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Phase 2 > MSK > Flashcards

MSK Flashcards

1
Q

Describe fracture healing

A

Heamatoma formation - release of cytokines, growth factors, heamatoma forms, swelling, inflammation, macrophages/neutrophils remove necrotic tissue
Fibrocartilaginous callus formation (1-2 weeks) - granulation tissue forms, angiogenesis, osteoblasts begin forming spongy bone
Bony callus formation (2 months) - osteoblasts continue, fibrocartilaginous callus converted to bony (cancellous) callus, endochondral and intramembranous ossification
Bone remodelling (<7 years) - bone remodelled into compact bone, osteoclasts aid
*Wolff’s law - bone can remodel and adapt to the loads placed on it

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2
Q

Describe factors that affect bone healing

A

Patient factors - children (stem cells, thicker periosteum), smoking (nicotine/CO causes vasospasm and vasoconstriction), diabetes (defective collagen production), vitamin deficiency (vitamin D, C), corticosteroids, hyperparathyroidism (stimulates osteoclasts), hyperthyroidism (stimulates osteoclasts)
Fracture characteristics - excessive movement (disrupts repair), interposed tissues (blocking/delaying reunion), infection (osteomyelitis), large surrounding soft tissue injury (damage to blood supply, limited delivery of factors)

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3
Q

Describe management of hip fractures

A

Intracapsular displaced - THR (mobile, young, minimal comorbidities) or hemiarthroplasty
Trochanteric - sliding hip screw
Subtrochanteric - intramedullary nail

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4
Q

What is the Nottingham hip fracture score?

A

Determines risk of death/poor outcomes

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5
Q

Describe the Garden classification of hip fractures

A

Predicts Dec elopement of AVN
I - undisplaced, incomplete fracture
II - undisplaced, complete fracture
III - incompletely displaced, complete fracture
IV - completely displaced, complete fracture

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6
Q

Describe the Gustilo classification of open fractures

A

I - puncture from within to out, <1cm, minimal comminution
II - 1-10cm, moderate soft tissue damage/comminution
III - high energy trauma, farmyard/canal/sea contamination
A - adequate soft tissue damage of bone
B - extensive soft tissue loss, periosteal stripping, requires reconstructive surgery
C - vascular injury

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7
Q

Describe treatment of an open fracture

A

Initial management:
ATLS, analgesia, antiemetic, IV ABx within 3hrs, tetanus prophylaxis, control bleeding, assess soft tissue damage, neurovascular, debridememt/irrigation, photo, cover , stabilise/splint, reassess neurovascular
Surgical management:
Theatre within 24h unless vascular injury/gross contamination/compartment syndrome, aggressive debridement and irrigation, fracture stabilisation, coverage/closure

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8
Q

List scenarios where primary amputation is necessary

A 
Uncontrollable haemorrhage
Incomplete traumatic amputation
4-6 hours ischaemia
Segmental muscle loss of two compartments
Bone loss > 1/3 tibia
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9
Q

List signs and treatment of acute compartment syndrome

A 
Pain (+ on passive stretch)
Swollen tense compartment
Paraesthesia
Pressure >40mmHg 
--> dermatofasciotomy
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10
Q

What is the most common primary bone neoplasia?

A

Myeloma (40%)

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11
Q

Describe types of changes on X-ray in keeping with neoplasia

A

Lyric
Sclerotic
Mixed

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12
Q

What cancers cause lytic bone changes?

A 
Renal
Thyroid
Adrenal
Uterine
GI
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13
Q

What cancers cause sclerotic bone changes?

A

Prostate
Breast
Renal (TCC)

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14
Q

What cancers cause mixed sclerotic/lytic bone changes?

A

Primary bone tumour (Ewing’s sarcoma/osteosarcoma/chondrosarcoma)

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15
Q

Which cancers metastasise to bone?

A 
Thyroid
Breast
Lung
Renal
Prostate
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16
Q

List red flag symptoms of back pain

A

Age <16 or >50 new onset
Non mechanical
Thoracic
Malignancy history, unexplained weight loss
Long term steroid use
Fevers/rigors, recent significant infection
Difficulty passing urine (retention), urine/faecal incontinence, bilateral sciatica, saddle anaesthesia, decreased anal tone

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17
Q

List yellow flag symptoms of back pain

A 
Attitudes
Beliefs
Compensation
Diagnosis
Emotions
Family
Work
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18
Q

Describe the conditions cauda equina syndrome, myelopathy, radiculopathy

A

Cauda equina - pressure on nerve roots at cauda equina of spinal cord due to prolapsed disc/infection/cancer/lumbar spinal stenosis
Myelopathy - injury to spinal cord due to severe compression
Radiculopathy - pinched nerve

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19
Q

Describe how you would undertake an examination of the spine

A

Look - posture, asymmetry, scoliosis, muscle wasting, soft tissue abnormalities, cafe au lait spots, cervical lordosis/thoracic kyphosis/lumbar lordosis
Feel - temperature, spinous processes, sacroiliac joints, paraspinal muscles
Move - lateral flexion, lumbar flexion and extension cervical spine flexion and extension/rotation/deviation, thoracic rotation
Special tests - modified shobers test, femoral nerve stretch test, straight leg raise

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20
Q

Describe the shoulder joints and how it is stabilised

A

Ball and socket joint
Joints - sternoclavicular, acromioclavicular, glenohumeral, scapulothoracic
Stabilised by - rotator cuff muscles, labrum, glenohumeral ligaments

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21
Q

List the functions and innervations of the rotator cuff muscles

A

Supraspinatus - abducts humerus, suprascapular nerve
Infraspinatus - external rotation, suprascapular nerve
Teres minor - external rotation, axillary nerve
Subscapularis - internal rotation, adducts humerus, subscapular nerve

22
Q

List the common shoulder problems in different age groups

A

Young - instability, fractures, dislocations
Middle (40-60) - impingement, frozen shoulder, rotator cuff tears, tendinitis, bursitis
Older (60-80) - arthritis

23
Q

Describe the difference between impingement syndrome and frozen shoulder

A

Impingement syndrome - tendons of the rotator cuff muscles become irritated and inflamed as they pass through a narrowed subacromial space
Frozen shoulder - benign, self limiting condition (freezing, frozen, thawing stages) where the connective tissue surrounding the glenohumeral joint becomes inflamed and stiff

24
Q

Describe signs and symptoms of impingement syndrome

A

Pain, weakness, loss of movement
Pain worsened by overhead activities
Worse at night, particularly if lying on the affected shoulder
Pain during abduction from 60-120 (painful arc)
Positive empty cans, Hawkins-Kennedy test, scarf test

25
Q

Describe signs and symptoms of frozen shoulder

A

Constant pain, worse at night and with cold weather
Severely restricted range of movement (active and passive)
Lack of external rotation on affected side
Positive scarf test
*Risk factors - diabetes, stroke, connective tissue disease, thyroid disease, heart disease

26
Q

List short term complications of anterior shoulder dislocations

A

Bankhart lesion
Hill Sachs lesion
Axillary nerve damage

27
Q

What is a Bankhart lesion?

A

Tear to anterio-inferior glenoid labrum +/- avulsion fracture

28
Q

What is a Hill Sachs lesion?

A

Compression to postero-lateral humeral head

29
Q

List long term complications of anterior shoulder dislocation

A

Recurrence
Glenohumeral arthritis
Deltoid muscle wasting

30
Q

Describe how you would undertake an examination of the shoulder

A

Look (front, side, behind) - asymmetry, rotation (internal = posterior shoulder dislocation), bony prominences, scars, bruising, swelling, muscle wasting, large effusions
Feel - temperature, bony landmarks, muscle bulk, tendons
Move (active first, passive if necessary) - forward flexion, extension, abduction, adduction, external rotation, internal rotation
Special tests - muscle power (push against wall, empty cans, bubble, napoleon), Hawkins-Kennedy, apprehension test, scarf test
*Function - getting hands behind head and behind back

31
Q

List red flag symptoms of hip pain

A

Severe night pain
Inability to weight bear
Malignancy history
Rapid deterioration

32
Q

List common hip problems and how they may present

A

Arthritis - groin/buttock pain, stiffness, decreased ROM, loss of internal rotation
Trochanteric bursitis - lateral pain over greater trochanter
Fracture - pain, shortened leg, externally rotated

33
Q

Describe how you would undertake an examination of the hip

A

Gait - walking phases, stride length, arm swing, trendelenburg, antalgic, high steppage, waddling, short leg
Tremdelenburg test
Look (standing) - straight stance, pelvic tilt, deformities, stoop, lumbar lordosis, scoliosis, gluteal atrophy, scars, true/apparent leg length
Feel - temperature, effusions, bony landmarks (greater trochanter, ASIS, pubic rami)
Move (active then passive) - flexion, internal/external rotation, abduction/adduction, extension
Special tests - Thomas test, trendelenburg

34
Q

List red flag symptoms of knee pain

A

Inability to weight bear, worsening pain, acutely very stiff, fever, night pain, malignancy history

35
Q

List common knee problems and how they may present

A

ACL tear - sport injury, high twisting force applied to a bent knee, loud crack, pain, rapid joint swelling (haemoarthrosis), poor healing, increased laxity on anterior drawer test
PCL tear - high energy trauma/hyperextension injury, tibia lies back on femur, increased laxity on posterior drawer test
Meniscal tears - sport injury, rotational, delayed knee swelling, joint locking/gives way, recurrent pain and effusions, tender over joint line, +ve McMurray’s test
Collateral ligament tears - effusion, tenderness over ligaments, varus laxity (LCL)/valgus laxity (MCL)
OA - pain, stiffness, decreased ROM, crepitus
Prepatellar bursitis - localised swelling over patella, precipitated by period of kneeling, tender over patella, normal ROM
Osteochondritis dissecans - swelling, occasional locking

36
Q

Describe how you would undertake an examination of the knee

A

Gait - phases (looking at knee), limp, movement restriction
Look (standing) - alignment, varus/valgus deformity, fixed flexion deformity, hyperextension, baker’s cyst
Look (lying) - scars, bruising, swelling, effusions, RA nodules, psoriasis, alignment, position, knobbly knees, quadriceps bulk
Feel - temperature, tibial lag, joint line, synovial thickening, effusions (sweep test, patella tap test)
Move (active then passive) - flexion, extension, hyperextension
Special tests - collateral tests, drawer test, lachman’s, McMurray’s, patellofemoral apprehension test
Function - squat test

37
Q

List common orthopaedic paediatric conditions including presentation and management

A

Clubfoot - feet rotated inwards and downwards –> ponseti method (manipulation and casting)
Septic arthritis - unable to weight bear, fever >38.5, raised WCC/CRP
Development dysplasia of the hip (DDH) - limping toddler (1-3 years), neonate checks (Barlow/Ortolani) –> pavlik harness
*Risk factors - breech birth, family history, female, oligohydramnios
Perthes - limping child (4-9 years), AVN of femoral head/epiphysis, can lead to OA, premature fusion of growth plates, *Catterall staging 1-4 –> cast/braces/observation/surgery
Transient sinovitis - limping child (2-10), associated with viral infection
Slipped upper femoral epiphysis (SUFE) - limping child (10-15), obese, M>F, knee/distal thigh pain, displacement of femoral head epiphysis posters-inferiorly, loss of internal rotation *xray = melting ice cream –> bed rest, no weight bearing/percutaneous pinning
Juvenile idiopathic arthritis (JIA) - arthritis in <16 year old for >3 months, pauciarticular = <4 joint affected - pain, swelling, limp, ANA +ve, anterior uveitis

38
Q

Describe the Salter Harris classification of fractures

A 
Involves growth plate
I - straight across physis
II - above physics
III - lower than physis
IV - through metaphysics, physis and epiphysis
V - rammed, crushed physis
50% are salter Harris II
39
Q

Describe when paediatric elbow ossification occurs

A 
CRITOL
Capitellum - 1 
Radial head - 3
Internal epicondyle - 5
Trochlea - 7
Olecranon - 9
Lateral epicondyle - 11
40
Q

Describe physiological genu varus/valgus

A

Infant - varus
18 months - normal
3.5 years - valgus
7 years - normal

41
Q

List causes of intoeing

A

Femoral neck anteversion
Tibial torsion
Metatarsal adductus

42
Q

Describe how to interpret a radiograph

A
  1. Describe the film - type of radiography, views, patient demographics
  2. The abnormality (fracture):
    Type - complete (transverse/oblique/spiral/comminuted), incomplete (buckle/greenstick)
    Location - epiphysis/metaphysics/diaphysis/apophysis, specific part of bone (e.g. neck of femur)
  3. Complications/other - evidence of compound fracture/fracture enters joint/another fracture
43
Q

Describe X-ray changes of osteoarthritis

A

Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

44
Q

Describe X-ray changes of rheumatoid arthritis

A 
Loss of joint space
Erosions
Osteopenia
Soft tissue swelling 
Ulnar deviation of hands
45
Q

What is Shenton’s line?

A

Imaginary curved line along superior border of obturator foramen and inferior border of femoral neck
Disruption = fracture/dislocation of neck of femur

46
Q

Name the likely organism in an animal bite injury

A

Pasteurella multocida

47
Q

Describe different wrist fractures

A

Colles - distal radial fracture with dorsal displacement
Smith - distal radial fracture with volar displacement
Barton - fracture dislocation of the radiocarpal joint
Monteggia - ulnar shaft fracture with radial heal dislocation
Galaezzi - distal radius fracture with distal radio-ulnar joint dislocation

48
Q

Describe Weber’s classification of ankle fractures and their management

A

Weber A - fracture of lateral malleolus distal to syndesmosis (usually stable)
Weber B - fracture at level of syndesmosis (may require ORIF)
Weber C - fracture above level of syndesmosis (requires ORIF)

49
Q

Describe the presentation, investigations, management and complications of a scaphoid fracture

A

FOOSH in an adolescent/young adult
CFs - pain/tenderness in anatomical snuffbox
Ix - X-ray (repeat in 7-10 days if no fracture seen), CT/MRI
Rx - cast immobilisation, internal fixation if unstable
Complications - malunion, secondary OA, avascular necrosis (of proximal part)

50
Q

Describe the treatment options for a Boxer’s fracture

A

Conservative
K-wire fusion
Closed reduction

Phase 2 (11 decks)

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