Ortho Flashcards
Closed fracture
Overlying skin laceration has been sutured
Simple fracture
Single fracture line
Comminuted fracture
Associated damage to adjacent nerves or vessels
Fatigue fracture
Occurs through diseased bone
Pathological fracture
If occurs through a bony metastasis
What fractures commonly results in non-union?
Fractures of fourth metatarsal Fractures of neck of femur Fractures of condyle of mandible Colles' fracture Scaphoid fracture
Newborn baby has bilateral clubfoot - treatment?
Manipulation and progressive casting starting soon after birth
Extracapsular hip frature - management?
Dynamic hip screw
Subtrochanteric hip fracture - management?
Intramedullary device
What fractures would require an intramedullary device?
Reverse oblique
Transverse
Subtrochanteric
Displaced intracapsular fracture > 70 - management?
Hemiarthroplasty non cemented prosthesis
Displaced intracapsular fracture < 70 - management?
Internal fixation > hip arthroplasty
Undisplaced intracapsular fracture - management?
Internal fixation or hemiarthroplasty (if sick)
Anterior shoulder dislocation results in _ of the upper limb
External rotation + abduction
What can be caused by anterior shoulder dislocation?
Axillary nerve palsy –> weak deltoid + sensory loss over badge patch
Impacted fractures of surgical neck of humerus - management?
Collar + cuff for 3 weeks –> PT
Severe –> open reduction + fixation or intramedullary advice
Difference in leg in hip fracture vs hip dislocation?
Fracture –> leg shortened + EXTERNALLY rotated
Dislocation –> leg shortened + INTERNALLY rotated
6 P’s of compartment syndrome
Pain (especially on movement) Parasthesiae Pallor Arterial Pulsation Paralysis Pressures > 40 = diagnostic
Considerations in post-operative patient - compartment syndrome
Fasciotomy can cause myoglobinuria –> renal failure –> aggressive IV fluids
What are the Ottawa ankle rules?
X-ray only necessary if there is pain in the malleolar zone and:
- inability to weight bear for 4 steps
- Tenderness over distal tibia
- Bone tenderness over distal fibula
Weber classification of fibular fracture
Type A –> below syndesmosis
Type B –> starts at level of tibial plafond and may extend proximally to syndesmosis
Type C - above syndesmosis
Ankle fracture in young - management?
Surgical –> compression plate
Ankle fracture in elderly - management?
Conservative as thin bone
Ankle fracture distal to syndesmosis - management?
below knee plaster cast to include midfoot
Features of supraspinatus tendonitis
Rotator cuff injury
Painful arc of abduction at 60-120 degrees
Tenderness over anterior acromion
Salter-Harris type I
Fracture through physis only
Salter-Harris type II
Fracture through physis and metaphysis
Salter-Harris type III
Fracture through physis and epiphysis to include joint
Salter-Harris type IV
Fracture through physis, epiphysis, and metaphysis
Salter-Harris type V
Crush injury involving physis
Scaphoid fracture - what neurovascular structure is compromised?
Dorsal carpal arch of the radial artery
When would you refer pt with Dupuytren’s contracture to ortho?
When MCP joints cannot be straightened, thus hand cannot be placed flat on table
Features of fracture of radial head
Fall on outstretched hand
Marked tenderness over head of radius
Sharp pain at extremes of rotation
Management of open fractures
1) IV antibiotics
2) Neurovascular status
3) immediate surgery - if vascular impaired
4) urgent surgery - if wound heavily contaminated
5) plastic + ortho team involved
6) debridement
7) cover wound
8) splint leg
9) vacuum foam dressing or antibiotic bead pouch
10) definite skeletal stabilisation
Classical features of menisceal tear?
Rotational sporting injuries
Delayed knee swelling
Joint locking
What drug can cause new-onset Achilles tendon disorders?
Ciprofloxacin
Most appropriate initial management for low back pain?
Oral naproxen
Which fractures are most commonly associated with compartment syndrome?
Supracondylar fractures in the arm
Tibial shaft fractures in lower leg
Which nerve roots can be compressed by a prolapsed lumbar disc?
L3, L4, L5, S1
L3 nerve root compression
Sensory loss over anterior thigh
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test
L4 nerve root compression
Sensory loss anterior aspect of knee
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test
L5 nerve root compression
Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test
S1 nerve root compression
Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test
Swelling over posterior aspect of elbow + middle aged man
Olecranon bursitis
What structure is divided in surgery for carpal tunnel
Flexor retinaculum
Red flags for lower back pain
age < 20 years or > 50 years history of previous malignancy night pain history of trauma systemically unwell e.g. weight loss, fever
Tapes equinovarus - describe foot
Inverted and plantar flexed foot
Tapes equinovarus - Rx
Ponseti method
Gartland classification
Supracondylar fractures in children
Weber classification
Fractures about syndesmosis
Garden classification
Neck of femur fractures
Meralgia paraesthetica
Burning thigh pain
Lateral cutaneous nerve of thigh
Subluxation of the radial head - management
Passive supination of elbow joint whilst flexed to 90 degrees
Osteochondritis dissecans - presentation
Locking and swelling of joint + tenderness
Smith’s fracture - what is it?
distal radius fracture with volar displacement
Osteomyelitis + SCA - organism
Salmonella
If sound like shin splints
Xray
Lumbar spinal stenosis - relieved by?
Bending forward
Lumbar spinal stenosis - investigation
MRI
Lumbar spinal stenosis - Rx
laminectomy
NOF - which artery?
medial circumflex femoral artery
