongoing oedema
  • movement at the fracture site
302
Q

what type of non-union occurs in attempted secondary bone healing with infection?

A

hypertrophic or atrophic non-union

303
Q

what is fracture disease?

A

stiffness and weakness due to a fracture and subsequent splintage in a cast

304
Q

how can you treat fracture disease?

A

should resolve with time

possibly physio

305
Q

what is complex regional pain syndrome?

A

a heightened pain response after injury

306
Q

what is type 2 complex regional pain syndrome caused by?

A

peripheral nerve damage

307
Q

what is the principle late systemic complication after a pelvic/lower limb fracture?

A

pulmonary embolism

308
Q

what is the gold standard imaging of the rotator cuff?

A

ultrasound

309
Q

which head is preominantly affected in biceps tendinopathy?

A

predominantly long head of biceps

310
Q

where is the pain in biceps tendinopathy?

A

anterior shoulder radiating to elbow

311
Q

what movements exacerbate the pain of biceps tendinopathy?

A

shoulder flexion
elbow flexion
pronation of forear

312
Q

where does the most inflammmation of biceps tendinopathy occur and why?

A

where the long head of biceps passes through the bicipital groove ]due to friction

313
Q

what does the popeye sign indicate?

A

biceps tendon rupture

314
Q

what movements exacerbate the pain of medial epicondylitis?

A

wrist flexion, pronation

grasping actions

315
Q

what 2 tendon sheaths are affected in De Quervain’s tenosynovitis?

A

abductor pollicis longus
extensor pollicis brevis
(extend and abduct the thumb)

316
Q

what are the 2 main clinical findings of knee extensor mechnaism tendon rupture?

A

palpable gap

no straight leg raise

317
Q

what is spinal shock?

A

a physiological response to injury with complete loss of sensation, motor function and reflexes below the level of the injury

318
Q

what is the bulbocavernous reflex?

A

a reflex contraction of the anal sphincter in response to a squeeze of the glans penis, tapping the mons pubis or pulling on a urethral catheter

319
Q

when does spinal shock usually resolve?

A

after 24 hours

320
Q

what does neurogenic shock occur secondary to?

A

temporary shutdown of sympathetic outflow from T1- L2

321
Q

what is the difference between complete and incomplete spinal injuries?

A

complete- no sensory or motor function below the level of injury
incomplete- some sensory or motor function below the level of injury

322
Q

what type of spinal cord injury (complete or incomplete) does sacral sparing suggest?

A

incomplete spinal cord injury

323
Q

compare prognosis of complete and incomplete spinal cord injury?

A

complete- poor prognosis

incomplete- better prognosis

324
Q

what type of shock (organ hypoperfusion) in the presence of spinal injury is most likely?

A 
hypovolaemic shock
(don't assume neurogenic shock)
325
Q

what are the 3 main patterns of pelvic injury?

A

lateral compression fracture
vertical shear fracture
anteroposterior compression injury

326
Q

a RTA will most likely give you what pattern of pelvic injury?

A

lateral compression fracture

327
Q

a fall from height will most likely give you what pattern of pelvic injury?

A

vertical shear fracture

328
Q

what pattern of pelvic injury is an ‘open-book’ pelvic fracture?

A

anteroposterior compression inury

329
Q

as the degree of wide disruption of a anteroposterior pelvic fracture increases what happens to the pelvic volume?

A

increases

330
Q

in a lateral compression fracture, where is the affected hemipelvis displaced?

A

medialy

331
Q

in a vertical shear fracture, where is the affected hemipelvis displaced?

A

superiorly

332
Q

why is a PR mandatory in a patient with a pelvic injury?

A

to assess sacral nerve root function

to look for the presence of blood

333
Q

what does the presence of blood on a PR exam following pelvic injury suggest?

A

rectal tear

higher risk of mortality

334
Q

in a fracture of the surgical neck of the humerus, what is the typical displacement of the humeral shaft?
and why?

A

medially

due to pull of pectoralis major

335
Q

how are minimally displaced proximal humeral fractures treated?

A

conservatively with a sling and gradual mobilisation

336
Q

how are persistently displaced fractures of the proximal humerus treated?

A

internal fixation

337
Q

how are humeral head splitting fractures usually treated? (and when would this not be the case?)

A

shoulder replacement

unless patient is young with very good bone quality

338
Q

which is more common- anterior or posterior traumatic shoulder dislocation?

A

anterior shoulder dislocation

339
Q

what are the main 2 movements/actions which may cause anterior shoulder dislocation?

A

excessive external rotation

fall onto the back of the shoulder

340
Q

what is a bankart lesion?

A

detachment of the anterior glenoid labrum and capsuls

341
Q

what is a Hill-Sachs lesion?

A

when the posterior head impacts on the anterior glenoid producing an impaction fracture of the posterior head

342
Q

in anterior shoulder dislocation, the axillary nerve can be stretched as it passes through what space?

A

quadrilateral space

343
Q

what is the principle sign of axillary nerve injury?

A

loss of sensation in the regimental badge area

344
Q

what is the mainstay of treatment for atraumatic shoulder dislocations?

A

physiotherapy

345
Q

what movement can cause posterior shoulder disloctions?

A

posteiror force on the adducted and internally rotated arm

346
Q

what does the light bulb sign on X ray suggest?

A

posteiror shoulder dislocation

347
Q

when the ACJ is subluxed what ligaments are ruptures?

A

acromioclavicular ligaments

348
Q

when the ACJ is dislocated what ligaments are ruptures?

A

acromioclavicular ligaments and coracoclavicular ligaments (conoid and trapezius ligaments)

349
Q

what is a nightstick fracture?

A

an isolated fracture of the ulna

350
Q

what are nightstick fractures caused by?

A

a direct blow

351
Q

what is a monteggia fracture?

A

an isolated ulna fracture with dislocation of the radial head at the elbow

352
Q

why do you need to take an x-ray of the elbow joint after finding an isolated ulna fracture?

A

may be a monteggia fracture dislocation

ulna fracture and dislocation at elbow

353
Q

what is the treatment for monteggia fractures?

A

ORIF of ulna

that should result in reduction of radio-capitellar joint

354
Q

what is a galeazzi fracture?

A

an isolated fracture of the radius with dislocation of the ulna at the distal radioulnar joint

355
Q

why do you need to take a lateral x-ray view of the forearm after finding an isolated radial fracture?

A

may be a galeazzi fracture (radius fracture and dislocation at distal radioulnar joint)

356
Q

what is the treatment for galeazzi fractures?

A

ORIF of radius

should cause distal radioulnar joint reduction

357
Q

what is a colles fracture?

A

an extra-articular fracture of the distal radius within 1 inch of the articular surface wit dorsal displacement or angulation

358
Q

why do colles fractures occur? (what action?)

A

usually fall onto outstretched hand

359
Q

what nerve is particularly susceptible to compression in a colles fracture? (how is this resolved)

A

median nerve

reduction of radius or carpal tunnel decompression

360
Q

what is a specific late local complication of a colles fractures?

A

extensor pollicis longus tendon rupture

361
Q

how is extensor pollicis longus tendon rupture secondary to a colles fracture treated?

A

tendon transfer

362
Q

why should all Smith’s fractures undergo ORIF using a plate and screws?

A

as they are highly unstable and malunion with excessive volar angulation reduces grip strengthn and wrist extension

363
Q

what is a Smith’s fracture?

A

an extra-articular fracture of the distal radius which causes volar displacement or angulation

364
Q

what action commonly causes smith fractures?

A

falling onto the back of a flexed hand

365
Q

what are bartons fractures?

A

intra-articular fractures of the distal radius causing subluxation of the carpal bones

366
Q

what are the 2 main classifications of bartons fractures?

A
  • volar barton fractures (intra-articular Smith’s fracture)

- dorsal barton fractures (intra-articular Colles fractures)

367
Q

what is the treatment of a barton’s fracture?

A

ORIF

368
Q

what is the treatment of a comminuted intra-articular distal radius fracture?

A

external fixation with supplementary wires

369
Q

what action causes scaphoid fractures?

A

fall onto outstretched hand

370
Q

where does tenderness tend to occur in scaphoid fractures?

A

anatomical snuff box

371
Q

if a scaphoid fracture is suspected clinically but there are no signs on X-ray what is the management?

A

splint wrist then re-do x-ray after 2 weeks

372
Q

what is the treatment of undisplaced scaphoid fractures?

A

plaster cast

373
Q

what is the treatment of displaced scaphoid fractures?

A

special compression screw (to avoid non-union)

374
Q

what is the treatment of non-union of the scaphoid following fracture?

A

screw fixation and bone grafting

375
Q

what is the treatment of symptomatic avascular necrosis of the scaphoid following fracture?

A

partial or total wrist fusion

376
Q

what 3 structures do penetrating volar hand injuries risk damage to?

A
  • flexor tendons
  • digital nerves
  • digital arteries
377
Q

what structures do penetrating dorsal hand injuries risk damage to?

A

-extensor tendons

378
Q

what is mallet finger?

A

an avulsion of the extensor tendon from its insertion into the terminal phalanx

379
Q

what is mallet finger caused by?

A

forced flexion of the extended DIPJ

can be caused by a ball at sport

380
Q

what is the treatment of mallet finger?

A

mallet splint

381
Q

after a flexor tendon injury, the fingers are splinted in a flexed position with an elastic traction. What movements does this allow? (and why?)

A

active extension
passive flexion

to prevent stiffness and adhesions within the tendon sheath

382
Q

compare treatment of intra-capsular hip fracture and extra-capsular hip fractures?

A

intra-capsular- hemiarthroplasty or THR

extra-capsular- internal fixation

383
Q

femoral fractures can cause fat embolism, where does the fat come from?

A

the medullary canal of the femur

384
Q

what is the initial management of a femoral fracture?

A

resuscitation
analgesia
femoral nerve block
thomas spint

385
Q

what is the purpose of a thomas splint for use of femur shaft fracture?

A

stabilises fracture to minimise further blood loss and fat embolism

386
Q

what is the definitive management of a femoral shaft fracture?

A

closed reduction and stabilisation with an IM nail

sometimes plate fixation can be used

387
Q

why is multi-ligament reconstruction typically required for a dislocated knee?

A

because in order for the knee to dislocate, multiple ligaments are usually torn

388
Q

which are more common- true knee dislocations or patellar dislocations?

A

patellar dislocations

389
Q

who tends to get patellar dislocations?

A

female adolescents

390
Q

what are the 4 main predispositions to patellar dislocations?

A
  • generalised ligamentous laxity-valgus alignment of the knee
  • shallow trochlea groove
  • rotational malaligment
391
Q

are proximal tibia plateau fractures intra or extra-articular fractures?

A

intra-articular

392
Q

a valgus stress to the knee may cause what plateau fracture?

A

lateral plateau fracture

393
Q

what nerve injury is indicated in foot drop?

A

common fibular nerve

394
Q

a varus stress to the knee may cause what plateau fracture?

A

medial plateau fracture

395
Q

what is required to fill the void in the bone once a depressed tibial plateau fracture has been elevated?

A

bone graft

396
Q

what displacement of the tibial shaft after fracture is especially poorly tolerated?

A

internal rotation

397
Q

if the tibia shaft is fractured with the fibula unaffected what alignment does the tibia drift into?

A

varus

398
Q

if the tibia shaft is fractured and the fibula is also fractured what alignment does the tibia drift into?

A

valgus

399
Q

what are the 2 major cons of external fixation?

A

pin-site infection

loosening

400
Q

is an isolated fracture of the distal fibula stable or unstable?

A

stable

401
Q

is a fracture of the distal fibula with rupture of the deltoid ligament stable or unstable?

A

unstable

402
Q

are bimalleoli ankle fractures stable or unstable?

A

unstable

403
Q

what is the treatment for an unstable ankle fracture?

A

ORIF

404
Q

what is a lisfranc fracture/dislocation?

A

fracture of the base of the 2nd metatarsal with dislocation of the base of the 2nd metatarsal from the medial cuneiform
(other metatarsals may also be dislocated at the tarso-metatarsal joints)

405
Q

how does a patient with a lisfranc fracture usually present?

A

grossly swollen and bruised foot which they are unable to weight bear

406
Q

what is the treatment of a lisfranc fracture?

A

closed or open reduction with fixation using screws

407
Q

what movement causes fractures of the 5th metatarsal?

A

inversion injury

408
Q

what is the usual treatment of toe fractures?

A

protection in a stout boot

409
Q

why do children’s fracture heal more quickly than adults?

A

thicker periosteum which is a rich source of osteoblasts

410
Q

why are greater degrees of displacement or angulation accepted in children’s fractures compared to adult fractures?

A

children have a greater potential to remodel so can correct angulation

411
Q

at what age do fractures start to be treated as an adult fracture?

A

once child has reached puberty (12 - 14)

412
Q

as the salter-harris classification of physeal fractures increases, what happens to the prognosis?

A

decreases

413
Q

which salter-harris classification is the commonest of physeal fractures?

A

salters harris II

414
Q

which salter harris fractures are intra-articular with the fracture splitting the physis?

A

salter harris III and IV

415
Q

what type of injury occurs to the physis in a salters harris V fracture?

A

compression injury to the physis

416
Q

what happens to the growth of the bone after a salters harris V fracture?

A

growth arrests

417
Q

what happens in a salter harris I fracture?

A

pure physeal separation (metaphyseal intact and still attached to the shaft)

418
Q

where are salter harris II fractures especially common?

A

distal radial physis

419
Q

in children, are complete fractures more likely to displace/angulate volar or dorsal?

A

dorsally

420
Q

how are monteggia and galeazzi fractures treated in children?

A

reduction and rigid fixation with plates and screws

421
Q

how are fractures of both bones in the forearm treated in children?

A

flexible IM nail

422
Q

which are more common- flexion or extension supracondylar fractures of the elbow?

A

extension supracondylar fractures

423
Q

what is a simple test to check if the median nerve is working?

A

ask patient to make an ok sign (flexor pollicis longus and flexor digitorum profunda)

424
Q

what 2 structures are at risk of injury in a supracondylar fracture?

A 
brachial artery
median nerve (mainly anterior interosseous branch)
425
Q

when in a supracondylar fracture is emergency surgery required?

A

if radial pulse is reduced (in volume) or absent

426
Q

what are the 2 main reasons you should avoid ORIF in high energy fractures?

A
  • will struggle to get wounds closed

- bone blood supply is already very impaired (don’t want to damage it any further)

427
Q

what is the most common nerve affected by compartment syndrome?

A

tibial nerve

428
Q

which is more common- valgus stress causing lateral tibial plateau fracture or varus stress causing medial tibial plateau fracture?

A

valgus stress causing lateral tibial plateau

429
Q

for a tibial shaft fracture, how long does there have to be without healing before you can say it has gone under non-union?

A

> 1 year

430
Q

compartment syndrome is a clinical diagnosis, when would you do pressure readings?

A

only if patient is unconscious

431
Q

what is a pilon fracture?

A

an intra-articular fracture of the distal tibia

432
Q

how are nightstick fractures usually managed?

A

conservatively

433
Q

what are the 3 degrees of nerve injury?

A

1st degree- neurapraxia
2nd degree- axonotmesis
3rd degree- neurotmesis

434
Q

what is neurapraxia?

A

temporary conduction block/demyelination

435
Q

when should neurapraxia resolve by?

A

28 days

436
Q

what is axonotmesis?

A

nerve cell axon dies distally from point of injury, endoneurial tubes remain intact

437
Q

how fast does axonotmesis regenerate?

A

1mm per day

438
Q

what is neurotmesis?

A

nerve transection

no recovery without surgery

439
Q

if there is apparent nerve injury, with no function returning, what is the management?

A

nerve conduction studies
nerve grafting
tendon transfers

440
Q

what is volkmann’s ischaemic contracture?

A

missed compartment syndrome causing necrosis and contraction of the muscles and tendons

causes reduced function of the limb

441
Q

what nerve is being tested by a thumbs up? (what muscles does it test?)

A

radial nerve

extensor policis longus

442
Q

what nerve is being tested by a starfish sign of the hands? (what muscles does it test?)

A

ulnar nerve

interossei muscles

443
Q

what nerve is being tested by an OK sign? (what muscles does it test?)

A

median nerve

flexor policis longus
flexor digitorum profundus and superficialis of index finger

444
Q

what are the 2 main mechanisms of traumatic shoulder dislocations?

A

fall onto outstretched hand

traction injury

445
Q

what is luxatio erecta?

A

an inferior glenohumeral dislocation

446
Q

what is the main nerve at risk with anterior shoulder dislocation?

A

axillary nerve

447
Q

what area of skin should be tested to assess if the axillary nerve is intact?

A

regimental badge area

448
Q

what are the main two mechanisms of traumatic posterior shoulder dislocations?

A

fall with shoulder in internal rotation

direct blow to anterior shoulder

449
Q

what movement is impaired with posterior dislocation of the shoulder?

A

external rotation

450
Q

in inferior dislocation of the shoulder, what position is the patients arm stuck in?

A

abduction

451
Q

what type of shoulder dislocation presents with squaring off of the affected shoulder?

A

anterior dislocation

452
Q

shoulder dislocations are usually treated with closed reduction under sedation. what type of dislocations are open reduction saved for?

A

locked posterior dislocations

453
Q

what is the main mechanism of injury causing elbow dislocations?

A

fall onto outstretched hand

454
Q

what is the main way to reduce an elbow dislocation?

A

closed reduction
(traction in extension +/- pressure over olecranon)
under sedation

455
Q

what is the recurrent instability risk of elbow dislocation?

A

low

456
Q

what are the 2 main mechanisms of injury causing interphalangeal dislocations?

A

hyperextension injury

direct axial blow

457
Q

what direction do IPJ dislocatioons usually occur in?

A

posterior dislocations

458
Q

sudden contraction of what muscles with a flexing knee causes patella dislocation?

A

sudden quads contraction with a flexing knee

459
Q

what direction do patella dislocations usually occur in?

A

laterally

460
Q

what ligament is always torn in a lateral patella dislocation?

A

medial patellofemoral ligament

461
Q

why does a big haemarthrosis and medial side tenderness occur in lateral patella dislocation?

A

due to torn medial patellofemoral ligament

tenderness also due to torn medial retinaculum

462
Q

what does genu valgum or femoral neck anteversion do to the Q-angle?

A

increases Q angle

463
Q

as the Q-anlge increases, what happens to the risk of patella dislocation?

A

increases

464
Q

weakness of what particular quadriceps muscle can play a part in patella dislocation?

A

weak vastus medialis

465
Q

under-development (hypoplasia) of which femoral condyle can play a part in patella dislocation?

A

hypoplasia of lateral femoral condyle

466
Q

describe lines 1 and 2 whcih make up the Q-angle?

A

line 1: ASIS to midpoint of patella

line 2: tibial tubercle to midpoint of patella

467
Q

who tends to have a larger Q angle- M or F?

A

females

468
Q

what movements tend to reduce patella dislocation?

A

extension

469
Q

why might you aspirate the haemarthrosis caused by a patella dislocation?

A

to make extension more comfortable

470
Q

what should you suspect if there is lateral collateral ligament of the knee injury and common fibular nerve injury?

A

(transient) knee dislocation

471
Q

which direction are knee dislocations most likely to be?

A

posterior

472
Q

what nerve is at risk with a true knee dislocation?

A

common fibular nerve

473
Q

what artery is at risk with a true knee dislocation?

A

popliteal artery

474
Q

if assessment of vascular supply after a knee dislocation is normal, what should be done?

A

admit and observe in hospital

due to high likelihood of vascular injury

475
Q

if assessment of vascular supply after a knee injury is abnormal, what should be done?

A

arteriogram/MRI

476
Q

what direction are hip dislocations most commonly?

A

posterior

477
Q

what position usually is the leg of a patient presenting with a posterior hip dislocation in?

A

hip flexed
hip internally rotated
knee adducted

478
Q

what nerve is at risk of injury with a hip dislocation?

A

sciatic nerve

479
Q

what is primus varus?

A

angulation of the 1st metatarsal towards the midline thus increasing the distance and angle between metatrsals 1 and 2

480
Q

when does primus varus typically appear?

A

teen years

481
Q

what is the driver of primus varus?

A

ligamentous laxity

482
Q

what deformity of the big toe can primus varus lead to?

A

secondary hallux valgus

483
Q

what is lesser toes metatarsalgia?

A

painful lesser metatarsal heads

484
Q

where is the pain felt in lesser metatarsalgia?

A

plantar surface of foot

485
Q

what heel alignment is common in pes planus?

A

heel valgus

486
Q

what heel alignment is common in pes cavus?

A

heel varus

487
Q

what does localised swelling of the olecranon suggest?

A

bursitis

488
Q

what is the carrying angle of the elbow?

A

the angle between the shaft of humerus and shaft of forearm

489
Q

compare a distal ulnar nerve lesion to a proximal ulnar nerve lesion in terms of patient presentation?

A

distal- ulnar clawing

proximal- ulnar paradox (hand looks normal)

Musculoskeletal (16 decks)

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