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Medicine > MSK/orthopaedic > Flashcards

MSK/orthopaedic Flashcards

1
Q

Classification system for intracapsular fractures

A

Gardens

1: incomplete fracture line
2: complete fracture line, non displaced
3: complete fracture line, partial displaced
4: complete fracture line, complete displaced

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2
Q

O/E femoral next fracture:

A

affected leg is shorted, adducted, externally rotated,

inability to weight bear, or straight leg raise, decreased mobility, painful to palpate/rotate

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3
Q

Management of extracapsular NOF fractures

A

Internal fixation with dynamic hip screw

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4
Q

Management Intracapsular NOF fractures

A 
Garden 1/2 : screws
Garden 3/4:
<55- screws
>75- hemiarthroplasty
55-75- total hip replacement
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5
Q

Classification system for pubic ramus fracture

A

Young & Burgess - based on vector of disrupting force

Tile- fractures based ons stability of pelvic ring

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6
Q

Patella fracture epidemiology

A

20-50y

M>F

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7
Q

Management patella fracture

A

conservative: if non/minimally displaced and no extensor injury –> brace/cylinder cast
Surgery: if extensor injury, ORIF with tension band wiring, or if more simple case can use screws instead of wires

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8
Q

ACL function

A

Limits anterior translation of the tibia relative to the femur

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9
Q

Cause of ACL injury

A

Sudden deceleration, often athlete twisting and weight bearing

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10
Q

ACL tests

A

Lachman

Anterior drawer test

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11
Q

Segond fracture

A

On xray it shows a bony avulsion of the lateral proximal tibia, it is pathognomic of ACL injury.

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12
Q

Medical collateral ligament function

A

vagus stabiliser

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13
Q

medial meniscus features

A

is less circular than the lateral and is attached to the medial collateral ligament

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14
Q

lateral meniscus

A

more circular

is not attached to the lateral collateral ligament.

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15
Q

RF for achilles tendon rupture

A

Sports that stress the Achilles (e.g., basketball, tennis and track athletics)
Increasing age
Existing Achilles tendinopathy
Family history
Fluoroquinolone antibiotics (e.g., ciprofloxacin and levofloxacin, Rupture can occur spontaneously within 48 hours of starting treatment.)
Systemic steroids

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16
Q

Achilles tendon ruptur O/E

A

When relaxed in a dangled position, the affected ankle will rest in a more dorsiflexed position
Tenderness to the area
A palpable gap in the Achilles tendon (although swelling might hide this)
Weakness of plantar flexion of the ankle (dorsiflexion is unaffected)
Unable to stand on tiptoes on the affected leg alone
Positive Simmonds’ calf squeeze test

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17
Q

Simmonds’ calf squeeze test

A

When squeezing the calf muscle in a leg with an intact Achilles, there will be plantar flexionof the ankle. Squeezing the calf pulls on the Achilles. When the Achilles is ruptured, the connection between the calf and the ankle is lost. Squeezing the calf will not cause plantar flexion of the ankle in a leg with a ruptured Achilles. A lack of plantar flexion is a positiveresult.

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18
Q

Management of achilles tendon rupture

A

RICE, VTE prophylaxis
Non surgical option: specialised boot
Surgical option: reattaching achilles and then boot

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19
Q

pilon fracture (plafond)

A

severe injuries affecting the distal tibia, talus driven into the plafond

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20
Q

Classification of lateral malleolus fractures

A

Danis-Weber
three fracture types (i.e., A, B, C ), defined by the location of the fibular fracture
A - below the tibiotalar joint , below the syndesmosis
B - at the level of the tibiotalar joint ,at the level of the syndesmosis
C - above the tibiotalar joint ( usually the most unstable) , above the level of the syndesmosis,almost always need surgical fixation.
also there is the Lauge-Hansen classification which is more detailed

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21
Q

Ottawa ankle rules

A

Used in diagnostic uncertainty
state plain radiographs must be undertaken if :
Bone tenderness at the posterior edge or tip of the lateral malleolus, OR
the medial malleolus, OR
An inability to bear weight both immediately and in the emergency department for four steps

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22
Q

Foot x-ray is only required if there is midfoot zone pain and any out of:

A

Bone tenderness at base of the fifth metatarsal.
Bone tenderness at navicular bone.
Inability to bear weight both immediately and in emergency department for four steps.

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23
Q

ORIF indicated for ankle fractures if

A

Displaced bimalleolar or trimalleolar fractures
Weber C fractures
Weber B fractures with talar shift indicates disruption of syndesmosis
Open fractures

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24
Q

Undisplaced ankle fractures can be treated with

A

elow knee cast for 6 weeks (or boot for type a )

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25
Q

Lisfranc injury

A

severe injuries to the tarsometatarsal (Lisfranc) joint between the medial cuneiform and the base of the 2nd metatarsal.

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26
Q

Lisfranc injury clinical features

A

severe pain, swelling, in the midfoot
difficulty in weight-bearing.
The ‘piano key’ sign is prominence of the metatarsal bones, which reduce back down with pressure
plantar bruising is highly suggestive of a Lisfranc injury

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26
Q

Xray features of Lisfranc injury

A

(take xray while weight bearing)
widening of tarsometatarsal joint ( 1st-2nd)
Fleck sign in the same space (Lisfranc segment avulsion)

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27
Q

O’Brien’s test

A

superficial pain localized to AC joint is suggestive of AC joint pathology

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28
Q

Risk factors bicep tendon rupture

A 
previous episodes of biceps tendinopathy
steroid use
Smoking
chronic kidney disease (CKD)
use of fluoroquinolone antibiotics.
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29
Q

Bicep tendon rupture clinical features

A

sudden onset pain and weakness
feeling of a “pop” during the incident.
marked swelling and bruising in the antecubital fossa.
As the proximal muscle belly retracts (due to loss of counter traction) a bulge may become evident in the arm; this is termed the “reverse Popeye sign”
The Hook test is a special test to identify a potential distal tendon rupture:The elbow is actively flexed to 90º and fully supinated, the examiner attempts to ‘hook’ their index finger underneath the lateral edge of the biceps tendon(which cannot be done in a ruptured biceps tendon)

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29
Q

classification system of clavicle fracture

A

Allman classification system, determined by the anatomical location of the fracture along the clavicle.
Type I – fracture of the middle third of the clavicle, most common
Type II – fractures involving the lateral third of the clavicle
Type III- medial ⅓ of clavicle, most serious

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30
Q

classification system of olecranon head fracture

A

Mayo classification and the Schatzker classification

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31
Q

Management of olecranon head fractures

A

Treatment is usually guided by the degree of displacement on imaging.
non-operative management is usually indicated for displacement <2mm, with immobilisation in 60-90 degrees elbow flexion
Operative management is usually indicated for displacement >2mm

32
Q

Essex-Lopresti fracture

A

describes a fracture of the radial head with disruption of the distal radio-ulnar joint, and will always require surgical intervention.

33
Q

Sail sign

A

Elbow effusions on a lateral projection

34
Q

classification system of radial head fractures

A

Mason classification:
Mason Type 1 – Non-displaced or minimally displaced fracture (<2mm).
Mason Type 2 – Partial articular fracture with displacement >2mm or angulation.
Mason Type 3 – Comminuted fracture and displacement

35
Q

Management of radial head fractures

A

Mason type 1 injuries – treated non-operatively, with a short period of immobilization with sling (less than 1 week) followed by early mobilisation
Mason Type 2 injuries – if no mechanical block then can be treated as per a type 1
Mason type 3- ORIF or adial head excision or replacement

36
Q

boxer’s fracture

A

fracture of the neck of the 4th or 5th metacarpal.

37
Q

injury to flexor digitorum profundus results in

A

loss of terminal Interphalangeal joint function ( the PIP and MP joints can still be flexed by FDS)

38
Q

Trigger finger

A

finger or thumb click or lock when in flexion, preventing a return to extension.
thought to be caused by inflammation of the long flexor tendons (often from repetitive movements of the fingers). In response to the inflammation, the tendon becomes thickened or develops a nodule – making it difficult for the tendon to pass through the pulleys.

39
Q

De Quervain’s tenosynovitis

A

type of repetitive strain injury where there is swelling and inflammation of the tendon sheaths in the wrist.
results in pain on the radial side of the wrist.

40
Q

types of distal radius fractures

A

Colles’ fracture (90% of all distal radius fractures)
Smith’s fracture
Barton’s fracture

41
Q

Colles’ Fracture

A

extra-articular fracture of the distal radius with dorsal angulation and dorsal displacement, within 2cm of the articular surface. This type of fracture typically occurs as a “fragility fracture” in osteoporotic bone..“dinner fork”

42
Q

Smith’s Fracture

A

volar angulation of the distal fragment of an extra-articular fracture of the distal radius (the reverse of a Colles fracture), with or without volar displacement.
caused by falling backwards and planting the outstretched hand behind the body,

43
Q

Barton’s Fracture

A

intra-articular fracture of the distal radius with associated dislocation of the radio-carpal joint.
A Barton fracture can be described as volar (more common) or dorsal (less common), depending on whether the volar or dorsal rim of the radius is involved.

44
Q

Risk factors distal radius fracture

A 
main risk factors for distal radius fractures are related to osteoporosis:
Increasing age
Female gender
Early menopause
Smoking or alcohol excess
Prolonged steroid use
44
Q

diagnosis of a distal radius fracture:

A

Radial height <11mm
Radial inclination <22 degrees
Radial (volar) tilt >11 degrees

45
Q

Surgery indicated for distal radius fracture

A

Significantly displaced or unstable fractures , Any fracture with an intra-articular step of the radiocarpal joint >2mm
ORIF with plating, or K-wire fixation.

45
Q

Epidemiology scaphoid fractures

A

most common in men aged 20-30 years and are high-energy injuries. Approximately 10% have an associated fracture.

46
Q

Xray of scaphoid fractures

A

not always detected by initial radiographs (especially undisplaced fractures); if there remains sufficient clinical suspicion, patient should have the wrist immobilised in a thumb splint and repeat plain radiographs in 10-14 days .If still negative, however clinical findings are still in keeping with a scaphoid fracture, an MRI scan of the wrist is indicated.

46
Q

risk of scaphoid fracture

A

avascular necrosis (in around 30% of cases) , which would present with pain and stiffness at the wrist.The more proximal the scaphoid fracture, the higher the risk of AVN.

46
Q

Froment’s sign

A

test for ulnar nerve palsy
– specifically paralysis of the adductor pollicis:
The patient is asked to hold a piece of paper between the thumb and index finger, as the paper is pulled away.
They should be able to hold the paper there with no difficulty (via adduction of the thumb).
A positive test is when the patient is unable to adduct the thumb due to weak adductor pollicis. Instead, they flex the thumb at the interphalangeal joint to try to maintain a hold

47
Q

Carpal tunnel syndrome

A

Compression of the median nerve within the carpal tunnel

48
Q

Carpal tunnel syndrome can be secondary to

A 
Diabetes
Pregnancy
Hypothyroidism
Acromegaly
Radial fracture
Rheumatoid arthritis
49
Q

Clinical presentation Carpal tunnel syndrome

A

numbness, tingling, and pain in the distribution of the median nerve (first 3 digits) .
Symptoms can wake the patient from sleep and are usually worse in the morning.
Relieved by skiing /hanging out hand at night
here may also be clumsiness in hand movements

50
Q

Tests for carpal tunnel syndrome

A

Tinel’s sign – tapping the nerve in the carpal tunnel to elicit pain in median nerve distribution.
Phalen’s manoeuvre – holding the wrist in flexion for 60 seconds to elicit numbness/pain in median nerve distribution.

51
Q

Management Carpal tunnel syndrome

A

splint, holding the wrist in extension overnight to relieve symptoms. If this is unsuccessful, corticosteroid injections into the carpal tunnel can be trialled. Surgical decompression of the carpal tunnel may be required in severe cases

52
Q

Erb’s palsy

A

upper roots, involves C5-6 nerve roots
“waiter’s tip” sign with shoulder adduction, elbow extension, forearm pronation and wrist flexion. It is most typically associated with shoulder dystocia and traumatic childbirth.

53
Q

Klumpke’s palsy

A

lower roots, C8-T1 nerve roots with corresponding dermatomal sensory loss, and weakness of the intrinsic muscles of the hand.

54
Q

Frozen shoulder epidemiology

A

Most common in adults aged 40-60

More common in those with diabetes, cardiovascular disease and cancer

55
Q

Clinical presentation Frozen shoulder

A

Presents with gradual onset pain and stiffness of the shoulder with reduced movement, most notably external rotation
Pain worsens initially and persists for weeks-months
Stiffness can persist for months-years

56
Q

Lateral epicondylitis or ‘tennis elbow’

A

pain at the site of insertion of the forearm extensors at the lateral epicondyle of the humerus. It typically presents in those over the age of 35 in those who perform repetitive activities involving elbow extension. Symptoms typically resolve with rest.

57
Q

Medial epicondylitis, ‘golfer’s elbow’

A

occurs due to tendinopathy of the wrist flexor tendons which attach to the medial epicondyle of the distal humerusmedial elbow pain exacerbated by activity, particularly flexion of the wrist. There may also be weakness of wrist flexion.

58
Q

Rotator cuff tendonitis

A

Rotator cuff disease
tendons of the rotator cuff muscles become inflamed. This may be due to microtrauma or impingement. The tendons may become calcified as a result of repeated inflammation

59
Q

Subacromial impingement

A

Rotator cuff disease
tendons of the rotator cuff muscles become compressed between the humeral head and the acromion. Presents with pain and stiffness, particularly when performing overhead activities.

60
Q

Rotator Cuff Injury

A

Rotator cuff disease
any injury of the four rotator cuff muscles.Typically presents with shoulder pain, reduced range of motion and shoulder weakness.

61
Q

Bankart lesions

A

are tears to the anterior portion of the labrum. These occur with repeated anterior subluxations or dislocations of the shoulder.

61
Q

key complication of shoulder injury

A

Axillary nerve damage - particularly anterior dislocation and proximal humeral fractures.

62
Q

Axillary nerve damage symptoms

A

nerve comes from the C5 and C6nerve roots.
Damage causes a loss of sensation in the “regimental badge” area over the lateral deltoid.
profound weakness of shoulder abduction due to disruption in the motor supple to deltoid and teres minor.
weakness in shoulder flexion, extension and external rotation
The extension lag test can be used to evaluate motor deficit. To perform this, elevate patient’s arm to near full extension, and ask the patient to maintain the position. The test is positive if the arm drops.

63
Q

Clinical presentation shoulder dislocation

A

They will hold their arm against the side of their body.
The deltoid will appear flattened,
the head of the humerus will cause a bulge and be palpable at the front of the shoulder.
painful shoulder
acutely reduced mobility
a feeling of instability
Patients will be reluctant to move the affected limb.
On examination, there is often an asymmetry with the contralateral side.

64
Q

Hill-Sachs lesions

A

are compression fractures of the posterolateral part of the head of the humerus. As the shoulder dislocates anteriorly, the posterolateral part of the humeral head impacts with the anterior rim of the glenoid cavity. Part of the humeral head is damaged, making the shoulder less stable and at risk of further dislocations.

65
Q

causes of pathological fractures

A

Tumours: Primary, Secondary (metastatic, most common)
Metabolic: Osteoporosis (most common)
Paget’s disease
Hyperparathyroidism

66
Q

Common peroneal nerve injury

A

commonly occurs due to injury around the knee. The common peroneal nerve is particularly vulnerable to injury at the neck of the fibula.
Injury causes a ‘foot drop’ (weakness of the dorsiflexion muscles ) due to paralysis of the foot extensors (tibialis anterior, extensor digitorum longus and extensor hallucis longus). Foot inversion may also occur as the common peroneal nerve also innervates the foot evertor muscles.

67
Q

Lateral epicondylitis exacerbated by

A

wrist extension and supination of the forearm

68
Q

Medial epicondylitis aggravated by

A

wrist flexion and pronation. Sometimes it is associated with ulnar nerve compression.

69
Q

Cubital tunnel syndrome clinical presentation

A

Presents with the signs of ulnar nerve compression. Paraesthesia is in the ulnar nerve distribution and is exacerbated when the elbow is flexed for extended periods of time.

70
Q

hand nerves

A

Finger flexion, Finger and wrist extension, finger abduction/adduction Rock, paper, scissors Median, radial, ulnar (alphabetical)

71
Q

Flail chest:

A

caused by two or more rib fractures along three or more consecutive ribs, usually anteriorly

72
Q

Fat embolism triad

A

hypoxaemia, neurological abnormalities (eg confusion ) and petechial rash

73
Q

Broad arm sling

A

clavicle fracture and shoulder dislocation

Medicine (72 decks)

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