MSK II

Question 1

Treatment of paediatric Monteggia/Galeazzi #?

Answer 1

Anatomic reduction and rigid fixation with plates and screws

Question 2

Nerve injury in supracondylar #?

Answer 2

Median nerve

Patient can’t make “OK” sign due to loss of FDS and FDP to the index

Question 3

Describe the treatment of femoral fractures in each of the following age groups

1. Less than 2
2. 2-6
3. 6-12
4. Older than 12

Answer 3

1. Gallows traction + hip spica cast
2. Thomas splint or hip spica cast
3. Flexible intramedullary nail
4. Adult type intramedullary nail

Question 4

Swelling on palmar surface around PIPJ of index and middle finger = ?
What is seen on histology?

Answer 4

Giant cell tumour of tendon sheath

Multinucleate giant cells and haemosiderin

Question 5

Treatment of trigger finger?

Answer 5

Injection of steroid

If recurrent do surgery to excise the pulley - does not affect function

Question 6

Why is it important to get flexor tendon injuries moving quickly after injury?

Answer 6

FDS and FDP run in the same synovial sheath - doesn’t take much for them to adhere to each other and cause stiffness

Question 7

How do you test FDP?

Answer 7

Hold finger straight at PIPJ and bend fingertip

Question 8

How do you test FDS?

Answer 8

Hold other fingers straight and flex affected finger

Question 9

What is trephination?

Answer 9

Making a hole in the nail with heat

Question 10

Treatment of fight bite?

Answer 10

Wash out in theatre - mouth organisms can cause nasty infection

Question 11

Dislocation of which joint in the hand is very susceptible to stiffness?

Answer 11

PIP - reduce it ASAP

Patient will be stiff and swollen for at least a few months after

Question 12

What is a Bennet #?

Answer 12

# of base of 1st MCP extending to the CMCJ
Intra-articular and almost always accompanied by some degree of subluxation or frank dislocation of CMCJ

Question 13

What is escharotomy?

Answer 13

Removal of thick leathery skin after burn

Question 14

No chance in hypotension + chest injury = ?

Answer 14

Cardiac tamponade

Question 15

What are the clinical manifestations of SIRS?

Answer 15

Pyrexia
Tachycardia
Tachypnoea
Leukocytosis

Question 16

What happens when there is excessive movement at a fracture site?

Answer 16

Hypertrophic non-union

Question 17

Treatment of an acetabulum fracture in an older patient?

Answer 17

THR

Question 18

Why are extra articular distal femoral fractures unstable?

Treatment?

Answer 18

Pull of gasrocnemii muscles forces distal segment into flexed position
Thomas splint
If not too distal can use intramedullary nail

Question 19

What should you consider in grossly unstable knee with torn LCL and PCL?

Answer 19

Momentary knee dislocation

Question 20

Where is there tenderness in patellar dislocation, and why is this?

Answer 20

Over medial retinaculum

Medial patellofemoral ligament is torn

Question 21

What leg injury can direct blow from car bumper cause?

Answer 21

Proximal fibular #

Injury to common peroneal nerve with foot drop

Question 22

What is the slowest healing long bone?

Answer 22

Tibia - 16 weeks

Question 23

Which criteria is used to identify suspected ankle #?

Answer 23

Ottawa criteria

Question 24

Medial tenderness and bruising of the ankle = ?

Answer 24

Ruptured deltoid ligament

Question 25

Treatment of a displaced but simple Colles #?

Answer 25

MUA

Question 26

Treatment of any Smith's #?

Answer 26

ORIF with plates + screws

Question 27

What are the two types of Barton's #?

Answer 27

Volar Barton's # = intra-articular Smith's # | Dorsal Barton's # = intra-articular Colles #

Question 28

High energy trauma resulting in hyper-dorsiflexion = ?

Answer 28

Peri-lunate dislocation

Question 29

Spilt cup sign on x-ray = ?

Answer 29

Lunar dislocation

Question 30

Terry Tomas sign on x-ray = ?

Answer 30

Increased gap between scaphoid and lunate - occurs when scapho-lunate ligaments rupture Sign of scapho-lunate dislocation

Question 31

What is neurapraxia?

Answer 31

Temporary conduction defect from compression or stretch | Resolves with full recovery - up to 28 days

Question 32

What is axonotmesis?

Answer 32

Sustained compression of nerve or high degree of force Internal structure is preserved but axons distal to the point of injury die Axons regenerate 1mm per day Recovery is variable and full power/sensation may not be achieved

Question 33

What is neurotmesis?

Answer 33

Complete transection of a nerve | No recover will occur unless affected nerve is surgically repaired and even then recovery is variable

Question 34

Sunray spectuloma

Answer 34

Osteosarcoma

Question 35

Onion peel sign

Answer 35

Ewing's sarcoma