Ortho, just ortho (MSK) Flashcards
Osteoarthritis- definition
Degenerative disease –> loss of hyaline cartilage + new bone formation at joint surface
Symptoms of osteoarthritis
Pain - worse at night + after movement
- Commonly affects knees, hip, PIP, DIP, base of thumb
Reduced ROM: ‘gelling’ after rest for -30min
Deformity (mild)
Investigations for suspected osteoarthritis
Bloods:
U+Es (renal function before giving NSAIDs)
Autoantibodies (exclude inflammatory arthritis)
X-Ray
Mx of osteoarthritis
Conservative: weight loss, PTOT
Medical: paracetamol, NSAIDs (+PPI), joint injection
Surgical: Hip/knee replacement, osteotomy for younger pt w medial knee OA + thumb OA,
2 types of bone
Woven bone - disorganised bone (embryonic skeleton + fracture callus)
Lamellar bone - mature bone. can be either CORTICAL (dense, outer layer) or CANCELLOUS (porous, central)
Fracture healing - 3 phases
Reactive phase (-48hrs) - Haematoma + inflammatory cell recruitment
Reparative phase (-2 weeks)
- Callus formation (osteoblasts + fibroblasts proliferate)
- Endochondral ossification (formation of lamellar bone)
Remodelling phase (- years) - Remodelling of lamellar bone to cope w mechanical stresses (Wolff's law)
Fracture classification
Traumatic
Stress (repeated strain –> bone fatigue)
Pathological (due to diseased bone)
Greenstick fracture
Young soft bone which bends + breaks
Comminuted fracture
> 2 fragments
Angulation - how is it described
the direction of the distal portion of the distal fragment
Fracture in the growth plate?
What types are there
Salter Harris fracture (Straight, Above, Lower, Through, crush) Type 1: growth plate fracture 2: growth plate + metaphysis 3: growth plate + epiphysis 4: growth plate + meta + epiphysis 5: crush fracture
Garden classification
Intracapsular NOF#
1: incomplete
2: complete, undisplaced
3: complete, partially displaced
4: complete, totally displaced
Distal radius articulates with
Scaphoid, lunate, ulna
Distal radial fracture with dorsal angulation
Colles fracture
Distal radial fracture with volar angulation
Smith fracture
Distal radial fracture involving the joint (intraarticular)
Barton fracture
Distal radial fracture + distal radioulnar dislocation
Galeazzi fracture
ulnar fracture + proximal radial head dislocation
Monteggia fracture
Mx of an open fracture
Analgesia Asses: N+V status, photograph Alignment: splint Antisepsis: wound swab, irrigation, Abx Anti-tetanus
4 pillars of fracture management
Resus (ABC)
Reduction (closed or open)
Restriction (slings, plaster, bracing, internal)
Rehabilitation (PTOT)
Methods of fracture reduction
Open (i.e. surgical incision)
or closed
Methods of fracture restriction
Hold = sling, plaster
Fixation = either external or internal
- External = monoplane or multiplanar
- Internal = inter medullary or extramedullary
Indications for external fixation device
Open #s
Burns
Tissue loss
Rehabilitation for fracture management
Physiotherapy - strengthen muscles
OT - mobility aids, splints
Social services - home help
Common palsies from the following #s:
- Shoulder dislocation
- Humeral shaft
- Elbow
- Hip dislocation
- Neck of fibula
-Shoulder dislocation = AXILLARY (weak shoulder abduc)
- Humeral shaft = RADIAL (wrist drop)
- Elbow = ULNAR (ulnar claw)
- Hip dislocation = SCIATIC (foot drop)
- Neck of fibula = COMMON PERONEAL (Foot drop)
Pathophysiology of compartment syndrome
Oedema from fracture –> increased compartment pressure –>reduced venous drainage
As compartment pressure > capillary pressure –> ischemia!
Post-op patient
w extreme pain
Pain on passive muscle stretching
Reduced pulses
COMPARTMENT SYNDROME
Causes of malunion
Infection
Ischemia - AVN
Interposition of tissue between fragments
Disease - malignancy, malnutrition
Cause of cubitus varus
Gunstock deformity from malunion of a supracondylar #
AVN - what is the consequence
Soft + deformed bone –> pain + stiffness + OA
Scaphoid fracture - common method of injury?
O/E?
FOOSH
tenderness in anatomical snuffbox
Tenderness on scaphoid tubercle (volar surface)
Scaphoid fracture - how long until visible on XR?
10 days after injury
Therefore, return to # clinic 10 days later for re-XR
Mx of scaphoid fracture? Main complication?
Plaster
Risk of scaphoid AVN –> pain + stiffness
2 types of shoulder dislocation?
Common causes of both?
Anterior: trauma, falling on hand
Posterior: epileptics
Bankart lesion
Associated w should dislocation
Damage to anteroinferior glenoid labrum
Hill Sach lesion
Associated w anterior shoulder dislocation
Cortical depression of posterolateral humeral head
Presentation of shoulder dislocation
Severe pain
Shoulder appears square
Bulge in subclavicular fossa
Arm supported by other hand
Ix + Mx of shoulder dislocation
NEUROVASCULAR ASSESSMENT
- Regimental badge area for axillary nerve damage
XR: AP and lateral view
Reduction: under sedation (propofol)
Restriction: Sling for 3-4 weeks
Rehab: Physio
2 complications of shoulder dislocation
Recurrent dislocation
Axillary nerve palsy
Impingement syndrome - pathology?
Entrapment of supraspinatus tendon + subacromial bursa
Trapped btw ACROMION + GREATER TUBEROSITY of humerus
Presentation of impingement syndrome
Painful arc 60-120
+ve Hawkins test
Mx of impingement syndrome
Conservative: rest + physio
Medical: NSAIDs, steroid injection
Surgical: Arthroscopic acromioplasty
Differential of painful arc
Impingement syndrome
Partial rotator cuff tear
OA of acriomoclavicular joint
Findings on examination of frozen shoulder
reduced ROM, esp EXTERNAL ROTATION and shoulder abudction
Rotator cuff tear: O/E
Partial: painful arc
Full tear: Active abudction possible after passive abduction up to 90 degrees
Commonest type of supracondylar fracture
Extension i.e. distal fragment is posteriorly displaced
Complication of supracondylar fracture
1) Neuromuscular damage: -Brachial artery, Radial nerve, Median nerve
2) COMPARTMENT SYNDROME: pain on passive extension of fingers
3) Gunstock deformity (cubitus varus)
Mx of ruptured ACL
autograft from SEMITENDINOSUS
Tendon threaded through heads of tibia + femur, held using screws
Definition of disc prolapse
Herniation of nucleus pulposus through annulus fibrosis
- Loss of sensation on inner dorsum of foot
- Foot drop and weak inversion
Intact reflexes
L5 root compression
Aching buttock on walking
Rapid onset
Pain on spine extension (leaning back\0
Spinal stenosis
Spinal stenosis - presentation
Pain on spine extension
Heavy, aching buttock on walking (spinal claudication)
Sx of acute cord compression
Pain - bilaterally at back + radicular
UMN signs below lesion
LMN signs at compression level
Sx of cauda equina syndrome
Asymmetrical symptoms
- radicular pain
- Saddle anaesthesia
- Faecal/urinary incontinence
Colour changes in Raynaud’s phenomenon
White –> blue –> crimson
Secondary causes of Raynaud’s
- Systemic disease: SLE, SS, RA
- Atherosclerosis
- Blood: polycythemia
- Trauma: vibration injury
Mx of Raynaud’s
Conservative: avoid cold, wear gloves, stop smoking
Medical: nifedipine
Technical term for bunions
Hallux valgus
Hallux valgus - how to examine?
Look: Degree of valgus Unilateral/bilateral Swelling Calluses on heel
Feel:
Swelling? - active bursitis
Move:
Toe joint ROM
Extras: look at shoes, assess gait
Hallux valgus - aetiology?
Ix?
Mx?
Aetiology: tight fitting shoes, familial, assoc with RA
Ix:
Weight bearing x ray w orthogonal views
- Assess degree of valgus + OA at MTP joint
Mx:
conservative: footwear, physic
surgical: bunionectomy, 1st metatarsal realignment osteotomy
Flattened medial arch of foot + ulcer on medial foot
Charcot joint
Features O/E of charcot joint
Painless deformed joint
Ulcers/necrosis
Swelling
Causes of charcot joints
Due to sensory loss
- DM
- peripheral neuropathy: B12, folate, alcohol
Carpal bones
Scaphoid Lunate Triquetrum Pisiform
Trapezium Trapezoid Capitate Hamate
Septic arthritis:
which abx for elderly/recurrent UTI/recent abdo surgery?
Ceftriaxone
Which Abx for IVDU w septic arthritis?
?Pseudomonas
Ceftazidime!!
