Ortho OSCE Flashcards
Complications of cervical traction
- bleeding from temporal artery
- pressure sore on scalp
- sepsis
- worsening neurological status
- cranial nerve 6 palsy
Nexus criteria to X-ray C-spine
- midline cervical tenderness
- focal neurologic deficits
- altered level of consciousness
- evidence of intoxication
- painful distracting injury
What does a unifacet dislocation look like on X-ray
- anterior displacement of vertebral body <25%
- bow-tie sign on lateral view
- rotation and misalignment of spinous processes on AP view
- widening of interspinous space
How does a unifacet dislocation occur?
- flexion/distraction with rotation
How does a Weber A happen?
Inversion and adduction
How does a Weber B happen?
Eversion, abduction and external rotation
How does a Weber C happen?
Abduction and external rotation
X-ray findings of Colles fracture
- extra-articular
- proximal to radioulnar joint
- dorsal angulation of the distal fracture fragment
- impaction and shortening of radius
- associated ulnar styloid fracture present in 50%
How to reduce a colles fracture
- disimpact
- hyperdorsiflex
- push down to reduce
- flex wrist
- ulnar deviation
Definition of sciatica
Pain in one side of the buttock which shoots down the length of the leg
- worse when sitting
- burning/tingling associated with weakness/numbness
Causes of sciatica
- lumbar disc herniation
- degenerative disc disease
- spondylolisthesis
- lumbar spinal stenosis
Treatment of sciatica
- rest
- analgesia and NSAIDS
- spinal decompression of a compressed nerve root that doesn’t improve with rest
Causes of cauda equina
- ruptured disc in lumbar area
- spinal stenosis
- spinal lesion or malignant tumour
- complication of lumbar injury
Signs and symptoms of cauda equina
- severe back pain
- numbness and weakness in one or both legs
- saddle anaesthesia
- bladder or bowel dysfunction
- sexual dysfunction
3 ways infection can get to bone
- bacteriaemic seeding
- direct inoculation
- contiguous spread
Differential for swollen knee
- gout
- pseudogout
- cellulitis
- bursitis
- prepatellar bursitis
Complications of septic arthritis
- chondrolysis
- stiffness
- AVN in the hip joint
X-ray features of osteoarthritis
- narrowed joint space
- cystic changes
- sclerosis
- osteophytes
- no osteopenia
Common elbow conditions
- tennis elbow (lateral)
- golfer’s elbow (medial)
- biceps tendonitis
- triceps tendonitis
- olecranon bursitis
- posterior olecranon impingement
- arthritis
Treatment of calcific tendonitis
- cortisone injection into painful area
- ultrasound guided aspiration
- surgical removal
Investigations for septic arthritis
- FBC
- ESR
- Blood culture
What is compartment syndrome
When the tissue pressure within a closed muscle compartment exceeds the perfusion pressure and results in muscle and nerve ischaemia (increased contents or increased extrinsic pressure)
What do patients with compartment syndrome complain of?
- pain out of proportion to injury
- pain on passive stretch
- parasthesia
Examination of compartment syndrom
- woody, hard compartment
- altered sensation
- muscle weakness
- pain on passive stretch
- pulses preserved until very late
Treatment of compartment syndrome
- immediate removal/splitting of POP
- if failure to remove in 15 mins, do open fasciotomy and delayed closure
Compartments of leg
- anterior
- lateral
- superficial posterior
- deep posterior
- tibialis posterior
What is a Volkmann contracture?
- muscle and nerves undergo ischemic necrosis and contract in compartment syndrome
Possible sites of compartment sydrome
- lower leg
- forearm
- wrist
- hand
How does an anterior shoulder dislocation occur?
- abduction, external rotation
Examination signs in anterior shoulder dislocation
- flattened/ hollow contour of shoulder
- patient supporting arm
- anterior fullness below the coracoid process
- painful limitation of all shoulder movements
X-Ray views for anterior shoulder dislocation
- AP view
- lateral ciew
- modified axillary view
Treatment of anterior shoulder dislocation
Analgesia/ anaesthesia - Kocher manouver - Hippocratic method - Modified Milch Sling and analgesia Re-X-ray
Complications of anterior shoulder dislocation
- recurrent disolcation
- Bankart lesion
- Hill-Sachs lesion
- axillary nerve damage
DD for shoulder problems
- traumatic anterior dislocations
- atraumatic dislocation
- rotator cuff syndrome
- biceps tendinitis
- calcific tendinitis
- rotator cuff tear
- ACJ arthritis
- frozen shoulder
- glenohumeral arthritis
Deposits in calcific tendonitis
Calcium phosphate
Causes of hip pain/problems
- osteoarthritis
- septic arthritis
- AVN
- trochanteric bursitis
- snapping hip
- inflammatory arthritis
- synovial chrondromatosis/ osteochondromatosis
Management of OA
- lose weight and modifty lifestyle
- initial alangesia and anti-inflammatories
- steroid injections
- then surgery (joint debridement/ osteotomy/ arthroplasty/arthrodesis/decompression)
When do you decide to operate in OA
- relief of uncontrollable pain
- symptoms interfere with ADLs
- risk of surgery outweighed by consequences of arthritis
- early surgery is easier
Aims of closed traction-reduction of cervical spine
- cervical spine re-alignment
- spinal cord decompression
- neurological outcome optimisation
Pre-requisites for Cohn’s callipers
- patient alert and co-operative
- neurological and physiological monitoring
Contraindications to Cohn’s callipers
- skull fracture (relative)
- severe soft tissue degloving
- unconscious/unco-operative patient
Endpoints of Cohn’s traction
- reduction
- failure of reduction
- worsening of neurological status
- radiographic features of over-distraciton
Gustilo-Anderson classification of open fractures
1 = wounds less than 1cm, minimal contamination 2= wounds 1-10cm, moderate comminution and contamination 3a = minimal periosteal stripping, ST coverage required 3b = significant periosteal stripping at fracture site, ST coverage required 3c = repairable vascular injury
Medial ankle ligament
Deltoid ligament
