ORTHO bro Flashcards

1
Q

Ac joint degenerative disease

A

a very common occurance, by 3rd decade of life usually.

pain particularly on overhead or cross body activities.

occurs due to large axial loads on a small surface area.

Ix: imaging with x-rays, or palpation

Rx: activity modification, nsaids.
steroid injection
surgery- remove only 8-10 mm as any more risks loosing ligamentous stability.

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2
Q

AC joint seperation

A

quite common, 9% of all shoulder injuries.- a fall onto adducted arm.

Rf: male, athletes.

S+S: pain, noticable seperation, history consistent, pain on adduction

Ix: imaging- x-ray Ap B/L.
+ axuillary lateral view + zanca view.

Classification:
1- no instability- reducable Rx with sling

2- AC torn, CC sprained, horizonal instability-inc CC distance <25% of contralateral– RX with sling.

3- AC + CC torn. inc CC dist 25-100% contralateral. - controversial management.
3A has only vertical instability
3B has both horiz and vert.

4- AC + CC Torn- skin tenting, posterior fullness. - lateral clav dinsplaced into trap posteriorly on axillary XR. – surgery.

5- Ac +CC torn- shoulder droop, not imp with shrug. CC dist > 100% contralat. – surg

6- inferior dislocation- surg

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3
Q

achilles tendon rupture

A

sudden dorsiflexion of a plantarflexed foot- I.e stepping backwards

clinical diagnosis- dangle angle, thompsons test, weakness.

MRI can confirm + plan surgical management.

Rf: male, 30-40, weekend warrior, steroid injections, fluroquinolones.

S+S: pop, weakness, difficulty walking.

Rx: mix of casting + bracing or surgery to re-approximate the ends.- similar outcomes.

if ends done approximate- hen ? surgical management.

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4
Q

role of nsaids and corticosteroids in achilles tendinopathy

A

nsaids in acute phase only, not for long term use

no corticosteroids

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5
Q

ACL tear

A

half of all knee injuries

Rf: female, previous concussion, landing in risky position.

non contact pivoting injury, assoc with lateral meniscus tears (54% of time) medial in chroinc cases.

2 bundles- AM- ightest in flexion,
PL- tightest in extension

S+S: pop, immediate swelling,

Ix: lachmans most sensitive, pivot shift,
confirm with MRI scan

Rx: can be conservative
or
reconstruction-

repair - in younger/ avulsion patients.

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6
Q

adhesive capsulitis

A

painful, restrictive shoulder condition. fibrosing pathology. usually lasts 18-24 months.

Rf: women, 40-70. recent trauma to shoulder. DM, Thyroid

S+S: pain, worse in bed and disturbs sleep.
stiffness- capsular pattern

Ix: diagnosis of exclusion- X-rays +/- ultrasound may help.

Rx:
heat pack, physio, analgesia.
2’ -steroid early if no progress with physio.
3’ - MUA, Hydrodilatation, arthroscopic release.

pain and stiffness for 3 months–> refferal.

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7
Q

ankle fracture

A

generally following trauma.
most commonly lat mal.
but can be medial +/- posterior also.

inability to wt bear/ ottowa ankle rules helpful

Ix: plain x-ray.

Rx: non-displaced, anatomically reduced- conservative- cast 6/52

if open- debride wound, saline irrigation
internal fixation once wound clean.

if talar shift, irreducable, webber C, - ORIF.

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8
Q

distal biceps tendon rupture

A

excessive eccentric contraction- avulses bicep off its radial tuberosity.

occurs in dominant hand in men in their 40s.

Rf: steds (both types) smoking,

S+S: acute, pop sound, weakness + pain in supination. reverse popeye sign,

Ix: Hook test, MRI- will help beetween partial/ full.

Rx: low demand + willing to ccept functional loss- non-op

op otherwise- done within a few weeks of injury.

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9
Q

biceps tendinopathy

A

painful, swollen, and structurally weaker tendon that is at risk of rupture

Rf: young, active,

S+S: pain worse on stressing tendon, tenderness on palp,

Ix: speeds test
clinical diagnosis- aided by uss.

Rx: analgesia, physio
uss guided injections

3’- arthroscopic tenodesis, tenectomy.

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10
Q

clavicle fracture

A

fall onto lateral shoulder +/- adducted arm.

most common fracture of childhood- 10% of all fractures.

middle 1/3 # in 70% of cases, lateral in 28%, v rare medial.

Rf: male, sports, young, cycling, older + falling.

S+S: pain, trauma, setp, tenderness on palp,

Ix: perform a complete neurovasc exam.
X-rays- AP + 45 deg cephalic tilt.

Rx
- non displaced- sling with less than 90 deg motion

displaced- fix-

absolut indications for surg- neurvasc compromise, open, tenting, angulation/ displacement.

shortening of 1.5cm or more, or 15% of contralateral side. floating shoulder, poly trauma, seziure disorder.

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11
Q

compartment syndrome

A

where the ossiofascial compartment of the leg reaches pressure that causes occlusion of the vessels. – causing hypoaemia and damage

S+S: severe foot ankle and leg pain, worsens with time and movement of the foot.
- pain out of proportion with current sitch

common following trauma/ crush injuries.

common in the young.

Ix: compartment pressure measurement- within 5cm of #.

Rx: generally emergency fasciotomy of all 4 compartments. - anterior lateral and posteriomedial incisions- 15-18 in length.

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12
Q

distal radius fracture

A

most common orthopaedic injury- nearly 20% of all fractures.

FOOSH

50% intra-articular

RF: osteoperosis- DEXA reccomended for all women with one.

S+S: swelling, pain, deformity.

Ix: X-rays, AP, lateral, oblique.

Rx: non-op if- less than 5mm radial shortening
dorsal angulation of less than 5’

ORIF- if intra articular step >2mm.

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13
Q

dupuytrens contracture

A

benign proliferative disorder

painless nodule progressing to diseased cords.

2:1 male- female ratio. 5-7th decades of life.
northern europeans most at risk.

autosomal dominant with variable penetrance.

ring > small> middle > index.

cytokine-mediated transformation of normal fibroblasts into abnormal myofibroblasts, turning normal fascial bands into pathological cords

generally painless, restricts ROM.

Ix: clinical diagnosis
Rx: watch + wait
hand therapy + injection
needle aponeurotomy

partial/ full palmary fasciectomy if severe

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14
Q

elbow dislocation

A

most often posteriorlateral dislocations.

10-20 year old active people.

axial load, supination force + valgus posteriolateral.

progression of lig injury lateral to medial.

simple- if no assoc #.
complex- if # e.g terrible triad (coronoid + radial head)

Ix: x-ray.

Rx: simple- closed reduction and immobilisation splint at least 90’ for 10 days.

complex- ORIF- LCL repair, fix #s.

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15
Q

flexor tendon injury zones

A

1- fdp
2fdp and fds
3- palm
4 - carpal tunnel
5- after wrist

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16
Q

extensor tendon injury zones

A

odd is on a joint
1- dip or later
2- middle phalanx
3- pip
4- prox phalanx
5- mcp
6- back of hand
7- wrist.

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17
Q

hip fracture- discuss frequency, classification, subclassificaiton of the classification and some treatment (but most covered next card)

A

65000 each year in the uk

30% one year mortality.

intra capsular- up to just proximal of the trochanters

extra-capsular. - 2 types
sub troch- lesser trochanter to 5cm more distal

inter-troch- as it says.

predominant blood supply- medial circumflex.-

displaced intracapsular fractures disrupt the blood supply- even if fixed. ——- need arthroplasty.

garden classification 1-4
1-2 non displaced (1 not fully through)
3-4 displaced- 3 partial 4 fully.

18
Q

hip fracture S+S, Ix, Rx.

A

S+S: trauma, shortened + externally rotated.

pain in the groin thigh or knee

Ix: plain film x-ray
if long lie- CK.

Rx: - displaced subcapital- him hemi/ full if they are good craic

intertroch- DHS

non displaced intra-capsular- cannulated hip screws. (or consider THR if good craic)

sub troch- IM fem nail.

19
Q

humeral fracture- shaft

A

bimodal- in young due to trauma

in old due to frailty.

sig risk of radial nerve damage.

S+S: pain and deformity after trauma.
reduced sensation over dorsal 1st webspace. , weakness in wrist extension

Ix: check neurovasc status
X-ray - AP and Lateral.

Rx: realign limb + brace. (<20 angulation, <30 deg var/val, <3cm shortening)

ORIF if big deformity
IM if pathological

20
Q

humeral head/ neck fracture

A

FOOSH injury, fragility fracture.

due to close relation to axillary nerve and circumflex art - need neurovas status of arm assessed.

Ix: plain film X-ray

classification-
greater tuberosity
lesser tuberosity

anatomical neck (articular segment)
humeral shaft (surgical neck)

Rx: nearly always non surg- immobilisation in collar + cuff 2-4 weeks.

surg if displaced, open or neurovasc comprimise.

21
Q

liz franc injury

A

severe injury to the tarsometatarsal joint
medial cuneiform and base of 2nd metatarsal.

can be ligamentous or bony also.

severe torsional or teanslational force through plantarflexed foot.

piano key sign- bones go down and back up with pressure.

Ix: plain film AP, Oblique, lateral foot.

Rx: non displaced- cast/immobilisation + NWB mvt.

displacement- op- ex fix if big swelling going on
screw fixation if not too much swelling. #

arthritis is significant risk, midfoot compartment syndrome also frequent.

22
Q

MCL injury

A

most commonly injured knee lig.

Pop with slower swelling over hours. pain common.

inc laxity on valgus test.

grade 3 is lax in both extension and 30 deg flex,
grade 2 only lax in 30 deg.

Ix: gold standard MRI

Rx: gd 2-3 - brace

surgery if distal avulsion alongside.

23
Q

meniscal tears

A

injury occurs through trauma or degeneration.

S+S: tearing feeling in knee, slow swelling. can lock.
joint tenderness

Ix: MRI gold standard

Rx: large or persistantly symptomatic - surg

in outer 1/3 suture repair
inner 1/3- trim (poor vasc)

sig risk for 2’ osteoarthritis.

24
Q

metacarpal/ phalangeal fractures- types of + ix rx etc.

A

boxers- classic
bennets - thumb displacement - intra articular

rolando- intra atricular 1st metacarpal - in Y or T shape (similar to bennets)

Ix: X-ray then build up to CT.

Rx: REMOVE jewlery
if simple- buddy strap for 3-4 weeks. re-xray at 1 weeks to asssess for displacement.

if rotational deformity, intraarticular involvement, angulation, shortening or unstable—– fix.

K wire or ORIF 2 choices.

25
Q

metatarsal stress fractures

A

most commonly 2nd or 3rd

sudden inc in duration or intensity of activity.

generally low risk stress fractures.

Ix: x-ray, MRI gold standard

Rx: analgesia and rest mostly

high risk of non union in neck of 2nd #s, but in stress its ok.

26
Q

mortons neuroma

A

compression neuropathy of common digital plantar nerve

mostly in 3rd intermetatarsal space.
occ in 2nd
rarely elsewhere

benign fibrotic thickening of the nerve due to constant irritation

RF: high arch feet, tight/ ill fitting shoes, heavy impact on feet.

avg age 50-55. 4:1 women : men

S+S: pain in forefoot, lump feeling, tingle, pain on squeezing.

Ix: clinical with x-ray and bloods to rule out # or gout etc.

27
Q

olecranon bursitis

A

either septic or aseptic

commonly found in young/ middle aged men.

people with repetitive trauma

generally only painful if infected- or in full flexion of elbow when the bursa is compressed.

Ix: clinically- if not infectious don’t aspirate

aspirate if concern about septic.

Rx: RICE, activity modification. can aspirate for symptoms relief. refer after 2 months if still bothering

if septic- aspirate- treat empirically

fluclox (500 mg four times daily)
2’-

Clarithromycin (500 mg twice daily) may be used if the person is allergic to penicillin. Erythromycin (500 mg four times daily) is the preferred macrolide in pregnancy and breastfeeding.

28
Q

olecranon fracture

A

common

often causes disruption of the extensor mechanism

mean age- 57 years.

direct blow- cominuted #
FOOSH- transverse / oblique #.

many classification systems.

Ix: plain film

Rx: non displaced with intact extensor mechs- immobilise 45-90 degrees - 1 week. early rom.

surgery if above criteria not met. many options.

29
Q

pathological fracture

A

500x more likely to be as a result of a met than a primary sarcoma.

lung, breast, thyroid, renal, and prostate- most frequently met to bone.

Ix: when detected- comprehensive work up if primary unkwown.

PSA CEA etc

x-ray - high aggression indicated by lesion diameter > 5 cm, cortical interruption, periosteal reaction, and associated pathologic fracture.

Rx: there are criteria to meet for prophylactic fixation (50% of diameter, 2.5cm in size, lesser trochanter, pain after radiotherapy)

healing rates for metastasis from multiple myeloma, renal, breast, and lung carcinoma are 67%, 44%, 37%, and 0%, respectively

if renal met- excise widely where possible.

30
Q

plantar fasciitis- one good fact but not the whole thing

A

assoc with seronegative arthritidies

31
Q

pubic ramus fracture

A

needs at least 3 x - rays to assess whole ring

AP
inlet view
outlet view

generally don’t operate

fragility fracture

6-8 weeks to solidify but FWB through the rehab, manage pain as needed.

32
Q

radial head fracture

A

most common elbow fracture

mean age 45. 85% occur before 60.

FOOSH- elbow extension and forearm pronation

Type I
Nondisplaced or minimally displaced (<2mm), no mechanical block to rotation
Type II
Displaced >2mm or angulated, possible mechanical block to forearm rotation
Type III
Comminuted and displaced, mechanical block to motion
Type IV
Radial head fracture with associated elbow dislocation

S+S: pain, possible blocks to elbow ROM (inc pro/sup)

Ix: x-ray
ct for surg workup

RX: type 1-2 with no block.
immobilise for 3-7 days then light rom

2 with block-3-4 ORIF if feasible.

if more than 3 bits- replace radial head, or if continued non union.

33
Q

scaphoid fracture

A

blood supply by dorsal carpal branch of radial artery

80% is supplied by retrograde flow.

snuffbox tenderness / tubercle tenderness is important
scaphoid compression (axial thumb) is pretty sensitive and specific.

Ix: 5 view scaphoid imaging

repeat in 14-21 days if no # seen but high suspicion.

or mri

Rx: cast immobilisation 21 at least- non displaced- if <1mm pretty high union rate

perc screw fixation - pole #, displacement >1mm, waist #.

ORIF if pretty mad looking x-rays.

34
Q

scoliosis

A

most common is adolescent idiopathic

affects 10-18 year old girls most commonly
(10-1 female-male for big curves >30’) equal ratio for smol ones.

multifactoral causes predominantly unknown.

Rf: FH

Ix: standing PA, lateral. Cobb angle (>10’ is scolisosis)

Rx: Cobb angle <25 deg. - nonop
Cobb angle 25-45- bracing.
cobb angle 45+ - surgery- posterior spinal fusion.

35
Q

septic arthritis

A

inflammation 2’ to infection

monoarticular usually.

staph aureus is common causitive organism.

more common in kids than adults.

Rf: kid or over 80, DM, RA, recet surg, prosthesis, prev injection, skin infections, hiv, sex,

S+S: acute monoarticular joint pain, fever, sepsis, swelling, inflammation.

Ix: synovial culture
Rx: antimicrobial therapy- Fluclox 4-6/52.

clincamycin if allergic.

if large collection- drainage and washout.

36
Q

shoulder dislocation

A

contact sports in young, falls in the old.

associated with bankart lesion
hill-sachs lesion
axillary nerve injury

mostly are anterior dislications, 2-4% are posterior

S+S: arm often abducted and externally rotated.

Ix: X-ray AP and axillary lateral/ Y views

Rx: reduce and sling
if recurrent - bankeart repair –> laterjet

37
Q

spondylosis/ spondylolisthesis

A

due to pars fracture insificciency- one vertebra slips foreward relative to the other one

causes: degenerative, isthmic, traumatic, dysplastic, or pathologic.

Ix: AP/ lateral flexion and extension.
graded: based on quaters of slippage.

Rx: grade 1- nothing
grade 2- probably nothing

after that no real defined terms for how to do the operations.

38
Q

spinal chord injury- types, how are they graded + treatment.

A

primary- irreversable arising from direct damage

2’- as a result of changes prod by primary.

most common cause- car crash.

Graded using ASIA score- A worse, E best.
Image with MRI

Rx:
maintain BP above 90 systolic,
consider need for intubation
catheterise if retaining

39
Q

trigger finger

A

A1 pulley mechanical impingement

progressive pain, clicking, triggering, tenderness

Rf: diabetic, female, over 50,

increaced type 3 collagen

associated with carpal tunnel 60% of the time.

Grading
1- pain
2- some locking but goes away on onw
3- locking requing manual release
4- locked

Ix: clinical diagnosis

Rx: splinting, activity modification, nsaids

steroid treatment

Operative- perc release of A1 tendon.

40
Q

ulner nerve entrapment

A

gen occurs in cubital tunner in elbow or in guyons canal

ulnar is medial chord of brachial plexus.

men 2:1 women at elbow.

Ix: x-rays to rule out any ossious/ ossification cause.

Rx: NSAIDs, pad the nerve, splints at night.

atrophy + weakness = release of ligaments, medial epicondylectomy.

41
Q

ganglion cysts

A

mucin filled synovial cysts
can occur spont or at site of injury.

most common hand mass

dorsal 70%.
volar carpal 20%
volar retinacular 10%

usually asymptomatic.
Ix: firm well circumscribed transilluminating mass- clinical

Rx: usually leave alone
closed rupture (bible) - high reocurrence
aspiration- 2’ line usually. avoid on volar due to radial artery.

operative- resection- recurrent