Ortho elective Flashcards
What are the key aspects of an orthopaedic/MSK examination?
Look
Feel
Move
Special test
What aspects may you comment on during inspection in a clinical examination?
Bruising
Scars
Deformity
Shortening
Swelling
Wasting
What is grade 0 muscle power?
No power
What is grade 5 muscle power?
full and normal muscle power
What is grade 3 power?
Enough to move limb against gravity
What is grade 2 power?
Enough to move limb without gravity
What is grade 4 power?
enough to move limb against gravity and provide some resistance
How may you eliminate scapulothoracic movement when assessing the GH joint?
Face palm downwards
What deformity may be present when inspecting a patient with a previous supracondylar fracture?
Gunstock deformity
What type of gaits are there?
Antalgic gait (pain)
Scissor gait (crosses over due to adductor spasm e.g. Cerebral palsy)
Drop foot gait (ankle dorsiflexion weakness due to Common peroneal nerve palsy)
Hemiplegic gait (flexor spasm)
Trendelenburg gait (abductors weak)
Painful foot gait (shuffling gait)
What is the primary difference between the Lachman and the anterior drawer test?
The Lachman test involves the knee being only partially flexed
What is the term for a flat foot?
Pes planus
What is the term for an arched foot?
Pes cavus
What is a synovial joint?
Communication of two joints which is lined by synovium, secreting synovial fluid. Articular ends of bones are lined with hyaline cartilage.
Name the types of joint?
Synovial joints
Cartilaginous joints (primary cartilaginous or secondary ‘symphyses’)
Fibrous joints
What types of bones exist?
Long bones
Flat bones
Short bones
Accessory ossicles
What is the apophyses?
Scale of growing bone
Give an example of the apophyses.
Olecranon
Acromion
Calcaneum
Outline some key aspect of bone perfusion.
Nutrient artery supplies bone marrow and periosteal vessels
Circulus vasculosus (vessel ring) around joint supplies collateral circulation at large ends of long bones
What are the two types of cartilage?
Hyaline
Type 2 collagen arranged in arcades with ECM consisting of PGs and other collagen types
Fibrocartilage
Elastic due to elastin and collagen
Give an example of how joint loading may be altered in disease.
Joint loading and the subsequent trabeculae pattern reflects the load of weight through a joint.
In hip disease, the antalgic gait may shift the centre of gravity closer towards the joint, leaning towards the affected side will prevent the abductors on the hip from working as hard and engaging the hip, reducing pain
Why may a periprosthetic fracture occur?
How has this attempted to be overcome?
Bones and their implants are of different stiffness thus a stress riser may be created and in time, result in a fracture.
Isoelastic implants have been created
What is a stress riser?
Bones with areas of differing stiffness may be susceptible to fracture
How may an implant be fixed to bone?
Interference fit (tight fit)
Screws (mechanically)
Bone cement
Bone ingrowth
How does bone heal?
1) Inflammatory phase: blood, macrophages and bone cells
2) Reparative phase (callus formation): Osteoblasts deposit and osteoclasts resorb
(seen 7-10 days post fracture)
3) Remodelling phase: external forces sensed by osteocytes and shaped by cycle of osteoclasts and osteoblasts
Describe the electrical activity of bone.
Bone is piezoelectric, emitting a current when deformed.
The convex side has a positive charge relative to the concave side under compression.
Important to note this when using screws and plates as differing piezoelectric properties may alter ability of bone to remodel
What is the difference between an autograft and an allograft?
Autograft = from the same patient
Allograft = from a different patient
How may a bone be lengthened?
Hormonally
Mechanically - Callotasis; Physeal distraction
What are the physical signs of a fracture?
Abnormal movement
Crepitus
Deformity
Bruising
Pain on stress
Impaired function
Swelling
Tenderness
How long does it take for bones to heal?
8 weeks; x2 in lower limb
What are the types of impaired bone healing?
Delayed union
Malunion
Non-union (hypertrophic and atrophic)
How would you classify a fracture?
Open vs closed
Morphology: transverse/oblique/spiral/comminuted/crush/greenstick/buckle
Displaced vs non-displaced
What are the mechanisms of action for fractures?
Direct force
Indirect force
Pathological
Fatigue (stress fractures)
How do you classify growth plate fractures in children?
Salter-Harris classification
SALTR
Straight across (epiphyseal slip)
Across (fracture through epiphyseal line)
Lower (below the physis)
Through (through the epiphyses)
cRushed (obliteration of epiphyseal plate)
List the potential early complications of a fracture
Wound infection
Fat embolism
Shock lung
Chest infection
DIC
Exacerbation of generalised illness
Compartment syndrome
List potentials late complications of a fracture.
Deformity
Poor healing (malunion; non-union; delayed union)
OA
Aseptic necrosis
Reflex sympathetic dystrophy
What are the clinical features of complex regional pain syndrome?
Skin sensation ∆
Skin colour change
Abnormal movement
Thought to be due to damage to sensory fibres sensing temperature change a painful stimuli thus hyperalgesia
What types of injuries to a joint can occur?
Subluxation
Dislocation
Fracture dislocation
What is the difference between subluxation and dislocation?
Subluxation is partial with some joint space contact cf dislocation is complete thus no joint contact
What is the difference between a sprain, partial rupture and complete rupture of a ligament?
Sprain is a partial tear but stability maintained
Partial rupture is a partial tear with stability compromised
A complete rupture is loss of both stability and continuity of the ligament
How may a blood vessel be damaged in a trauma?
Division (completely ruptured)
Stretched (soft tissue injuries indirectly impact vessel)
Spasm (blood vessel contracts and relaxes)
Crushing (direct trauma compresses intima)
What are the potential nerve injuries exhibited in trauma?
Neurapraxia (outside pressure with transient loss of function)
Axonotmesis (loss of function due to compression but incomplete)
Neurotmesis (division of the nerve with no neural continuity)
How may muscle be damaged in a trauma?
Crushing (direct force)
Laceration
Ischaemia
Ectopic ossification (haematoma leads to bone deposition)
What is the demographic of ankle fractures?
Bimodal
Young (15-24)
Elderly (75-84)
What are the most common locations of ankle fractures?
Isolated malleolar = 70%
Bimalleolar = 20%
Trimalleolar = 10%
What type of joint is the ankle joint?
Hinge joint
What is the range of motion of the talocrural joint?
Dorsiflexion = 10 degrees (30 degrees when knee is flexed)
Plantarflexion = 30 degrees
Which fibres make up the medial collateral ligament of the ankle?
4 components to the ‘delta’ ligament:
- Tibionavicular (Anterior)
- Tibiocalcaneal (Intermediate)
- Anterior tibiotalar (Deep)
- Posterior tibiotalar (Posterior)
Which fibres make up the lateral collateral ligament of the ankle?
3 components:
- Anterior tibiofibular ligament
- Posterior tibiofibular ligament
- Calcaneofibular ligament
When operating on the ankle using an anterior approach, which structures may be damaged?
Anterior tibial artery
Deep peroneal nerve
Both course over anterior ankle between EDL and EHL
When operating on the ankle using a posterior approach, which structures may be damaged?
Posterior tibial artery
Tibial nerve
These course posterior to medial malleolus between FDL and FHL tendons
If posterolateral approach, may damage superficial perineal nerve and sural nerve
What are the biomechanics of the medial collateral ligament of the ankle?
Restrains anterolateral talar displacement
Which ankle fracture variants are you aware of?
Bosworth
Maisonneuve
LeFort-Wagstaffe
Tillaux-Chaput
