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Final year Medicine > Ortho > Flashcards

Ortho Flashcards

1
Q

Immediate Complications of fractures

A

Immediate:
General: Haemorrhage
Shock
Fat embolus

Specific: Neurovascular injury
Muscle/tendon/ligament injury
Compartment syndrome

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2
Q

fracture complications Early <30days

A

General: DVT/pe
Infection/sepsis
UTI
pressure sores

Specific: local infection

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3
Q

Fracture late complications

A 
General:
DVT/PE
Infection/sepsis
UTI
Pressure sores
Specific:
Arthritis
Reflex sympathetic dystrophy
Non/malunion
Contractures
Avascular necrosis
growth disrurbance
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4
Q

Causes of NOF fractures

A

Osteoporosis

Trauma

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5
Q

Hx from NOF

A 
Age
Comorbidity
Preinjury mobility
Current meds
Mental state
reason for fall
Social hx: relatives, stairs, etoh
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6
Q

Mx of Extracapsular fracture

A

Dynamic hip screw

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7
Q

Mx of Intracapsular fractures

A

Undisplaced (garden 1/2): Fix with screws/DHS

Displaced:
<55 -> open reduce and fix with screws
FU with arthroplasty if AVN in future.

> 65 -> fit and mobile (1 stick or less, no cognitive impairment): THR
Less fit-> Hemiarthroplasty

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8
Q

Describe a fracture XR

A

Location
Pieces (simple/multifragment)
Pattern (transverse oblique, spiral)
Displacement (Shortening, translation, angulation, rotation)

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9
Q

Gustilo anderson classification open fractures

A
  1. <1cm
  2. > 1cm minimal soft tissue damage
  3. Extensive soft tissue damage

C. perfringens-gas gangrene
Benpen, clindamycin
Debridement

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10
Q

Hip arthroplasty scars

A

Anterolateral - via abductors and superior gluteal nerve -> trendelenburg gait post op.

Posterior - higher risk of dislocation, sciatic nerve damage-> foot drop.

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11
Q

Mx of osteoarthritis

A

Conservative: Lose weight
Physio

Medical: Analgesia: WHO pain ladder. check U+Es before NSAIds, and not old wo PPI
Steroid injections

Surgical: arthroscopic washout - knees, trim cartilage, remove loose bodies. 
Realignment osteotomy
Arthroplasty
Arthrodesis
Microfracture
Autologous chondrocyte implantation
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12
Q

osteoarthritis definition and features

A

Degenerative loss of hyaline cartilage and new bone formation

Rfs: age, obesity, joint abnormality

Pain worse w movement, worse at end of day

Stiff after resting, lasts 30mins

deformity

decreased ROM, first lost is IR
exclude Rheum disease - FBC, ESR, ANA< Rhf

XR: LOSS D

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13
Q

Garden Classification

A

Intracapsular NOFs

  1. Incomplete/impacted injury w valgus distal angulation
  2. complete, undisplaced.
  3. Complete, partially displaced
  4. Complete - totally displaced.
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14
Q

Rheumatoid on XR

A

Soft tissue swelling
Periarticular osteopenia
Periarticular erosions
Severe deformity

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15
Q

Complications of Hip arthroplasty

A

Immediate: Nerve injury
fracture
Cement reaction

Early:
DVT, infection - sepsis
dislocation

Late: loosening, leg length discrepancy, metallosis, revision.

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16
Q

Salter classification

A

growth plate fractures

  1. Straight across (top)
  2. Above (metaphysis)
  3. lower/Below (epiphysis)
  4. Two/through (all)
  5. Erasure /crush
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17
Q

Complications of TKR

A

Immediate

  • fracture
  • cement reaction
  • nerve injury - common peroneal - foot drop
  • vascular injury - SFA, popliteal

Early

  • DVT
  • Infection

Late

  • Maltracking
  • loosening
  • instablitity
  • periprosthetic fractures
  • reduced ROM
18
Q

True leg length

A

ASIS - medial malleolus
- shortened - NOF, hip dislocation, growth disturbance tib/fib (osteomyeleitis)
surgery, SUFE, Perthes

19
Q

Apparent leg length

A

Xiphistenum to medial malleolus

- Scoliosis of spine.

20
Q

Thomas test

A

FFD = OA/NOF

21
Q

Trendelenburg test

A

Abductor injury - OA, superior gluteal nerve injury, DDH

22
Q

Carpal tunnel causes

A 
Idiopathic
Pregnancy, Hypothyroidism
Radial fracture
Inflammation (rheumatoid, gout)
Soft tissue swelling (lipoma, acromegaly, amyloid)
Toxic (alcohol, DM)
23
Q

Mx Carpal tunnel syndrome

A

Conservative: Wrist splint neutral position at night

medical: local steroid injections
surgical: decompression by division of flexor retinaculum

24
Q

Colles fracture

A

radius - distal dorsall displacement

25
Q

Smiths fracture

A

distal volar displacement

26
Q

Barton fracture

A

intraarticular fracture of distal radius

27
Q

Scaphoid fracture signs

A

Tender anatomical snuffbox

Risk of AVN
non union and arthritis

28
Q

Monteggia fractures

A

Ulna fracture and dislocation of proximal radial head

29
Q

Galeazzifracture

A

Radius fracture and dislocation of distal ulnar

30
Q

Complications of shoulder dislocation

A

Hill sachs - cortical depression in humeral head

Bankart - glenoid labrum defect

31
Q

Disc herniation mx

A

Conservative

  • max 2 days bed rest
  • encourage activity and physio

Med:analgesia
diazepam (relaxant)
facet joint injections

Surg:
Percutaneous Microdiscectomy
Endoscopic discectomy
Hemilaminectomy + discectomy.

32
Q

Causes of charcot foot

A

Central: syringomyelia
Tabes dorsalis

Peripheral
-DM, peripheral nerve injury, leprosy.

33
Q

Ix NOF

A

ECG
FBC U+E, clotting
Cross match
XR pelvis/hip

34
Q

Signs of NOF

A

Shortening of leg
External rotation of leg
Swelling of hip

35
Q

Initial mx of NOF

A 
Analgesia
IV fluids
Skin traction
Urinary catheter
O2 prn
NBM
36
Q

Initial mx femoral shaft fracture

A 
Analgesia
IV fluids
FBC U+Es
Cross match 2 units
XR pelvis/femur
Splintage affected limb
Check pedal pulses
Check evidence other injuries
37
Q

Tibial fracture mx

A 
Analgesia
Bloods: clotting, FBC, U+E. 
Splint
NBM
IV fluids

Internal/external fixation
if not displaced/minimal -> manipulation/plaster immobilisation

38
Q

Mx achilles tendon rupture

A

Equinus cast

39
Q

Positive fromets sign
Claw hand
Extension of 4th and 5th fingers at MCPs, and flexion at interphalangeal joints.

A

Ulnar nerve injury
distal to wrist

flexor digitorum profundus intact, not countered by small muscles of hand.

40
Q

Features of adhesive capsulitis

A 
frozen shoulder
DM
External rotation affected most
active and passive affected
painful freezing phase
bilateral 20%
6m -2y
NSAIDS, physio, steroids.
41
Q

Claudication buttocks and thighs
atrophy of leg muscles
impotence

A

Leriche syndrome
-atherosclerosis of aorta iliac vessels

Ix: Angiography, mX - stents

42
Q

wrist pain after FOOSH, normal XR
hyperextended wrist
radially deviated.
loss of grip/pinch strength

Point tenderness over anatomical snuffbox. 
wrist effusion
pain on telescoping thumb
tender scaphoid tubercle. 
pain on ulnar deviation.
A

normal XR
repeat XR 7-10days.

Scaphoid #
gradually worsening pain

refer to Ortho, for MRI + surgery.

XR: AP, Laterla. oblique with wrist pronated at 45 deg, ziter view - PA with wrist in ulnar deviation and beam angulated at 20deg.

MRI

MX: Immobilisation with futuro splint/below elbow backslab.
referral to ortho , futher imaging MRI 7-10 days

Undisplaced: cast 6-8w.
displaced - surgery
proximal pole - surgery

Final year Medicine (18 decks)

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