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MBChB IV Orthopaedics > Ortho OSCE Topics > Flashcards

Ortho OSCE Topics Flashcards

1
Q

Which 4 areas are often affected by compartment syndrome?

A 
Elbow (supracondylar #)
Forearm bones (proximal)
Proximal 1/3 of the tibia
Foot 
Scapula
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2
Q

Name causes of compartment syndrome

A

Intracompartmental

  • fracture
  • reperfusion injury
  • crush injury
  • ischemia

Extracompartmental

  • constrictive dressing
  • poor position during surgery
  • circumferential burn
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3
Q

How is compartment syndrome diagnosed?

A 
1st sign = paraesthesia
2nd = pain out of proportion
3rd = pain on passive stretch 
Woody, hard swelling of the compartment
Suspicious history
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4
Q

How does compartment syndrome result in paraesthesia?

A

Compression of the small aa that supply the nerve

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5
Q

What is pain out of proportion?

A 
Not resolving after splinting
Adequate analgesia (morphine, tramadol, perfalgan)
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6
Q

How do you test pain on passive stretch in the lower limb?

A

Flex the big toe

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7
Q

Which compartment is first affected in the lower limb?

A

Anterior compartment

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8
Q

How do you test pain on passive stretch in the upper limb?

A

Extension of the fingers

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9
Q

Which compartment is usually affected in compartment syndrome of the upper limb?

A

Flexor compartment

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10
Q

Name the classic features of compartment syndrome

A
  1. Paraesthesia
  2. Pain out of proportion
  3. Pain on passive stretch
  4. Pallor
  5. Paralysis
  6. Pulselessness
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11
Q

What investigations do you do in compartment syndrome?

A

It is a clinical diagnosis therefore investigations are usually not necessary

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12
Q

How do you diagnose children or unconscious patients with compartment syndrome as clinical exam is unreliable?

A

Compartment pressure monitoring with catheter

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13
Q

What is the normal compartment pressure?

A

0mmHg

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14
Q

What compartment pressure suggests compartment syndrome?

A

Pressure >30mmHg
OR
DBP - pressure <30mmHg

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15
Q

Discuss the non-operative management of compartment syndrome

A 
Decompress threatened compartments
- cut casts, bandages, dressing
- split the splint bandages to keep fracture stable
- cut circular POP on both sides 
Keep limb at the level of the heart 
Wait 20-35min and repeat examination 
- improvement = continue
- no improvement = fasciotomy
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16
Q

Why should you keep the limb at the level of the heart in compartment syndrome?

A

Decreases end capillary pressure which aggravates the muscle ischemia

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17
Q

Discuss operative management of compartment syndrome

A

Surgically open the compartment
Leave the wound open and inspect 48-72h later
If muscle necrosis -> debridement
If healthy tissues -> suture wound without tension or use skin graft

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18
Q

How do you do a fasciotomy of the leg?

A

Open all 4 compartments through medial and lateral incisions

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19
Q

How long does it take for muscle necrosis to occur?

A

4-6h of total ischemia

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20
Q

Name complications of compartment syndrome

A

Volkmann’s ischemic contracture
Rhabdomyolysis
Renal failure secondary to myoglobinuria

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21
Q

Define an open fracture

A

Fractured bone and hematoma in communication with the external/contaminated environment

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22
Q

Discuss the acute management of open fractures

A
  1. ABCs
    Primary survey
    Resus
  2. Control bleeding with direct pressure
  3. Remove obvious foreign material
  4. Irrigate with normal saline if grossly contaminated
  5. Cover wound with saline soaked sterile dressings
  6. IV antibiotics once diagnosis of open fracture is confirmed
    - coamoxiclav
    - cefuroxime
    - clindamycin
  7. Tetanus toxoid if previously immunized
    Tetanus immunoglobulin if not previously immunized
  8. Reduce bone/joint
  9. Splint the limb until surgery
  10. NPO and preparation for theater
    - bloods
    - consent
    - ECG
    - CXR
  11. Monitor state of soft tissues and neurovascular supply
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23
Q

What are the 4 essentials of open fracture care?

A

Antibiotic prophylaxis
Prompt wound debridement
Fracture stabilization
Early definitive wound cover

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24
Q

How are open fractures classified?

A

Gustilo Anderson classification

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25
Q

Discuss the Gustilo Anderson classification

A 
Grade I
- <1cm long
- minimal soft tissue injury
- simple, low-energy fracture
Grade II
- >1cm long
- moderate soft tissue injury w/ some mm damage
- moderate comminution 
Grade IIIA
- >1cm long
- extensive soft tissue injury with adequate ability of soft tissue to cover wound 
- high-energy fracture, comminuted
Grade IIIB
- >10cm long
- severe loss of soft tissue cover
Grade IIIC
- >10cm long
- severe loss of soft tissue cover with vascular injury
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26
Q

Which antibiotic do you give for a Gustilo Anderson grade I and II?

A
  1. 1st gen cephalosporin (cefazolin) 2g IV q8h 2d
  2. Allergy = clindamycin 900mg IV tds
  3. MRSA + = vancomycin 15mg/kg IV bd
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27
Q

Which antibiotic do you give for a Gustilo Anderson III?

A
  1. 1st gen cephalosporin (cefazolin) 2g IV q8h 2d plus gentamicin/ceftriaxone for 3d
  2. Metronidazole w/wo penicillin G for soil/fecal contamination
  3. MRSA + = vancomycin 15mg/kg IV bd
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28
Q

Discuss the post-acute management of open fractures

A 
Operative irrigation and debridement within 6-8h and repeat 24-48h until wound viable 
External fixation
Wound dressing
- vac
- antibiotic bead pouch
Delayed wound closure within 3-7d
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29
Q

Define osteomyelitis

A

Bone infection with progressive inflammatory destruction

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30
Q

What is the most common mechanism of paediatric osteomyelitis?

A

Hematogenous seeding of bacteria to metaphyseal region of bone

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31
Q

How do you diagnose acute hematogenous osteomyelitis?

A

Kocher criteria

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32
Q

Discuss the Kocher criteria

A
  1. Non-weight bearing on affected side
  2. ESR>40mm/hr
  3. Fever
  4. WBC>12000
Probability:
4/4 = 99%
3/4 = 93%
2/4 = 40%
1/4 = 3%
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33
Q

How does acute haematogenous osteomyelitis present clinically?

A

Non-weight bearing on affected side
Fever
Bone tenderness on palpation

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34
Q

What investigations should you perform in acute hematogenous osteomyelitis?

A 
XR to exclude fractures
Bloods
- ESR
- CRP
- WCC
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35
Q

How do you manage acute hematogenous osteomyelitis?

A

Refer to orthopaedics
No antibiotics
Drain pus
Send pus for MCS

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35
Q

How do you manage acute hematogenous osteomyelitis?

A

Refer to orthopaedics
No antibiotics
Drain pus
Send pus for MCS

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36
Q

Why do we not give antibiotics in acute osteomyelitis?

A

Patient is presenting with clinical signs therefore past bone oedema phase and in abscess phase, therefore manage as an abscess

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37
Q

What is the most common organism involved in acute osteomyelitis?

A

Staph aureus

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38
Q

Name risk factors for acute osteomyelitis

A 
Recent trauma
Recent surgery
Immunocompromised
Haemoglobinopathy
RA
Chronic renal disease
IV drug use
Microvascular disease
Peripheral neuropathy
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39
Q

What are the mechanisms of acute osteomyelitis spread?

A

Haematogenous
Direct inoculation
Contiguous focus

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40
Q

Name XR findings in osteomyelitis

A 
Early
- normal
- loss of soft tissue planes
- soft tissue oedema 
- new periosteal bone formation 5-7d 
- osteolysis 10-14d
Late
- metaphysical rarefaction 
- abscess
- mottled, non-homogenous, moth eaten appearance
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41
Q

What occurs in chronic osteomyelitis after the area of bone has been destroyed by acute infection?

A

Sequestra surrounded by dense sclerosed bone which provoke chronic seropurulent discharge which escape through sinus at the skin surface

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42
Q

Define sequestrum

A

Dead bone

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43
Q

How does sequestrum appear on XR?

A

Sclerotic (more white)

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44
Q

Define involucrum

A

New bone formation around dead bone to protect the bone from breaking

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45
Q

Define a sinus

A

A hole in the skin draining fluid

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46
Q

What is a “sinus” in the bone cortex called?

A

Cloaca

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47
Q

Define a fracture

A

A break in the continuity of the bone cortex

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48
Q

Name the red flags of back pain

A 
BACK PAIN
Bowel/bladder dysfunction
Anesthesia (saddle paresthesia)
Constitutional symptoms
Khronic disease
Paresthesias
Age >50yo or <15yo
IV drug use
Neuromotor deficits
Other:
Weight loss 
Pain at night, while sleeping, at rest
Morning stiffness
Sensory loss
Fever 
Cancer history
Hypercalcemia
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49
Q

What questions should be asked on history in back pain?

A

SOCRATES

Site
Onset
Characteristics
Radiation
Associated symptoms
Time
Exacerbating/relieving factors
Severity
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50
Q

Define wrist drop

A

Inability to extend the wrist and the fingers at the metacarpophalangeal joints

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51
Q

Which nerve is affected in wrist drop?

A

Radial nerve (high lesion)

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52
Q

Name causes of high lesions of the radial nerve

A

Humeral fracture
Prolonged tourniquet
Saturday night palsy

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53
Q

Which muscles are affected in wrist drop?

A

Wrist extensors

  1. Extensor carpi radialis longus
  2. Extensor carpi radialis brevis
  3. Extensor carpi ulnaris
  4. Extensor digitorum
  5. Extensor digiti minimi
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54
Q

Which nerve is affected in foot drop?

A

Common peroneal/fibular nerve

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55
Q

Define foot drop

A

Weak dorsiflexion and eversion of the foot resulting in tendency to trip and fall while walking

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56
Q

Which muscles are affected in foot drop?

A

Tibialis anterior
Extensor hallucis longus
Extensor digitorum longus
Fibularis tertius

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57
Q

Name mechanisms of injury of the axillary nerve

A

Proximal humerus fracture
Humeral neck fracture
Shoulder dislocation

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58
Q

How do you examine the motor function of the axillary nerve?

A

Isometric deltoid contraction

Place hand on the lateral side of the injured arm to prevent movement and other hand on the deltoid to feel contraction

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59
Q

How do you examine the sensory function of the axillary nerve?

A

Numbness over the deltoid

Difficult to test due to pain

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60
Q

Name mechanisms of injury to the radial nerve

A 
Very high lesion
- crutch palsy
High lesion
- humeral fracture
- prolonged tourniquet pressure
- Saturday night palsy
Low lesion
- elbow fracture
- elbow dislocation
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61
Q

How do you examine the motor function of the radial nerve?

A

Very high lesion:
Triceps paralyzed and wasted

High lesion:
Wrist extension
Thumbs up

Low lesion:
Metacarpophalangeal joint extension

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62
Q

How do you examine the sensory function of the radial nerve?

A

Dorsum of the 1st web space

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63
Q

Name mechanisms of injury to the median nerve

A 
High lesion
- supracondylar fracture
- elbow dislocation
Low lesion
- carpal dislocation
- cuts in the front of the wrist
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64
Q

How do you examine the motor function of the median nerve?

A

High lesion:
O sign
Index DIP flex for positive benediction sign

Low lesion:
Thumb abduction

65
Q

What is the purpose of the O sign?

A

Flexor pollicus and deep flexor of index finger supplied by anterior interosseous nerve

66
Q

What is the innervation of the abductor pollicis muscle?

A

Recurrent thenar br of median nerve

67
Q

Which test for the median nerve is not applicable in a distal radius fracture?

A

O sign

68
Q

How do you examine the sensory function of the median nerve?

A

Pulp of the index finger

69
Q

Name the mechanisms of injury of the ulnar nerve

A

High lesion
- elbow fracture
Low lesion
- wrist pressure/laceration

70
Q

How do you examine the motor function of the ulnar nerve?

A

On a flat surface, finger abduction and adduction

Froment’s test

71
Q

How do you examine the sensory function of the ulnar nerve?

A

Ulnar side of little finger

72
Q

Explain Froment’s test

A

Ask patient to hold piece of paper in hands between thumb and index fingers to test adductor pollicis
If test is positive, patient will acutely flex in IPJ of the thumb because flexor pollicis longus is supplied by median nerve

73
Q

Name the mechanisms of injury of the femoral nerve

A

Anterior hip dislocation

Gunshot wound

74
Q

How do you examine the motor function of the femoral nerve?

A

Knee extension (anterior thigh compartment)

75
Q

How do you examine the sensory function of the femoral nerve?

A

Anterior thigh

Medial aspect of leg

76
Q

Name the mechanisms of injury of the sciatic nerve

A

Posterior hip dislocation

Hip replacement

77
Q

How do you examine the motor function of the sciatic nerve?

A

All muscles below the knee eg foot dorsiflexion

78
Q

How do you examine the sensory function of the sciatic nerve?

A

Majority of the leg

79
Q

Name the mechanisms of injury of the common peroneal nerve

A

Fibular neck fracture

80
Q

How do you examine the motor function of the common peroneal nerve?

A

Foot dorsiflexion
Foot eversion
Drop foot

81
Q

How do you examine the sensory function of the common peroneal nerve?

A

Anterolateral half of lower leg

Dorsum of foot

82
Q

How will an injury to the superficial branch of the common peroneal nerve appear?

A

Dorsiflexion intact

Loss of sensation over anterolateral lower leg and foot

83
Q

How will an injury to the deep branch of the common peroneal nerve appear?

A

Weakness of dorsiflexion

Loss of sensation around 1st web space on dorsum of foot

84
Q

What nerve is likely injured if a patient is stabbed in the antecubital fossa?

A

Median nerve

85
Q

What is Gallow’s traction?

A

Used in infants/children with femoral fractures
Fractured and healthy femur placed in skin traction and infant suspended from special frame with buttocks just off the bed for 1 week per year of age + 1 week
Start mobilizing at 6w

86
Q

Name the complications of Gallow’s traction

A

Vascular compromise
Occipital pressure sore
Aspiration
Compartment syndrome

87
Q

What is Waddell’s triad?

A

Femur fracture
Head injury
Thoracic/abdominal injury

88
Q

When is a Thomas splint used?

A

For femur fractures with skin/skeletal traction

89
Q

How do you determine the size of the Thomas splint?

A

Thigh circumference at groin + 4cm for ring

True limb length + 20cm

90
Q

How do you calculate the weight of traction with a Thomas splint?

A

10% of patient’s body weight

Maximal weight = 5kg (skin sloughing)

91
Q

Name indications for skin traction

A

Femur fractures
Hip dislocation
Hip fracture-dislocation

92
Q

What views do you want in a trauma series XR?

A
  1. AP chest
  2. AP pelvis
  3. Lateral c spine
  4. AP and lateral of all suspected bones injured
93
Q

Name complications of bed ridden patients

A
  1. Delirium
  2. Confusion
  3. Pneumonia
  4. PE
  5. Ileus
  6. Constipation
  7. Stress ulcers
  8. UTI
  9. Pressure sores
  10. DVT
  11. Muscle weakness
  12. Contractures
94
Q

How do you prevent pneumonia in bed ridden patients?

A

Physiotherapy

95
Q

How do you prevent PE in bed ridden patients?

A

DVT prophylaxis

96
Q

How do you prevent constipation in bed ridden patients?

A

High fiber diet

Lactulose

97
Q

How do you prevent stress ulcers in bed ridden patients?

A

PPI

H2 receptor antagonists

98
Q

How do you prevent UTI in bed ridden patients?

A

Silicon catheter

Treat with antibiotics

99
Q

How do you prevent pressure sores in bed ridden patients?

A

Turn 4hrly
Examine pressure points regularly
Ripple bed

100
Q

How do you prevent DVT in bed ridden patients?

A

LMWH

Pressure stockings

101
Q

How do you prevent contractures in bed ridden patients?

A

Early mobilization

Physiotherapy

102
Q

What is the peak age of supracondylar fractures?

A

7yo

103
Q

Name the mechanisms of supracondylar fractures

A

96% extension injuries via FOOSH

4% flexion injuries

104
Q

What is the most common displacement in supracondylar fracture?

A

Posterior displacement

105
Q

Name the clinical features of a supracondylar fracture

A 
Pain, swelling, tenderness
S-deformity (posterior displacement)
Neurovascular injury 
- radial aa
- radial, median, ulnar nn
106
Q

What on XR will suggest supracondylar fracture?

A

Disruption of anterior humeral line

Fat pad sign

107
Q

What is the anterior humeral line?

A

Line drawn down the anterior surface of the humerus that should intersect the middle third of the capitulum
Indicates supracondylar fracture if not

108
Q

What is the radiocapitellar line?

A

Line drawn through center and long axis of the radius that should go through the capitulum
Indicates radial head dislocation if not

109
Q

Discuss the Gartland classification of supracondylar humeral fractures

A

Type I
- non-displaced
Type II
- anterior cortex displaced but posterior cortex still in continuity
IIa
- less severe with distal fragment angulated
IIB
- severe with distal fragment angulated and malrotated
Type III
- completely displaced fracture with preserved posterior periosteum
Type IV
- displaced with periosteal disruption, unstable in flexion and extension

110
Q

Discuss the management of supracondylar humeral fractures

A

Acute
- gently splint in 30 degrees flexion to prevent movement and neurovascular injury during XR
Non-displaced = non-operative
- long arm plaster backslab in 90 degree flexion for 3w
- XR 5-7d later to ensure no displacement
Operative:
a) Displacement >50%
b) Vascular injury
c) Open fracture
- percutaneous pinning with k wires followed by limb cast with elbow flexed <90 degrees

111
Q

Name complications specific to supracondylar humeral fracture

A 
Stiffness
Brachial artery injury
Medial, radial, ulnar nn injury
Compartment syndrome
Malalignment cubitus varus
112
Q

What is Dunlop traction used for?

A

Maintenance of reduction in paediatric supracondylar humeral fractures

113
Q

When is Dunlop traction contraindicated?

A

Open fracture

Skin defects

114
Q

Explain the method of Dunlop traction

A

Skin traction placed on forearm and elevate 45 degrees over drip stand with 1.5kg weight
Broad sling around upper arm to enable traction along axis of forearm and right angles to humerus
Bed blocks required on lateral side of the bed

115
Q

What should you do if there is no pulse in a displaced supracondylar humeral fracture?

A

Pink pulseless hand:
Modified Dunlop
No pulse -> Dunlop
No pulse -> orthopaedics

Cold pulseless hand
Full Dunlop and phone the vascular surgeon

116
Q

Name the mechanisms of injury of tibial and fibular fractures

A
  1. Twisting force causing spiral fracture of both at different levels
  2. Angulatory force producing transverse/oblique fractures at same level
  3. Indirect low energy injury causing spiral or long oblique fracture that may pierce the skin
  4. Direct high energy injury crushes/splints the skin over the fracture
117
Q

Name clinical features of tibial and fibular fractures

A

Severe swelling
Bruising
Crushing/tenting of the skin
Neurovascular injury

118
Q

Discuss the management of tibial and fibular fractures

A

Closed and minimally displaced
- long leg cast 8-12w w/ functional brace after

Displaced and closed
- ORIF w/ IM nail, plate and screws or EF
Displaced and open
- AB
- I&D
- EF or IM nail
- vascularised coverage of soft tissue defects

119
Q

Name complications of tibial and fibular fractures

A 
Vascular injury 
Compartment syndrome
Infection
Joint stiffness
Complex regional pain syndrome
120
Q

Which vascular supply is endangered by tibial fracture?

A

Popliteal artery

121
Q

Where is spinal TB most often found in the spine?

A

Thoracic spine

122
Q

What is the most common site of skeletal TB?

A

Spine

123
Q

Name clinical features of TB spine

A 
Constitutional symptoms
- chronic illness
- malaise
- night sweats
- weight loss
Back pain
Kyphotic/gibbus deformity
Neurological deficit
Cervical = dyspnoea, dysphagia
Thoracic = pectus carinatum
124
Q

What are the mechanisms of neurological deficit in TB spine?

A
  1. Mechanical pressure on cord by abscess, granulation tissue, tubercular debris, caseous tissue
  2. Mechanical instability from sublaxation/dislocation
  3. Stenosis from ligamentum flavum ossification and severe kyphosis
125
Q

What investigations should you do to diagnose TB spine?

A 
Skin tests (sensitive, non-specific)
HIV status 
ESR
WCC 
XR
MRI
Needle biopsy
126
Q

Name the features of spinal TB on XR

A 
Early
- local osteoporosis of 2 adjacent vertebrae 
- loss of crispness of the end plate
Late
- disk space destruction
- collapse of adjacent vertebral bodies 
- severe kyphosis 
- paraspinal soft tissue shadows
127
Q

Give a differential diagnosis for TB spine

A

Malignancy
Pyogenic infection
Fungal infection
Parasitic infection (hydatid disease)

128
Q

Discuss the treatment of TB spine

A 
1. Pharmaceutical
Full drug treatment for 9-12mo
OR
Pulmonary strategy:
RIPE for 2 months then RI for 9-18 months
Resistance
- fluoroquinolone
- aminoglycoside
2. Surgical
- abscess drainage
- advanced disease
- neurological deficit that has not responded to drug therapy within 8w
129
Q

Which TB drug is bacteriostatic?

A

Ethambutol

130
Q

Name side effects of TB treatment to monitor for?

A

Hepatitis (isoniazid)
Depression (ethambutol)
Visual acuity (ethambutol)

131
Q

What is the mnemonic for TB drug side effects?

A

INH (iron accumulation, neuritis, hepatitis)
Ethambutol = eyes
Rifampin = red
Pyrazinamide = hyperuricemia

132
Q

What is the main complication in TB spine?

A

Pott’s paraplegia

  • early onset paresis
  • late onset paresis
133
Q

Name early local complications of fractures

A 
Skin
- necrosis
- fracture blister
- open wound
Muscle
- compartment syndrome
Nerve
- neuropraxia
- axonotmesis
- neuronotmesis
Vessels
- arterial injury 
Tendon injury
Infection
134
Q

Name early systemic complications of fractures

A 
Hemorrhagic shock
FES
ARDS
SIRS
MOFS
DVT
PE
Delirium tremans
Pressure sores
Tetanus 
Sepsis
135
Q

Name late complications of fractures

A 
Delayed union
Non-union
Malunion
Avascular necrosis
Growth disturbance
Osteoarthritis
Joint stiffness
CRPS
Heterotopic ossification
Osteomyelitis
136
Q

Name fractures that always require surgery

A

Neck of femur in young patients
Galeazzi
Monteggia
Lower limb in elderly

137
Q

Name general indications for ORIF

A 
Failure of closed reduction
Failure to maintain closed reduction
Displaced intra-articular fractures 
Polytrauma
Pathological fracture
Non-union
Floating elbow/knee
138
Q

Name sites of intra-articular fractures

A 
Tibial plateau
Tibial plafond
Intra-articular distal radius
Radial head
Femoral intercondylar
Humeral intercondylar
139
Q

Which ankle fracture does not recieve ORIF?

A

Non-displaced lateral malleolus without medial tenderness

140
Q

What does medial ankle tenderness indicate?

A

Medial malleolus fracture
OR
Deltoid ligament injury

141
Q

How are foot fractures generally managed?

A

Non-operative if non-displaced
Talus ORIF
Calcaneus ORIF

142
Q

What is the most common malignant tumour type in a patient <10yo?

A

Ewing’s sarcoma

143
Q

What is the most common malignant tumour type in a patient 10-20yo?

A

Osteosarcoma

144
Q

What is the most common malignant tumour type in a patient >50yo?

A

Metastases

145
Q

Which sites does osteosarcoma commonly affect?

A

Sites of rapid growth

  • distal femur
  • proximal tibia
  • proximal humerus
146
Q

Name risk factors for osteosarcoma

A

Paget’s disease

Previous radiation

147
Q

Name clinical features of osteosarcoma

A

Progressive pain
Night pain
Poorly defined swelling
Decreased ROM

148
Q

Name XR findings in osteosarcoma

A 
Variable appearance
- hazy osteolytic areas
- unusually dense osteoblastic areas 
Poorly defined margins 
Sunburst effect
Codman's triangle
149
Q

Discuss the management of osteosarcoma

A 
Multiagent chemotherapy for 8-12w
Complete resection w/ limb salvage 
Neoadjuvant chemotherapy
Bone scan
CT chest
150
Q

How do you see if the talus has shifted?

A

Spaces on all 3 sides (medial, lateral, superior) of the talar dome must be equal

151
Q

How do we classify ankle fractures?

A

Denis-Weber
Type A - infrasyndesmotic
Type B - trans-syndesmotic
Type C - suprasyndesmotic

152
Q

Discuss the management of ankle fractures

A 
Acute
- reduction under conscious sedation
- below knee backslab 
Surgical
- ORIF
153
Q

What is a Pott’s fracture?

A

Name for a variety of bimalleolar fractures
Tibia and fibula splay
Talus goes superior

154
Q

What are the signs of flexor tenosynovitis?

A

Kanavel’s signs

  • flexed posturing of the involved digit
  • tenderness to palpation over tenderness sheath
  • marked pain with passive extension of the digit
  • fusiform swelling of the digit
155
Q

Define a dislocation

A

Joint surfaces are completely displaced and no longer in contact

156
Q

Define a sublaxation

A

A lesser degree of displacement such that the articular surface are partially apposed

157
Q

Define fat embolism syndrome

A

An inflammatory response to embolized fat globules in the circulation

158
Q

Give the criteria for fat embolism syndrome

A

Gurd’s criteria

1 major + 4 minor
Major
- petechial rash
- respiratory involvement
- cerebral involvement
Minor
- tachycardia
- pyrexia
- retinal changes 
- anuria/oliguria
- thrombocytopenia
- anemia
- high ESR
- fat macroblobinemia
159
Q

What are the theories of FES aetiology?

A
  1. Mechanical obstruction in pulmonary capillaries

2. Free fatty acids directly affecting pneumocytes

160
Q

Discuss the treatment of FES

A

Adequate splinting of long bone fractures
O2 administration
Fluids

MBChB IV Orthopaedics (15 decks)

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