ortho Flashcards
extracapsular hip fractures
trochanteric
subtrochanteric
intertrochanteric
intracapsular hip fractures
intracapsular
subcapital
mx of undisplaced intracapsular hip fracture
internal fixation
hemiarthroplasty if unfit
mx of displaced intracapsular hip fracture
arthroplasty - either THR or hemiarthroplasty (THR > hemiarthroplasty)
mx of extracapsular hip fractures
dynamic hip screw
intramedullary device if reverse, oblique, transverse or subtrochanteric
location of Bouchard’s and Heberden’s nodes
Bouchard’s - proximal IPJ
Heberden’s - distal IPJ
type of shoulder dislocation that results in loss of external rotation
posterior (nb they are much rarer than anterior)
common after seizures
features of adhesive capsulitis
active and passive movement limited
external rotation most affected
features of plantar fasciitis
heel pain that is worse around the medial calcaneal tuberosity
exacerbated by walking on tip toes
Salter Harris classification
SALT-C Straight across (physis) Above (physis and metaphysis) Lower (physis and epiphysis) Through (physis, metaphysis and epiphysis) Crush
mechanism of anterior shoulder dislocation
forced abduction, extension and external rotation of affected arm
which fractures is compartment syndrome most commonly associated with
supracondylar and tibial shaft fractures
mx for ganglion
reassurance and review if not setting, often disappear spontaneously
mx of children and young people with unexplained bone swelling or pain
urgent x-ray to assess for bone sarcoma
hand osteoarthritis x-ray changes
osteophytes at DIPs and base of thumb
hand rheumatoid arthritis x-ray changes
joint space narrowing at PIP with joint effusion
ix for osteoporotic vertebral fracture
whole spine x-ray
ix for hip fractures
x-ray
MRI if x-ray normal but hip fracture is suspected (e.g. patient in pain and unable to weight bear)
what is Colles’ fracture
transverse fracture of radius, 1 inch proximal to radio-carpal joint with dorsal displacement and angulation
classically follows FOOSH
‘dinner fork’ deformity
features of radial head fracture
common in young adults following FOOSH
marked local tenderness over radial head (proximal forearm) and restricted supination and pronation
causes of dupuytren’s contracture
manual labour
phenytoin treatment
alcoholic liver disease
diabetes mellitus
feature of epidural abscess
signs of systemic sepsis with neurological features, especially if changing LL neurology
reasons for revision of THR
aseptic loosening - most common
pain, dislocation and infection
features of meniscal tear
rotational sports injury
delayed knee swelling
joint locking
causes of carpal tunnel syndrome
ARMPIT
Acromegaly Rheumatoid Myxoedema (hypothyroid) Pregnancy Idiopathic Trauma
describe the ulnar nerve paradox
proximal ulnar nerve lesions produce a less prominent deformity (clawed hand) than distal lesions
therefore, clawing more likely with damage to ulnar nerve at elbow
features of hand osteoarthritis
squaring of the thumb
episodic joint pain
stiffness
a teenage girl with knee pain on walking downstairs or rising from prolonged sitting
chondromalacia patellae
athletic teenagers with inflammation, pain and tenderness at tibial tuberosity
osgood-schlatter disease
red flags suggesting an alternative dx in OA of the hip
rest pain
night pain
morning stiffness >2 hours
mx of ankle fractures
Weber A&B: cast/boot and weight bear as tolerated Weber C (unstable): open reduction, internal fixation
Weber classification
type A: below syndesmosis
type B: level of syndesmosis
type C: above syndesmosis, often unstable
nerves and nerve roots tested in UL reflexes
biceps reflex - musculocutaneous nerve (C5-7)
triceps reflex - radial nerve (C7)
features of Brown-Sequard syndrome
caused by hemisection of the spinal cord
ipsilateral paralysis and loss of proprioception and fine discrimination
contralateral loss of pain and temperature
what does surgical decompression of carpal tunnel syndrome involve?
division of flexor retinaculum
ix for achillies tendon rupture
USS
features of osteochondritis dissecans
knee pain after exercise
locking
‘clunking’
features of supraspinatous tendonitis
painful arc of abduction between 60-120 degrees
tenderness over anterior acromion
features of complex regional pain syndrome
PORTS
Pain Oedema Restriction of movement Temperature/colour change Stiffness
what medication may precipitate Achilles’ tendon rupture
Ciprofloxacin
features of ruptured ACL
twisting mechanism
loud crack, pain and rapid joint swelling
mx of pain in OA
- paracetamol and/or topical NSAID
- oral NSAID, COX2 inhibitor or opiate
NB if CKD avoid COX2 and NSAIDs
mx of undisplaced scaphoid waist fracture
cast for 6-8 weeks
what types of scaphoid fractures need surgical fixation
displaced scaphoid waist fracture
proximal scaphoid pole fractures
medial vs lateral epicondylitis
medial - tenderness over medial epicondyle and medial wrist pain on resisted wrist pronation
lateral - tenderness over lateral epicondyle and lateral elbow pain on resisted wrist extension
when to perform spinal x-ray in back pain
any red flag symptoms (e.g. being woken from sleep)
long duration of symptoms (i.e. months)
spinal tenderness
most prominent sign of T1 nerve root lesions
intrinsic hand muscle wasting
damage to which structures causes winged scapula
long thoracic nerve leading to serratus anterior being affected
ix of tibial stress syndrome
radiographs of bilateral tibia and fibula to rule out stress fractures or periosteal exostoses
crystals for pseudogout
weakly positively birefringement rhomboid-shaped crystals
ABX for septic arthritis
flucloxacillin
clindamycin if penicillin allergic
drug that can cause achilles tendon rupture
quinolone, e.g. Ciprofloxacin
features of iliotibial band syndrome
common cause of lateral knee pain in runners
tenderness 2-3cm above joint line
