Ortho Revision Questions Flashcards
Management to avoid devleopment of chest infections in elderly patients who may have fallen
chest physiotherapy & analgesia
squaring of the thumbs is a common feature in?
osteoarthritis
Main causes of avascular necrosis of the hip
- CHEMOTHERAPY
- LONG TERM STEROID USE
- excess alcohol
- Trauma
ACL injury mechanisms
- direct blow to the back of the knee
- excessive hyperextension
Treatment for Pagets
Bisphosphonates
Carpal Tunnel Treatment
6 weeks conservative management –> WRIST SPLINT +/- CORTICOSTEROID INJECTIONS
In severe cases - surgical decompression - flexor retinaculum division
Management for Cauda Equina
Surgical Decompression
Colles Fracture Features
DINNER FORK DEFORMITY
DISTAL RADIUS FRACTURE
DORSAL ANGULATION
Smiths Fracture Features
GARDEN SPADE DEFROMITY
DISTAL RADIUS FRACTURE
PALMER ANGULATION
Nerve affected in Meralgia Parasthetica
Lateral Femoral Cutaneous nerve
Compartment Syndrome Investigation
Manometer
Normal - 0-10
Abnormal - 20-40
Diagnostic - 40 above
Most Common Fracture that causes compartment syndrome
tibia / fibula TIBFIB
T-score for bone density
-1 and above = normal
-1 - -2.5 = osteopenia
-2.5 and below = osteoporosis
Osteomyelitis Management
surgical debridement & 6 weeks FLUCLOXACILLIN (with rifampicin / fusidic acid for the first 2 weeks)
*If penicillin allergy use clindamycin
How soon should hip fractures be surgically treated?
within 48 HOURS
Management of an intracapsular undisplaced hip fracture:
Internal Fixation
Management of an intracapsular displaced hip fracture
Total Hip replacement to all patients providing they are:
1. able to walk independently out doors with no more than a walking stick
2. not cognitively impaired
3. are medically fit for anaesthesia & the procedure
Extracapsular (stable intertrochanteric) Hip Fracture Management
dynamic hip screw
Extracapsular (reverse oblique / transverse / subtrochanteric) Hip Fracture Management
intramedullary device
–> should weight bear IMMEDIATELY after the operation. = reduces risk of VTE.
How soon should patients weight bear after hip fracture surgery?
immediately post op
Backpain 1st line treatment
NSAIDs
Osteoarthritis Management
- Patient education via: weight loss, physiotherapy, occupational therapy, orthotics
- Analgesia:
- Oral paracetamol and topical NSAIDs
- Oral NSAIDs - ibuprofen / naproxen (w/ ppi)
- Opiates - codeine
How long should prophylaxis LMWH for VTE be given to patients following Knee replacement?
14 days
How long should prophylaxis LMWH for VTE be given to patients following hip replacement?
28 days
What is the most common reason for hip replacement revision surgery?
aseptic loosening
What is a potential complication of a total hip replacement?
Posterior dislocation - presenting with internal rotation and shortening of the leg
What structures are included in the anatomical snuffbox?
- Radial artery
- Superficial radial nerve
- Cephalic vein
Scaphoid fracture main symptom
anatomical snuffbox tenderness
What is the most common nerve to be damaged in a colles fracture?
Median nerve
What are the Ottawa rules for ankle injuries?
The rules state that an ankle x-ray is only required if there is any pain in the malleolar zone and any one of the following findings:
- Bony tenderness in the lateral malleolar zone. (From tip of lateral malleolus to include 6cm of posterior border of fibula)
- Bony tenderness in the medial malleolar zone . (From tip of medial malleolus to include 6cm of posterior border of tibia)
- Inability to walk 4 weight bearing steps immediately after the injury and in the ED.
What are some main side effects of bisphosphonates such as alendronic acid?
- Gastrointestinal - reflux / oesophageal erosions
- Osteonecrosis of the jaw
- Osteonecrosis of the external auditory canal
- Atypical fractures
What is Gurd’s MAJOR criteria for diagnosing fat embolisms?
CRP:
- Cerebral involvement
- Respiratory distress
- Petechial rash
What is a late sign of cauda equina?
Urinary incontinentence
How can you differentiate between cauda equina and metastatic spinal cord compression?
Cauda equina presents with LMN signs:
1. Weakness / paralysis
2. Decreased reflexes - loss of tendon reflex
3. Decreased tone - flaccidity
4. Muscle wasting
5. Fasciculations
What are the Ottawa knee rules?
To determine if a patient requires an x-ray of their knee. The following should be present:
1. Aged 55 or above
2. Patella tenderness
3. Fibular head tenderness
4. Cannot flex knee to 90 degrees
5. Cannot weight bear - cannot take 4 steps (limps count)
Complications of discitis?
- sepsis
- epidural abscess
Discitis Investigation
MRI
Causative organism of Discitis?
Staph. Aureus
Undisplaced scaphoid fracture Management
Cast for 6-8 weeks
RIB fracture management
- ANALGESIA - NSAIDs, opioids, intercostal nerve blocks
- Chest drain - if hemothorax / pneumothorax
- Surgical management - if fracture has not healed even after 12 weeks
Diagnostic scan for rib fracture
CT scan of chest
Clubbed foot management
- Ponseti Method
- Deformity corrected 6-10 weeks after birth
- Night time braces should be used until the child is 4 years old
