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FINALS (not specialities) > MSK/Orthopaedics > Flashcards

MSK/Orthopaedics Flashcards

1
Q

What are the classic signs of osteoarthritis on x-ray?

A

Loss of joint space
Subchondral sclerosis
Subchondral cysts
Osteophytes at joint margins

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2
Q

Give 4 differentials for a hot, swollen joint

A

Septic arthritis
Osteomyelitis
Gout
Charcot joint (diabetics)

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3
Q

What is a Charcot joint?

A

A joint which has become badly disrupted and damaged secondary to a loss of sensation (usually due to diabetes)

Red, swollen and warm
Less painful that would be expected for such a disrupted joint due to the sensory loss

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4
Q

Define a sprain. What is the most likely mechanism of injury in the ankle?

A

A stretching, partial or complete tear of a ligament. Usually due to inversion if in the ankle

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5
Q

How would a posterior hip dislocation present?

A

The affected leg is shortened, adducted, and internally rotated

Most common!

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6
Q

How would an anterior hip dislocation present?

A

abducted and externally rotated.

No leg shortening.

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7
Q

Give 4 complications of a hip dislocation

A

Sciatic or femoral nerve injury

Avascular necrosis

Osteoarthritis: more common in older patients.

Recurrent dislocation: due to damage of supporting ligaments

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8
Q

What is the management of a hip dislocation?

A

Short term =
A to E and Analgesia
Reduction under general anaesthetic within 4 hours to reduce the risk of avascular necrosis.

Long-term =
Physiotherapy to strengthen the surrounding muscles.

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9
Q

How would a fractured neck of femur present?

A

Typically elderly females

pain
shortened and externally rotated leg
patients with non-displaced or incomplete neck of femur fractures may be able to weight bear

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10
Q

Describe the difference between intra and extracapsular hip fractures

A

Intra = edge of the femoral head to the insertion of the capsule of the hip joint

extra= these can either be trochanteric or subtrochanteric (the lesser trochanter is the dividing line)

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11
Q

Which classification system is the one for fractured NOFs?

A

Garden

Vascular compromise associated with type 3&4

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12
Q

What is the management of intracapsular NOF fractures?

A

Undisplaced = internal fixation, or hemiarthroplasty if unfit.

Displaced = replacement arthroplasty

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13
Q

In terms of replacement arthroplasty for displaced hip fractures, when is a total hip replacement favoured over a hemiarthroplasty?

A

IF PATIENTS CAN:

Walk independently out of doors with no more than the use of a stick AND

No cognitive impairment AND

are medically fit for anaesthesia and the procedure.

Basically TRH if they’re healthy

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14
Q

What is the management of an extracapsular hip fracture?

A

dynamic hip screw

OR

if reverse oblique, transverse or subtrochanteric: intramedullary device

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15
Q

Give 6 ‘things’ that can occur due to falling on an outstretched hand

A

Wrist = scaphoid, colles

Forearm = Monteggia, Galeazzi (+dislocations)

Shoulder = dislocation of the humerus, clavicle fracture

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16
Q

which fracture occurs by falling on a flexed wrist? Describe the fracture

A

Smith’s fracture

fracture of the distal radius + volar angulation (wrist is flexed)

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17
Q

describe a colles fracture

A

FOOSH + elderly

distal radius fracture + dorsal angulation

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18
Q

what complication can occur due to a scaphoid fracture and why?

A

avascular necrosis as the blood supply runs distal to proximal

can predispose osteoporosis in later life (young people get scaphoid fractures)

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19
Q

describe a Monteggia fracture

A

Man Utd

Monteggia = ulna

Fracture of the ulnar shaft + dislocation of the proximal radial head

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20
Q

describe a Galeazzi fracture

A

Glasgow Rangers

Rangers = Radius

Fracture of the radial shaft and dislocation of the radioulnar joint

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21
Q

When does a supracondylar fracture occur and what is a complication of it?

A

FOOSH in a child

Can get damage to the brachial artery and therefore ischaemia to the forearm

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22
Q

How do anterior and posterior dislocations of the humeral head present?

A

anterior = more common.
Abducted and externally rotated

Posterior = seizure/electrocution
internally rotated and abducted

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23
Q

What structure can be damaged in a humeral head dislocation and what are the effects of this?

A

Axillary nerve

loss of sensation to the regimental badge

loss of innervation to the deltoid = unable to abduct

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24
Q

Which structure can be damaged due to a fracture to the surgical neck of the humerus?

A

axillary nerve

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25
Q

Which structure can be damaged due to a fracture of the humeral shaft and what can occur as a result?

A

Radial nerve + profunda brachii artery

Wrist drop = unopposed flexion of the wrist due to loss of extension from the triceps

Loss of sensation to the dorsum of the hand and the later 3.5 digits

26
Q

Where is the clavicle most commonly fractured and what happens to the fragments as a result?

A

middle 1/3

medial 1/3 gets pulled superiorly due to sternocleidomastoid

lateral 2/3 gets pulled inferiorly due to pec major

27
Q

Name the 4 muscles of the rotator cuff from superior to inferior and give their action

A

SUPRAspinatus = ABduction to 15 degrees

INFRAspinatus = external rotation

Teres minor = external rotation

Subscapularis = internal rotation

external rotation sandwich

28
Q

How does a rotator cuff tear present?

A

pain over the lateral aspect of shoulder

can’t abduct the arm above 90 degrees

29
Q

what is the management of a rotator cuff tear?

A

conservative = analgesia + physio. ? corticosteroid injections

surgical if >2 weeks since injury or symptomatic despite conservative = arthroscopic or open repair

30
Q

What is the main complication of a rotator cuff tear?

A

adhesive capsulitis

Glenohumeral joint capsule becomes contracted and adherent to the humeral head

= pain and loss of range of movement

analgesia, physio, ?steroid injection ?surgery

31
Q

What are the causes of carpal tunnel?

A

MEDIAN TRAP

Myxoedema (hypothyroid)
oEdema
Diabetes mellitus
Idiopathic
Acromegaly
Neoplasia

Trauma
Rheumatoid arthritis
Amyloidosis
Pregnancy

32
Q

What are the 2 tests for carpal tunnel?

A

Tinnels Test (tap the median nerve)

Phalen’s Test (hold wrist in full flexion for one minute = parasthesia)

33
Q

How does carpal tunnel present?

A

pain, numbness, and/or paraesthesia throughout the median nerve distribution

sx usually worse at night

wasting of the thenar evidence

weakness of thumb abduction

34
Q

How would an ACL tear present?

A

Hx of twisting the knee whilst weight bearing

Rapid joint swelling

Can’t weight pain

Pain +++

35
Q

Which tests can be done to identify ACL damage?

A

Anterior draw (flex knee at 90 degrees + apply force anteriorly)

Lachman (flex knee 30 degrees + pull tibia forward)

MRI scan is gold standard

36
Q

How would a meniscal tear present?

A

Tearing sensation in knee

Sudden onset pain +++

Slow swelling

Knee locking

joint line tenderness

37
Q

Which tests can be done to identify meniscal damage?

A

McMurray’s

38
Q

What is the classification system used for lateral malleolus fractures?

A

Weber’s

a = below syndesmosis + usually transverse

B = at the level of the syndesmosis + usually spiral

C = above level of syndesmosis

more proximal = increased risk of instability

39
Q

What are the Ottawa rules?

A

if there is diagnostic uncertainty in ankle fractures e.g. can mobilise and has no deformity

presence of:
bone tenderness at posterior edge/tip of lateral OR medial malleolus
can’t weight bear for 4 steps

= get a plain radiograph

40
Q

When should surgical management be used in a patient with an ankle fracture?

A

Displaced bimalleolar or trimalleolar fractures

Weber C fractures

Weber B fractures with talar shift

Open fractures

41
Q

What is the surgical management of osteoarthritis and when should it be offered?

A

Osteotomy, joint fusion or joint replacement

if conservative and medical interventions don’t manage the condition

42
Q

What is compartment syndrome?

A

a critical pressure increase within a confined compartmental space

fascial compartments are rigid and can’t distend so excess fluid = increase in intracompartmental pressure

compresses veins and nerves
compromises arterial inflow = ischaemia

43
Q

How does compartment syndrome present?

A

5Ps

Parasthesia + paralysis

Pain (disproportionate to injury and not improved with analgesia)

Pallor

Perishingly Cold

Pulselessness

44
Q

How is compartment syndrome managed?

A

A-E
Remove splints/casts/etc
Analgesia
Monitor renal function

URGENT FASCIOTOMY

45
Q

What is septic arthritis?

A

Infection of a joint, usually due to staph aureus

Bacteria seeds to the joint from a bacteraemia, direct inoculation or spreading from near osteomyelitis

46
Q

What are the risk factors for septic arthritis?

A 
non-modifiable:
age >80
pre-existing joint disease e.g. RA
diabetes/immunosuppressed
chronic renal failure

modifiable:
IVDU
Joint prosthesis

47
Q

How does septic arthritis normally present?

A

Red, swollen, hot joint

pain on active and passive joint movement

pyrexia

can’t wait bear

48
Q

Which investigations should be done to manage septic arthritis?

A

Bed - a-e
Bloods - FBC, U&E, CRP, Urate, Blood cultures
Imaging - plain radiograph xray
Other - joint aspiration!!! Before abx. if have joint prosthesis then do it in theatre

49
Q

What is the management of septic arthritis?

A

Empiral abx ASAP. give these IV and long term

Surgical irrigation and debridement for native joints
Washout and revision surgery for prosthetic

50
Q

Give 2 complications of septic arthritis

A

Osteoarthritis and osteomyelitis

51
Q

What is osteomyelitis and how is it caused?

A

Infection of the bone

haematogenous spread
direct inoculation
direct spread from nearby infection

usually bacterial by staph aureus
pseudomonas in IVDU
salmonella in sickle cell

52
Q

How does osteomyelitis present?

A

Severe pain
low grade fever

tender to palpate + overlying erythema and swelling

Long bones normally infected in children

53
Q

What are the risk factors for osteomyelitis?

A

Non modifiable:
Immunosuppressed
Diabetes mellitus

modifiable:
alcohol excess
IVDU

54
Q

How should osteomyelitis be investigated?

A

Normal bloods

MRI = definitive diagnosis
Gold standard = bone biopsy when derided

55
Q

What is the management of a patient with osteomyelitis?

A

Long term IV abx

curettage if deteriorate

56
Q

What are 3 complications of osteomyelitis?

A

SEPSIS + DEATH
Septic arthritis

growth disturbance in children

can become chronic

57
Q

What counts as a tetanus prone wound?

A

Needs surgery but has been delayed for >6 hours

Significant degree of devitalised tissue/Puncture-type injury

Foreign body in situ/ significant contact with spores likely to contain tetanus e.g. manure or soil

Compound fractures

Systemic sepsis is present

(Give these all tetanus immunoglobulin)

58
Q

Which abx prophylaxis is required for an infected wound?

A

Contaminated = co-amoxiclav

Clean = Flucloxacillin

*** swab wound before abx

59
Q

How does adhesive capsulitis normally present?

A

Middle aged women

external rotation is affected more than internal rotation or abduction

both active and passive movement are affected

60
Q

What is Paget’s disease of bone?

A

increased bone turnover + remodelling

defective mineralisation

61
Q

Give 3 investigations for Paget’s disease of bone?

A

Xrays of affected areas

serum calcium, phosphate and alk phos

serum hydroxyproline

62
Q

What is the management of Paget’s disease of bone?

A

Analgesia and rest

bisphosphonates

FINALS (not specialities) (7 decks)

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