MSK elective surgery and general trauma formative Flashcards
Name a tendon which needs surgical repair
Patellar tendon- need it to function
achilles, rotator cuff, long head of biceps, distal biceps can be managed conservatively
Do upper or lower limb fractures heal quicker?
Upper limb - better blood supply
Name a bone which is very slow to heal
Tibia
Fractures typically take 16 weeks, can take up to a year!
Nerve damaged in humeral shaft fracture?
Radial
Nerve damaged in colles (distal radial) fracture?
Median nerve
Nerve damaged in anterior dislocation of shoulder?
Axillary nerve
Cardinal sign of compartment syndrome?
Increased pain on passive stretching of the involved muscle
- the limb will be tensely swollen and the muscle is usually tender to touch
- Loss of pulses is a feature of end stage ischemia and the diagnosis has been made too late
Volkmanns contracture
- Can occur following compartment syndrome
- fibrotic contracture
A complete transection of a nerve requiring surgical repair for any chance of recovery of function
Neurotmesis
A temporary conduction defect from compression or stretch and will resolve over time with full recovery
Neurapraxia
Nerve injury sustained due to compression or stretch from a higher degree of force with death of the long nerve cell axons distal to the point of injury die
Axonotmesis
GCS that implies loss of airway control?
Can be associated with hypertrophic non-union when the fracture is not properly stabilised
2ndry bone healing
Involves an inflammatory response and laying down of immature bone
2ndry bone healing
Occurs in anatomically reduced fractures fixed rigidly with plates and screws
Primary bone healing
Occurs with a fracture gap of less than 1mm
Primary bone healing
Blow to the lateral aspect of the knee (“Bumper injury”) can result in damage to which nerve?
Common peroneal
Posterior dislocation of the hip could damage which nerve?
Sciatic
Salter Harris intra-articular fractures?
III and IV
Most common salter harris fracture?
II
Which type of salter harris cannot be diagnosed on x-ray?
Type V
These are compression injuries (with subsequent growth arrest)
Occur due to torsional forces acting on the bone. These fractures are most unstable to rotational forces but can also angulate
Spiral fracture
Occur when bone is exposed to a shearing force (e/g/ fall from height, deceleration). There is a risk of shortening and angulation with these fractures as they’re inheritently unstable
Oblique fracture
Occur when a pure bending force is applied to a bone. The cortex on one side fails in compression and the cortex on the other side fails in tension
Transverse fracture
Tendons that need managed surgically?
Patellar
Hip adductor
Quadriceps
Good for end stage ankle arthritis
Arthrodesis
Good for end stage wrist arthritis
Arthrodesis
Good for hallux rigidus (OA of the first MTP)
Arthrodesis
Artery to watch out for in shoulder dislocation?
Axillary artery
Artery to watch out for in knee dislocation?
Popliteal artery
Artery to watch out for in paediatric supracondylar fracture?
Brachial artery
Maximum GCS
15
Minimum GCS
3
Treatment for mallet finger
Mallet splint holding the DIPJ extended
-worn for a minimum of four weeks
Avascular necrosis can occur in which part of scaphoid?
Proximal pole (as blood supply comes distally from a branch of the radial artery)
Treatment for displaced scaphoid fracture?
Special compression screw sunk into the bone to avoid non-union
Mortality from hip fracture?
10% at 1 month
20% at 4 months
30% at 1 year
Criteria to clinically clear a C-spine
No history of loss of consciousness, GCS 15 with no alcohol intoxication
No significant distracting injury (such as head injury, chest trauma or other fractures including more distal spinal fractures)
No neurological symptoms in the upper or lower limbs
No midline tenderness on palpation of the c-spine,
No pain on gentle active neck movement (ask the patient to gently flexed forward, then rotate to each side)
Name a tendon which needs surgical repair
Patellar tendon- need it to function
achilles, rotator cuff, long head of biceps, distal biceps can be managed conservatively
Do upper or lower limb fractures heal quicker?
Upper limb - better blood supply
Name a bone which is very slow to heal
Tibia
Fractures typically take 16 weeks, can take up to a year!
Nerve damaged in humeral shaft fracture?
Radial
Nerve damaged in colles (distal radial) fracture?
Median nerve
Nerve damaged in anterior dislocation of shoulder?
Axillary nerve
Cardinal sign of compartment syndrome?
Increased pain on passive stretching of the involved muscle
- the limb will be tensely swollen and the muscle is usually tender to touch
- Loss of pulses is a feature of end stage ischemia and the diagnosis has been made too late
Volkmanns contracture
- Can occur following compartment syndrome
- fibrotic contracture
A complete transection of a nerve requiring surgical repair for any chance of recovery of function
Neurotmesis
A temporary conduction defect from compression or stretch and will resolve over time with full recovery
Neurapraxia
Nerve injury sustained due to compression or stretch from a higher degree of force with death of the long nerve cell axons distal to the point of injury die
Axonotmesis
GCS that implies loss of airway control?
Can be associated with hypertrophic non-union when the fracture is not properly stabilised
2ndry bone healing
Involves an inflammatory response and laying down of immature bone
2ndry bone healing
Occurs in anatomically reduced fractures fixed rigidly with plates and screws
Primary bone healing
Occurs with a fracture gap of less than 1mm
Primary bone healing
Blow to the lateral aspect of the knee (“Bumper injury”) can result in damage to which nerve?
Common peroneal
Posterior dislocation of the hip could damage which nerve?
Sciatic
Salter Harris intra-articular fractures?
III and IV
Most common salter harris fracture?
II
Which type of salter harris cannot be diagnosed on x-ray?
Type V
These are compression injuries (with subsequent growth arrest)
Occur due to torsional forces acting on the bone. These fractures are most unstable to rotational forces but can also angulate
Spiral fracture
Occur when bone is exposed to a shearing force (e/g/ fall from height, deceleration). There is a risk of shortening and angulation with these fractures as they’re inheritently unstable
Oblique fracture
Occur when a pure bending force is applied to a bone. The cortex on one side fails in compression and the cortex on the other side fails in tension
Transverse fracture
Tendons that need managed surgically?
Patellar
Hip adductor
Quadriceps
Good for end stage ankle arthritis
Arthrodesis
Good for end stage wrist arthritis
Arthrodesis
Good for hallux rigidus (OA of the first MTP)
Arthrodesis
Artery to watch out for in shoulder dislocation?
Axillary artery
Artery to watch out for in knee dislocation?
Popliteal artery
Artery to watch out for in paediatric supracondylar fracture?
Brachial artery
Maximum GCS
15
Minimum GCS
3
Treatment for mallet finger
Mallet splint holding the DIPJ extended
-worn for a minimum of four weeks
Avascular necrosis can occur in which part of scaphoid?
Proximal pole (as blood supply comes distally from a branch of the radial artery)
Treatment for displaced scaphoid fracture?
Special compression screw sunk into the bone to avoid non-union
Mortality from hip fracture?
10% at 1 month
20% at 4 months
30% at 1 year
Criteria to clinically clear a C-spine
No history of loss of consciousness, GCS 15 with no alcohol intoxication
No significant distracting injury (such as head injury, chest trauma or other fractures including more distal spinal fractures)
No neurological symptoms in the upper or lower limbs
No midline tenderness on palpation of the c-spine,
No pain on gentle active neck movement (ask the patient to gently flexed forward, then rotate to each side)
Criteria to clinically clear a C-spine
No history of loss of consciousness, GCS 15 with no alcohol intoxication
No significant distracting injury (such as head injury, chest trauma or other fractures including more distal spinal fractures)
No neurological symptoms in the upper or lower limbs
No midline tenderness on palpation of the c-spine,
No pain on gentle active neck movement (ask the patient to gently flexed forward, then rotate to each side)
Deformity in which plane is not well tolerated and requires manipulation and possible fixation?
Rotational deformity
Most common site for proximal humerus fracture?
Surgical neck of the humerus
Osgood Schlatters
Inflammation of the tibial tubercle
Sinding Larsen Johanssen disease
Inflammation of the inferior pole of the patella
Risk factors for patello-femoral dysfunction
The aetiology is unclear and may be due to muscle imbalance, ligamentous laxity and subtle skeletal predisposition (genu valgum, wide hips, femoral neck anteversion)
Talipes equinovarus (club foot) is more common in which gender?
- Boys
- around 50% of cases are bilateral
- may be genetic link with positive family history
- low amniotic fluid
- breech presentation
Often the first sign of Perthes?
Loss of internal rotation
-common in very active boys of short stature haha
- loss of internal rotation
- then loss of abduction
- then positive trendelenberg test
Patients with SUFE, proportion that are bilateral?
1/3
Loss of primitive reflexes
1-6 months
Head control
2 months
Speaking a few words
9-12 months
Eats with fingers, uses spoon
14 months
Stacks four blocks
18 months
Understands 200 words, learns around 10 words a day
18-20 months
Potty trained
2-3 years
Approx how many patients with a dislocated patellar will dislocate it again in the future?
20%
