Ortho

Question 1

What is at risk in shoulder dislocation?

Answer 1

Axillary nerve and axillary artery

Question 2

Common direction of dislocation:
Shoulder
Elbow
Hip
Knee

Answer 2

Shoulder: a
Elbow: p
Hip: p
Knee: either

Question 3

What is at risk in elbow dislocation?

Answer 3

Brachial artery, median nerve, ulnar nerve

Question 4

What is at risk in hip dislocation?

Answer 4

Sciatic nerve and blood supply to femoral head

Question 5

What is at risk in knee dislocation?

Answer 5

popliteal artery and vein, ACL, PCL, peroneal nerve (esp with posterior)

Question 6

Which dislocations need immediate relocation?

Answer 6

Knee (don’t wait for x-ray)

Hip

Question 7

Where do the knee menisci lie?

Answer 7

Between femoral and tibial surfaces

Question 8

Which meniscus more commonly torn?

Answer 8

Medial

Question 9

How is the meniscus usually torn?

Answer 9

Traumatic (knee flexed and twisting/ maybe in association with previous ligamentous injury as knee chronically unstable)
Degenerative (oldies with abnormal cartilage)

Question 10

How is a meniscal cyst formed?

Answer 10

synovial fluid pumped into the meniscal tear, valve effect stops them returning

Question 11

General mx principle for meniscal tear

Answer 11

more peripheral = more amenable to healing

Question 12

How does meniscal tear present?

Answer 12

Locked knee
Effusion (large suggests v peripheral)
Joint line tenderness
McMurray’s (but not v reliable)

Question 13

Mx of meniscal tear

Answer 13

RICE and early physio

may need surgery (but removal of significant portions leads to OA changes)

Question 14

Classic hx for chronic ACL injury

Answer 14

Can run in straight line but can’t turn

Question 15

Effusion biggest in ACL or meniscal tear?

Answer 15

ACL: huge effusion in minutes/ hours
meniscal: develops over 24h

Question 16

how is ACL usually injured?

Answer 16

Twisting or valgus strain when knee extended or slightly flexed

Question 17

How do PCL tears usually occur?

Answer 17

Rare - dashboard injuries, goalkeeper, knee forcibly hyperextended

Question 18

Which collateral ligament commonly injured with ACL?

Answer 18

MCL

Question 19

How to differentiate from ACL and MCL tears, based on hx?

Answer 19

Both cases something pops - but no effusion if MCL

Question 20

Causes of patellar dislocation

Answer 20

More commonly in young women with ligamentous laxity/ recurrent dislocations from minor injury

Traumatic: side impact on slightly flexed knee

(V painful, usually reduced before transport)

Question 21

What causes patellofemmoral pain syndrome?

Answer 21

Provoked by stairs, squatting, or sitting with flexed knees for long time.

Over half are bilateral (but maybe one side worse)

Diagnosis of exclusion

Question 22

Knee pain you came across in GP

Answer 22

Osgood-Schlatters

Pain and swelling below knee cap

Question 23

Ottawa ankle rules

Answer 23

xray if:
can’t weight bear after injury and in ED
pain on posterior edge of either malleolus
base of 5th metatarsal pain

Question 24

Examples of pathological fractures

Answer 24

Osteoporotic
Malignancy
Mets
Metabolic disorders
Stress fractures

Question 25

Comminuted fracture

Answer 25

more than 1 bone fragment

Question 26

Compound fracture

Answer 26

open fracture

Question 27

Impacted fracture

Answer 27

affects cancellous bone

Question 28

greenstick fracture

Answer 28

partial crack on convex side, bend on concave side

Question 29

Buckle fracture

Answer 29

impaction injury in children where cortex is buckled but not disrupted

Question 30

Dislocated vs subluxed

Answer 30

Subluxed: partial loss of contact of the joint surfaces

Question 31

What 7 As does an open fracture require?

Answer 31

``` Analgesia Antibiotics Anti-tetanus Antiseptic dressing A splint A photograph An op ```

Question 32

Immediate complications of fractures

Answer 32

Systemic: hypovolaemic shock Local: injury to major vessels, muscles/ tendons, joints, viscera

Question 33

Early complications of fractures

Answer 33

Systemic: hypovolaemic shock, ARDS, fat embolus, DVT, crush syndrome, sepsis (open) Local: infection, compartment sx

Question 34

Late complications of fractures

Answer 34

Problems with union, avascular necrosis, shortening, OA...

Question 35

Complications of compartment sx

Answer 35

muscle necrosis, nerve damage, contractures, myoglobinuria

Question 36

Cardinal signs of arthritic joint

Answer 36

pain, stiffness, functional limitation

Question 37

Cardinal features of OA on x-ray

Answer 37

Loss of joint space Osteophytes Subchondral cysts Subchondral sclerosis

Question 38

Pain when IT band adducted - in hill walkers/ runners

Answer 38

Greater trochanteric bursitis | seen on imaging

Question 39

What is fractured in hip #?

Answer 39

Proximal femur

Question 40

Which hip fractures are at risk of avascular necrosis?

Answer 40

Intracapsular

Question 41

In a hip fracture, how may the leg present? | What is elicited o/e?

Answer 41

Shortened leg, adducted and externally rotated aggravated by flexion and rotation of leg may only have referred knee pain

Question 42

What line do you look for in hip x-rays?

Answer 42

Shenton's line - disrupted in fractures

Question 43

Commonest OA pattern in knees

Answer 43

varus