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Surgery > Ortho elective > Flashcards

Ortho elective Flashcards

1
Q

What are the key aspects of an orthopaedic/MSK examination?

A

Look
Feel
Move
Special test

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2
Q

What aspects may you comment on during inspection in a clinical examination?

A

Bruising
Scars
Deformity
Shortening
Swelling
Wasting

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3
Q

What is grade 0 muscle power?

A

No power

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4
Q

What is grade 5 muscle power?

A

full and normal muscle power

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5
Q

What is grade 3 power?

A

Enough to move limb against gravity

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6
Q

What is grade 2 power?

A

Enough to move limb without gravity

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7
Q

What is grade 4 power?

A

enough to move limb against gravity and provide some resistance

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8
Q

How may you eliminate scapulothoracic movement when assessing the GH joint?

A

Face palm downwards

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9
Q

What deformity may be present when inspecting a patient with a previous supracondylar fracture?

A

Gunstock deformity

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10
Q

What type of gaits are there?

A

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)

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11
Q

What is the primary difference between the Lachman and the anterior drawer test?

A

The Lachman test involves the knee being only partially flexed

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12
Q

What is the term for a flat foot?

A

Pes planus

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13
Q

What is the term for an arched foot?

A

Pes cavus

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14
Q

What is a synovial joint?

A

Communication of two joints which is lined by synovium, secreting synovial fluid. Articular ends of bones are lined with hyaline cartilage.

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15
Q

Name the types of joint?

A

Synovial joints

Cartilaginous joints (primary cartilaginous or secondary ‘symphyses’)

Fibrous joints

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16
Q

What types of bones exist?

A

Long bones
Flat bones
Short bones
Accessory ossicles

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17
Q

What is the apophyses?

A

Scale of growing bone

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18
Q

Give an example of the apophyses.

A

Olecranon
Acromion
Calcaneum

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19
Q

Outline some key aspect of bone perfusion.

A

Nutrient artery supplies bone marrow and periosteal vessels

Circulus vasculosus (vessel ring) around joint supplies collateral circulation at large ends of long bones

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20
Q

What are the two types of cartilage?

A

Hyaline
Type 2 collagen arranged in arcades with ECM consisting of PGs and other collagen types

Fibrocartilage
Elastic due to elastin and collagen

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21
Q

Give an example of how joint loading may be altered in disease.

A

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

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22
Q

Why may a periprosthetic fracture occur?

How has this attempted to be overcome?

A

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

23
Q

What is a stress riser?

A

Bones with areas of differing stiffness may be susceptible to fracture

24
Q

How may an implant be fixed to bone?

A

Interference fit (tight fit)

Screws (mechanically)

Bone cement

Bone ingrowth

25
Q

How does bone heal?

A

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

26
Q

Describe the electrical activity of bone.

A

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

27
Q

What is the difference between an autograft and an allograft?

A

Autograft = from the same patient

Allograft = from a different patient

28
Q

How may a bone be lengthened?

A

Hormonally

Mechanically - Callotasis; Physeal distraction

29
Q

What are the physical signs of a fracture?

A

Abnormal movement
Crepitus
Deformity
Bruising
Pain on stress
Impaired function
Swelling
Tenderness

30
Q

How long does it take for bones to heal?

A

8 weeks; x2 in lower limb

31
Q

What are the types of impaired bone healing?

A

Delayed union
Malunion
Non-union (hypertrophic and atrophic)

32
Q

How would you classify a fracture?

A

Open vs closed

Morphology: transverse/oblique/spiral/comminuted/crush/greenstick/buckle

Displaced vs non-displaced

33
Q

What are the mechanisms of action for fractures?

A

Direct force
Indirect force
Pathological
Fatigue (stress fractures)

34
Q

How do you classify growth plate fractures in children?

A

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)

35
Q

List the potential early complications of a fracture

A

Wound infection
Fat embolism
Shock lung
Chest infection
DIC
Exacerbation of generalised illness
Compartment syndrome

36
Q

List potentials late complications of a fracture.

A

Deformity
Poor healing (malunion; non-union; delayed union)
OA
Aseptic necrosis
Reflex sympathetic dystrophy

37
Q

What are the clinical features of complex regional pain syndrome?

A

Skin sensation ∆
Skin colour change
Abnormal movement

Thought to be due to damage to sensory fibres sensing temperature change a painful stimuli thus hyperalgesia

38
Q

What types of injuries to a joint can occur?

A

Subluxation
Dislocation
Fracture dislocation

39
Q

What is the difference between subluxation and dislocation?

A

Subluxation is partial with some joint space contact cf dislocation is complete thus no joint contact

40
Q

What is the difference between a sprain, partial rupture and complete rupture of a ligament?

A

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

41
Q

How may a blood vessel be damaged in a trauma?

A

Division (completely ruptured)
Stretched (soft tissue injuries indirectly impact vessel)
Spasm (blood vessel contracts and relaxes)
Crushing (direct trauma compresses intima)

42
Q

What are the potential nerve injuries exhibited in trauma?

A

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)

43
Q

How may muscle be damaged in a trauma?

A

Crushing (direct force)
Laceration
Ischaemia
Ectopic ossification (haematoma leads to bone deposition)

44
Q

What is the demographic of ankle fractures?

A

Bimodal
Young (15-24)
Elderly (75-84)

45
Q

What are the most common locations of ankle fractures?

A

Isolated malleolar = 70%
Bimalleolar = 20%
Trimalleolar = 10%

46
Q

What type of joint is the ankle joint?

A

Hinge joint

47
Q

What is the range of motion of the talocrural joint?

A

Dorsiflexion = 10 degrees (30 degrees when knee is flexed)

Plantarflexion = 30 degrees

48
Q

Which fibres make up the medial collateral ligament of the ankle?

A

4 components to the ‘delta’ ligament:
- Tibionavicular (Anterior)
- Tibiocalcaneal (Intermediate)
- Anterior tibiotalar (Deep)
- Posterior tibiotalar (Posterior)

49
Q

Which fibres make up the lateral collateral ligament of the ankle?

A

3 components:
- Anterior tibiofibular ligament
- Posterior tibiofibular ligament
- Calcaneofibular ligament

50
Q

When operating on the ankle using an anterior approach, which structures may be damaged?

A

Anterior tibial artery
Deep peroneal nerve

Both course over anterior ankle between EDL and EHL

51
Q

When operating on the ankle using a posterior approach, which structures may be damaged?

A

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

52
Q

What are the biomechanics of the medial collateral ligament of the ankle?

A

Restrains anterolateral talar displacement

53
Q

Which ankle fracture variants are you aware of?

A

Bosworth
Maisonneuve
LeFort-Wagstaffe
Tillaux-Chaput

Surgery (10 decks)

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