MSK/ortho

Question 1

Answer 1

• anterior posterior view
• location? right leg, mid/distal third tibia
• simple (not multifragmentary)
• pattern: complete oblique fracture
• displaced: valgus displacement
• minimal angulation (distal part anteriorly tilted 10 degrees)

Question 2

Answer 2

• anterior posterior view
• location: right leg of a paediatric patient
• simple or multifragmentary? multifragmentary
• pattern: complete oblique fractures of the fibula and tibia
• displaced: valgus displacement
• lateral view: anterior displacement (look at the most distal part of the fracture!)

Question 3

general principles of fracture management?

Answer 3

Reduce: closed or open
Hold: metal or non-metal
Rehabilitate: move, phyiotherapy, use

Question 4

types of reduction

Answer 4

closed:
- manipulation
- (not done so much now) traction (skin or skeletal ie pins in bone)

open:
- incise and put the bones together (mini-incision or open ie full exposure)

Question 5

types of holding

Answer 5

• fixation (metal)
• closed
  (plaster or traction - again traction not used so much)

Question 6

types of fixation

Answer 6

internal
- intramedullary (sticking into canal of bone) - pins or nails
- extramedullary (not going into bone) - plates/screws or pins

external
- stick metal in under the skin but outside the bone, closing skin over it
types: monoplanar or multiplanar

Question 7

types of rehabilitation

Answer 7

• use (pain relief, retrain)
• move
• strengthen
• weight bear

Question 8

chronic regional pain syndrome

Answer 8

nerves end up being overactive in pain fibres -> autonomic response

treatment: pain relief, physio

Question 9

indications for external fixation

Answer 9

allows you to see and treat infection much more easily - e.g. complex fractures, crush fractures. use when there’s soft tissue damage

can use temporarily whilst soft tissue under control wrt infection

Question 10

complications of fractures - categorising?

Answer 10

LOCAL or GENERAL

Immediate (<24hr)
Early (<30 days)
Late (>30 days)

Question 11

Complications of fractures?

Answer 11

General:

• fat embolus
• DVT
• infection
• prolonged immobility
  (-> UTI, chest infections, sores)

Local:
- neurovascular injury
- muscle/tendon injury
- non union.malunion
- local infection
- degenerative change (intrarticular)
- reflex sympathetic dystrophy

Question 12

signs of fracture

Answer 12

• pain
• swelling
• crepitus
• deformity
• adjacent structural injury: nerve, vessels, tendons

Question 13

osteoarthritis knee changes

Answer 13

• loss of joint space
• osteophytes
• sclerosis
• subchondral cysts

Question 15

broad union times

Answer 15

fracture union time <3 months in upper limb, <6 months in lower limb