MUSK

Question 1

What is Osteomyelitis

Answer 1

Infection of the bone

Question 2

What is the most common cause of Osteomyelitis?

Answer 2

S.aureus, Salmonella species in sickle cell anaemia

Question 3

What 5 conditions predispose to Osteomyelitis?

Answer 3

DM
Sickle cell anaemia
IVDU
Immunosuppression
Alcohol

Question 4

How do you investigate osteomyelitis?

Answer 4

MRI

Question 5

Rx Osteomyelitis?

Answer 5

Flucloxacillin for 6 weeks, clindamycin if penicillin allergic

Question 6

Diagnosis of pain over anatomical snuff box?

Answer 6

Scaphoid fracture

Question 7

Rx of Scaphoid fracture

Answer 7

Refer for urgent ortho/ED review due to risk of avascular necrosis

Question 8

Features of Lateral epicondylitis (Tennis elbow) (3)

Answer 8

1. Pain and tenderness localised to the lateral epicondyle
2. Pain worse on resisted wrist extension with the elbow extended or supination of the forearm with the elbow extended
3. Episodes typically last between 6 months and 2 years, pts tend to have acute pain for 6-12 weeks

Question 9

Features of medial epicondylitis (Golfer’s elbow) (3)

Answer 9

1. Pain and tenderness localised to the medial epicondyle
2. Pain aggravated by wrist flexion and pronation
3. Sx may be accompanied by numbness/tingling in the 4th and 5th finger due to ulnar nerve involvement

Question 10

Cause of Radial tunnel syndrome

Answer 10

Most commonly due to compression of the posterior interosseous branch of the radial nerve. Thought to be due to overuse.

Question 11

Features of radial tunnel syndrome (3)

Answer 11

1. Sx similar to lateral epicondylitis
2. However, pain tends to be around 4-5cm distal to the lateral epicondyle
3. Sx may be worsened by extending the elbow and pronating the forearm

Question 12

Cause of cubital tunnel syndrome

Answer 12

Compression of the ulnar nerve

Question 13

Features of cubital tunnel syndrome(3)

Answer 13

1. Initially intermittent tingling in the 4th and 5th finger
2. May be worse when the elbow is resting on a firm surface or flexed for extended periods
3. Later numbness in the 4th and 5th finger with associated weakness

Question 14

What is olecranon bursitis and how does it present?

Answer 14

Swelling over the posterior aspect of the elbow.

There may be associated pain, warmth and erythema. Typically affects middle-aged male patients

Question 15

What is a Galeazzi fracture?

Answer 15

Dislocation of the distal radioulnar joint with an associated fracture of the radius

Question 16

3 features of a Colles’ fracture?

Answer 16

Transverse fracture of the radius
1 inch proximal to the radio-carpal joint
Dorsal displacement and angulation

Question 17

What is a smith’s fracture?

Answer 17

Volar angulation of distal radius fragment

Caused by falling backwards onto the palm of an outstretched hand or falling with wrists flexed

Question 18

What is a Bennett’s fracture?

Answer 18

Intra-articular fracture of the first carpometacarpal joint
Caused by fighting
X-ray: Triangular fragment at ulnar base of metacarpal

Question 19

What is a Monteggia’s fracture?

Answer 19

Dislocation of the proximal radioulnar joint in association with an ulna fracture

Question 20

What is a Pott’s fracture?

Answer 20

Bimalleolar ankle fracture

Forced foot eversion

Question 21

What is a Barton’s fracture?

Answer 21

Distal radius fracture (Colles’/Smith’s) with associated radiocarpal dislocation

Question 22

How does a posterior hip dislocation present?

Answer 22

Affected leg is shortened, adducted and internally rotated

90% of hip dislocations

Question 23

How does an anterior hip dislocation present?

Answer 23

Affected leg is abducted and externally rotated, no leg shortening

Question 24

How do you manage hip dislocation?

Answer 24

ABCDE
Analgesia
Reduction under GA within 4 hours to reduce risk of avascular necrosis
Long term: PT

Question 25

Complications of hip dislocation? (4)

Answer 25

Sciatic or femoral nerve injury Avascular necrosis OA Recurrent dislocation due to damage of supporting ligaments

Question 26

What are the clinical features of a fat embolism?

Answer 26

Respiratory: Early persistent tachycardia, Tachypnoea, pyrexia Derm: Red/brown impalpable petechial rash, subconjunctival and oral haemorrhage/petechiae CNS: Confusion and agitation, retinal haemorrhages and intra-arterial fat globules on fundoscopy

Question 27

Rx of Fat embolism?

Answer 27

Prompt fixation of long bone fractures DVT prophylaxis General supportive care

Question 28

Features of hip fracture?

Answer 28

Pain | Shortened and externally rotated leg

Question 29

Garden classification of hip fractures

Answer 29

Type I: Stable fracture with impaction in valgus Type II: Complete fracture but undisplaced Type III: Displaced fracture, usually rotated and angulated, but still has bony contact Type IV: Complete bony disruption

Question 30

Management of intracapsular hip fracture

Answer 30

Undisplaced: Internal fixation, or hemiarthroplasty if unfit Displaced: Young and fit (<70)= reduction and internal fixation, older and reduced mobility= hemiarthroplasty or THR

Question 31

Management of extracapsular hip fracture

Answer 31

Dynamic hip screw | If reverse oblique, transverse of subtrochanteric: intramedullary device

Question 32

What is definition of avascular necrosis?

Answer 32

Death of bone tissue secondary to loss of the blood supply. Most commonly affected the epiphysis of long bones such as the femur

Question 33

Causes of avascular necrosis (4)

Answer 33

Long term steroid use Chemotherapy Alcohol XS Trauma

Question 34

X-ray findings in avascular necrosis

Answer 34

May be normal initially. Osteopenia and microfractures may be seen early on. Collapse of the articular surface may result in the crescent sign

Question 35

Rx of avascular necrosis

Answer 35

Joint replacement may be necessary

Question 36

What is the main neurovascular structure that is compromised in a scaphoid fracture?

Answer 36

The dorsal branch of the radial nerve

Question 37

What is compartment syndrome?

Answer 37

It is a particular complication that may occur following fractures. It is characterised by raised pressure within the compartment which will eventually compromise tissue perfusion resulting in necrosis

Question 38

What are the 2 main fractures carrying the risk of compartment syndrome?

Answer 38

Supracondylar | Tibial shaft

Question 39

What are the features of compartment syndrome?

Answer 39

``` Pain Parasthesiae Pallor Paralysis Arterial pulsation may still be felt as the necrosis occurs as a result of microvascular compromise ```

Question 40

How do you diagnose compartment syndrome?

Answer 40

Measurement of intracompartmental pressure measurements, >20mmHg is abnormal, >40mmHg is diagnostic

Question 41

Rx of compartment syndrome

Answer 41

Prompt and extensive fasciotomies | Aggressive IV fluids (due to possibility of myoglobinuria following fasciotomy)