Ortho Flashcards
Causes of a true leg length shortening?
NOF fracture hip dislocation developmental delay - SUFE/ Perthes osteomyelitic surgery
Causes of apparent shortening of leg length?
scoliosis or poor posture
Where is the pain in hip pathology?
groin
pain going to the back of the hip is usually referred from the spine
Causes of a positive trendelenberg
Wasting secondary to chronic pain
surgery damaging the superior gluteal nerve
UM/LM lesions
Developmental dysplasia of the hip
?gluteus medius weakness is root
What stance is common in OA
Varus - wide knees
valgus - knock kneed is RA
how does spinal stenosis present?
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
cauda equina management?
MRI spine within 6 hours urgent
Symptoms of cauda equina syndrome?
Radicular pain in legs
saddle anaeshesia
incontinence of bladder and bowel
loss of anal tone
Acute cord compression syndrome?
Upper motor neurone signs in legs with LMN at the level of the lesion
back and radicular pain
sphincter disturabnce
Management of a tumour compressing a cord?
radiotherapy and steroids
discectomy or laminectomy if others
Tennis elbow signs?
lateral epicondyle
Golfers elbow signs?
medial epicondyle
imaging of choice for osteomyelitis?
MRI
thenar eminence nerve supply
median - wasting occurs in carpal tunnel
talipes management?
early surgical correction and casting
management of suspected compartment syndrome
measure compartmental pressures
fasciotomy extensive
aggressive fluid management to prevent renal failure due to myogobinurea
Dupytrens contracture?
alcoholic liver disease
phenytoin
trauma
manual labour
Salter harris classification of fractures?
SALTCRUSH Straight through Above Lower Through Crush
management of suspected scaphoid fracture - strong suspicion?
orthopaedic clinic urgently - may need MRI or CT scan
vascularised bone graft
what sign is positive with a prolapsed disc?
straight leg raise - therefore without this it may just be facet joint pain
Frozen shoulder?
initially painful
active and passive movements reduced with external rotation being the worst affected
symptoms of supraspinatus tendonitis
painful arc at 60-120 with tenderness on palpation
may show calcification on x ray
causes of carpal tunnel
idiopathic pregnancy heart failure and odema rheumatoid arthritis lunate fracture
FRAX
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
What is an avulsion fracture?
when ligament or tendon pulls off bit of bone
What is an articular fracture?
involvement of the surface which interacts at the joint etc
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
What are the 4 R’s of fracture management?
resuscitation
reduction
restriction
rehabilitation
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
What medications should be given to protect against clostridium perfrigens
ben pen, clindamycin
Main complication of open fractures?
gas gangrene - clostridial myonecrosis
causes shock and renal fauilure - muscle necrosis and sepsis
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
What are the benefits of fixation?
Reduces pain, increases stability, increases patient functionality, decreases strain on the healing bone therefore improving healing process.
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
what is neuropraxia?
temporary loss of nerve conduction without axonal damage
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
5Is of delayed or nonunion (mal means bad)
Infection Inflamation secondary to underlying diseasemalignancy? Ischemia - poor supply interfragmental strain interspersed tissue
Name 3 common sites of AVN?
Scaphoid
femoral head
talus
Also occurs in Sicklecell, SLE, steroid use
salter harris types?
SALT Crush Straight above lower Trhough Crush
Risk factors for osteoporosis?
Age+female +SHATTERED Steroid Hyperpara/thyroidism Alcohol and cigarettes Menopause early BMI/testosterone low Liver/renal failure
What is the prognosis after hip fracture?
30 percent mortality at 1yr
50% dont recover premorbid function
different management for unidirectional and multidirectional recurrent shoulder instability?
uni - surgery
multi - rehab (may require inferior capsular shift)
Which motion is restricted most in adhesive capsulitis?
external rotation <30deg
absuction too
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
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
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
What is the management for ACL tear?
Prehab
repair using harvest of semitenonosus/gracilis/patella tendon
held using screws?
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?
What is osteochondritis dissecans?
small piece of bone falls into the joint space requiring arthroscpic removal
What are the risk factors for osteomyeltitis
D VITS diabetes vascular diesease Immunosuppression Trauma Sickle Cell disease - salmonella
children - rich blood supply?
workup for osteomyelitis?
CRP, WCC, ESR
blood cultures - 60% pos
xray
MRI - gold standard
most common infective agent in osteomyeltis and septic arthritis?
staphylococcus
Management of septic arthritis
WCC CRP ESR
Blood cultures
xray
aspiration - MC and S
Management for oseomyelitis and septic arthritis
Debridement/washout where possible or if required
IV vanc and Cefotaxime
analgesia
physio after
Complications of septic arthritis?
For the Attention Of
FAO
Fusion
Arthritis
Osteomyelitis
most common bone tumour?
secondary metastasis from: bronchus thyroid kidney breast prostate
