ortho Flashcards

1
Q

commonly replaced joints

A

knee
hip
shoulder

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2
Q

indications for joint replacement

A

OA
fracture
septic arthritis
bone tumour
RA

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3
Q

hemiarthroplasty

A

half the joint is replaced

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4
Q

what happens in a total hip replacement

A

lateral incision
metal/ceramic replacement head of femur
stem cemented or uncemented
acetabulum hollowed out and replaced with metal socket

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5
Q

what happens in a total knee replacement

A

vertical anterior incision
articular surfaces of femur and tibia removed and replaced with metal
spacer added

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6
Q

what happens in a total shoulder replacement

A

usually anterior incision
head of humerus replaced and glenoid socket replaced my metal

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7
Q

what is a reverse shoulder replacement

A

sphere in glenoid and cup to replace head of humerus

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8
Q

VTE prophylaxis THR

A

LMWH 28d

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9
Q

VTE prophylaxis TKR

A

LMWH 14d

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10
Q

common cause prosthetic joint infection

A

staph aureus

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11
Q

RF prosthetic joint infection

A

prolonged operation
obese
DM

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12
Q

mx prosthetic joint infection

A

irrigation
debridement
replacement

+abx

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13
Q

what is a compound #

A

skin broken

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14
Q

what is a stable #

A

sections of bone still in allignment

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15
Q

types of fracture

A

transverse
oblique
spiral
segmental
comminuted
compression

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16
Q

typically only in children

A

greenstick
buckle

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17
Q

what # can only happen in children

A

salter-harris (growth plate)

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18
Q

what is a colles fracture

A

transverse # distal radius and the distal portion displaces posteriorly (up) = dinner fork deformity

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19
Q

cause colles #

A

fall onto outstretched hand

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20
Q

common cause scaphoid #

A

fall onto outstretched hand

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21
Q

sx scaphoid #

A

tenderness in anatomical snuffbox

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22
Q

why is there a risk of avascular necrosis and non union with scaphoid #

A

retrograde blood supply

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23
Q

bones with vulnerable blood supply

A

scaphoid, femoral head, humeral head, talus, navicular, 5th metatarsal

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24
Q

weber classification for # lateral malleolus

A

A=below ankle joint therefore syndesmosis intact
B=at joint therefore syndesmosis intact or partially torn
C=abive joint therefore syndesmosis disrupted

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25
major complication pelvic ring #
intra abdo bleeding
26
what bones commonly # in pathological #
femur vertebral bodies
27
cause of pathological #
osteoporosis pagets tumour - prostate, renal, thyroid, breast, lung metastasise to bone
28
fragility #
withou approproate trauma, due to osteoporosis
29
ix for #
2 view XR CT if inconclusive
30
fracture mx
1. mechanical aligment: open or closed reduction 2. relative stability: cast, k wire, intramedullary nail, screw
31
early # complications
damage to local structures haemorrhage compartment syndrome fat embolism VTE
32
long term # complications
delayed union malunion non-union avascular necrosis infection joint instability/stiffness contractures arthritis chronic pain complex regional pain syndrome
33
when/how does a fat embolism occur
24-72hr after # # long bone -> fat globules released ->lodged in vessels->obstruction
34
criteria for fat embolism
GURDS major=resp distress, petechial rash, cerebral involvement minor inc jaundice, thrombocytopenia, fever, tachycardia
35
RF hip #
age osteoporosis F
36
mx hip #
sugrery within 48h analgesia VTE mx orthogreis MDT wt bear and physio
37
types hip #
extracapsular intracapsular-femoral neck
38
extracapsular hip #
outside capsule so blood supply to head of femur intact
39
mx extracapsular hip #
intertrochanteric=screw subtrochanteric=nail
40
intracapsular hip # classification
GARDEN 1. incomplete # non displaced 2. complete # non displaced 3. partial displacement 4. full displacement
41
intracapsular hip # mx
non-displaced=screw if 3 and 4 then vessels damaged so head of femur needs replacing
42
sx hip #
>60y fall - why pain in groin/hip cant wt bear shortened, abducted externally rotated leg
43
ix hip #
XR - AP and lateral views on AP seee disruption to shentons line in nof
44
what causes compartment syndrome
usually # or crush injury increased pressure in fascial compartment due to bleeding/oedema cuts off blood supply
45
where does compartment syndrome usually occur
legs
46
sx compartment syndrome
5 PS!! disproportionate pain paraesthesia pale pressure paralysis
47
ix compartment syndrome
needle manometry
48
mx compartment syndrome
elevate good BP emergency fasciotomy debridement every few d wound closure in weeks
49
chronic compartment syndrome
on exertion
50
sx chronic compartment syndrome
pain, numbness, paraesthesia
51
mx chronic compartment syndrome
fasciotomy
52
what is osteomyelitis
inflammation bone and bone marrow
53
common cause osteomyelitis
staph aureus
54
RF osteomyelitis
open# operation DM PAD IVDU immunosuppressed
55
sx osteomyelitis
fever pain erhythema swelling
56
XR findings osteomyelitis
none periosteal rxn localised osteopenia destruction
57
best ix osteomyelitis
MRI
58
mx osteomyelitis
surgical debridement + abx (6w fluclox)
59
most common bone tumour
osteosarcoma
60
chondrosarcoma
cancer from cartilage
61
ewing sarcoma
cancer of bone and soft tissue in children and young aduls
62
rhabdomyosarcoma
skeletal muscle tumour
63
leimyosarcoma
smooth muscle tumour
64
sx sarcoma
soft tissue lump, bone swelling, persistant bone pain
65
ix sarcoma
XR CT or MRI biopsy
66
mx sarcoma
surgery chemo radio
67
causes mechanical backpain
muscle/ligament sprain facet joint dysfunction SIJ dysfunction herniated disc spondylolisthesis scoliosis degeneration
68
spondylolisthesis
anterior displacement vertrba
69
causes neck pain
muscle/ligament strain torticollis whiplash cervical spondylosis
70
red flag causes back pain
spinal # cauda equina spinal stenosis ankylosing spondylitis infection
71
other causes of back pain
pneumonia ruptured AAA kidney stone pyelonephritis pancreatitis prostatitis PID endometriosis
72
sciatic nerve root
L4-S3
73
sx sciatica
unilateral pain from buttock down paraeshtesia numbness weakness
74
causes of sciatica
compression sciatic nerve - herniated disc, spinal stenosis, spondylolisthesis
75
mx sciatica
physio analgesia amitryptiline duloxetine injections surgical decompression
76
mx lower back pain
if mechanical no further ix if unsure cause - XR, CT STarT screening=risk developing chronic educated, exercise, physio, analgesia (NSAID, codeine)
77
cauda equina cause
compression (herniated disc, tumour) of cauda equina
78
sx cauda equina
saddle anaesthesia loss bladder/bowel sensation and control urinary retention bilateral sciatica weakness decreased anal tone LMN SIGNS
79
mx cauda equina
emergency MRI and surgucal decompression
80
features metastatic spinal cord compression
UMN SIGNS AS HIGHER back pain and motor and sensory deficits worse when cough/strain
81
mx metastatic spinal cord compression
MRI high dose dexamethasone surgery chemo radio
82
what is spinal stenosis
narrowing spinal cannal usually cervical or lumbar
83
types of spinal stenosis
central stenosis=central canal lateral stenosus=nerve root canals foraminal stenosis=intervertebral foramina
84
causes spinal stenosis
congenital degeneration herniated disc thickened ligamentum flavum or post longitudinal ligament spinal # spondylolisthesis tumour
85
sx spinal stenosis
gradual onset in central stenosis=intermittent neurogenic claudication (LBP, buttock and leg pain, weakness) worse standing/walking, better bending forward
86
ix spinal stenosus
MRI
87
mx spinal stenosis
exercise analgesia physio decompressive surgery
88
what is meralgia paraesthetica
compression lateral femoral cutaneous nerve (L1-3)
89
sx meralgia paraesthetica
sensory sx on anterior upper outer thigh - burning, numbness, paraesthesia aggravated by walking/standing/hip extension
90
mx meralgia paraesthetica
wt loss physio analgesia - paracetamol, nsaids, amitriptyline injection surgery
91
sx trochanteric bursitis
middle aged lateral hip/thigh pain aching worse with activity tender trendelenburg positive pain on resisted abduction/internal rotation/external rotation hip
92
mx trochanteric bursitis
ice rest analgesia physio steroid injections
93
causes bursitis
friction from movement trauma RA infection = septic bursitis
94
cause meniscal tear
sport twisting ->pop
95
sx meniscal tear
pain swelling stiffness decreased ROM locking instability O/E: tender joint line, Mc Murrays and Apley grind test
96
mx meniscal injury
conservatibe nsaids physio surgery - arthroscopic repair or resection
97
ottawa knee rules
XR if: >55y, patella tenderness, fibular head tenderness, cant felx knee to 90 degrees, cant wt bear
98
ACL
originated from lateral aspect intercondylar notch of femur and attaches to anterior intercondylar area tibia stops tibia sliding forward
99
PCL
originates from medial aspect intercondylar notch of femur and attaches to posterior intercondylar area tibia stops tibia sliding back
100
cause ACL inury
twist
101
sx ACL injury
pop when happens pain, swelling, instability positive anterior draw and lachmans
102
mx ACL injury
conservatibve nsaids physio arthroscopic surgery often required - tendon graft from hamstrong/quad
103
osgood schlatters
inflammation at tibial tuberosity where patella ligament inserts due to multiple small avulsion #
104
sx osgood schlatters
10-15y m hard tender lump ant knee pain in activity/kneeling/extension
105
mx osgood schlatters
rest ice nsaids physio
106
what forms popliteal fossa
semimembranosus and semintendanosus tendons, biceps femoris tendon, medial and lateral heads gastrocnemius
107
where is bakers cyst
popliteal fossa
108
causes bakers cyst
non secondary to degeneration - meniscal tear, OA, RA
109
sx bakers cyst
pain palpable lump reduced rom fouchers sign=lump smaller when knee flexed to 45 degrees can rupture = swelling and pain (rarely compartment syndrome)
110
ix bakers cyst
uss
111
mx bakers cyst
none nsaids physio injecion
112
types achilles tendinopathy
insertion (within 2cm of insertion) mid-portion (2-6cm from insertion)
113
RF achilles tendinopathy
certain sports inflammation -RA DM high cholesterol flouroquinolone abx - ciprofloxacin
114
sx achilles tendinopathy
pain stiff tender swelling
115
mx achilles tendinopathy
rice physio extracoroporeal shock wave AVOID steroid injection s- increased risk rupture
116
RF achilles tendon rupture
sports increased age achilles tendinopathy fhx fluoroquinolone abx systemic steroids
117
sx achilles tendon ruptire
pain snapping sound feel like hit in back of leg O/E: dorsiflexed, palpable gap, weak plantar flexion, cant tip toe positive simmonds calf squeeze
118
mx achilles tendon rupture
rice non-surgical: 6-12 weeks in boot, start in plantarflexion the move to neutral and rehab surgery: reattach then rehab
119
sx plantar fascitis
gradual onset pain in plantar heel and tender
120
mx plantar fasciits
rice nsaids physio
121
cause fat pad atrophy
impact obesity steroid injecyions
122
sx fat pad atrophy
pain and tender on plantar heel
123
mx fat pad atrophy
custom shoes lose wt
124
what is mortons neuroma
dysfunctional nerve between 3rd and 4th metatarsal
125
sx mortons neuroma
pain sensation of alump burning paraethesia O/E: deep pressure, metatarsal squeeze=pain, mulders sign=painful click
126
mx mortons neuroma
analgesia insoles steroid injection surgery
127
hallux valgus
bunions deformity at 1st MTP ->bony lumo
128
mx hallux valgus
bunion pad inshoe analgesia surgery
129
adhesive capsulitis
frozen shoulder primar or secondary to trauma inflammation and fibrosis in joint capsule ->adhesion
130
RF adhesive capsulitis
middle age DM
131
phases of sx in adhesive capsulitis
1=pain 2=stiff - ext rptation 3=thawing - improves
132
ix adhesive capsulitis
USS=thickened joint capsule
133
mx adhesive capsulitis
nsaids, physion, intra articular steroid injection, surgery
134
rotator cuff mucles
supraspinatus - abducts infraspinatus - ext rotation teres minor - int rotation subscapularis - int rotatio
135
cause rotator cuff tear
injury degeneration overhead activities
136
sx rotator cuff tear
shoulder pain and weakness
137
mx rotator cuff tear
surgery useful in acute or full thickness rice nsaids physio
138
subluxation
partial shoulder dislocation
139
types shoulder dislocation
mostly anterior posterior - electrc shocks and epilpesy
140
associated injuries with shoulder dislocation
labrum tear bankart lesion hills sachs lesion axillary nerve damage # rotator cuff tear - older adults
141
bankart lesion
tear to ant labrum, occur with repeated anterior subluxation od dislocation
142
hills sachs lesion
compression # posterolateral head of humerus less stable so risk further dislocations
143
sx shoulder disliocation
patient usually knows acute deltoid appears flattened apprehension test for instability - not in acute phase
144
mx shoulder dislocation
relocate sling physio +/- stabilisation surgery
145
cause olecranon bursitis
leaning on elbow students, certain jobs
146
sx olecranon bursitis
swollen, warm, tender, fluctuant at elbow
147
mx olecranon bursitis
aspirate if think infection rice avoid leanin gon aspiraye steroid injections
148
what is a repetitive strain injury
soft tissu irritation, microtrauma and strain due to repetitive activities (small movements, vibration, awkward)
149
sx repetitive strain injury
pain ache weak cramping numbness
150
mx repetitive strain injuet
rice rest and adapt activity nsaid phusio
151
lateral epincondylitis
tennis elbow where extensory attach
152
test for lateral epicondylitis
pain ain weakness mills test=palpate lateral epincondyle and flex their wrist cozens test=resistance with hand in fist
153
medial epincondylitis
golfers elbow where flexers attach
154
mx epindondylitis
rest and adapt activities physio steroid/FRP injection
155
what is de quervains tenosynovitis
swelling and inflammation of abductor pollicus longus and extensor pollicus brevis tendons
156
sx de quervains tenosynovitis
at radial aspect base of thumb-pain, weak, numb finkelsteins test: make fist with thumb in and adduct wrist
157
mx de quervains tenosynovitis
rest spints nsaids physio steroid injectin rarely surgery to release extensory retinaculum
158
what is trigger finger
stenosing tenosynovitis nodule on tendon at A1 pulley at MCP catches tendon in extension so gets stuck
159
sx trigger finger
finger stuck flexed and pops when released
160
mx trigger finger
rest splint steroid injection surgery
161
dupuytrens contracture
nodules and thickening and tighetning palmsar fascia so flexes ring finger most affected, index lease
162
RF dupuytrens contracture
agre fhx m vibrating tools DM epilepsy smoking alcojol
163
test for dupuytrens conctracture
table top test - cant flatten
164
mx dupuytrens contracture
none surgery
165
carpal tunnel syndrome
compression median nerve in carpal tunnel
166
RF carpal tunnel syndrome
obesity repetitive strain perimenopause RA DM acromegaly hypothyroid
167
sx carpal tunnel
start with at night worse at night sensory sx on thumb and 1st, 2md and half 3rd fingers motor sx = weakness and wasting thernal muscles
168
tests for carpal tunnel
phalens tinnels
169
ix carpal tunnel
nerve conduction studies
170
mx carpal tunnel
rest splint steroid injections surgery
171
thernal muscles
abductor pollicis brevis opponens pollicis flexor pollicis brevis
172
bilateral carpal tunnel causes
screen for - RA, DM, acromegaly, hypothyroid
173
ganglion cysts
synovial fluid from tendon sheath or joint often in wrist and fingers
174
sx ganglion cysts
painless well circumscribed transilluminate
175
mx ganglion cysts
USS resolve spontaneously needle aspiration surgucal excision
176
Describing a fracture
Site: bone and which bit (metaphyses, diaphyses, articular) Displacement: distal relative to proximal Soft tissue: open or closed, complications
177
Principles fracture management
Reduce Stabilise Rehab