Orthopaedic Flashcards
When perfroming a femoral block what are key landmarks to identifying the femoral nerve? how much local can you inject ?
In line with the inguinal ligament. The femoral artery will be medial, then a fat pad then the sartorius muscle will be lateral. The nerve will be under the fascia iliaca. 20 ml of 1% lignocaine or 0.5% bupivocaine
What would be the management of superivial wound infections of the hand?
they are more likely to resolve with conservative management and can be managed with.
IV antibiotics (broad spectrum)
elevation
wound care
tetanus vaccination
splint immobilisation
What are some key features of history taking to illicit in a hand wound?
All about the injury mechanism and contamination
age and comorbidities and medications , previous surgeries.
occupation and exposures.
Handedness
signs and symptoms of hematogenous spread
What are key features to ask about in the history of an acutely swollen joint?
Timecourse
associated symtpoms
personal medical history
joint history. surgery?
exaserbating and relieving factors
weight bearing
recent GU or GI symtpoms.
What are some invesigations you can request for an acutly swollen joint?
Bloods for FBC, CRP, ESR and blood cultures is septic, uric acid.
Imaging: USS. CT
joint aspiration
When sending fluid for miscroscopy from an acture joint what do you request it to be tested for ?
WCC count
light microscopy for crystals
MCS
What are the main differentials for an actutely swollen joint?
trauma
gout
septic
reactive
rheumatological
What bacteria are usually responsible for septic arthritis?
staph, strep, gonorrhorea, salmonella (in sickle cell disease)
What are the basic features of fracture management?
reduce hold and rehabilitate
When is traction necessary on a fracture ?
muscular pull across a fracture which makes it unstable , femoral shaft fracture, NOF, displaced acetabular, certain pelvic fractures.
Why do antibiotics fail to treat osteomyelitis?
becuase bone destruction leads to avascular areas and necrosis of the bone, this dead bone is called sequestrum and antibiotics cannot penetrate.
how do you report a fracture from x-ray ?
- demographics of the patient and the x-ray
- location. describe in 1-3rds of the bone
- type of fracture: transverse, spiral, avulsion, oblique, greenstick.
- displacement: refer to the location of the distal fragment compared to the proximal fragment. i.e: inpaction, angulation, translated, angulation,
What are some special tests to consider when examining a hip?
trendelenburg, fixed flexion deformity, leg height.
What location of NOF is common to experience avascular necrosis?
intracapsular because of the medial femoral circumflex artery. Therefore they need hip replacment not just nail.
What are some complications of a hip replacment?
short term: VTE, bleeding, infection
long term: dislocation, leg length discrepancy, loosening of the prosthesis and needs a revision at 20 years.
