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6th Year > Ortho > Flashcards

Ortho Flashcards

1
Q

Causes of a true leg length shortening?

A 
NOF fracture
hip dislocation
developmental delay - SUFE/ Perthes
osteomyelitic
surgery
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2
Q

Causes of apparent shortening of leg length?

A

scoliosis or poor posture

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3
Q

Where is the pain in hip pathology?

A

groin

pain going to the back of the hip is usually referred from the spine

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4
Q

Causes of a positive trendelenberg

A

Wasting secondary to chronic pain
surgery damaging the superior gluteal nerve
UM/LM lesions
Developmental dysplasia of the hip

?gluteus medius weakness is root

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5
Q

What stance is common in OA

A

Varus - wide knees

valgus - knock kneed is RA

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6
Q

how does spinal stenosis present?

A

spinal claudicant like buttock or leg pain worsened by walking which eases of but is helped by flexing at the hips i.e beding forward or crouching down.
pain is rapid onset and may be associated with numbness or tingling.

generalised narrowing of the spinal canal can be worsened by osteoarthritis or may be a genetic developmental issue

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7
Q

cauda equina management?

A

MRI spine within 6 hours urgent

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8
Q

Symptoms of cauda equina syndrome?

A

Radicular pain in legs
saddle anaeshesia
incontinence of bladder and bowel
loss of anal tone

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9
Q

Acute cord compression syndrome?

A

Upper motor neurone signs in legs with LMN at the level of the lesion
back and radicular pain
sphincter disturabnce

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10
Q

Management of a tumour compressing a cord?

A

radiotherapy and steroids

discectomy or laminectomy if others

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11
Q

Tennis elbow signs?

A

lateral epicondyle

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12
Q

Golfers elbow signs?

A

medial epicondyle

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13
Q

imaging of choice for osteomyelitis?

A

MRI

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14
Q

thenar eminence nerve supply

A

median - wasting occurs in carpal tunnel

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15
Q

talipes management?

A

early surgical correction and casting

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16
Q

management of suspected compartment syndrome

A

measure compartmental pressures
fasciotomy extensive
aggressive fluid management to prevent renal failure due to myogobinurea

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17
Q

Dupytrens contracture?

A

alcoholic liver disease
phenytoin
trauma
manual labour

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18
Q

Salter harris classification of fractures?

A 
SALTCRUSH
Straight through
Above
Lower
Through
Crush
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19
Q

management of suspected scaphoid fracture - strong suspicion?

A

orthopaedic clinic urgently - may need MRI or CT scan

vascularised bone graft

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20
Q

what sign is positive with a prolapsed disc?

A

straight leg raise - therefore without this it may just be facet joint pain

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21
Q

Frozen shoulder?

A

initially painful

active and passive movements reduced with external rotation being the worst affected

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22
Q

symptoms of supraspinatus tendonitis

A

painful arc at 60-120 with tenderness on palpation

may show calcification on x ray

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23
Q

causes of carpal tunnel

A 
idiopathic
pregnancy
heart failure and odema
rheumatoid arthritis
lunate fracture
24
Q

FRAX

A

should be used in all women over 65 and men over 75 or those younger at risk of fractures.

it will inform the managemetn and say whether they require scanning DEXA or immediate management bisphos

25
What is an avulsion fracture?
when ligament or tendon pulls off bit of bone
26
What is an articular fracture?
involvement of the surface which interacts at the joint etc
27
What benefits does reduction confer?
reduced pain reduced bleeding reduced risk of neurovascular compromise this should be considered even before x ray in unstable patients
28
What are the 4 R's of fracture management?
resuscitation reduction restriction rehabilitation
29
what are the 6A's of open fracture management?
Analgesia - M+M Assess - Neurovasc, soft tissues Alignment Antisepsis - copious irrigation and cleaning Anti-tetanus Antibiotics - dependant on gustillo classification fluclox/1st gen cephalosporin (cephalexin) debride and fix in theatre cross match 2 units in tibial fracture and 4 units in femoral fracture
30
What medications should be given to protect against clostridium perfrigens
ben pen, clindamycin
31
Main complication of open fractures?
gas gangrene - clostridial myonecrosis | causes shock and renal fauilure - muscle necrosis and sepsis
32
What are the indications for open reduction?
``` open fracture intra articular more than 1 fracture int he same limb requirement for accurate reduction failed conservative rx ```
33
What are the benefits of fixation?
Reduces pain, increases stability, increases patient functionality, decreases strain on the healing bone therefore improving healing process.
34
Difference between internal and external fixation?
EX - better for allowing infection resolution in open fractures. less risk of compartment synrome and infecion internal(pins plates, screws, nails) - allow perfect alignment, mobilise quickly
35
what is neuropraxia?
temporary loss of nerve conduction without axonal damage
36
What are the clinical findings in compartment syndrome?
increased pain on passive stretching of muscles pain which is much greater than the clinical findings. warm, red swollen limb. mx - elevate, remove bandages, fasciotomy
37
5Is of delayed or nonunion (mal means bad)
``` Infection Inflamation secondary to underlying diseasemalignancy? Ischemia - poor supply interfragmental strain interspersed tissue ```
38
Name 3 common sites of AVN?
Scaphoid femoral head talus Also occurs in Sicklecell, SLE, steroid use
39
salter harris types?
``` SALT Crush Straight above lower Trhough Crush ```
40
Risk factors for osteoporosis?
``` Age+female +SHATTERED Steroid Hyperpara/thyroidism Alcohol and cigarettes Menopause early BMI/testosterone low Liver/renal failure ```
41
What is the prognosis after hip fracture?
30 percent mortality at 1yr | 50% dont recover premorbid function
42
different management for unidirectional and multidirectional recurrent shoulder instability?
uni - surgery | multi - rehab (may require inferior capsular shift)
43
Which motion is restricted most in adhesive capsulitis?
external rotation <30deg | absuction too
44
Weber classification?
to classify distal fibula fractures A below syndesmosis - POP/boot B involving syndesmosis C above synd. B/C boot/pop unless displaced in which case closed reduction and pop
45
What are the causes of a knee haemarthrosis?
most common ACL tear 1- Coagulopathy - warfarin/haemophilia 2-Trauma ACL -80% Patella dislocation 10% outer meniscal injury
46
What is the management for knee injuries?
x ray to ensure no fractures Rest elevate, ice, compression MRI to check for ligament or meniscal damage
47
What is the management for ACL tear?
Prehab repair using harvest of semitenonosus/gracilis/patella tendon held using screws?
48
What is osteoarthritis
Pathological process of joints, whereby softening of articular cartilage leads to eventual loss of cartilage and joint space, leading to ossification and fibrosis of the articular surfaces, resulting in painful damage within the joint capsule?
49
What is osteochondritis dissecans?
small piece of bone falls into the joint space requiring arthroscpic removal
50
What are the risk factors for osteomyeltitis
``` D VITS diabetes vascular diesease Immunosuppression Trauma Sickle Cell disease - salmonella ``` children - rich blood supply?
51
workup for osteomyelitis?
CRP, WCC, ESR blood cultures - 60% pos xray MRI - gold standard
52
most common infective agent in osteomyeltis and septic arthritis?
staphylococcus
53
Management of septic arthritis
WCC CRP ESR Blood cultures xray aspiration - MC and S
54
Management for oseomyelitis and septic arthritis
Debridement/washout where possible or if required IV vanc and Cefotaxime analgesia physio after
55
Complications of septic arthritis?
For the Attention Of FAO Fusion Arthritis Osteomyelitis
56
most common bone tumour?
``` secondary metastasis from: bronchus thyroid kidney breast prostate ```

6th Year (19 decks)

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