Ortho

Question 1

what are the 2 main types of NOF #s?

Answer 1

intracapsular (intramedullary nail, DHS)
extracapsular (?undisplaced/displaced) -> internal fixation - cannulated screws, hemiarthroplasty, THR

Question 2

Management of a trauma call

Answer 2

Trauma team leader leads trauma call
- someone will be managing bloods
- someone will scribe
- someone will manage survey
- anaesthetist will manage airway

most patients will get a pan CT

patient will be immobilized with blocks and neck stabilisation

ATLS approach -> advanced trauma life support
A->E

Question 3

AMPLE hx

Answer 3

Allergies
Medications
PMH
Last ate
Events that led up to injury/problem

Question 4

Management of open #

Answer 4

Broad spectrum IV abx within 1h of coming to ED
assess tetanus status/vaccinate
document neurovascular status (if concerns, escalate!)
take picture
remove debris, place saline soaked gauze over wound
reduce #, immobilize
prepare for theatre (NBM, consent, mark, stop anticoagulation, G&S, clotting)

In theatre:
- washout, debridement, closure, ORIF / external fixation (orthoplastics)

when admitted make sure to think about VTE prophylaxis

Question 5

Management of a hot, swollen joint

Answer 5

-> SA

admit
joint aspiration -> send for culture, MC&S, crystals
blood cultures, FBC, CRP, LFTs, U&E
+/- sepsis 6
abx (flucloxacillin)
analgesia
VTE assessment
prep for theatre (NBM, bloods, consent)
washout

Question 6

fat pads in elbow fractures

Answer 6

???

good for diagnosing supracondylar #

Question 7

What is very important to document when you are an ortho FY1/SHO when examining a patient?

Answer 7

a focused neurovascular examination

Question 8

What is the crescent sign on x-ray pelvis pathognomonic for?

Answer 8

vascular necrosis of the femoral head

Question 9

What can you see O/E in a hip fracture?

Answer 9

leg is shortened and externally rotated

Question 10

1st line ix for ?achilles tendon rupture

Answer 10

USS

Question 11

What are the indications/benefits of external fixation?

Answer 11

• In extensive soft tissue damage
• lets you see and treat infection much sooner

Question 12

What are the complications for fractures?

Answer 12

General:
- fat embolus
- DVT
- Infection
- prolonged immobility (UTI, chest infections, sores)

Specific:
- neurovascular
- nonunion/ malunion
- arthritis
- reflex sympathetic dystrophy/ chronic regional pain syndrome

Question 13

Cause of NOF #

Answer 13

osteoporosis
trauma
combination of both

Question 14

Hx in NOF #

Answer 14

age
comorbidity
meds
functional baseline, ADLs
social hx (relatives, stairs, ETOH)

Question 15

describe hemiarthroplasty vs THR on x-ray

Question 16

Causes of knee effusion

Question 17

Explain how you would perform the sweep test on the knee

Question 18

What is used to stabilise a shoulder that was reduced following dislocation?

Answer 18

broad arm sling is most suitable

Question 19

Mx of trochanteric fractures

Answer 19

they have a good chance of healing well so generally you would opt for a DHS (dynamic hip screw) - not hip replacement

Question 20

Normal ROM in hip examination

Answer 20

flexion: 120 dg
extension: 10-20 dg (proned)

adduction: 30dg
abduction: 45 dg

int rotation: 40dg
external rotation: 45 dg

Question 21

How do you perform a Trendelenburg test in aa hip exam?

Answer 21

• ask the patient to stand, can but their arms on their shoulders for stabilisation
• place your fingers/hands on their ASIS bilaterally
• ask the patient to lift one leg up

interpretation:
- ASIS on same level or slightly higher on side of raised leg: normal

• ASIS on side of raised leg drops: hip abductor weakness

Question 22

How do you perform Thomas’ test?

Answer 22

ask if the pt had ever had a hip replacement! if yes, do not do this test as there is a risk of posterior hip dislocation.

1. put your hand under the patients back with the palm facing up
2. ask the patient to flex their hip by bringing their knee to the chest

interpretation: look at knee
-> flexion of the knee and lifting off of the knee would show
positive (abnormal) if there is fixed flexion deformity (knee/thigh lifts off)