Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Medicine Finals - Imperial & Quick Medical Revision > Ortho Flashcards > Flashcards

Ortho Flashcards

1
Q

Fracture Healing phases?

A
  1. Reactive Phases (injury - 48hr). Can be a haematoma from bleeding into the site, or from inflammation via cytokines and GF, vasoactive mediator release.
  2. Reparative Phase (2 days-2 weeks)
    - Proliferation of osteoblasts + fibroblasts –> Cartilage + woven bone –> Callus
    - Consolidation (endochondral ossification) of woven bone –> Lamellar bone.
  3. Remodelling Phase (1 week-7yrs)
    - Remodelling of lamellar bone to cope with mechanical forces applied to it (Wolff’s law: form follows function).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which fractures heal in 3 weeks?

A

Closed, Paediatric, metaphyseal, upper limb: 3 weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which fracture heals in 6 weeks

A
  • Adult
  • Lower limb
  • Diaphyseal
  • Open
  • Smoking slows healing time.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Types of a traumatic fracture?

A

Traumatic fracture

  • Direct
  • Indirect e.g FOOSH –> Clavicle fracture (fall on outstretched hand)
  • Avulsion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is a stress fracture?

A
  • Bone fatigue due to repetitive strain
  • E.g foot fractures in marathon runners

Can get it in in tibia.

Would be unwise to discharge therefore need an X-ray initially.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is a pathological fracture?

A

Normal forces but diseased bone

  • Local: tumours
  • General: osteoporosis, Cushing’s, Paget’s.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Classifications of fractures?

A

Stress
Pathological
Traumatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How does one describe a fracture?

A

Radiographs must be orthogonal: request AP and lat. films.
Need images of joints above and below fracture.

PAIDSS

  1. Demographic
    = Pt details, date radiograph was taken
    = Orientation and content of image
  2. Pattern
    - transverse
    - Oblique = fracture lies obliquely to long axis of bone.
    - Spiral = severe oblique fracture with rotation along long axis of bone.
    - Multifragmentary
    - Crush
    - Greenstick - young, soft bone breaks (one cortex is ok, the other isn’t as it is more bendy)
    - Avulsion - occurs when a fragment of bone tears away from the main mass of bone as a result of physical trauma.

Plastic deformity - stres on bone resulting in deformity without cortical disruption

Buckle Fracture - incomplete cortical disruption leading to bulging of the cortex.

  1. Anatomical location
    - Diaphyseal, metaphyseal, epiphyseal
  2. Intra/extra-articular
    - Dislocation or subluxation (incomplete or partial dislocation)
  3. Deformity (distal relative to proximal)
    - Translation
    - Angulation or tilt (normal axis of the bone is different) (dorsal, palmar). Distal portion of bone points off in a different direction.
    - Rotation - Rotation of distal fracture fragment in relation to proximal part.
    - Impaction (–> shortening)
  4. Soft tissue
    - Open or closed
    - Neurovascular status
    - Compartment syndrome
  5. Specific classification type
    - Salter Harris
    - Garden
    - Colles’, Smith’s, Monteggia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the 4 Rs for Fracture Management?

A
  • Resuscitation
  • Reduction
  • Restriction
  • Rehabilitation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the principles of Resuscitation?

A

ATLS Guidelines
- Trauma in primary survey: C-spine, chest and pelvis
- # usually assessed in 2dry survey
- Assess neurovascular sttus and look for dislocations
- Consider reduction and splinting before imaging
(decreased pain, bleeding, risk of neurovascular injury)
- X-ray once stable.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Urgent management of an open fracture (once which breaks the skin)?

A
  • Analgesia: M+M (morphine)
  • Assess: NV status, soft tissues, photograph
  • Antisepsis: wound swab, copious irrigation, cover with betadine-soaked dressing
  • Alignment: align fracture and splint
  • Anti-tetanus: check status (booster lasts 10yrs)
  • Antibiotics: co-amoxiclav or cefuroxime

Fracture is stabilised and an external fixator is often used in the first instance.

Management: Debridement and fixation in theatre and should be delayed until soft tissues have recovered. Should be done within 6hr of injury.

Long-term = Definitive skeletal and soft tissue reconstruction. Avoid internal fixation until thoroughly debrided.

Remember: Vascular impairment requires immediate surgery and restoration of circulation, ideally within 3-4 hrs. FOllow the sequence of shunting, temporary skeletal stabilisation and then vascular reconstruction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Classification of open fractures?

A 
Gustillo's 
1. Wound <1cm in length
2. Wound >1cm with minimal soft tissue damage
3. Extensive soft tissue damage 
a - adequate soft tissue coverage
b - inadequate soft tissue coverag
c(implies vascular compromise) fos
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Most dangerous complication of open #?

A

Clostridium perfringes

  • Wound infection + gas gangrene
  • ± shock and renal failure
  • Management: debride, benpen + clindamycin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Principles of Reduction?

A

Displaced #s should be reduced

  • Unless no effect on outcome (ribs)
  • Aim for anatomical reduction (if articular surfaces involved - correct alignment)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the methods of reduction?

A

Manipulation/Closed reduction

  • Under Local, regional or general anaesthetic
  • Traction to disimpact
  • Manipulation to align

Traction (generally pulling)

  • Not typically used now
  • Employed to overcome contration of large muscles e.g femorals #s
  • Skeletal traction vs skin traction

Open reduction (and internal fixation)

  • Accurate reduction vs risk of surgery
  • Intra-articular #s
  • open #s
  • 2# in 1 limb
  • Failed conservative management
  • Bilateral identical fractures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Principle of restriction?

A
  • Interfragmentary strain hypothesis dictates that tissue formed @ #site depends on strain it experiences
  • Fixation –> decreased strain –> Bone formation
  • Fixation also –> Decreased pain, increased stability, increased ability to function
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Methods of restriction?

A

Non-rigid

  • Slings
  • Elastic supports

Plaster

  • POP
  • In first 24-48hrs use back-slab or split case due to risk of compartment syndrome

Functional bracing
- Joints free to move but bone shafts supported in cast segments

Continuous traction
- E.g collar-and-cuff

Ex-Fix

  • Fragments held in position by pins/wires which are then connected to an external frame
  • Intervention is away from field of injury.
  • Useful in open fractures, burns, tissue loss to allow wound access and decrease infection risk
  • Risk of pin-site infection

Internal fixation

  • Pins, plates, screws, IM Nails
  • Usually perfect anatomical alignment
  • Increased stability
  • Aid early mobilisation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Principles of Rehabilitation?

A

Immobility –> decreased muscle and bone mass, joint stiffness

  • Need to maximise mobility of uninjured limbs
  • Quick return to function decrease later morbidity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Methods of Rehabilitation?

A

Physiotherapy: Exercises to improve mobility
OT: Splints, mobility aids, home modification
Social services: meals on wheels, home help.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

General complications of fractures?

A
  • Tissue Damage
  • Anaesthesia
  • Prolonged Best Rest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Problems with tissue damage?

A
  • Haemorrhage and shock
  • Infection
  • Muscle damage –> Rhabdomyolysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Problems with anaesthesia?

A
  • Anaphylaxis
  • Damage to teeth
  • Aspiration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Problems with bed rest?

A
  • Chest infection
  • UTI
  • Bed sore and pressure sores
  • DVT
  • Decreased bone mineral density
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Specific complications for fractures?

A
  • Immediate
  • Early
  • Late
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Immediate complications of fractures?

A
  • Neurovascular damage

- Visceral damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Early complications of fractures?

A
  • Compartment syndrome
  • Infection (worse if associated with metalwork)
  • Fat embolism –> ARDS

Recent injury and physical signs that would be concordant with fat embolism syndrome. Normally within 3 days.

Triad = Hypoxaemia, neurological abnormalities, petechial rash.

Resp = Early persistent tachycardia, tachypnoea, dyspnoea hypoxia, pyrexia.
Derm: red/brown impalpable petechial rash. Subconjunctival and oral haemorrhage.

CNS - confusion + agitation. Retinal haemorrhage and intra-arterial fat globules on fundoscopy.

Management

  • Prompt fixation of long bone fracutre
  • Some debate vs medullary reaming in femoral shaft.
  • DVT prophylaxis
  • General supportive care.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Late complications with fractures?

A
  • Problems with union
  • AVN
  • Growth disturbance
  • Post-traumatic osteoarthritis
  • Complex regional pain syndromes
  • Myositis ossificans
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Neurological complications of fractures?

A
  • Severance is rare, stretching over bone edge commoner

- Seddon classification describes three types of injury?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Seddon classification of 3 neurological complications?

A

Neuropraxia - Temporary interruption of conduction w/o loss of axonal continuity

Axonotmesis

  • Disruption of nerve axon -> distal Wallerian degeneration.
  • Connective tissue framework of nerve preserved
  • Regeneration occurs and recovery is possible

Neurotmesis

  • Disruption of entire nerve fibre
  • Surgery required and recovery not usually complete
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Palsy as a result of anterior shoulder dislocation or humeral surgical neck?

A

Axillary Nerve damage –> Numb chevron and weak abduction

Check pulses and nerves.

Always do X-ray.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Palsy as a result of #humeral shaft?

A

Radial nerve –> Waiter’s tip (Erb’s Palsy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Palsy as a result of elbow dislocation?

A

Ulnar nerve –> Claw Hand (Klumpke’s Palsy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Palsy as a result of hip dislocation?

A

Sciatic Nerve –> Foot drop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Palsy as a result of #neck of fibula or knee dislocation?

A

Fibular Nerve –> Foot drop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Compartment syndrome pathophysiology?

A
  • Osteofacial membranes divide limbs into separate compartments of muscle.
  • Oedema following # –> increased the compartment pressure –> decreases venous drainage –> increased compartment pressure
  • If compartment pressure > capillary pressure –> Ischaemia.
  • Muscle infarction –>
  • Rhabdomyolysis and ATN
  • Fibrosis –> Volkman’s ischaemic contracture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Presentation of compartment syndrome?

A

Due to supracondylar fracture and tibial shaft fracture.

  • Pain > clinical findings
  • Pain on passive muscle stretching - passive ankle dorsiflexion
  • Warm, erythematous, swollen limb
  • Increased CRT and weak/absent peripheral pulses
  • Remember presence of pulse does not rule out compartment syndrome.

Diagnosis

  • Intracompartmental pressure measurement - Pressure excess of 20mmHG are abnormal and >40mmHG is diagnostic.
  • Compartment syndrome will show nothing on x-ray
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Management of compartment syndrome?

A
  • Elevate limb
  • Remove all bandages and split/remove cast
  • Fasciotomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Complications of fractures: problems with union?

A

Delayed union: union takes longer than expected?

Non-union: # fails to unite

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Causative factors of malunion: 5 Is

A

Ischaemia: poor blood supply or AVN
Infection
Increased interfragmentary strain
Interposition of tissues between fragments
Intercurrent disease: e.g malignancy or malnutrition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Non-union classification?

A
  • Hypertrophic: bone end is rounded, dense and sclerotic

- Atrophic: Bone looks osteopenic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Management for non-union?

A

Management

  • optimise biology: infection, blood supply, bone graft, BMPs
  • Optimise mechanics: ORIF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is malunion?

A

healed in imperfect position

  • Poor appearance and/or function
  • Gunstock deformity (varus)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is avascular necrosis?

A
  • Death of bone due to deficient blood supply
  • Sites: femoral head, scaphoid, talus
  • Consequences = Soft + deformed bone –> pain, stiffness and OA
  • X-ray shows sclerosis and deformity.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is Myositis ossificans?

A
  • Heterotopic ossification of muscles @ site of haematoma formation.
  • Leads to restricted, painful movement
  • Commonly affects the elbow and quadriceps
  • Can be excised surgically
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is Pellegrini-Stieda disease?

A
  • Form of MO

- Calcification of the superior attachment of MCL @ knee following traumatic injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Complex Regional Pain Syndrome Type 1 (Reflex Sympathetic Dystrophy, Sudek’s Atrophy)

A
  • Complex disorder of pain, sensory abnormalities, abnormal blood flow, sweating and trophic changes in superficial or deep tissues.
  • No evidence of nerve injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Causes of complex regional pain syndrome type 1?

A
  • Injury: #s, carpal tunnel release, ops for Dupuytren’s contracture
  • Zoster, MI, Idiopathic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Presentation of CRPS T1

A
  • Wks - months after injury
  • Not traumatised area that is affected: affects a neighbouring area
  • Lancing pain hyeralgesia or allodynia
  • Vasomotor: hot and sweaty or cold and cyanosed
  • Skin: swollen or atrophic and shiny
  • NM: weakness, hyper-reflexia, dystonia, contractures.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Management of CRPS

A
  • Usually self-limiting
  • Refer to pain team
  • Amitryptilline, gabapentin
  • Sympathetic nerve blocks can be tried.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

CRPS Type II?

A

Causalgia

- Persistent pain following injury caused by nerve lesions.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Growth disturbances classification?

A

Salter-Harris Classification for growth plate injuries - In children

  • S = Straight across (type 1) = physis (can be completely slipped.
  • A = Above + across (type 2) = metaphysis and physis
  • L = Lower (type 3) include joint. = physis and epiphysis
  • T = Through (Type 4 )
  • CRUSH = Type 5
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Examples of a Salter Harris Type 1?

A

SUFE. Normal growth with good reduction (re duce = Bring back to normal).

Through physis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Examples of a Salter Harris Type 4?

A

Union across physis may interfere with bone growth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Examples of a Salter Harris Type 5?

A

Crush –> Physis injury –> Growth arrest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Epidemiology of hip fractures?

A
  • 80/100,000
  • 50% in >80 yrs old - It is a disease of old age
  • F>M = 3:1
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Pathophysiology of hip fracture?

A 
Old = Osteoporosis with minor trauma (e.g fall) 
Young = Major trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Osteoporosis risk factors: age + SHATTERED..

A
  • Steroids
  • Hyper-parathyroidism
  • Alcohol and Cigarettes
  • Thin (BMI <22)
  • Testosterone low
  • Early Menopause
  • Renal/Liver failure
  • Erosive/inflammatory bone disease (RA, myeloma)
  • Dietary Ca low/malabsorption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Presentation of hip fracture?

A

Anterior O/E: shortened leg and externally rotated

If internally rotated = posterior hip dislocation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Key questions in a hip fracture history?

A
  • Mechanism of injury
  • Risk factors for osteoporosis/pathological fractures
  • Premorbid mobility
  • Premorbid independence
  • Comorbid independence
  • Comorbidities
  • MMSE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Initial Management for hip fracture?

A
  • Resuscitate: dehydration, hypothermia
  • Analgesia: M+M (morphine/iliofascial block recommended and midazolam)
  • Assess neurovascular status of limb
  • Imaging: AP and lateral films
  • Prep for theatre

If patient has clinical signs of hip fracture, do further imaging. MRI is first line recommended.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What does prepping for theatre entail?

A

ABCDEFG

  • Inform Anaesthetist and book theatre
  • Bloods: FBC, U+E, Clotting, X-mathc (2U)
  • CXR
  • DVT (prophylaxis: TEDS, LMWH)
  • ECG
  • Films: orthogonal X-rays
  • Get Consent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Imaging for hip fracture?

A
  • Ask for AP and lateral films
  • Look @ Shenton’s lines
  • Intra- and extra-capsular
  • Displaced or non-displaced
  • Osteopaenic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What are Shenton’s lines

A
  • Imaginary curved line drawn along inferior border of superior pubic ramus and along inferomedial border of neck of femur.
  • In the joint capsule (up to the neck) or outside. (extracapsular)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Key anatomy of the hip?

A
  • Capsule attaches proximally to acetabular margin and distally to intertrochanteric line.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Blood supply to the femoral head?

A
  • Retinacular vessels, in capsule, distal –> Proximal
  • Intramedullary vessels
  • Artery of ligamentum teres
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What happens if the retinacular vessels are damaged?

A

Risk of AVN at the femoral head –> leads to pain, stiffness and OA.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Classification of a hip fracture?

A
  • Intracapsular: Subcapital (junction of head and neck), transcervical, basicervical (base of femoral neck)
  • Extracapsular: Intertrochanteric, subtronchanteric
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Garden Classification of INTRACAPSULAR FRACTURES?

A
  1. Incomplete #, undisplaced
  2. Complete #, undisplaced
  3. Complete #, partially displaced
  4. Complete #, completely displaced
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Surgical management of intracapsular Garden 1,2 #?

A

Painkillers - Iliofascial nerve block - reduced need for morphine or opioids.

ORIF with multiple cannulated screws.

Undisplaced fracture = internal fixation or hemiarthroplasty if unfit/major illness.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Surgical management intracapsular Garden 3, 4#?

A

<70: ORIF with screws. Follow- up in OPD and do arthroplasty if AVN develops (in 30%).

(young people need hip for long time - therefore hip prosthesis require one or more revisions). Follow up for AVN.

Independently mobile, does not use more than a stick.
>70: Total hip replacement

If major/immobile.
>70: Hemiarthroplasty (can be total too):
- Mobilises: cemented Thompson’s - mainly cemented.
- Non-mobiliser: non-cemented Austin Moore.

Consider Bipolar vs Unipolar (swivelling of head in bipolar).

Post surgery
- Full weight bearing immediately post-op. This reduces length of stay and complications associated with prolonged immobility.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What is a hemiarthroplasty?

A

Placing half the joint, not the internal capsule.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Management of extracapsular hip fracture?

A

If intertrochanteric

  • ORIF with Dynamic Hip Screws
  • For unstable inter-trochanteric fracture can use intra-medullary nails (cephalomedullary).

Subtronchanteric = Intramedullary nail.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What is a dynamic hip screw?

A
  • Large cancellous lag screw that glides freely in a metal sleeve.
  • Sleeve attached to a plate which is fixed to the lateral femoral cortex.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Discharge of hip fracture patients?

A
  • Involves OT and physios

- Discharge when mobilisation and social circumstances permit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Specific complications with hip fracture?

A
  • AVN of femoral head in displaced #s due to damage to the retinacular vessels.
  • Non/mal-union (10-30%)
  • Infection
  • Osteoarthritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Prognosis of a hip fracture?

A

30% mortality @ 1 yr
50% never regain pre-morbid functioning
>10% unable to return to premorbid residence
- Majority will have some residual pain or disability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Distal Forearm fracture examples?

A
  • Colles’ Fracture
  • Smith’s
  • Barton’s Fracture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Clinical features of Colles’ fracture?

A
  • Fall onto an outstretched hand
  • Most common in elderly females with osteoporosis
  • Dinner fork deformity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Radiographic features of a Colles’ Fracture?

A
  • Extra-articular # of distal radius (w/i 1.5 inches of joint)
  • Dorsal displacement of distal fragment
  • Dorsal angulation of distal fracture 11 degrees volar tilt
  • Decreased radial height (norm = 11mm )
  • Decreased radial inclination (norm = 22 deg)
    = ± avulsion of ulnar styloid
    ± impaction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Specific management of a Colles’ Fracture?

A
  • Examine for neurovascular injuries as median and radial artery lie close
  • if much displacement –> reduction
    (under haematoma block, IV regional anaesthesia (Bier’s block) or GA. Disimpact and correct angulation. Position: ulnar deviation + some wrist flexion
  • Apply dorsal backslab: provide 3-point pressure. When you want to prevent flexion or extension.
  • Repeat X-ray
  • If comminuted, intra-articular or re-displaced: Surgical fixation with ex-fix, Kirschner-wires or ORIF and plates.

This is a significant fracture at high velocity therefore will need ORIF.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Colles Fracture - Re X-ray - Satisfactory position?

A

No: Ortho review and consider MUA ± K wires
Yes: home with # f/up within 48hr for completion of POP.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Specific complications with Colles Fracture?

A
  • Median N.injury
  • Frozen Shoulder/adhesive capsulitis
  • Tendon Rupture: Esp EPL (extensor pollux longus)
  • Carpal Tunnel Syndrome
  • Mal/non-union
  • Complex regional pain atrophy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Anatomy of the hand nerves

A
  • Median Nerve THUMB

- Ulnar Nerve (Little finger)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

What is a Smith’s Fracture?

A
  • Fall on back of flexed wrist
  • Fracture of distal radium with volar displacement and angulation of distal fragent
  • Reduce to restore anatomy and POP for 6 weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

What is a Barton’s Fracture?

A
  • Oblique intra-articular # involving the dorsal aspect of the distal radius and dislocation of radio-carpal joint. Smiths/Colles with radiocarpal.
  • Reverse Barton’s Involves the volar aspect of the radius
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Clinical features of a scaphoid fracture?

A
  • FOOSH
  • Pain in anatomical snuffbox
  • Pain on telescoping the thumb
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Specific management of a scaphoid fracture?

A
  • Request scaphoid X-ray view
  • If clinical history and exam suggest a scaphoid #, it should initially be treated even if the x-ray is normal
  • # may become apparent after 10 days due to localised decalcification
  • Therefore immobilise straight away.
  • Place wrist in scaphoid plaster (beer glass position)
  • Can use futura splint.
  • If initial x-ray is negative, pt return to # clinic after 1- days for re-xray.
  • # visible –> Plaster for 6 weeks
  • No visible # but clinically tender –> plaster for 2 weeks.
  • # not visible and not clinically tender –> no plaster
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Specific complications of scaphoid fracture?

A
  • Main risk of AVN of the scaphoid as blood supply runs distal to proximal. Dorsal carpal branch of the radial artery is the main neurovascular structure that is compromised in a scaphoid fracture.
  • -> Stiffness and pain at the wrist.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Bones of the hand distal to proximal

A 
Distal Phalanx
Middle Phalanx 
Proximal Phalanx
Metacarpal 
Carpal bones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Mnemonic for carpal bones?

A 
Some - Scaphoid 
Lovers - Lunate
Try - Triquetrum 
Positions - Pisiform
That - Trapezium
They - Trapezoid
Can't -  Capitate
Handle - Hamate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Radial and Ulna Shaft Fractures Classification?

A

Monteggia

  • # of proximal 3rd of ulnar shaft. (ulnar
  • Anterior dislocation of radial head at capitellum
  • May lead to a palsy of deep branch of radial nerve - weak finger extension but no sensory loss.

Galleazzi

  • Fracture of radial shaft between mid and dital 3rd.
  • Dislocation of distal radio-ulnar joint.

GRUsome MURder

G-aleazzi R-adius fracture, ULnar radial dislocation

Monteggia Ulnar fracture, radial dislocation

Normal radial head fracture - usually caused by fal on outstretched hand. Marked local tenderness over head of radius, impaired movement at the elbow, sharp pain at the lateral side of the elbow and sharp pain at the lateral side of the elbows on pronation and supination.

Radial head subluxation

  • during pulling injuries.
  • Signs are limited supination and extension of elbow.
  • Managed with reduction of radial head into position by passive supination of the elbow joint at 90 degrees.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Management of Radial and ulnar shaft fractures?

A
  • Unstable fractures
    Adults: ORIF
    Children: MUA + above elbow plaster
  • Fractures of forearm should be plastered in most stable position
    Proximal #: Supination (S for Sky)
    Distal #: pronation
    Mid-shaft: Neutral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Classification of a shoulder dislocation?

A

Anterior

Posterior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What is an anterior shoulder dislocation?

A
  • 95% of shoulder dislocation
  • Direct trauma of falling on hand
  • Humeral head dislocated anterio-inferiorly.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What is a posterior shoulder dislocation?

A
  • Caused by direct trauma or muscle contraction (seen in epileptics)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

Associated lesions with shoulder dislocation?

A

Bankart lesion

  • Damage to anteroinferior glenoid labrum . Leads to a glenohumeral dislocation.
  • See on x-ray displacement of the glenoid labrum
  • Usually due to recurrent dislocation and may need to be surgically repaired.

Hill-Sach’s Lesion at top cos hill.
- Cortical depression in the posterolateral part of the humeral head following impaction against the fleniod rim during anterior dislocation.

  • When the humerus is driven from the glenoid cavity, its relatively soft head impacts against the anterior edge of the glenoid. The result is a divot or flattening in the posterolateral aspect of the humeral head, usually opposite the coracoid process.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

What is the presentation of shoulder dislocation?

A
  • Shoulder contour lost :appears square
  • Bulge in infraclavicular fossa: humeral head
  • Deltoid is flat.
  • Arm supported in opposite hand
  • Severe pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Specific management of a shoulder dislocation?

A
  • Assess for neurovascular deficit: do this by assessing the ‘chevron’ area of the shoulder for axillary nerve damage.
  • DO an X-ray: AP and transcapular.
  • Reduction under sedation (e.g propafol)
    1) Hippocratic: longitudinal traction with arm in 30 degrees abduction and counter traction at the axilla.
    2) Kocher’s: External rotation of adducted arm, anterior movement, internal rotation.
  • Rest arm in sling for 3-4 weeks
  • Physio

Posterior dislocation

  • Rare, caused by seizure or electrocution
  • Lightbulb sign on X-ray
  • Refer to orthopaedic surgeons.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

Why is an Transcapular X-ray good?

A

It is a pertinent projection to assess suspected dislocations, scapula fractures, and degenerative changes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Complications of shoulder dislocations?

A
  • Recurrent Dislocation - 90% have traumatic dislocations in less than 20 yrs.
  • Axillary N.injury.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Recurrent Shoulder Instability management?

A

TUBS: Traumatic Unilateral dislocations with a Bankart Lesion often require surgery.
- Surgery involves a Bankart Repair.
AMBRI: Atraumatic Multidirectional Bilateral shoulder dislocation is treated with Rehabilitation, but may require inferior capsular shift.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

What is painful arc/Impingement syndrome?

A
  • Entrapment of supraspinatus tendon and subacromial bursa between acromion and greater tuberosity of humerus

–> Subacromial bursitits and or supraspinatous tendonitis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Anatomy of the shoulder posterior muscles?

A
  • Supraspinatus
  • Infraspinatus
  • Teres Minor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

Anatomy of shoulder anterior

A
  • Supraspinatus
  • Subscapularis
  • Infraspinatus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Rotator cuff muscles?

A
  • Supraspinatus - Abducts to humerus. On top of your shoulder and runs parallel to your deltoid.
  • Subscapularis - Internally rotates the humerus. Medially.
  • Infraspinatus - Externally rotates the shoulder joint.Rotates arm laterally.
  • Teres Minor - External Rotation. Adducts and rotates laterally.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

Function of the rotator cuff?

A

Maintaining stability of the glenohumeral joint. Hold the cuff in the glenoid fossa of the scapula.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

Presentation of impingement syndrome?

A

Painful arc: 60-120
Weakness and decreased ROM
+ve Hawkin’s Test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

Investigations for impingement syndrome?

A
  • Plain X-ray: Bony spurs?
  • US
  • MRI arthrogram
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

Management for impingement syndrome?

A
  • Conservatively: Rest and Physiotherapy
  • Medical: NSAIDS/Steroid injections
  • Surgical: Acrthroscopic acromioplasty.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

Differentials for painful arc?

A
  • Impingement
  • Supraspinatous tear or partial tear
  • AC joint OA.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

Frozen shoulder presentation?

A
  • Progressive decreased active and passive ROM (range of movement)
  • Decreased external rotation <30
  • Decreased abduction <90
  • Shoulder pain especially at night (unable to lie on painful side)

Tendonitis?
- Inflammation as muscles pass through the subacromial space
- Symptoms: pain decreased ROM, weakness
Diagnosis: clinical
Treatment :rest, physiotherapy, steroids, surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

Causes of frozen shoulder presentation?

A
  • May be due to trauma in the elderly

- Associated with T2DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

Management of a frozen shoulder?

A
  • Conservative: rest, physio

- Medical: NSAIDS, Subacromial bursa steroid ± LA injection.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

What is a rotator cuff tear?

A
  • 2ndry to degen or sudden jolt or impingement syndrome.
  • A partial tear presents with painful arc
  • Complete tear
    : Passive movement full range
    Shoulder tip pain
    Cannot abduct the arm

After passive motion may be able to abduct to 90, then drop, drop arm sign.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

Supracondylar Fractures of the Humerus presentation?

A

Common in children after FOOSH
Elbow very swollen and held semi-flexed.
Sharp edge of proximal humerus may injure brachial artery which lies anterior to it.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

Classification of supracondylar fracture of the humerus?

A

Extension
- Distal fragment displaces posteriorly
Type 1: non-displaced
Type 2: anglated with intact posterior cortex
Type 3: Displaced with no cortical contact.

Flexion

  • Less common
  • Distal fragment displaces anteriorly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

Specific management of SC # Humerus?

A
  • Ensure there is no neurovascular damage
    (if the radial pulse is absent or there is damage to a brachial artery, take to theatre for open reduction + on-table angiogram
  • Median nerve is also vulnerable

Restore anatomy
- No displacement –> flex the arm as fully as possible and apply a collar and cuff for 3 weeks –> triceps acts as sling to stabilise fragment

  • Displacement –> MUA + Fixation with K-wires + collar and cuff with arm flexed for 3 weeks.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

Specific complications for supracondylar fractures of the humurus?

A

Neurovascular injury?
- Brachial artery
- Radial nerve
- Median nerve esp anterior interosseous branch
(Supplies deep forearm flexors (FPL, Lateral half of FDP and pronator quadratus).

Compartment syndrome

  • Monitor closely during the first 24hrs
  • Pain on passive extension of the fingers (stretches flexor compartment) is earl sign
  • Mx: try extension of elbow, surgical management may be needed.
  • Volkmann’s ischaemic contracture can result –> fibrosis of flexors –> claw hand.

Gunstock deformity

  • Valgus, varus and rotiational deformities in the coronal plane do not remodel and –> cubitus varus.
  • Cubitus varus deformity is referred to as a gunstock deformity.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

Femoral and Tibial Fractures management?

A
  • Resuscitation and management of life-threatening injuries first.
  • X-match
    Tibial #: 2 units
    Femoral #: 4 units
  • Assess neurovascular status: esp distal pulses.
  • If open
    Abx and ATT
    Take to theatre urgently for debridement, washout and stabilisation
  • Fixation methods
    Intramedullary nail
    Ex-fix
    Plates and screws
    MUA with fixed traction for 3-4 months.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

Specific complications of femoral and tibial fractures?

A
  • Hypovolaemic shock
  • Neurovascular
    : SFA: swellign and check pulses
    Sciatic nerve
  • Compartment syndrome
  • Respiratory complications
    Fat Embolism
    ARDS
    Pneumonia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

Ankle Injuries - Ligament strain?

A
  • Typically twisting inversion injury
  • Strains anterior talofibular part of lateral collateral ligament
  • Medial deltoid ligament strains are rare
  • May be associated with malleolar avulsion #s

Management - RICE (Rest, ice, compression, elevation.
NSAIDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

Ankle fracture - Ottawa ankle rules?

A

X-ray ankle if pain in malleolar zone + in any of:

  • Tenderness along distal 6cm of posterior tib/fib including posterior tip of malleoli.
  • Medial or Lateral malleolus, Base of the 5th metatarsal, Navicular
  • Bony tenderness at the medial malleolar zone
  • INability to walk four weight bearing steps immediately after the injury and in an emergency department.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

Bones of the ankle?

A

Below TIbia

  • Talus
  • Navicular
  • Cuneiform Bones
  • Metatarsal bones
  • Phalanges

Fibula

  • Calcaneus
  • Cuboid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

Weber Classifications for ankle fractures?

A
  • Relation to fibula # to the joint line. Below the level of the tibiofibular syndesmosis.
  • A: below the joint line
  • B: at the joint line
  • C: above the joint line

Weber’s B and C represent possible injury to the syndesmotic ligaments between tibia and fib –> instability.

Modified Weber?

  • A = Infra-syndesmotic or below syndesmosis
  • B = Trans-syndesmotic or level of syndesmosis
  • C = Supra-syndesmotic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

Management of Weber A?

A

All fractures should be promptly reduced to remove pressure on overlying skin + subsequent necrosis. VERY IMPORTANT.

  • Boot or below-knee POP. Use an Below knee POP once radiological union is achieved.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

Management of non-displaced Weber B/C

A
  • Below-knee POP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

Management of displaced Weber B/C?

A
  • Closed reduction and POP if anatomical reduction achieved
  • ORIF if closed reduction fails. If these is disruption of the tibio-fibular syndesmosis the surgical repair is warranted.

This is very important initial management. If displaced must reduce. Once reduced it can then be classified.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

Diagnostic factors of an ankle fracture?

A
  • Pop heard on fall
  • Ankle deformity
  • Tenderness of proximal fibula
  • Inability to weight-bear
  • Medial or lateral malleolus swollen and tender to palpation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

Other types of classifications of ankle injuries?

A 
Displaced vs undisplaced
Talar shift vs no talar shift
Reducible vs non-reducible
Open vs closed
bimalleolar vs trimalleolar
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

Knee injury history and presentation?

A

Knee Swelling
- If immediate = haemarthrosis = # or torn cruciates

  • Overnight = effusion = meniscus or other ligaments

Pain/tenderness

  • Joint line = meniscal
  • Med/lateral margins = collateral ligaments

Locking: meniscal tear –> mechanical obstruction
Giving way: instability following ligament injury.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

Anatomy of the knee?

A

Quadriceps -

  • Rectus femoris
  • Vastus lateralis
  • Vastus medialis
  • Vastus Intermedius
Above - Femur with patella. 
Within the knee 
- Lateral collateral ligament
- Medial collateral ligament
- ACL from front (injured in twisting sports)
- PCL from back (hyperextension)

Lateral meniscus and medial meniscus

Fibula and tibia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

ACL injury definition

A
  • Occurs as a result of acute non-contact deceleration injury,
  • forceful hyperextension,
  • excessive rotational forces about knee
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

ACL history?

A
  • Acute trauma
  • Using spikes
  • Audible pop
  • Rapid knee swelling
  • Sensation of knee instability
  • Pain
  • Most accurate = Positive Lachman’s test - Lifting up.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

Management of ACL?

A

Sedentary patients?

  • Protected weight bearing, rest, ice, compression, elevation. medicine (PRICEM)
  • Physio to strengthen quads and hamstring
  • Moderate intensity demands?
    Formal physiotherapy + customised bracing
  • High intensity
    Bone-patellar tendon-bone autograft.

Hamstring tendon grafts (bundling/augmentation and tunnelling approaches).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

What is the unhappy triad of O’Donoghue

A
  • An injury of the ACL, PCL and lateral meniscus/medial meniscus.
  • Pain in affected knee
  • Stiffness + swelling
  • Locking of knee
  • Instability of knee

= Injury due to lateral force on knee whilst fixed on the ground. - Pivot Shift mechanism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

Management of acutely injured knee?

A
  • Full examination of acutely swollen knee after injury is hard
  • Take x-ray to ensure no #s
    Fluid level indicates a lipohaemarthrosis and indicates either a # or torn cruciate.
  • If no # –> RICE + later re-exam for pathology
  • If meniscal or cruciate injury suspected –> MRI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

Knee Arthroscopy?

A

Direct vision of inside of knee joint by arthroscope.
Can examine knee under anaesthesia (decreased muscle tone)
- Meniscal tears can be trimmed or repaired/suturing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

Osteoarthritis definition?

A

Degenerative joint disorder in which there are progressive loss of hyaline cartilage and new bone formation at the joint surface and its margin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

OA Aetiology/Risk Factor?

A
  • Age (80% >75yrs)
  • Obesity
  • Female gender
  • Joint abnormality
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

Classifications of OA?

A

Primary: no underlying cause
Secondary: due to obesity, joint abnormality/damage, rheumatoid arthritis, gout.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

Symptoms of osteoarthritis?

A
  • Affects: Knees, hips, DIPs, PIPs, thumb CMC. (carpometacarpal). Joint above CMC is the MCP
  • Pain: Worse with movement, background rest/night pain, worse at the END of the day.
  • Stiffness: especially after rest, lasts around 30 mins (e.g AM)
  • Deformity
  • Decreased Range of Movement.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

Which joint of the hand does osteoarthritis spare?

A

MCP. Involves the PIP and DIP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

OA Signs in the hand?

A
  • B(P)ouchards (prox) and Heberdens (dips) (distal).
  • thumb CMC squaring
  • Fixed flexion deformity (knee)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

History in OA

A
  • Pain severity, night pain
  • Walking distance
  • Analgesic requirements
  • ADLs and social circumstances
  • Co-morbidities
  • Underlying causes: trauma, infection, congenital.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

Pathophysiology of Osteoarthritis?

A
  • Softening of articular cartilage –> Fraying and fissuring of smooth surface –> underlying bone exposure.
  • Subchondral bone becomes sclerotic with cysts. (fluid-filled hole).
  • Proliferation and ossification of cartilage in unstressed areas –> Osteophytes.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

Differential for OA?

A
  • Septic Arthritis
  • Crystal Arthropathies
  • Trauma
  • Rheumatoid arthritis
  • Psoriatic Arthritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

X-ray changes of osteoarthritis?

A

LOSSD

Loss of joint spaces
Osteophytes
Subchondral sclerosis
Subchondral cysts
Deformity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

Bloods in OA?

A
  • CRP may be mildly elevated

- Ca, Po4 and ALP all normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

Management of OA?

A

MDT - GP, Physio, OT, Dietician, Orthopod
Conservative:
- Lifestyle: decreased wt, increased exercise
- Physio: muscle strengthening/quads strengthing
- OT: walking aids, supportive footwear, home mods.
Medical
- Analgesia
local topical: Capsaicin topical, methylsalicylate, diclofenac
Then add Paracetamol
NSAIDS: eg arthrotec (diclofenac + misoprostol)
Tramadol

Joint injections: local anaesthetic and steroids

If persistent pain despite multiple treatment modalities or with severe disability

Surgical
- Arthroscopic washout (not recommended)
Mainly knees
trim cartilage
remove loose bodies
- Realignment osteotomy
Small area of bone cut out
useful in younger pts with medial knee OA
High tibilar valgus osteotomy redistributes weight.
- Arthroplasty: replacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

Definition of mechanical back pain?

A
  • Soft tissue injury –> dysfunction of whole spine –> muscle spasm –> pain.
  • May have inciting event e.g lifting
  • Younger patients with no sinister features
151
Q

Management of mechanical back pain?

A

Acute < 4 weeks.

Conservative

  • Max 2d bed rest
  • Education: keep active, how to life/stop
  • Physiotherapy
  • Psychosocial issues re chronic pain and disability
  • Warmth e.g swimming in a warm pool
  • Can use spinal manipulation.

Medical

  • Analgesia: NSAIDS ± codeine. First line is naproxen.
  • Muscle relaxant: low-dose diazepam (short-term)

Chronic
: CBT, acupuncture, TCI, Opioids.Exercise programme. Manual therapy.

152
Q

History in lower back pain + Red flags?

A

Onset, duration, location, radiation, character, Aggravating + relieving factors, severity.

Absence of red-flag symptoms:

  • Thoracic pain
  • recent trauma,
  • milder trauma in age >50,
  • unexplained weight loss, - immunosuppression,
  • history of cancer, prolonged
  • used of steroids, osteoporosis, - duration ?6 weeks,
  • focal neurological deficit with progression.

Investigation for suspected osteoporotic vertebral fracture
- X-ray spine.

Most common site for osteoporotic fracture = spine.

FRAX = for patients 40-90. 10 yr risk of fragility. If intermediate result = do a DEXA.

If high risk = offer bone protection treatment.

= Advancing age is a major risk for osteoporotic fracture. Women >65 yrs old and men >75 yrs old should be considered for fracture risk assessment.

Think FRAX.

Presentation of osteoporotic vertebral fracture
- Asymptomatic: osteoporotic vertebral fracture may be diagnosed through an incidental finding on X-ray. Acute back pain, breathing difficulties. GI problems.

Signs

  • Loss of height.
  • kyphosis
  • Localised tenderness on palpation.

Then do X-ray then describe if CT or MRI (for tumours).

FRAX tool or QFracture used to estimate 1-yr risk.

153
Q

Diagnostic algorithm for back pain?

A

Group 1: Associated with spinal stenosis and radiculopathy.
Group 2: lower back pain from cauda equina, neoplasia, infection, vertebral fracture, arthritis.
Group 3: Non specific.

Group 1-2 require MRI/Consultant review. Group 3 do not require imaging if pain lasted <4 weeks.

154
Q

Physical exam in back pain?

A

Inspection: Obvious deformities, abnormal curvature.
Palpation of spinous processes: Feeling for taut bands, trigger points.
A+P ROM: Pain on flexion that radiates to leg suggests disc herniation with impingement on nerve root. Pain on extension suggests facet arthropathy or spinal stenosis.

Special tests
Schober’s: PSIS and 1-cm above and 5cm below. Ask patient to flex forward macimally. Distance between 2 marked. +ve test is when the distance between these 2 marks is <20cm. +ve Schober’s test in combo with +ve findings on sacroiliac exam prompt referral to rheumatologist.

FABER: (flexion, aduction, external rotation of hip): Patient supine, flexion, abduction and external rotation.

Gaenslen test: Patients lie supine at edge of exam table, asking them to flex one hip (bring knee to chest) while extending the other hip over the edge of the exam table.

155
Q

Disc prolapse definition? (Herniated nucleus pulposus)

A

Herniation of nucleus pulposus through annulus fibrosus.

156
Q

Presentation of Disc prolapse?

A
  • L5 and S1 roots most commonly compressed by prolapse of L4/5 and L5/S1 disc.
  • May present as severe pain on sneezing, coughing or twisting a few days after low back strain.
  • Lumbago: low back pain
  • Sciatica: shooting radicular pain down buttock and thigh.
157
Q

Signs of disc prolapse?

A
  • Limited spinal flexion and extension
  • Free lateral flexion
  • Pain on straight-leg raise: Lesague’s Sign
  • Lateral herniation –> radiculopathy
  • Central herniation –> Corda equina syndrome
158
Q

History of disc prolapse?

A

Check for red flags like night pain, weight loss, fever, GI, urinary or cardioresp signs. Could have discitis from IV drug abuse, TB.

Pain from disc normally presents with history of previous episodes of acute pain, trauma. Pain referred to paraspinal muscles, buttocks, back of thigh.
- May be associated pain in the dermatomal distribution.

159
Q

Signs of L5 Root compression?

A
  • Weak hallux extension + foot drop
  • In foot drop due to L5 radiculopathy, weak inversion (tib. post) helps distinguish from peroneal N palsy.
  • Decreased sensation on inner dorsum of foot.

L3 = Sensory loss over anterior thigh
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test

L4 = Sensory loss anterior aspect of knee
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test

160
Q

Signs of S1 Root compression?

A
  • Weak foot plantarflexion and eversion
  • Loss of ankle-jerk
  • Calf pain
  • Decreased sensation over sole of foot and back of calf
161
Q

Investigations of Disc prolapse?

A
  • Erect Lumbar spine X-ray

- MRI (emergency if cauda equina)

162
Q

Management of disc herniation?

A
  • Brief rest, analgesia and mobilisation effective in >90%.
  • Conservative: brief rest, mobilisation
  • Medical: analgesia (paracetamol + oral NSAID), transforaminal steroid, consider diazepam as a muscle relaxant, or injection.
  • Surgical: discectomy, laminectomy may be needed in cauda-equina, continuing pain or muscle weakness.

Can also consider decompression surgery (Lumbar Microdiscectomy)

  • Commonest procedure for disc prolapse
  • Microscopic resection of protruding nucleus pulposus
  • Posterior approach with pt in prone position
  • May be performed endoscopically.
163
Q

What is spondylolisthesis?

A
  • Displacement of one lumbar vertebra on another
  • Usually forward
  • Usually L5 on S1
  • May be palpable.
164
Q

Causes of Spondylolisthesis?

A
  • Congenital malformation
  • Spondylosis (Spondylosis is the degeneration of the vertebral column from any cause.)
  • Osteoarthritis
165
Q

Presentation of spondylolisthesis?

A
  • Onset of pain usually in adolescence or early adulthood
    Worse on standing
  • ± sciatica, hamstring tightness, abnormal gait.
  • Examination with exaggerated lordosis.
166
Q

Investigations for Spondylolisthesis?

A
  • Plain xray (in the spondylolysis - Deficiency in the pars interarticularis of the neural arch of a vertebral body). Refers to a small segment of bone that joins the facet joints in the back of the spine
  • May see a Scotty Dog Appearance.
167
Q

Management of Spondylolisthesis?

A
  • Corset
  • Neve release
  • Spinal fusion
168
Q

What is spinal stenosis?

A
  • Developmental predisposition ± facet joint osteoarthritis

- generalised narrowing of lumbar spinal canal.

169
Q

Presentation of spinal stenosis?

A
  • Spinal claudication
    Aching or heavy buttock and lower limb pain on walking (activity related) - positional related.
  • Rapid onset
  • May c/o paraesthesiae/numbness
  • Pain eased by leaning forward (on bike) (stooped posture when walking)
    Pain on spine extension
170
Q

Investigations for spinal stenosis?

A
  • X-ray (narrowing of disc space, osteophyte formation)

- MRI (compression of neural elements) - most accurate.

171
Q

Management of spinal stenosis?

A
  • Corsets
  • NSAIDs
  • Epidural steroids injection
  • Canal decompression surgery - laminectomy.
172
Q

Neurosurgical emergencies for back pain?

A
  • Acute cord compression

- Acute cauda equina compression

173
Q

What is acute cord compression?

A
  • Process of compression or displacement of arterial, venous and cerebrospinal fluid spaces as well as cord itself.
  • Can occur due to extrinsic or intrinsic cause.
174
Q

Causes of acute cord compression

A
  • Trauma
  • vertebral fracture
  • intervertebral disc herniation
  • primary or metastatic spinal tumour
  • Infection
175
Q

Classes of SCI?

A

Acute
Sub-acute
Chronic

176
Q

History of SCC?

A

Patients should be immobilised with cervical collar.

  • History of trauma
  • Bilateral pain: back and radicular
  • LMN signs at compression level
  • UMN signs and sensory level below compression
  • Sphincter disturbance
177
Q

Symptoms of SCC

A
  • Altered sensation (pin, touch, vibration)
    Hemisensory loss.
  • Motor hemiplegia/tetrapelgia
  • Bladder or bowel dysfunction
  • Hyperreflexia
  • SYmmetrical sensory loss
  • Hypotonia below level of injury
  • Neurogenic shock (hypotension and bradycardia, dry extremities, peripheral vasodilation).
178
Q

High cervical complete cord transection?

A
  • Quadriplegia
  • Resp insufficiency
  • Loss of bladder + bowel function
  • Anaestheia below affected level
  • Neurogenic shock
179
Q

Lower cervical transection

A

Spares resp muscles

Horner’s syndrome (miosis, anhydrosis, ipislateral ptosis)

180
Q

High thoracic lesions

A
  • Paraparesis + autonomic function loss

- Lower thoracic, lumbar and sacral cord transection.

181
Q

Symptoms of acute cauda equina compression

A

Due to disc compression + stenosis of spinal canal.

- Syndrome consists of saddle anaesthesia, bladder retention, leg weakness.

182
Q

Management of back neurosurgical emergencies?

A

Acutely

  • Immobilisation + decompressive surgery. (consider steroids)
  • Large prolapse/disc compression: Laminectomy/disectomy
  • Tumours: Radiotherapy and steroids
  • Abscesses: decompression
183
Q

What is osteochondritis?

A
  • Idiopathic condition in which bony centres of children become temporarily softened due to osteonecrosis.
  • Pressure –> Deformation
  • Bone hardens in new, deformed position.
184
Q

Radiography on osteochondritis?

A

Initially: increased density/sclerosis
Then: Patchy appearance

185
Q

What is Scheuermann’s Disease?

A
  • Affecting adolescents
  • Vertebral ring epiphyses
  • Leads to kyphosis - due to wedge shaped thoracic vertebrae on X-ray. Progressive kyphosis with at least 3 vertebrae invovled.
  • Back pain and stiffness.
  • Vertebral tenderness
186
Q

Kohler’s Disease?

A

Pain in mid-tarsal region
Navicular bone (loses its blood supply temporarily).
Children 3-5 yrs.

187
Q

Kienboch’s Disease?

A
  • Lunate bone
  • Adults
  • Pain over lunate esp on active movement
  • Impaired grip
188
Q

Friedburg’s disease?

A
  • 2nd/3rd metatarsal head
  • Around puberty
  • Forefoot pain worse with pressure
189
Q

Panner’s Disease?

A
  • Capitulum of humerus
190
Q

Perthes’ Disease?

191
Q

Acute Osteomyelitis organisms?

A

Infants

  • S aureus
  • Group B strep

Children

  • S aureus
  • Strep pyogenes
  • Haem infl (non-immunised)

Adults

  • Gram negative bacilli (E.coli, Pseudomonoas)
  • S aureus

Sickle Cell = Salmonella

192
Q

Risk factors for Acute osteomyelitis?

A

RFs

  • Vascular disease
  • Trauma
  • Sickle Cell Disease ( S aureus or Salmonella)
  • Diabetes
193
Q

Signs and symptoms of osteomyelitis?

A
  • Pain, tenderness, erythema, warmth, decreased ROM.
  • Effusion in neighbouring joints
  • Signs of systemic infection

Typically affects the metaphysis in children.

Epiphysis in adults. Adults = Elders = Epiphysis .

194
Q

Investigations for osteomyelitis?

A
  • ESR/CRP/ WCC
  • +ve blood cultures in 60%
  • X-ray
    : - Changes take 10-14ds
  • Haziness + decreased bone density
  • Sub-periosteal reaction
  • Sequestrum and involucrum
  • Osteopenia
  • Fallen leaf sign

1st line: MRI sensitive + specific

195
Q

Management of Acute Osteomyelitis?

A
  • Local Guidelines
  • IV Abx Vanc + Cefotaxime until MCS Known
  • Drain abscess + remove sequestrae
  • Analgesia
196
Q

Pathophysiology of septic arthritis?

A
  • From direct injection or haematogenous route.
  • Mostly Staph or Strep.
  • Consider Gonococcal arthritis.
  • Gram -ve bacilli.
197
Q

Risk factors for septic arthritis?

A
  • Joint disease - RA
  • CRF
  • Immunosuppression (DM)
  • Prosthetic joints.
198
Q

Symptoms of septic arthritis?

A
  • Acutely inflamed tender, swollen joint
  • Decreased ROM
  • Systemically unwell
199
Q

Investigations for septic arthritis?

A
  • Joint aspiration for MCS
    (Shows High WCC (>50,000/mm): Mostly PMN.
  • Increased ESR/CRP, increased WCC, Blood cultures.
  • X-ray
200
Q

Management of septic arthritis

A

IV abx: Vanc + cefotaxime

  • Consider joint washout under GA
  • Splint joint
  • Physiotherapy after infection resolved
201
Q

Complications of septic arthritis?

A

Osteomyelitis
Arthritis
Ankylosis: fusion

202
Q

Differential for septic arthritis?

A
  • crystal arthropathy

- Reactive arthritis

203
Q

Anatomy of the Brachial Plexus?

A
  • Consists of C5-T1.
  • Roots leave between scalenus anterior and medius.
  • Divisions occur under the clavicle, medial to coracoid process.
  • Plexus has intimate relationship with subclavian and brachial arteries.
204
Q

C5-C6

A

Forms Lateral trunk, splits to form anterior part of median and the musculocutaneous

205
Q

C7

A

Forms posterior trunk, and then the axillary and radial nerve. (Also form C5-T1 for Radial).

206
Q

C8-T1

A

Forms Median trunk, and ulnar nerve + posterior part of median.

207
Q

Causes of brachial plexus injuries?

A

Direct: shoulder girdle #, penetrating or iatrogenic injury.
Indirect: e.g avulsion (body structure torn off) or traction injuries.

208
Q

What is the Leffert Classification of brachial plexus injuries?

A
  1. Open
  2. Closed
    a - Supraclavicular
    b - Infraclavicular
  3. Radiation-induced
  4. Obstetric
    a. Upper
    b. Lower
    c. Mixed
209
Q

High C5/C6 Injury?

A

Erbs Palsy

  • Abductors and external rotators paralysed
  • Waiter’s tip position
  • Loss of sensation in C5/C6 dermatomes.

C6 entrapment = weakness in biceps or reduced biceps reflex.

210
Q

Low C8/T1 injury?

A

Klumpke’s Paralysis

  • Paralysis of small hand muscles
  • Claw hand
  • Loss of sensation in C8/T1 dermatomes.
211
Q

Radial Nerve injury (C5-T1) - Low Lesion?

A 
Posterior interosseous nerve. 
- Site: # around elbow or forearm 
- E.g #head of radius.
Loss of extension of CMC joint (thumb drop) 
- No sensory loss.
212
Q

Radial Nerve injury (C5-T1) - High Lesion?

A
  • Site: # shaft of humerus where N. is in radial groove.
  • Wrist Drop
  • Loss of sensation to dorsum of thumb root (snuff box)
  • tricep functions normally
213
Q

Radial Nerve injury (C5-T1) - V. High Lesion.

A

Site: Axilla - crutches or Sat Night Palsy

- Paralysis of tricep and wrist drop

214
Q

Ulnar Nerve (C8-TI)

A

Site: Elbow: cubital tunnel
Wrist: Guyon’s Canal

Effects: Intrinsic hand muscle paralysis –> claw hand
Ulnar paradox: lesion at elbow has less clawing as FDP is paralysed, decreasing flexion of 4th/5th digits.
- Weakness of finger ab/adduction (interrosei)
- Sensory loss over little finger.

The closer to the paw, the bigger the claw.

Ulnar nerve supplies ulnar border of hand and mdial forearm. Thumb flexion is not affected by ulnar nerve lesions

215
Q

Test for Ulnar Nerve Damage?

A

Can’t cross fingers for luck
Froment’s sign: Flexion of thumb IPJ when trying to hold onto paper held between thumb and finger
- Indicates weak adductor policis.

216
Q

Median Nerve (C5-T1)

A

Injury above the Antecubital fossa?

  • Can’t flex index finger IPJ (e.g on clasping hand)
  • Can’t flex terminal thumb phalanx (FPL)
  • Loss of sensation in median distribution.

Injury at wrist
- Typically affects abductor pollicis brevis.

217
Q

Carpal Tunnel Syndrome Anatomy?

A

Carpal Tunnel formed by flexor retinaculum and carpal bones
- Contains
4 tendons of FDS (flexor digitorum superficialis)
4 tendons of FDP (flexor digitorum profundus)
1 tendon of flexor pollicis longus)
Median Nerve

Burning in the night, numbness and tingling of thumb, index, middle and inner side of ring finger.

Amyloidosis - blue nerve.

218
Q

What does Median Nerve supply?

A

LOAF

  • Lumbricals
  • Opponens pollicis
  • Abductor pollicis brevis
  • Flexor pollicis Brevis

Palmar cutaneous branch travels superficial to flexor retinaculum –> Spares sensation over thenar area.

219
Q

Causes of CTS?

A

F>M
- Primary/idiopathic
- Secondary
Water: preganncy, hypothyroidism, Acromegaly
Radial #
Inflammation: RA (younger patient) , gout

Soft tissue swelling: lipomas, acromegaly, amyloidosis
Toxic: DM, ETOH, Obesity

220
Q

Symptoms of CTS

A
  • Tingling/pain in thumb, index and middle finger
  • Pain worse at night or after repetitive actions
  • Relieved by shaking/flicking
  • Clumsiness
221
Q

Signs of CTS

A
  • Decrease sensation over lateral 3.5 fingers.
    -Decreased 2-point touch discrimination
    Early sign of irreversible damage
  • Wasting of thenar eminence
    late sign of irreversible damage
    Phalen’s flexing test and Tinel’s tapping test.
222
Q

Investigations for CTS?

A

Not usually performed
Nerve conduction test
US

223
Q

Non-surgical management CTS

A 
Treat underlying cause
Wrist splints 
- Neutral position 
- Esp. @ night
Local steroid injections
224
Q

Surgical Mx CTS

A

Carpal tunnel decompression by division of the flexor retinaculum

225
Q

Complications of surgery CTS

A

Scar formation: high risk for hypertrophic or keloid
Scar tenderness: up to 40%
Nerve injury
- Palmar cutaneous branch of the median nerve
- Motor branch to the thenar muscle
Failure to relieve symptoms

226
Q

Other locations of median nerve entrapment?

A

Pronator syndrome (supernate to the sky)
- Entrapment between two heads of pronator teres
Anterior interroseous syndrome
- Compression of the anterior interosseous branch by the deep head of pronator teres.
Muscle weakness only
- Pronator quadratus
- FPL
- Radial half of FDP

227
Q

Minor Hand conditions - Dupuytren’s Contractures

A

Progressive, painless fibrotic thickening of palmar fascia.

228
Q

Signs in patients with Dupuyrtren’s Contracture?

A
  • M>F
  • Middle Age / Elderly
  • Skin Puckering and tethering
  • Fixed Flexion Contracture of ring and little fingers
  • Often bilateral and symmetrical
  • MCP and IP joint flexion.
229
Q

Dupuytrens Associations?

A

BAD FIBERS
- Peyronies (3%)
- AIDS
- DM
- FH: AD
- Idiopathic
- Booze: ALD
- Epilepsy and epilepsy meds (phenytoin)
- Reidel’s thyroiditis and other fibromatoses
: Ledderhose disease (fibrosis of plantar aponeurosis)
- Smoking

230
Q

Management of Dupuytrens

A
  • Conservative: e.g physio/exercise
  • Fasciectomy
    e.g When hand can’t be placed flat on the table - refer to surgery.
    Z-shaped scar: prevent contracture
  • Can damage ulnar nerv
  • Usually recurs
231
Q

Differential for Dupuytren’s Contracture

A
  • Skin contracture: old laceration or burn
  • Tendon fibrosis, trigger finger
  • Ulnar N.palsy
232
Q

Trigger Finger

A
  • Tendon Nodules which catches on proximal side of tendon sheath –> triggering on forced extension. Leaves a fixed flexion deformity.
  • Usually ring and middle finger
  • Associated with RA, and diabetes. Idiopathic in the majority.
233
Q

Management of Trigger Finger

A
  • Steroid injection (high recurrence) or surgery
234
Q

What is a ganglion?

A
  • Smooth, multiocular cystic swellings
  • Mucoid degeneration of joint capsule or tendon sheath
  • May be in communication with joint capsule/tendons.
235
Q

Presentation of ganglion

A

90% located dorsum wrist
Subdermal, fixed to deeper structures
- Limits planes of movement
May cause pain or nerve pressure symptoms.

236
Q

Management Ganglion?

A
  • 50% disappear spontaneously
  • Aspiration ± steroid and hyaluronidase injection
  • Surgical excision
237
Q

Differential for ganglion?

A
  • Lipoma
  • Fibroma
  • Sebaceous cyst
238
Q

Minor Leg and Foot conditions? -Meralgia paraesthetica

A
  • Entrapment of lateral cutaneous nerve of thigh
  • Between ASIS and inguinal ligament
  • Pain ± paraethesia on lateral thigh
  • Increased risk with obesity: compression by belts, underwear.
    Relieved by sitting down
  • Can occasionally be damaged in lap hernia repair.
239
Q

Chondromalacia Patella

A
  • Predominantly young women
  • Patellar aching after prolonged sitting or climbing stairs
  • Pain on patellofemoral compression: Clarke’s test
  • Ix: no abnormality on X-ray
  • Rx: vastus medialis strengthining
240
Q

Baker’s Cyst

A
  • Popliteals swelling arising between medial head of gastrocnemius and semimembranous muscles
  • Herniation from joint synovium
  • Usually 2ndry to OA or gout. Following minor trauma to knee.
  • Rupture: acute calf pain and swelling: DVT Differential.
241
Q

Hallux Valgus (Bunion)

A
  • Great toe deviates laterally @ MTP joint.
  • Pressure of MTP against shoe –> Bunion.
  • Increased wt bearing @ metatarsal head.
  • -> Pain: Transfer metatarsalgia
  • -> Hammer toe (at second metatasal head)
242
Q

Aetiology of Hallux Valgus?

A

Pointed shoes

Wearing high heels

243
Q

Management of Hallux Valgus?

A

Conservative: bunion pads, plastic wedge between great + second toes.
Surgical: Metatarsal osteotomy

244
Q

Other toe deformities

A

Hammer Toe
Claw Toe
Mallet Toe

245
Q

Morton’s Neuroma

A
  • Pain from pressure on an interdigital neuroma between metatarsals
  • Affects the intermetatarsal plantar nerve in the inter-metatarsophalangeal space.
  • Pain radiates to medial side of one toe and lateral side of another
  • Investigations is used for US.
  • Management: neuroma excision.

Features
- Forefoot pain, most commonly in the third inter-metatarsophalangeal space.
- Worse on walking. May be described as shooting or burning pain. May feel like they have a pebble in their shoe.
- Mulder’s click: one hand tries to hold the neuroma between finger and thumb. One hand squeezes the metatarsal together. A click may be heard as the neuroma moves between the metatars
sal heads.
Loss of sensation distally.

Management

  • Avoid high-heels
  • Metatarsal pad
  • CKS recommends referral if symptoms persist for >3 months despite footwear
  • Orthotist may give patient metatarsal dome orthotic
  • Can use steroid injection and neurectomy of involvement interdigital nerve.

Stress fracture - unlikely if not doing regular exercise.

246
Q

Where you would use an MRI over CT?

A

Soft Tissue

247
Q

Straight leg raise

A

Compare side to side
Active and Passive
Fracture NOF on Active (won’t happen). Do it passively and more helpful.
Knee effusion - Active is useful.

248
Q

Strain and Sprain

A

Strain - Pull in muscle due to excessive stretch, pain, spasm, oedema.

Sprain - Ligament tear (3 degrees based on severity).

249
Q

Dislocation

A

Complete loss of congruity of joint surface.

Younger the patient is, the more prone they are for further dislocations.

250
Q

Subluxation

A

Partial loss of congruity of joint surface

251
Q

Describing a fracture

A 
Anatomical location
- bone and bone site (distal/proximal) 
- Direction of fracture line (transverse, oblique, spiral) 
- Linear/comminuted 
- Fragments - one or more segments 
- Displaced/undisplaced
Open/Closed
Stable/unstable (spinal fracture)

Articular involvement/epiphyseal injury
- Fracture extends to involve joint, dislocation.
Soft tissue injury.

252
Q

Children’s fractures?

A

Bowing fracture /plastic fracture
Torus or Buckle Fracture
Toddler’s Fracture - Swelling and pain with screaming.

253
Q

Soft tissue injury - De Quervain’s Tenosynovitis

A

De Quervain’s = common condition in which the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflammed. 30-50.

Pain on the radial side of the wrist
Tenderness over the radial styloid process
Painful abduction of the thumb.
FInkelstein’s =

Finkelnstein Test = the examiner pulls the thumb of the patient in ulnar deviation and longitudinal traction. In a patient with tenosynovitis this action causes pain over the radial styloid process and along the length of extensor pollisis brevis and abductor pollicis longus

Management

  • Analgesia
  • Steroid injection
  • Immobilsation with thumb splint
  • Surgical treatment
254
Q

Achilles Tendon

A

Can present as tendinopathy, partial tear and complete rupture of the Achilles tendon.

RF: Ciprofloxacin and hypercholesterolaemia - predisposes to tendon xanthomata.

Tendonitis

  • Gradual onset of posterior heel pain worse following activity.
  • Morning pain and stiffness
  • Calf muscle excercises.

Rupture -

IN a person describing an audible pop in the ankle whilst playing sport.

Simmond’s triad - le prone with their feet over edge of bed. Look for abnormal angle of declination. GREATER DORSIFLEXION ON INJURED FOOT. GAP IN THE TENDON AND GENTLY squeeze calf

Distance between both parts of the tendon. Conservatively or surgically.

Diagnosis: Palpation-gap can be felt, swelling at back of heel, decreased active plantar flexion, increased passive dorsifleciton, inability to heel rise. Impaired gait, positive Thompson test.

Investigation = MRI/CT.

Treatment: surgical suture and conservative (cast in 30 plantar flexion).

255
Q

Tennis Elbow

A

Lateral epicondylitis
- Causes: overuse of forearm extensor
Symptoms: pain, increasing with movements. Medial wrist pain on resisted wrist pronation with elbow extended.
Diagnosis: clinical, imaging to rule out fracture
- Treatment; rest, physiotherapy, NSAIDs

256
Q

Golfer’s elbow

A

Golfer’s elbow - Medial epicondylitis (less common)

  • Causes: overuse of forearm flexors
  • Symptoms: pain, increasing with movements
  • Diagnosis: clinical, imaging in to rule out fractures
  • TReatment: rest physiotherapy, NSAIDS
257
Q

Patella Dislocation

A

Commonly occurs as traumatic primary event.
Genu valgum, tibial torsion and high riding patella are risk factors.

Common cause of haemarthrosis and many will spontaneously reduce when the leg is straightened. In the chronic setting physiotherapy is used to strengthen the quadriceps muscle.

X-ray/CT scan - Skyline X-ray views of patella are required, although displaced patella may be clinically obvious.

258
Q

Fracture at the neck of talus is associated with what?

A

AVN due to retrograde blood supply.

259
Q

Foot anatomy?

A

Longitudinal arch higher on medial than lateral.

Posterior part of calcaeneum form a posterior pillar to support the arch.

Head of talus marks the summit of this arch.

260
Q

Intertarsal joints?

A

Sub talar joint
- Formed by the cylindrical facet on the lower surface of the body of the talus and the posterior facet on the upper surface of the calcaneus. The facet on the talus is concave anteroposteriorly, the other is convex. The synovial cavity of this joint does not communicate with any other joint.

261
Q

Talocalcaeneonavicular

A

The anterior part of the socket is formed by the concave articular surface of the navicular bone, posteriorly by the upper surface of the sustentaculum tali. The talus sits within this socket

262
Q

Calcaneocuboid joint

A

Highest point in the lateral part of the longitudinal arch. The lower aspect of this joint is reinforced by the long plantar and plantar calcaneocuboid ligaments.

263
Q

Muscles of the foot?

A

Abductor hallucis

Medial side of the calcaneus, flexor retinaculum, plantar aponeurosis

Medial plantar nerve. Abducts the great toe.

264
Q

Flexor Digitorum brevis?

A

Flexes all the joints of the lateral 4 toes except for the interphalageal joint.

Medial plantar nerve.

265
Q

Abductor digit minimi

A

Abducts the little toe at the metatarsophalangeal joint

Lateral plantar nerve

266
Q

Flexor hallucis brevis

A

Flexes the metatarsophalangeal joint of the great toe.

Medial plantar nerve

267
Q

Adductor hallucis

A

Adducts the great toe towards the second toe. Helps maintain the transverse arch of the foot.

Lateral planar nerve

268
Q

Lateral plantar nerve

A

Passes anterolaterally towards the base of the 5th metatarsal between flexor digitorum brevis and flexor accessorius. On the medial aspect of the lateral plantar artery. At the base of the 5th metatarsal it splits into superficial and deep branches.

269
Q

Medial plantar nerve

A

Passes forwards with the medial plantar artery under the cover of the flexor retinaculum to the interval between abductor hallucis and flexor digitorum brevis on the sole of the foot.

270
Q

Meniscal tear?

A

Usually caused by twisting the knee and on examination - McMurray’s will be positive.

Not able to extend knee, locked in flexion - VERY IMPORTANT.

Features

  • Pain worse on straightening the knee
  • Knee may give way
  • Displaced meniscal tears may cause knee locking
  • tenderness along the joint line
  • Thessaly’s test - weight bearing at 20 degrees of knee flexion patient supported by doctor, positive if pain on twisting knee.

Knee held in one hand, which is placed along the joint line and flexed while the sole of the foot is held with the other hand.

Investigation - MRI is most appropriate imaging modality to diagnose mensical tears.

271
Q

Osteoarthritis of the knee?

A

Patient is typically > 50 years, often overweight
Pain may be severe
Intermittent swelling, crepitus and limitation of movement may occur

272
Q

Infrapatellar bursitis

Clergyman’s knee

A

Associated with kneeling

273
Q

Prepatellar bursitis

Housemaid’s knee

A

Associated with more upright kneeling

274
Q

Anterior Cruciate ligament?

A

Twisting of the knee - popping
Rapid onset of knee effusion
Positive draw test or Postive lachman’s

Poor healing
- Management: intense physiotherapy or surgery.

275
Q

Posterior cruciate ligament

A

May be caused by anterior force applied to the proximal tibia (knee hitting dashboard during accident)

Paradoxical anterior draw test.

276
Q

Collateral ligament

A

Tenderness over the affected ligament
Knee effusion may be seen

Lateral collateral - direct blow to the medial aspect of the leg with lateral joint line tenderness.

277
Q

Meniscal lesion?

A

May be caused by twisting of the knee
Locking and giving way are common feature
Tender joint line.

278
Q

Menisceal tear

A

Rotational sporting injuries
Delayed knee swelling
Joint locking
Recurrent episode of pain and effusions are common, often following minor trauma.

279
Q

Chondromalacia patellae?

A

Teenage girls following an injury to knee - Dislocation patella

Typical history of pain on going downstairs or at rest.

Tenderness, quadriceps wasting.

280
Q

Dislocation of patella?

A

Most commonly occurs as a traumatic primary event, either through direct trauma or through severe contraction of quadriceps with knee stretched in valgus and external rotation
Genu valgum, tibial torsion and high riding patella are risk factors
Skyline x-ray views of patella are required, although displaced patella may be clinically obvious
An osteochondral fracture is present in 5%
The condition has a 20% recurrence rate

281
Q

Fractured patella

A

2 types:

i. Direct blow to patella causing undisplaced fragments
ii. Avulsion fracture

282
Q

Tibial plateau fracture

A

Occur in the elderly (or following significant trauma in young)
Mechanism: knee forced into valgus or varus, but the knee fractures before the ligaments rupture
Varus injury affects medial plateau and if valgus injury, lateral plateau depressed fracture occurs
Classified using the Schatzker system (see below)

Type 1 - Vertical split of lateral condyle
2 - Vertical split of the lateral condyle combined with an adjacent load bearing part of the condyle

3- Depression of the articular surface with intact condylar rim

4 - Fragment of the medial tibial condyle

5- Fracture of both condyles

6- Combined condylar and subcondylar fractures

283
Q

Acromioclavicular joint injury

A

Injury to the AC joint is relatively common and typically occurs during collision sports such as rugby following a fall on to the shoulder or FOOSH.

Positive scarf test, with swelling, popping, clicking or grinding (on degeneration).

Grade 1 and 2 are very common. Managed conservatively including resting the joint using a sling.

IV V and VI require surgical intervention.

284
Q

Adhesive capsulitis?

A

Common cause of shoulder pain.

Mostly affects middle-aged females. Aetiology of frozen shoulder is not fully understood.

  • Associated with diabetes mellitus: Up to 20% of diabetics may have an episode of frozen shoulder.

Features
- external rotation is affected more than internal rotation or abduction
- both active and passive movement are affected
patients typically have a
- painful freezing phase, an adhesive phase and a recovery phase
bilateral in up to 20% of patients
the episode typically lasts between 6 months and 2 years

Management

  • No single intervention has been shown to improve outcome in the long-term
  • Treatment options include NSAIDs, physiotherapy, oral corticosteroids, intra-articular corticosteroids.
285
Q

Bennett’s Fracture? = Boxer

A

Intra-articular fracture of the first carpometacarpal joint
Impact on flexed metacarpal
X-ray: triangle fragment at ulnar base of metacarpal

286
Q

Pott’s Fracture - Like a pot.

A

Bimalleolar ankle fracture

Forced foot eversion

287
Q

Femoral nerve damage

A

Weakness in knee extension
Loss of patella reflex
Numbness of the thigh

Damage in hip and pelvis fractures

288
Q

Lumbosacral trunk

A

Weakness in ankle dorsiflexion, numbness of the calf and foot

289
Q

Sciatic nerve

A

Weakness in knee flexion and foot movement, pain and numbness from gluteal region.

290
Q

Obturator nerve

A

Weakness in hip adduction
Numbness over medial thigh

Damage in anterior hip dislocation

Most nerve injuries recover within 6-8 weeks, occassionally can be permanent.

291
Q

Lateral cutaneous nerve of the thigh

A

Compression of the nerve near the ASIS –> Meralgia paraesthetica - condition characterised by pain, tingling and numbness in the distribution of the lateral nutaneous nerve.

292
Q

Tibial nerve

A

Foot plantar flexion and invesion

-Not commonly injured as deep and well protected. Popliteal laceration, posterior knee dislocation.

Tibialis posterior is responsible for plantar flexion and eversion of foot.

293
Q

Common peroneal nerve

A

Foot dorsiflexion and eversion

Extensor hallucis longus
Injury often occurs at the neck of the fibula
Tightly applied lower limb plaster cast

Injury causes foot drop

More likely to be injured in a surgical damage for a TKR.

294
Q

Superior gluteal nerve

A

Misplaced intramuscular injection
Hip surgery
Pelvic fracture
Posterior hip dislocation

Injury results in a positive Trendelenburg sign

295
Q

Inferior gluteal nerve

A

Generally injured in association with the sciatic nerve

Injury results in difficulty rising from seated position. Can’t jump, can’t climb stairs

296
Q

Ganglion

A

Cyst arising from the joint or tendon sheath.

Most commonly seen around the back of the wrist and are 3x more common in women.

Ganglions often disappear spontaneously after several months.

297
Q

Plantar Fasciitis?

A

Exacerbated by walking on tip toes unlike subcalcaneal bursitis.

Most common cause of heel pain in adults.

Pain is worse around the medial calcaneal tuberosity.

Management - rest the feet where possible, wear shoes with good arch support and cushioned heels. Insoles and heel pads may be helpful.

Try ibuprofen.

Patients with persistent symptoms that have failed 6-12 months worth of conservative management should be referred to orthopaedics for consideration of surgical intervention as well as physiotherapy.

298
Q

Achilles tendonitis?

A

Pain is at the calcaneal insertion of the tendon or further up the tendon depending on the area affected.

299
Q

Slipped Upper Femoral Epiphysis?

A

Typical age group = 10-15 yrs

More common in obese children and boys.
Displacement of the femoral head epiphysis postero-inferiorly.

May present acutely following trauma or more commonly with chronic, persistent symptoms.

Features

  • Knee or distal thigh pain is common
  • Loss of internal rotation of the leg in flexion.
300
Q

Radial tunnel syndrome?

A

Most commonly due to compression of the posterior interosseous branch of the radial nerve. Thought to be a result of overuse.

Similar to lateral epicondylitis.
Pain tends to be 4-5 cm disral to the lateral epicondyle.
- Symptoms may be worsened by extending the eblow and pronating the forearm.

301
Q

Cubital Tunnel Syndrome?

A

Due to the compression of the ulnar nerve.

Features
initially intermittent tingling in the 4th and 5th finger
may be worse when the elbow is resting on a firm surface or flexed for extended periods
later numbness in the 4th and 5th finger with associated weakness

302
Q

Olecranon bursitis?

A

Swelling over the posterior aspect of the elbow

Associated with pain, warmth and erythema. Typically affects middle-aged male.

303
Q

Hand disease?

A

Dupuytrens contracture

  • Fixed flexion contracture of the hand where the finger bends towards the palm and cannot be fully extended.
  • Caused by underlying contracture of the palmar aponeurosis.
  • Ring and little finger affectred the most.
  • Associated with liver disease, alcoholism.
  • treatment is surgical and fasciectomy.
304
Q

Carpal tunnel syndrome?

A

Idiopathic median neuropathy at the carpal tunnel.
Characterised by altered sensation of the lateral 3 fingers.

Symptoms occur mainly at night in early stages of the condition.
Examination may demonstrate wasting of the muscles of the thenar eminence and symptoms may be reproduced by Tinels test (compression of the contents of the carpal tunnel).
Formal diagnosis is usually made by electrophysiological studies.
Treatment is by surgical decompression of the carpal tunnel, a procedure achieved by division of the flexor retinaculum. Non - surgical options include splinting and bracing.

305
Q

Osler Nodes

A

Osler’s nodes are painful, red, raised lesions found on the hands and feet. They are the result of the deposition of immune complexes.

306
Q

Bouchard’s nodes

A

Hard, bony outgrowths or gelatinous cysts on the proximal interphalangeal joints (the middle joints of fingers or toes.) They are a sign of osteoarthritis, and are caused by formation of calcific spurs of the articular cartilage.

307
Q

Heberden’s nodes

A

Typically develop in middle age, beginning either with a chronic swelling of the affected joints or the sudden painful onset of redness, numbness, and loss of manual dexterity. This initial inflammation and pain eventually subsides, and the patient is left with a permanent bony outgrowth that often skews the fingertip sideways.

308
Q

Ganglion

A

Swelling in association with a tendon sheath commonly near a joint. They are common lesions in the wrist and hand. Usually they are asymptomatic and cause little in the way of functional compromise. They are fluid filled although the fluid is similar to synovial fluid it is slightly more viscous. When the cysts are troublesome they may be excised.

309
Q

L3 nerve root compression

A

Sensory loss over anterior thigh
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test.

310
Q

L4 nerve root compression

A

Sensory loss anterior aspect of knee
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test

311
Q

L5 nerve root compression

A

Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test

312
Q

S1 nerve root compression

A

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

313
Q

Osteomyelitis?

A

Describes infection of the bone
Staph A is the most common cause except in patients with sickle cell anaemia.

Predisposing conditions

  • DM
  • Sickle cell
  • IVDU
  • Immunosuppression or HIV
  • Alcohol excess.

image = MRI most sensitive.

Manage with Fluclox.

314
Q

Leriche syndrome

A

Atherosclerotic occlusive disease involving the abdominal aorta and/or both iliac arteries.

Management involves correcting underlying risk factors such as hypercholesterolaemia + stopping smoking.

  • Claudication of the buttocks and thighs
  • Atrophy of the musculature of the legs
  • Impotence due to paralysis of the L1 nerve.
315
Q

Osteoarthritis of the hip?

A
  • Second most common presentation of OA after the knee.
  • RF = increasing age, female gender, obesity, DDH.

Features

  • Chronic history of groin ache following exercise and relieved by rest.
  • Red flag features suggesting an alternative cause including rest pain, night pain and morning stiffness > 2hrs.

Investigations = clinical (maybe X-ray)

Management

  • Oral analgesia
  • Intra-articular injections: provide short-term benefit
  • Total hip replacement remains the definitive treatment

Complications of total hip replacement

  • VTE
  • Intraoperative fracture
  • Nerve injury

Reasons for total hip replacement

  • Aseptic loosening
  • Pain
  • Dislocation
  • Infection
316
Q

Cauda Equina syndrome?

A

Features

  • lower back pain
  • urinary incontinence/retention
  • reduced sensation in the perianal area
  • decreased anal tone

Investigation
- urgent MRI

Needs urgent investigation. Most common cause is herniation of an intravertebral disc compressing the cauda equina.

317
Q

Dorsal column lesions?

A
  • Loss vibration and proprioception

- Tabes dorsalis, SACD

318
Q

Spinothalamic tract lesions?

A

Loss of pain, sensation and temperature

319
Q

Central cord lesions?

A

Flaccid paralysis of the upper limbs.

320
Q

Osteomyelitis

A

Normally progressive
Staph aureus in IVDU, normally cervical region affected
Fungal infections in immunocompromised
Thoracic region affected in TB

321
Q

Infarction spinal cord

A

Dorsal column signs (loss of proprioception and fine discrimination

322
Q

Cord compression

A

UMN signs
Malignancy
Haematoma
Fracture

323
Q

Brown-sequard syndrome

A

Hemisection of the spinal cord
Ipsilateral paralysis
Ipsilateral loss of proprioception and fine discrimination
Contralateral loss of pain and temperature

324
Q

Hip flexors

325
Q

Knee extensors (quadriceps)

326
Q

Ankle dorsiflexors (tibialis anterior)

327
Q

Toe extensors (hallucis longus)

328
Q

Ankle plantar flexors (gastrocnemius)

329
Q

Elbow flexor/Bicep?

330
Q

Wrist extensors

331
Q

Elbow extensors/Triceps

332
Q

Long finger flexors

333
Q

Small finger abductors

334
Q

Sciatic neuropathy?

A

Commonly confused with this would cause a loss of an ankle jerk and plantar response and loss of knee flexion and power below the knee.

335
Q

L5 radiculopathy?

A

Weakness of hip abduction and foot drop.

Does not affect the reflex loop.

336
Q

Stress fracture?

A

Repetitive activity and loading of normal bone may result in small hairline fractures.

Whilst these may be painful they are seldom displaced.

They may present late following the injury in which case callus formation may be identified on radiographs.

Such cases may not require formal immoblisations.

337
Q

Positioning in the Lloyd Davies stirrups carry risk?

A

Peroneal nerve neuropraxia.

338
Q

Ilioinguinal nerve?

A

Entrapment in a mesh causing a neuroma

339
Q

Sciatic nerve?

A

Posterior approach due to a total hip replacement.

340
Q

Which muscles does deep peroneal supply?

A

Tibialis anterior
Extensor digitorum longus
Peroneus tertius
Extensor hallucis longus

Dorsiflexion ankle, inversion of the foot.
Extends lateral four toes
Dorsiflex ankle joint
Extends big toe.

341
Q

Which muscles does superficial peroneal nerve supply?

A

Peroneus longus
Peroneus brevis

Evertion of the foot and plantar flexion

342
Q

Tibial nerve?

A

Gastrocnemius
Soleus

Plantar flexion

Flexion of lateral four toes, and great toe.

343
Q

Musculocutaneous nerve (C5-C7)

A

Elbow flexion = supplies biceps and supination

344
Q

Axillary nerve (C5-C6)

A

Shoulder abduction (Deltoid)

Damage due to humeral neck fracture/dislocation. Flattened deltoid.

345
Q

Radial nerve (C5-C6)

A

Extension (forearm, wrist, fingers, thumb)

Humeral midshaft fracture.

346
Q

Median nerve? (C6,C8,T1)

A

LOAF muscles.

Carpal tunnel syndrome.

347
Q

Ulnar nerve (C8-T1)

A

Intrinsic hand muscles except loaf

Wrist flexion

Medial epicondyle fracture
- Claw hand

348
Q

Psoas abscess?

A

Psoas abscess is a collection within the psoas muscle. It is commonly missed or diagnosed late due to its numerous differential diagnoses and a high index of suspicion is required in those with risk factors. The psoas muscle extends from T12 - L5 caudally, inserting on the lesser trochanter of the femur. It can be of primary origin or a result of spread from local sources such as pyelonephritis or inflammatory bowel disease. Left untreated it can lead to septicaemia and multi organ failure.

Caused by Staph or Strep.

Pain is usually non specific initially but increases over several days. It is worth suspecting if there is no history of trauma or injury. Fever may be present but not always. Psoas irritation is evidenced when the position of comfort is the patient lying on their back with slightly flexed knees. Inability to weight bear or pain when moving the hip is usually evident.

Secondary to Crohns, Diverticulitis, UTI, GU cancer, Vertebral osteomyelitis, femoral catheter, Endocarditis.

CT abdomen may identify the abscess but MRI is the gold standard.

Management is with antibiotic therapy +/- drainage. Alongside managing any predisposing risk factors if appropriate.

349
Q

Iliotibial band syndrome?

A

Iliotibial band syndrome - common cause of pain in runners.

Tenderness 2-3cm above lateral joint line.

Management

  • activity modification and iliotibial band stretches.
  • If not improving then physiotherapy referral.
350
Q

Osgood Schlatter’s

A

Tibial apophysitis, typically causes pain and swelling over tibial tubercle.

351
Q

Patellar tendonitis

A

Pain after exercise - normally be located at the lower aspect of the patella

352
Q

Patellofemoral pain syndrome

A

Anterior knee pain worsening by going up or down stairs.

353
Q

Charcot’s joints?

A

Bone remodelling
Fragmentation of midfoot.

Presence of swollen, red, warm joint in patient with history of poorly controlled diabetes highly suggestive of Charcot’s joints.

Also in alcoholic neuropathy.

Damaged due to loss of sensation due to diabetes.

Before we caused by neuropathy secondary to syphilis (tabes dorsalis).

X-ray shows osteolysis of the distal metatarsals and wide-spread joint dislocation in the forefoot.

354
Q

Hip OA?

A

Total hip replacement remains the definitive treatment

355
Q

Pagets?

A
  • Focal bone resorption followed by excessive and chaotic bone deposition
  • Affects (in order): spine, skull, pelvis and femur
    Serum alkaline phosphatase raised (other parameters normal)
  • Abnormal thickened, sclerotic bone on x-rays
    Risk of cardiac failure with >15% bony involvement
    Small risk of sarcomatous change

Bisphosphonates

356
Q

Osteoporosis?

A
  • Excessive bone resorption resulting in demineralised bone
  • Commoner in old age
    Increased risk of pathological fracture, otherwise asymptomatic
  • Alkaline phosphatase normal, calcium normal

Bisphosphonates, calcium and vitamin D

357
Q

Secondary bone tumours

A

Bone destruction and tumour infiltration
Mirel scoring used to predict risk of fracture
Appearances depend on primary (e.g.sclerotic - prostate, lytic - breast)
Elevated serum calcium and alkaline phosphatase may be seen

Radiotherapy, prophylactic fixation and analgesia

358
Q

Posterior hip dislocation?

A

Sciatic nerve injury in 10-20% of posterior hip dislocations.

359
Q

AVN?

A

During fractures. Less during dislocations.

360
Q

Types of hip dislocation

A

Posterior dislocation: Accounts for 90% of hip dislocations. The affected leg is shortened, adducted, and internally rotated.
Anterior dislocation: The affected leg is usually abducted and externally rotated. No leg shortening.
Central dislocation

Management
- ABCDE approach.
Analgesia
A reduction under general anaesthetic within 4 hours to reduce the risk of avascular necrosis.
Long-term management: Physiotherapy to strengthen the surrounding muscles.

361
Q

Complications of hip dislocation?

A

Sciatic or femoral nerve injury

Avascular necrosis - increased risk with previous chemotherapy. Also due to steroids or alcohol. Can see osteopenia, microfractures and collapse of articular surface in the crescent sign. MRI is investigation of choice.

Osteoarthritis: more common in older patients.

Recurrent dislocation: due to damage of supporting ligaments

362
Q

Proximal humerus fracture?

A

Very common. Usually through the surgical neck (around the neck of the bone)

  • Rare to have fracture through the anatomical neck
  • Anatomical neck fractures which are displaced by 1cm or more carry a risk of avascular necrosis to the humeral head.
  • Impacted fractures of the surgical neck are managed with a collar and cuff for 3 weeks followed by physio.
363
Q

Parsonage-Turner Syndrome

A

Peripheral neuropathy that may complicate viral illness and resolves spontaneously.

364
Q

Talipes Equinovarus

A

Talipes equinovarus, or club foot, describes an inverted (inward turning) and plantar flexed foot. It is usually diagnosed on the newborn exam.

365
Q

Rotator cuff injury?

A

Spectrum of disease

  • Subacromial impingement
  • Calcific tendonitis
  • Rotator cuff tear
  • Rotator cuff arthropathy

Rotator cuff tear pain is in first 60 degree.
Subacromial impingement = 60-120.

366
Q

Facet joint

A

Acute or chronic
Pain worse in the morning and on standing
On examination there may be pain over the facts
Pain is typically worse on extension of the back

367
Q

Patient who is worried about osteoporosis?

A

Check her risk factors

  • +ve family history
  • Smoking
  • Excess alcohol intake.
368
Q

Straight leg raise?

A

Distribution of the sciatic nerve then the test is positive.

Therefore L5 or Sciatic nerve. Can be due to underlying herniated disc.

369
Q

Posterior ankle impingement

A

Pain on forced plantar flexion - common in footballers or gymnasts.

370
Q

Discitis?

A

Infection in the intervertebral disc space.

Leads to serious complications such as sepsis or an epidural abscess.

Due to Staph, Viral, TB, Aseptic.

MRI/CT guided biopsy.

371
Q

Scoliosis

A

Curvature of the spine in the coronal plane
Structual or non-structural
= Postural scoliosis will typically disappear on manoevures such as bending forward.

372
Q

Spina bifida?

A

Non fusion of the vertebral arches during embryonic development
Three categories;
myelomeningocele
meningocele - may have fluid in bulge.
Spina Bifida Occulta - hair, no bone over spinal cord.

Myelomeningocele is the most severe type with associated neurological defects that may persist in spite of anatomical closure of the defect
Up to 10% of the population may have spina bifida occulta, in this condition the skin and tissues (but not not bones) may develop over the distal cord. The site may be identifiable by a birth mark or hair patch
The incidence of the condition is reduced by use of folic acid supplements during pregnancy

373
Q

Giant cell tumour of bone?

A

Soap bubble appearance
Present as pain or pathological fractures

Mets to the lungs.

Pain and swelling of the left shoulder. Large radiolucent lesion in the head.

374
Q

Ewings Sarcoma?

A

Most common in males between 10-20.
Can occur in girls.

Lytic lesion with a lamellated or onion type periosteal reaction is classical finding.

Medicine Finals - Imperial & Quick Medical Revision (29 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions