Orthopaedic Red Flags Flashcards
What usually happens in avascular necrosis of the scaphoid?
Normally, fracture demineralises
Can see change on x-ray quite quickly
How can you tell there is avascular necrosis of the scaphoid on plain film?
Proximal pole quite dense
What fracture of the wrist is common with a fall on outstretched hand?
Scaphoid fracture
If you do not see a fracture on plain x-ray after a fall on outstretched hand, what modality do you use to image, and what does it show?
CT scan
Can show displacement
What is the gold standard for scaphoid fractures?
MRI
What used to be done for suspected scaphoid fractures that were not visible on x-ray?
Splint wrist > re-x-ray in a week
Is a bone scan useful in detecting a scaphoid fracture?
Not immediately
How long do scaphoid fractures take to heal?
In cast, 90% heal in 6 weeks
What are the potential complications of a scaphoid fraacture?
Avascular necrosis
Non-union scaphoid > osteoarthritis = SNAC wrist
Non-union scaphoid > sometimes persistent pain
What is a SNAC wrist?
Scaphoid
Non-union
Advanced
Collapse
What is a Colles fracture?
Fracture of distal radius with dorsal and radial displacement of wrist and hand
In what sort of injury is a Colles fracture common?
Fall on outstretched hand
Why is it a bad sign if the ulnar is also involved in a Colles fracture?
Instability ++
What are the options for anaesthesia for manipulation and plaster of a Colles fracture?
Bier block > highly dangerous
Prolocaine
Intra-haematomal block
Sedation
In what position is a Colles fracture immobilised?
Flexion and ulnar deviation
What is the sail, or rosethorn, sign?
Elevation of anterior fat pad in elbow, visible on x-ray
Because haematoma pushes it out
In what fracture is the sail sign seen?
In children, commonly with supracondylar fracture
In adults, commonly with radial head fracture
What happens if a displaced radial head fracture is missed?
Malunion
Affects pronation and supination
Why is a radial head fracture not put in a cast?
Oedema can’t escape > fibrous deposit
What is done with a radial head fracture for comfort?
Put in sling
Later, get them to flex and extend elbow
What clinical findings in a suspected radial head fracture might you expect, which would encourage you to investigate further in the absence of diagnostic x-rays?
Tenderness of radial head
Intense pain due to tense haemarthrosis
Not much swelling because haematoma contained
In what sort of dislocation of the shoulder can an x-ray look normal?
Posterior dislocation
What is the lightbulb sign?
Abnormal AP radiograph appearance of humeral head in posterior shoulder dislocation
Looks like light bulb
What is the lesion common after recurrent anterior dislocations of the shoulder?
Hill-sachs lesion = posterolateral humeral head compression fraction
What is the lesion common after recurrent posterior dislocations of the shoulder?
Reverse Hill-Sachs lesion = McLaughlin lesion = impaction fracture of anteromedial humeral head
What is chondromalacia patellae?
= “Runner’s knee”
Cartilage on under-surface of kneecap deteriorates and softens
What are the symptoms of chondromalacia patellae?
Common in young, athletic people
Episodic pain
Inability to sit with knees flexed for long time without extending
Self-limiting
What is a sun-raised spicule on plain x-ray a sign of?
Osteosarcoma
What causes a sun-raised spicule?
Periosteum trying to heal
Why is septic arthritis an orthopaedic emergency?
Pus very corrosive > destroys articular cartilage
What are the principles of treatment of septic arthritis?
Drain and wash out joint
Identify organism
Appropriate Abx
What associated features should you look for with sacral fractures?
Disruption of pelvic girdle
What sort of neck of femur fractures should can be difficult to see on the A-P view of the pelvis? What should you do?
Impacted, undisplaced neck of femur fractures
Check trabecular lines
Consider further imaging
What other site should you check in an elderly or osteopaenic patient with hip pain after a fall?
Pubic rami, especially if no neck of femur fracture
What tibial fractures can be subtle?
Fractures of tibial plateua, especially if margins of plateau not displaced
What clavicular injury can be fatal?
Dislocation of medial end
How are dislocations of the medial end of the clavicle diagnosed?
Can’t diagnose with x-ray
Have to get CT
What should you consider in a 11-13 year-old child who has had a limp for 4-5 days?
Slipped upper femoral epiphysis
- Common in males
- Commin in Pacific Islanders
- Surgical emergency
What is a slipped upper femoral epiphysis?
Capital epiphysis not yet fused
Get stress fracture through it
