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Orthopaedic Surgery > Orthopaediac Surgery > Flashcards

Orthopaediac Surgery Flashcards

1
Q

Define compartment syndrome

A

In adequate tissue oxygenation with in an osseofascial compartment resulting from intracompartmental be sure that is greater than the capillary perfusion pressure.

Initially Venus outflow is impaired and pulse may still be palpable as the cells become hypoxic and then swell a further rise in pressure compromises arterial blood flow

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2
Q

Describe the clinical signs of compartment syndrome

A

Pain out of proportion to the injury

  • especially on passive stretching
  • crescendo pain

Paraesthesia

Paralysis

Pulselessness

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3
Q

Who get compartment Syndrome?

A

Fractures in 69% of cases

Cash injury

Conclusions

gunshot wounds

Tight cast, Dressings

Buns

Extravasation of IV infusion

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4
Q

What does the indications for compartment pressure measurements?

A

Poly trauma patients

Patients not alert or unreliable

Inconclusive physical examination findings

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5
Q

What is the management of compartment syndrome?

A

ATLS principles

Splint the cost

Leg in a neutral position

Analgesias

Reduce fractures

Emergency fasciotomy of all four compartment - Two incisions are made:
Lateral incision: from the head of the fibula to the lateral malleolus
Medial incision: 1 cm behind the tibial plateau to the medial malleolus

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6
Q

What should you be aware of when making a lateral incision fasciectomy?

A

The peroneal nerve

Incision of the peroneal nerve can cause drop-foot

Record pre-op drop foot and post-op foot

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7
Q

List the four muscle compartment of the lower leg

A

Anterior

Lateral

Superficial posterior

Deep posterior

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8
Q

What is the blood supply to the femoral head?

A

Lateral femoral circumflex artery

Medial Femoral circumflex artery

Obturator artery

Ligamentum Terres artery

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9
Q

Where is the important blood supply the femoral neck located?

A

On the posteriorly superior aspect of the femoral neck

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10
Q

What are the causes of avascular necrosis of the hip (femoral head)

A

Femoral head fracture

Hip dislocation

Basicervical fracture

Cervicotrochanteric fracture

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11
Q

What does the rest factors associated with a vascular necrosis of the femoral head?

A

Corticosteroid use

Alcohol abuse

Coagulopathies

Gout

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12
Q

What is the mechanism of injury for clavicle fractures?

A

A direct blow to the lateral aspect of the Shoulder or fall on an outstretched arm

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13
Q

What is the clinical presentation of a clavicle fracture?

A

Shoulder pain

Deformity of the shoulder

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14
Q

What is the non-operative treatment of clavicle fractures?

A

Sling immobilisation with gentle range of motion exercises at 2 to 4 weeks

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15
Q

What is the operative management of clavicle fractures?

A

Open reduction and internal fixation

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16
Q

What are the indication for surgery of clavicle fractures?

A

Unstable fractures

Open fractures

Displaced fracture with skin tenting

Floating shoulder

Symptomatic non-union

Displaced with >2cm shortening

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17
Q

Define a monteggia fracture

A

Fracture of the proximal third of the ulnar with radial head dislocation

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18
Q

What are the signs and symptoms of a monteggia fracture ?

A

Pain and swelling at the elbow joint

Loss of range of motion at the elbow

Posterior interosseous nerve neuropathy
> radial deviation of hand with wrist extension
> weakness of thumb extension
> weakness of metacarpophalangeal extension

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19
Q

What is the operative management of a monteggia fracture?

A

ORIF of ulnar shaft fracture

If fails then;

ORIF of ulnar shaft fracture, open reduction of radial head

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20
Q

What are the complications of a monteggia fracture?

A

PIN neuropathy

Malunion with radial head dislocation

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21
Q

Describe a type II bado classification of a monteggia fracture

A

Most common in adults

Fracture of the proximal or middle third of the ulnar with posterior dislocation of the radial head

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22
Q

Describe a type I bado classification of a monteggia fracture

A

Most common in children and young adults

Fracture of the proximal or middle third of the ulnar with anterior dislocation of the radial head

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23
Q

Define a Galeazzi fracture

A

Distil third the radius shaft fracture and associated distal radioulnar joint injury

24
Q

What is the mechanism of injury for a Galeazzi facture?

A

Direct restroom are typically dorsolateral aspect Falls onto outstretched hand with forearm in pronation

25
Q

What is the presentation of a galeazzi fracture?

A

Pain and swelling

Visible deformity

Tenderness over fracture site

Decreased range of motion

26
Q

What is the treatment of a Galaezzi fracture?

A

ORIF of the radius with reduction and stabilization of the distal radioulnar joint

27
Q

What other complications of a Galeazzi fracture?

A

Compartment syndrome

Neurovascular injury

Re-fracture

Non-union / malunion

DRUJ subluxation

28
Q

What is the mechanism of injury of an AC joint injury?

A

A direct blow to the point of the shoulder

Falling onto the shoulder

29
Q

What is the non-operative treatment of AC joint injury and which injuries are treated non-operatively?

A

Ice, Rest, Sling for 3 weeks
Followed by early rehab of range of motion

Type I, II and III

30
Q

What is the operative treatment of AC joint injury?

A

ORIF

or

Ligament reconstruction

31
Q

What is the mechanism of injury for anterior shoulder dislocation?

A

This is caused by a fall on a backward stretching hand

Or

Forced abduction and external rotation of the shoulder

32
Q

What is the clinical picture of a patient with an anterior shoulder dislocation?

A

The patient support arm due to pain but opposite hand

Rounded shoulder contour

The humoral head is palpable anteriorly

Movement of the shoulder is very painful

There may be neurovascular injury to the axillary nerve - test sensation over deltoid

33
Q

What is the treatment of an anterior shoulder dislocation?

A

Reduction under general Anastasia as soon as possible

After reduction apply sling or cuff, immobilize for 3 weeks in adults and 1 week in elderly and start physiotherapy

34
Q

Discuss posterior dislocation of the shoulder

A

Rare

Caused by forced internal rotation or a direct blow to the shoulder- electric shock / fit

X-rays show light bulb sign

Treatment is closed reduction by rotating the arm laterally while the humeral head is pushed forward

35
Q

What is the mechanism of injury of a proximal humerus fracture?

A

Low energy: elderly patient with osteoporotic bone

High energy: trauma in young patients and concomitant soft tissue and neurovascular injuries

Associated with axillary nerve palsy

36
Q

What is the clinical presentation of a proximal humerus fracture?

A

Pain and swelling with decreased motion

Axillary nerve palsy
> loss of movement or lack of sensation over the deltoid
> weakness with flexion, abduction and external rotation

37
Q

What is the non-operative management of a proximal humerus fracture?

A

Sling immobilization

Progressive rehab

38
Q

What is the operative management of a proximal humerus fracture?

A

ORIF

Hemianthroplasty

Total should anthroplasty

Reverse shoulder anthroplasty

39
Q

What are the indications for ORIF for a proximal humerus fracture?

A

Greater tuberosity displaced >5mm

2, 3 and 4 part fracture in young patients

Head splitting fracture in young patients

40
Q

What are the indications for hemianthroplasty in a proximal humerus fracture?

A

Anatomical neck fractures in elderly

4 part fracture and fracture dislocation

Rotator cuff compromise

41
Q

What are the complications of proximal humerus fracture?

A

AVN of the humerus head

Axillary nerve injury

Malunion

Nonunion

42
Q

What is the mechanism of injury in a supracondylar fracture?

A

Usually seen in paediatrics

Fall on an outstretched hand

43
Q

What is the clinical presentation of a supracondylar fracture?

A

Pain and swelling over the elbow

Anterior interosseous nerve neuropraxia
> unable to make OK sign

Radial nerve neuropraxia
> inability to extend wrist

Cold, pale and pulseless hand in vascular injury

44
Q

What are the X-ray finding of a supracondylar fracture?

A

Displacement of the anterior humeral line

45
Q

What is the non-operative management of a supracondylar fracture and who should receive it?

A

Type I (non-displaced) fractures and Type II fractures

Posterior moulded splint then long arm casting at 90 degrees or less (backslab)

46
Q

What is the operative management of a supracondylar fracture?

A

Closed reduction and percutanous pinning

Or

Open reduction and percutanous pinning when closed can’t be obtained

Or

Immediate closed reduction and percutanous pinning if there vascular compromise or risk of compartment syndrome

47
Q

What are the complications of a supracondylar fracture?

A

Pin migration

Cubitus valgus - can lead to tardy ulnar nerve palsy

Cubitus varus

Vascular injury

Volkmann ischaemic contracture

48
Q

What is the acute presentation of acute anterior shoulder dislocation?

A

Shoulder pain

Deformity

Immobility

Arm in ABduction and externally rotated

Squaring of the shoulders

Reduction in sensation over deltoid > axillary nerve neuropraxia

Rotator cuff injury

49
Q

What is the management of acute anterior shoulder dislocation?

A

Reduction followed by sling immobilization
* Kocher’s method

Anthroscopic bankart repair with capsular plication

Anthroscopic bankart repair with capsular shift

50
Q

What are the risk factors for a Frozen shoulder?

A

DM

Smoking

IHD

Cervical radiculopathy

Trauma

Hyperthyroidism

51
Q

What is the management of a frozen shoulder?

A

NSAIDs

Intra-articular steroid injections

NO physiotherapy

52
Q

What are the tendons of the rotator cuff?

A

Supraspinatus

Infraspinatous

Teres minor

Subscapularis

53
Q

What is the presentation of a rotator cuff injury (impingement syndrome)?

A

Pain and tenderness

Pain worse at night when lying on affected shoulder

Difficulty with overhead reach

54
Q

Provide a DDx for rotator cuff injury (impingement syndrome)

A

Frozen shoulder

AC joint arthritis

Biceps tendonitis

Cervical radiculopathy

55
Q

What is the management of a rotator cuff injury(impingement syndrome)?

A

NSAIDs

Physiotherapy

Steroid injection into subacromial space

Surgery:
* Anthroscopic subacromial decompression

Orthopaedic Surgery (3 decks)

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