MSK Flashcards by Anjali Yapa

What are the primary and secondary risk factors for osteoporosis?

Primary:
-ageing
-gonadal insufficiency

Secondary:
-nutrition- scurvy, malnutrition, malabsorption
-malignancy- leukaemia, myeloma
-endocrine- hyperparathyroid, thyrotoxicosis, cushing’s
-drugs- corticosteroids, alcohol, heaprin
-systemic disease- TB, RA, chronic liver disease (esp PBC)

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Most common bacteria that causes osteomyelitis

Staph aureus

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Most common organism to cause osteomyelitis in:
-sickle cell anaemia patients
-IVDU
-HIV/ AIDS
-immunosuppressed/ long term IV meds/nutrition

-Salmonella (also septic arthritis)
-Pseudomonas
-Bartonella
-Fungal osteomyelitis

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Commonest site for ostemyelitis?

Long bones (upper/ lower limbs)

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Commonest site for osteomyelitis in dialysis patients

Thoracic spine + ribs

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Commonest site for osteomyelitis in IVDU patients

Medial/ lateral clavicle

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Risk factors for osteomyelitis

Recent trauma/ surgery
systemic dieases- DM/ sickle cell
poor vascular supply
peripheral neuropathy
IVDU

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What is the reverse popeye sign indicative of?

Distal biceps brachii tendon rupture

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Risk factors for biceps brachii tendenopathy

-steroids
-smoking
-flouroquinolone abx
-CKD

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With rupture of the biceps brachii tendon which forearm action would be the weakest

Elbow supination

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What are the potential spaces between the neck fascia

Retropharyngeal space
Visceral space

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Describe the potential spaces between the neck fascia

Retropharyngeal- between the pretracheal (visceral) and prevertebral fascia
-extends from skull base -> posterior mediastinum

Visceral- space within visceral pre-tracheal fascia
-extends from hyoid –> superior mediastinum

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What types of injuries are likely to be missed in a FAST scan

Retroperitoneal injuries
(eg: renal laceration)

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Commonest organism to cause septic arthritis in young sexually active adults

N Gonorrhea

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Describe the Trendenlenburgs position and physiological effects

Head down-legs up

Improves blood pressure
Increases venous return
reduces intra-cranial pressure

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Describe the Reverse- Trendenlenburgs position and physiological effects

Head up-legs down

Reduces blood pressure
Reduced venous return
Reduced cerebral perfusion

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Fractures of which bones are most likely to indicate high energy trauma and severe hidden soft tissue injuries?

Sternum
Scapula
1st rib

[extremely hard to brake- have great vessels and cardiopulmonary apparatus underneath]

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Describe the flexor tendon injury zones

https://orthofixar.com/wp-content/uploads/flexor-tendon-zones-2.webp

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What nerve supplies all muscles in the extensor compartment of the forearm

Radial nerve

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How many muscles are there in the superficial extensor compartment

7:
-Brachioradialis
-Extensor carpi radialis longus
-brevis
-Extensor digitorum
-Extensor digiti minimi
-Extensor carpi ulnaris
-Anconeus

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What are the muscles of the deep extensor compartment of the forearm

-Supinator
-Abductor pollicis longus
-Extensor pollicis longus
-brevis
-Extensor indicis

(only to thumb + index finger)

Patient presents with new confusion, shortness of breath, tachycardia, pyrexia, oliguria and a petechial rash following a RTA with a femoral fracture the day before.

Whats the Dx?

Fat embolism syndrome

Risk factors for Fat embolism syndrome

Long bone fractures
IM nailing

What structures are damaged in O’Donoghue’s triad/ unhappy triad

-ACL
-MCL
-medial meniscus

What was later found to be contradictory to the unhappy triad?

LCL tears are more likely to accompany ACL ruptures than MCL tears

When are Abx indicated in orthopaedic surgery

-All joint replacements -All prosthetic/FB implantations

Clinical characteristics of osteogenesis imperfectica

B-blue sclera D-dentogenesis imperfectica (stained teeth) S- sensorineural hearing loss M- multiple fractures

What is the difference in having hypertension w/ bradycardia vs hypotension w/ bradycardia?

HYPER +brady = raised ICP (cushings triad) HYPO + brady (in absence of hypovolaemia) = cervical cord injury (loss of sympathetic drive)

Clinical findings suggestive of cervical cord injury

-pain above but not below clavicle -flaccid areflexia -can flex but not extend at elbows -hypotension + bradycardia -diaphragmatic breathing -priapism

Why does cervical cord injury lead to diaphramatic breathing

No innervation of intercostal muscles when there is a spinal cord injury above T1 hence only the diaphragm is available for breathing

Commonest salter harris type fracture?

Salter harris type 2

Least common SH fracture

Salter harris type 5 then type 1

Describe a Jefferson fracture

Blow out/ burst fracture of the ATLAS (anterior and posterior parts separate) Best diagnosed on CT (not open mouth xr view)

Describe a hangman's fracture

Bilateral fracture of the pars interarticularis of the AXIS

MOI of jefferson and hangman's fractures

Jeffersons = axial loading Hangmans = hyperextension of neck

How would you identify a cervical vertebra

-large triangular vertebral foramen -short transverse processes w/ foramina -short bifid spinous process -no/ v-small vertebral bodies

What pass's through the transverse foramina of cervical vertebrae

Vertebral arteries

What section of vertebrae increase in size the further down the spine you go

Lumbar

Describe thoracic vertebrae

-Large vertebral bodies -long transverse and spinous processes -circular vertebral foramen -have costal and 2 demi facets each (articulate with ribs)

Where are the lamina and pedicles on the vertebrae

Lamina= connects the transverse and spinous processes Pedicle= just next to the vertebral bodies, connect it to the rest of the vertebral arch

Name the spinal ligaments from anterior to posterior

-Anterior spinal ligament -Posterior -ligamentum flavum -interspinal ligament -supraspinal ligament

Superiorly in the cervical spine, what does the supraspinous ligament continue as

Nuchal ligament

Describe the classification of odontoid peg fractures

ADERSON & D'ALONZO classification: Type1 = odontoid tip # (due to disruption of alar ligament) Type 2= base of odontoid peg # (high non-union rate/ AVN as vascular supply disrupted) Type 3 = # extends into body of axis (C2)

What are the ligaments present between C1 & C2

2 alar ligament 1 apical ligament 1 transverse ligament

Describe the sequence of changes to bone in osteomyelitis

-transient bacteriaemia -focus of acute inflammation at the metaphysis of long bones -necrosis of bone and formation of sequestrum -formation of new subperiosteal bone that forms a shell over the dead bone -pus may drain into: nearby joint OR through sinus out onto skin surface

T/F: Children are more affected by septic arthritis than adults

True

Risk factors for septic arthritis

-steroid injections -diabetes -RA -immunosuppression

Which organisms cause septic arthritis in: -normal patients -IVDU -children -discitis -prosthetic joints

-staph aureus -gram -ve organisms -H. influenzae -brucella abortus -staph epidermidis

What are the steps in bone healing following a fracture

Fracture = damage to bone + periosteal blood vessels -Haematoma forms -macrophages, polymorphs and fibroblasts arrive at haematoma -fibrosis, angiogenesis and formation of an organised clot (end of week 1) -osteoblasts lay down woven bone to form callus -woven bone remodelled into lamellar bone (according to stress orientation)

Commons sites for AVN

-NOF -anatomical neck of humerus -scaphoid -talus