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Ortho BMSc > Orthopaedic medicine > Flashcards

Orthopaedic medicine Flashcards

1
Q

What are the two principal symptoms in orthopaedics?

A

pain stiffness

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2
Q

which cell characterises acute disease?

A

polymorphic leucocytes

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3
Q

which cell characterises chronic disease?

A

lymphocytes

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4
Q

What is the difference between -otomy and -ectomy?

A

-otomy = open something up -etomy = remove something

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5
Q

What is osteomyelitis?

A

bacterial infection resulting in inflammation of bone

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6
Q

What is the difference between primary and secondary OA?

A

primary has unknown cause

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7
Q

What is Perthes disease?

A

idiopathic osteochondritis of femoral head in children

  • AVN occurs causes abnormal growth
  • occurs in short, active boys
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8
Q

Why are the lower limb joints subject to high loads?

A

muscles around the joint exert leverage several times body weight

eg. 3x body weight in hip during walking

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9
Q

Explain normal walking

A

contract abductor muscles in the leg we step on

lift pelvis opposite way

other leg swings forward

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10
Q

How does a walking stick help hip OA?

A

it reduces load on the hip by reducing abductor muscle activity carry stick in opposite hand lets shoulder girdle tilt the pelvis instead of the muscle tiling the pelvis

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11
Q

what is arthrodesis?

A

surgical stiffening of a joint in a position of function. Essentially, a relatively stiff and very painful joint is cut out and the remaining raw bone ends are held together either by an external splint or screws until they heal with a bony bridge

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12
Q

How can arthrodesis work in hip?

A

30° flexion and some abduction allows walking + sitting

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13
Q

Name some negatives of hip arthrodesis

A

interferes with female sexual activity

strain on adjacent joints in long-term eg. opposite hip, lumbar spine and knee

a large joint is technically difficult to fuse

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14
Q

In which body parts is arthodesis useful?

A

ankle and wrist

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15
Q

what is an osteotomy?

A

surgical realignment of a joint to redirect forces

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16
Q

who does osteotomy work for?

A

good in a joint deformity eg more wear due to bow-leg

  • young people
  • good ROM
  • reasonable articular cartilage
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17
Q

If someone has bad ROM is arthrodesis or osteotomy better?

A

arthrodesis

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18
Q

is arthroplasty better in upper or lower limb? why?

A

lower because upper needs better ROM

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19
Q

what function ROM is needed in the hip after arthroplasty?

A

10° extension 40° flexion few ° abduction

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20
Q

what function ROM is needed in the knee after arthroplasty to get up and down stairs?

A

90° flexion stable in extension

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21
Q

List general complications of arthroplasty

A

chest infection UTI DVT PE

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22
Q

List specific early complications of arthroplasty

A

dislocation infection

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23
Q

List specific late complications of arthroplasty

A

late infection loosening and wear

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24
Q

4 requirements of joint replacement

A

functional ROM

stability

relief from pain

can withstand load

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25
Q

What joints are affected in rheumatoid arthritis?

A

Small joints affected symmetrically

  • fingers (not DIP)
  • wrists
  • feet
  • ankles
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26
Q

How does rheumatoid arthritis present?

A

chronic presentation that is more common in women

  • severe pain
  • swelling
  • deformity
  • stiffness worse in the morning
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27
Q

Give 2 surgical treatment for RA and who they are suitable for

A

synovectomy: early in disease, younger patient, retained movement but pain, good at wrist

excision arthroplasty: combined with synovectomy at wrist or elbow, good at removing pain but joint damaged so never full return to function

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28
Q

What sites are affected by post-traumatic AVN?

A

femoral head due to #fem neck

proximal scaphoid

proximal talus

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29
Q

what bones are affected by non-traumatic AVN?

A

lunate bone

femoral head

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30
Q

what is Caisson’s disease?

A

AVN of the femoral head in chronic alcohol abuse, steroids, deep sea divers

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31
Q

How does AVN present ?

A

acute and often severe joint pain, which is made worse by movement, and to some degree relieved by rest.

With the passage of time symptoms become indistinguishable from osteoarthritis and then it may be treated as such.

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32
Q

What causes gout?

A

urate crystal deposition

  • dehydration post-surgery
  • chemotherapy
  • over-use of diuretics
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33
Q

Which joints does gout commonly affect?

A
  1. knee
  2. first MTP (base of big toe)
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34
Q

what can pseudogout cause in the knee?

A

calicification of joint surfaces and menisci

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35
Q

How does presentation of acute septic arthritis differ between adults and children?

A

children very acute illness with a stiff, hot and tender joint

adults have a minor upset of a chronically abnormal joint –> delay in recognition results in septicaemia and death

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36
Q

which organism causes

a) septic arthritis most commonly?
b) chronic septic arthritis?
c) acute septic arthritis in a young adult?

A

a) staphylococcus
b) TB
c) gonococcus

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37
Q

How does chronic septic arthritis present?

A
  • chronic ill health
  • weight loss
  • considerable muscle wasting around the affected joint
  • x-ray shows marked thinning of bone
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38
Q

Manage acute septic arthritis

A

surgical washout and IV antibiotics

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39
Q

how do meniscal lesions present

A

pain effusion locking/giving way

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40
Q

which meniscus is more likely to be damaged

A

medial

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41
Q

which type of meniscal lesion occurs in old age

A

cleavage lesion: a horizontal flap that allows in fluid –> cyst

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42
Q

most common type of meniscal lesion

A

bucket handle tear

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43
Q

what MOI in meniscal lesion

A

twisting injury

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44
Q

How are meniscal lesions managed surgically?

A

ARTHROSCOPY

  • try to preserve meniscus
  • suture peripheral tears
  • if tear in meniscus itself remove torn part as no capacity to heal
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45
Q

how do loose bodies present

A

injury causes osteochondral fragment to break off with an initial haemarthrosiswhich settles

later pain, locking, giving way, effusion

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46
Q

spontaneous loose bodies in adolescents is called

A

osteochondritis dissecans

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47
Q

MOI for cruciate ligaments

A

hyperextension/twist with anchored foot

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48
Q

PC cruciate injury

A

“pop” haemarthrosis –> settles chronic injury

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49
Q

what causes patellar dislocation?

A
  • congenital eg. Down’s syndrome
  • trauma
  • malformed patella/femoral condyle results in maltracking which causes muscle spasm and spontaneous dislocation
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50
Q

what is maltracking patella

A

patella does not stay in its place on femur causing abrasion

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51
Q

treat minor patella maltracking

A

split vastus lateralis

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52
Q

treat recurrent, severe patella maltracking

A

plication (medial tightening of vastus medialis)

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53
Q

what do we call non-nervous tissue in the spine?

A

spondylitides

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54
Q

what surrounds nerve roots exiting from vertebral foramina?

A

facet joints intervertebral discs

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55
Q

How is referred pain in the leg distinguished from sciatica?

A

referred pain: back to buttock to leg (not below knee) sciatica: leg to foot

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56
Q

where does nerve root pain in cervical spine go to?

A

hand and forearm

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57
Q

what are localising signs?

A

loss of sensation or muscle weakness

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58
Q

what are the facet joints?

A

joint between articular processes of adjacent vertebrae

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59
Q

what is the pars interarticularis?

A

part between inferior and superior articular processes of the facet joint

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60
Q

how does lifting something with a straight back and holding it close to the spine prevent back sprain?

A

it causes less leverage and reduces spinal load

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61
Q

do we see signs of nerve compression in back sprain?

A

no

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62
Q

what is mechanical backache? what causes it?

A

recurrent sprains of unknown cause - may be due to spondylosis or primary OA

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63
Q

what is spondylosis?

A

degeneration of the intervertebral disc leading to increased loading of the facet joints and secondary OA

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64
Q

what is spondylolithesis?

A

slippage of one vertebrae relative to the one below it

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65
Q

how does spondylolithesis occur?

A
  • congenital
  • acquired following acute or fatigue # of pars interarticularis
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66
Q

how do you manage spondylolithesis if there is severe pain?

A

spinal fusion

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67
Q

what is spondylolysis?

A

of pars interarticularis without forward slippage. can cause pain

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68
Q

how does a prolapsed lumbar disc present?

A

acute leg pain (down to foot) +/- backache

can be after an episode of strain or spontaneous

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69
Q

Why does someone get a prolapsed disc?

A

abnormal intervertebral disc leads to prolapse of nucleus pulposis through annulus fibrosis

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70
Q

Which vertebrae are most commonly affected by prolapsed discs? What does this result in?

A

sacrum and 5th lumbar

sciatica as sciatic nerve exists from the above nerve root so pain is perceived in the sciatic nerve

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71
Q

How do we confirm what disc is affected in prolapsed disc?

A

myelography: inject radio-opaque die into spinal fluid and it wont go where prolapse is on xray

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72
Q

What is impinged when the nucleus puloposus herniates

a) backwards + laterally?
b) posteriorly?

A

a) nerve root
b) spinal cord

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73
Q

What is bony root entrapment?

A

bony overgrowth around vertebral foramina compresses nerve root

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74
Q

Why does bony root entrapment occur?

A

secondary to degenerative change eg primary OA or disc degeneration

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75
Q

Does bony root entrapment occur in response to a prolapsed disc?

A

no

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76
Q

Who is affected by bony root entrapment in the lumbar spine?

A

over 40 hx of mechanical back pain

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77
Q

What characterises spodylosis?

A

osteophytes growing around a degenerated disc

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78
Q

what is cervical spondylosis?

A

a degenerative disease of the cervical discs leading to secondary arthritic changes in the adjacent facet joints

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79
Q

Who does cervical spondylosis affect?

A

women over 40

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80
Q

How does cervical spondylosis present?

A

dull neck ache that refers to shoulders and upper arms tingling arms

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81
Q

Can cervical spondylosis progress?

A

yes it can progress to bony nerve root entrapment

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82
Q

How do you manage cervical spondylosis?

A

no localising signs = analgesia, NSAIDs, collar, physio

nerve root entrapment = fuse vertebrae

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83
Q

How can we differentiate between cervical spondylosis and cervical disc disease?

A

disc disease tends to have no history of cervical neck problems

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84
Q

What happens following cervical disc prolapse?

A

muscle spasm restricted movement

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85
Q

How do we manage cervical disc prolapse?

A

most will recover with

  • rest, gentle traction, supporting collar

if marked localising sings / symptoms dont regress

  • surgery to fuse vertebrae
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86
Q

Normal milestone for

a) sitting b) standing c) walking

A

a) 9 months
b) 1 year
c) 20 months

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87
Q

What is genu valgum?

A

knock knees - normal alignment

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88
Q

What is genu varum?

A

bow legs

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89
Q

Which of genu valgum and varum causes an increased gap at the feet?

A

genu valgum

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90
Q

What is the normal foot gap for children?

A

4cm

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91
Q

When do knock knees and bow legs tend to resolve?

A

by age 7

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92
Q

What are curly toes?

what toe is most commonly affected?

should they be operated on?

A

minor overlapping of toes

5th

discourage operating unless discomfort in shoes

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93
Q

Give some causes of intoeing

A

femoral neck anteversion tibial torsion abnormal forefoot

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94
Q

How does the femur develop

A

During the later stages of the normal development of the foetus, the leg rotates on the pelvis so that the acetabulum points almost backwards and the femoral head on the neck is orientated forwards.

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95
Q

What movements does a child with femoral neck anteversion do ?

A
  • lots of internal rotation
  • limited external rotation
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96
Q

When should femoral neck anteversion fix itself?

A

by age 10

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97
Q

What is tibial torsion?

how should it be managed?

A

where the bone is literally distorted or warped along its vertical axis

it is a normal variation and should be ignored.

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98
Q

What are the two types of flat feet?

A

rigid and mobile

  • mobile is normal
  • rigid may be due to underlying bony abnormality or RA
99
Q

Which toe is particularly common to overlap?

A

5th toe

100
Q

What age in childhood is knee pain common?

A

10-12

101
Q

what is osgood-schlatter’s disease? what is the mechanism behind it?

A

inflammation of the attachment of the patellar tendon to the growing tibial epiphysis due to excessive traction by the quadriceps

The cause is unknown but it may be an overuse injury as it is more common in very active children who are often involved in organised sport.

102
Q

what can arthroscopy show in a girl with adolescent knee pain?

A

arthroscopy can shoe chondromalacia patellae (worn out patella)

103
Q

what is the occurence of CDH

A

1/2 per 1000 live births

104
Q

How is CDH screened?

A

at birth manoeuvres: one to dislocate and one to reduce a dislocated hip –> positive if click/clunk screened again at 3,6,12 months

105
Q

Signs of CDH

A

positive ortolani/barlow limb shortening asymmetrical skin creases limited abduction and a limp

106
Q

how do you manage a) a click? b) a clunk?

A

a) refer to specialist at 3 months for x-ray b) treat from birth

107
Q

how is early CDH treated?

A

splintage to put femoral head in acetabulum

108
Q

how is late CDH treated?

A

not walking: gentle traction, open/closed manipulation, 3 months of splintage walking: major surgery to deepen acetabulum and reangulate femoral neck

109
Q

what is the name for club foot?

A

talipes equinovarus

110
Q

what does equinus mean?

A

plantarflexion

111
Q

what are the two forms of club foot?

A
  1. mild postural after breech birth
  2. fixed form due to developmental abnormality of nerves and muscles
112
Q

How is club foot managed?

A

manipulate at birth with 6 weeks splintage with Ponseti technique corrects hindfoot equinus then mid+forefoot varus

  • severe cases may need surgery after this if correction incomplete
  • follow up until feet stop growing
113
Q

What are the two forms of spina bifida?

A

spina bifida occulta (minor bony abnormality, more common) spina bifida cystica (neural plate tissue open with little or no skin or bone cover)

114
Q

What is a diastomatomyelia?

in what form of spina bifida does it occur?

A

tethering of spinal cord to higher lumbar vertebrae during growth

occulta

115
Q

what is a meningocele?

A

when nerve tissue covered by a cyst

116
Q

What is a meningomyelocele?

A

when nerve tissue is incorporated into a cyst

117
Q

Which type of spina bifida may cause hydrocephalus?

A

cystica

118
Q

what is cerebral palsy?

A

neuromuscular disorder with onset before 2‐3 years of age due to an insult to the immature brain before, during or after birth

119
Q

how does spastic cerebral palsy present?

A

spaastic paralysis: some muscles to strong but uncoordinated, some weak and flacid missing milestones like walking lack of co-ordination and purpose of movement

120
Q

Give an example of minor spastic cerebral palsy

how can this be treated

A

toe-walking in adolescence due to spastic calf muscles

–> may need tendo-achilles lengthening

121
Q

What MSK problems do people with cerebral palsy suffer from?

A

joint contractures, scoliosis and hip dislocation (non‐congenital).

122
Q

How are MSK problems in CP managed ?

A
  • careful physio
  • baclofen and botox to reduce spasticity
  • surgery to lengthen tight muscles, denervate them, move them
  • hip surgery to help sit in a wheelchair
  • splintage can make spasms worse
123
Q

How is spina bifida managed?

A

surgery on feet to keep normal shape keep mobile till adolescence using splints + hand-held aids

124
Q

Are orthopaedic problems more severe in spina bifida or cerebral palsy?

A

CP

125
Q

What is scoliosis?

A

abnormal lateral curvature of the spine with a rotatory abnormality of the vertebrae

126
Q

What is the underlying cause for scoliosis?

A
  • most idiopathic
  • neuromuscular disorder eg spina bifida
  • congenital abormality of vertebrae
  • tumour
127
Q

is scoliosis painful?

A

it should not be painful - sometimes pain secondary to distress about condition

128
Q

how does scoliosis occur?

A

abnormal lordosis leads to buckling and twisting of vertebral column due to muscles and gravity

129
Q

Why would scoliosis warrant an operation?

A

progressive curve distressing to patient to allow to sit in wheelchair restrictive lung defect in severe cases

130
Q

What does a limp from birth indicate?

A

? CDH or hip infection

131
Q

What are imaging findings for perthes?

A

xray may be normal at first then fragment excess fluid on US

132
Q

how do you manage perthe’s?

A

leave minor cases alone

more severe may need splintage, osteotomy periods of traction

133
Q

What are the long-term effects of perthe’s disease in older children?

A

secondary OA

134
Q

What age does perthe’s disease present?

A

4-10 years

135
Q

which two groups get a SUFE?

A

boys age 12 who are sexually immature girls age 14 who have had recent growthspurt

136
Q

Where does SUFE tend to cause pain?

A

pain in the knee due to obturator nerve radiation

137
Q

How do you manage a) minor SUFE? b) major SUFE?

A

a) pin hip b) gentle manipulation of head back on to neck –> high risk of AVN

138
Q

do you need to observe the other hip in perthes or sufe?

A

SUFE

139
Q

when does osgood-schlatters present?

A

age 10-12

140
Q

which gender are affected more by Perthes?

A

boys

141
Q

What is an enthesis?

A

the short, fibrous origin of a muscle

142
Q

Name 2 common sites of enthesopathy

A
  1. Golfer’s elbow: flexor muscles of forearm 2. Tennis elbow: extensor muscles of forearm
143
Q

What is the prognosis for elbow enthesopathy

A

good esp if known cause - most resolve spontaneously

144
Q

How do you manage severe or chronic enthesopathy?

A

anti-inflammatories steroid injection into point of max tenderness surgery to scrape origin off bone + decompress

145
Q

What is neuropraxia?

A

compression/stretching injury to nerve

146
Q

Which nerve is most commonly damaged by extrinsic causes?

A

common peroneal nerve as it winds around fibula

147
Q

What nerves are commonly damaged by intrinsic causes?

A

median and ulnar nerves at the wrist ulnar nerve at the elbow posterior tibial nerve at the ankle

148
Q

What symptoms should make you suspicious of nerve entrapment?

A

numbness or tingling

149
Q

What symptoms are diagnostic of nerve entrapment?

A

weakness and real sensory loss

150
Q

How do we manage nerve entrapment?

A

remove obvious cause surgical decompression

151
Q

What is a bursa?

A

a small sac of fibrous tissue lined with synovial membrane and filled with fluid

152
Q

What do bursae do?

A

acts as natural bearing to improve muscle and joint function by reducing friction where tendons and ligaments pass over bone

153
Q

How does bursitis present?

A

chronic discomfort that might be exacerbated with movement or pressure swelling

154
Q

How does an infected bursa present?

A
  • tense swelling
  • cellulitis
  • malaise
155
Q

How do you treat a) asymptomatic b) tender c) infected bursitis?

A

a) dont b) excise and treat cause c) incise and drain

156
Q

What may painful, spasmodic flat feet indicate?

A
  • infection
  • chronic inflammatory disease
  • impending rupture of tibialis posterior if acute
157
Q

How do you manage painful flat feet?

A

medial heel lift –> subtalar joint fusion (disturbs foot and ankle joint)

158
Q

What is a bunion?

A

fluid-filled bursae around bony prominences

159
Q

Where do bunions most commonly occur?

A

distal part of 1st metatarsal

160
Q

What is a corn?

A

painful excessive skin

161
Q

Why do bunions and corns form?

A

natural response to pressure that indicates underling abnormality

162
Q

What is hallux valgus?

A

the turning away of the phalanges of the big toe from the mid-line, usually because of a deformity at the joint line.

163
Q

What is hallux rigidus?

A

osteoarthritis of the first metatarsophalangeal joint.

164
Q

Why does hallux rigidus occur in adolecents and how do you treat it?

A

osteochondral #

metatarsal bar which often fails then surgery

165
Q

Describe surgical treatment of hallux rigidus

A
  1. remove osteophytes and osteotomy of proximal phalanx
  2. fusion
  3. silicone spacer arthroplasty

( physio also useful)

166
Q

when is hallux valgus seen alone and how is it treated?

A

in women with a short 1st metatarsal in varus

realign laterally and excise bony prominence

167
Q

What is a claw foot? Why does it happen?

A

when muscles waste to make the bones and nails look prominent

occurs due to muscle weakness or deficiency eg spinal abnormality

168
Q

What is hammer toe secondary to?

A

metatarsophalangeal joint disruption

169
Q

What is metatarsalgia?

A

generally sore forefoot

170
Q

What is morton’s neuroma?

A

cutaneous nerves to the toes bcome trapped/irritated between metatarsal heads due to repetitive trauma

171
Q

How does mortons’s neuroma present?

A

dull, throbbing with sharp exacerbations tingling sideways compression causes click

172
Q

Where does the plantar fascia span from?

A

os calcis to base of each toe

173
Q

How does plantar fascitis present?

A

sore instep worse on rising and if sitting for hours minimal relief from walking

174
Q

How do you treat plantar fascitis?

A

self-limiting condition with ways to relieve symptoms

  • insoles and soft shoes
  • local injection of steroids + local anaesthetic to point of tenderness
  • surgery to strip fascia is questionable
175
Q

What is sensory neuropathy?

A

a loss of sensation caused by disease or injury to sensory peripheral nerves.

176
Q

How does achilles tendonitis present?

A

pain where the tendon inserts into os calcis

177
Q

Who gets achilles tendonitis?

A

young athletes middle aged men

178
Q

How do you treat achilles tendon rupture?

A

equinus plaster for 8 weeks or suture

179
Q

What structures can contribute to shoulder pain?

A
  • subacromial bursa
  • supraspinatous tenson
  • Acriomiocalvicular joint
  • biceps tendon
  • rotator cuff
180
Q

What condition presents with tenderness under active movement with painful arc ?

A

supraspinatous tendon inflamamtion or subacromial bursitis

181
Q

What pathology in the acriomioclavicular joint can cause shoulder pain?

A

degenerative change, and osteophytes in the acromio- clavicular joint

may lead to rupture of the supraspinatus muscle which is part of the rotator cuff. Such rotator cuff tears can become large rents and even small ones cause a lot of discomfort and pain.

182
Q

What is frozen shoulder? who gets it?

A

little or no glenohumeral movement idiopathic or after trauma eg epileptic fit or electric shock

183
Q

How long does frozen shoulder last?

A

18 months - 2 years

184
Q

What is the periosteum?

A

the membrane covering the outside of the bone

185
Q

signs of a fracture

A

pain deformity tenderness swelling discolouration loss of function crepitus

186
Q

What determines the position of a) the proximal fragment? b) the distal fragment?

A

a) muscles b) gravity

187
Q

How does a radioisotope scan work?

A

inject radioactive material into blood, it joins to phosphate and is taken up into bone increased at fracture site because it is more metabolically active

188
Q

What is a spiral #?

A

occurs due to twisting injury low energy easy to heal as soft tissues ok

189
Q

What is an oblique fracture?

A

buckling/ shearing force eg deceleration/ fall from height high energy –> hard to heal

190
Q

What is a transverse fracture?

A

bending force, cortex fails on one side in compression and other in tension. high energy –> hard to heal

191
Q

What is displacement?

A

is the distal bone fragment aligned wrong eg posterior/anterior, medial/lateral

192
Q

What is angulation?

A

distal fragment points elsewhere eg posterior/anterior, valgus/varus

193
Q

How can we relieve pain following fracture?

A

drugs: inject morphine or pethidine

splintage to steady #: encompass joint above and below

194
Q

When is traction useful?

A

to help with muscle spasm femoral neck #

195
Q

How much blood is lost in a) femoral #? b) pelvic #? c) tibial #?

A

a) 2-3 units b) 6 units c) 1 unit

196
Q

How do you manage an open fracture?

A

surgery ASAP - may need to open wound and excise down to bone - most left open due to concern over skin closure

197
Q

What are the two stages of fracture management?

A

reduction and holding

198
Q

What must holding allow for?

A

keep # in place until united and consolidated (can weight bear)

199
Q

name types of holding

A

casts internal fixation external fixation traction

200
Q

describe how casting is done

A

place limb in cast at appropriate length immobilise joints above and below pressure at 3 points

201
Q

What are some disadvantages of casting?

A

heavy can’t re-examine muscle wasting due to immobilisation

202
Q

What is a good alternative to casting?

A

functional braces - but these can only be applied after a few weeks once swelling and pain go down

203
Q

When is external fixation useful?

A

high energy injury where there is soft tissue damage

204
Q

Give types of internal fixation

A

apposition interfragmentary compression onlay device inlay device

205
Q

What is apposition? give an example

A

holding a fracture in alignment so it can heal eg K wires

206
Q

What is interfragmentary compression?

A

using screws and tension band wiring

207
Q

what is an onlay device?

A

a rigid metal plate used to strengthen structures around joints and in upper limb long bones

208
Q

Which types of internal fixation stop natural healing?

A

onlay device

209
Q

What is an inlay device?

A

intramedullary

210
Q

When are inlay devices not useful?

A

around joints

211
Q

Give 3 types of traction

A

static: uses own body as pulley
balanced: takes pressure off body by using a weight
dynamic: allows joints to move using pulleys

212
Q

How does traction work as a holding method?

A
  • application of a relatively small weight to a limbexerts a pull along the axis of the broken limb.
  • This pull of at most 5 kilograms stimulates muscles to contract. Muscles completely surround a bone, and this slight contraction (which is really an increase in muscle tone), is sufficient to hold a broken bone in the position achieved at reduction.
  • effectively “massage” the aligned fracture ends until natural healing takes place.
213
Q

Describe fracture healing at a) 0-2 weeks b) 2-6 weeks c) 6-12 weeks

A

a) swelling b) callus forms c) bone forms

214
Q

How do bones heal?

A

with micromovement along the long axis of the bone at right angles to the break

215
Q

Does rigid fixation speed up bone healing?

A

no it slows it down as no movement

216
Q

How can low energy fractures be treated?

A
  1. manipulation and casting 2. traction eg femur 3. internal fixation if early mobilisation
217
Q

How should a displaced, intra-articular fracture be treated?

A

internal fixation screws to hold cancellous bone fragments as there is little soft tissue support

218
Q

How should high energy injuries be treated?

A

external fixation as damage to blood supply

219
Q

What does bone cancer occur secondary to?

A

thyroid kidney breast lung

220
Q

Name 6 early complications that occur due to a fracture

A
  • blood loss
  • infection if open
  • compartment syndrome
  • renal failure
  • soft tissue injury
  • fat embolism
221
Q

name 5 late complications that occur due to a fracture

A
  • non-union
  • delayed union
  • mal-union
  • growth arrest
  • arthritis
    *
222
Q

name 5 early complicatios that occur due to fracture treatment

A

plaster disease renal stones immobility compartment syndrome infection

223
Q

name 2 late complications that occur due to fracture treatment

A

mal-union infection

224
Q

manage a) a stable fracture w infection? b) an unstable fracture w infection

A

a) drain + antibiotics b) external fixation, debridement + then bone graft later

225
Q

How does fat embolism present?

A

men under 20 with long bone # 2-5 days after they have tachypnoea and confusion

226
Q

Treat fat embolism?

A

high % o2 chest physio steroids

227
Q

When does someone get renal failure following a #

A

major soft tissue damage person was trapped ischaemic limb in shock

228
Q

What is a fascial sheath?

A

thick fibrous tissue surrounding a group of muscles

229
Q

How does compartment syndrome happen?

A

causes bleeding and inflammation of adjacent compartment, inc pressure reduces blood flow and causes ischaemia

230
Q

What is fracture/plaster disease?

A

muscle wasting stiffness skin sores

231
Q

How long does normal healing take in a) upper limb b) lower limb compared to non-union?

A

a) 6 weeks then 10 weeks b) 12 weeks then 20 weeks

delayed union somewhere in between

232
Q

Which bone is most commonly affected by non-union?

A

tibia

233
Q

How is non-union treated?

A
  • remove cause
  • stabilise #
  • autologous bone graft
234
Q

What is malunion?

A

fixation of fracture in a bad position for function

235
Q

How is malunion treated?

A

ORIF

236
Q

Why does growth arrest occur following a #?

A

if it breaches the germinal layer of the epiphyseal growth plate

237
Q

What are the radiological changes in AVN?

A

initially none

then bone dense as blood supply lost

238
Q

treat TB

A

2 RIPE 4 RI

- 2 months Rifampicin, Isoniazid, Pyrazinamide, Ethambutol

  • 4 months Rifampicin, Isoniazid
239
Q

Which knee ligament repairs spontaneously and which doesn’t?

A

collateral repair as good blood supply

cruciate don’t

240
Q

What is osteochondritis?

A

fragmentation of bone and underlying cartilage

241
Q

How can a sore, calcified supraspinatous tendon be treated?

A

injection

surgery

242
Q

How to treat painful arc?

A

steroid injection into bursa or around tendon

243
Q

What causes # to the shaft of long bones?

how are they treated

A

most are low energy injuries

treat with

  1. casting and manipultation

use traction if this is difficult

internal fixation is justified if it allows for early mobilisation

Ortho BMSc (14 decks)

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