Orthopaedic Surgery Flashcards
Which classification is used to describe intracapsular neck of femur fractures?
Garden classification
What are the four different stages in the garden classification?
1- incomplete fracture of the neck
2- complete without displacement
3- complete with partial displacement
4- complete femoral neck fracture with full displacement
In the <60 age group are neck of femur fractures more common in men or women?
Men
What is Homan’s sign?
Assesses presence of DVT by forcing dorsiflex ion of the foot
What are some X-ray findings with early and late rheumatoid arthritis?
Early: loss of joint space, juxta-articular osteopenia, soft tissue swelling
Late: periarticular erosions, subluxation
What is a compound fracture?
Where the skin is broken and the broken bone is exposed to air
What is a pathological fracture?
When a fracture occurs due to an abnormality within the bone
Which fractures typically occur in children rather than adults?
Green stick, buckle and salter-Harris (growth plate fracture)
What is a key sign on examination indicating scaphoid fracture?
Tenderness in anatomical snuffbox
Which bones are at risk of avascular necrosis when they fracture?
Femoral head, scaphoid, humeral head, talus, navicular, 5th metatarsal
How is the distal portion of bone displaced in a Colle’s fracture? Which deformity does this give rise to?
The potion of bone distal to the fracture will be displaced posteriorly, causing a dinner fork deformity
Where will a Weber’s A ankle fracture be located?
Below the syndemosis
Where will a Weber’s B ankle fracture be located?
At the level of the syndesmosis
Where will a Weber’s C ankle fracture be located?
Above the level of the syndesmosis,
What are the main cancers which metastasise to the bones? (PoRTaBLe)
P-prostate R- renal T- thyroid B- breast L- lung
What investigation is used to measure bone density?
DEXA scan
What tool helps us predict a patient’s risk of a fragility fracture?
FRAX tool
What are the first line medications used to reduce risk of fragility fractures?
Calcium and vitamin D, Bisphophonates (alendronic acid)
Into which two groups can extracapsular be broken down into?
Inter-trochanteric, sub-trochanteric
What bloods would you request for a patient with suspected neck of femur fracture?
FBC, U+Es, clotting, group and save, CK (if a long lie)
What would be the chosen surgical management for a displaced sub capital/ intracapsular neck of femur fracture?
Total or hemiarthroplasty
What would be the chosen surgical management for a inter-trochanteric neck of femur fracture?
Dynamic hip screw
What would be the chosen surgical management for a non-displaced intracapsular neck of femur fracture?
Cannulated hip screws
What would be the chosen surgical management for a sub trochanteric neck of femur fracture?
Intermedullary femoral nail
What is a neck of femur fracture classified using Garden classification as grade 1?
Non-displaced, incomplete fracture
What is a neck of femur fracture classified using Garden classification as grade 2?
Non-displaced, complete fracture
What is a neck of femur fracture classified using Garden classification as grade 3?
Complete fracture, partially displaced
What is a neck of femur fracture classified using Green classification as grade 4?
Full displacement
An elderly patient has a displaced intracapsular NOF fracture, they can walk independently and are fit for surgery. What surgical management should they be offered?
Total hip replacement
How will a neck of femur fracture typically present?
Shortened, abducted and externally rotated leg
Pain in hip which may radiate to hip
Unable to weight bear
Valgus deformity of the knee associated with chronic pain makes you consider which differential?
Rheumatoid arthritis
Varus deformity of the knee associated with chronic pain makes you consider which differential?
Osteoarthritis
What sign of X-ray is an indication of pseudo gout?
Chondrocalcinosis
E.g in the knee this will appear as linear calcifications of menisci and articular cartilage
According to the Ottawa rules, an ankle X-ray is required is there is any pain in the malleolus zones and one of what other findings?
- bony tenderness at the lateral malleolus zone
- bony tenderness at the medial malleolus zone
- inability to walk four weight bearing steps immediately after injury and in ED
What is pathophysiology of dupuytren’s contracture?
Fibroplastic hyperplasia and altered collagen matrix of the longitudinal palmar fascia causing it to thicken and contract
What are the main risk factors for dupuytren’s contracture?
Smoking, alcoholic liver cirrhosis, diabetes, occupational exposure (vibration tools, manual work)
Which digits are most commonly involved in dupuytren’s contracture?
Little finger and ring finger
What is Hueston’s test? (Tabletop test)
See if patient is able to lay their palm flat on a tabletop- if they are unable to do so this is a positive test
What non-surgical management options are available for dupuytren’s contracture?
Hand therapy, injectable CCM (collagenase clostridium histolyticum)
What is the surgical treatment of dupuytren’s contracture?
Fasciectomy
What is the pathophysiology of trigger finger?
Localised nodal formation on the tendon after following tenosynivitis
How can trigger finger present?
Painless clicking/snapping/catching of the affected digit on extension, as node gets pulled through the pulley
How can trigger finger be managed?
Splinting at night, steroid injections, surgery
What type of cell is responsible for repairing and maintaining cartilage?
Chondrocytes
At what age do NICE suggest a diagnosis of osteoarthritis can be made without any investigations, provided there are symptoms and no red flags?
Over 45
What are the options for elective joint replacement surgery?
Total joint replacement, hemiarthroplasty, partial joint resurfacing
What medication may be used during an elective joint replacement surgery to minimise blood loss?
Tranexamic acid
What duration of LMWH do the NICE guidelines recommend after an elective hip replacement?
28 days
What duration of LMWH do the NICE guidelines recommend after an elective knee replacement?
14 days
What organism is the most common cause of prosthetic joint infections?
Staphylococcus aureus
What is the key complication associated with scaphoid fractures?
Avascular necrosis and non-union
What monoclonal antibody reduces the risk of fractures relating to osteoporosis? How does it work?
Denosumab, blocks the activity of osteoclasts
What are the options for achieving the mechanical alignment of a fracture?
Open or closed reduction
What term is used to describe the slow healing of a fracture?
Delayed union
What criteria are used to establish a diagnosis of a fat embolism?
Gurd’s criteria
What is the target timeline for operating on a hip fracture?
Within 48 hours
What does disruption to Shenton’s line indicate?
Neck of femur fracture
What are the two most notable types of acute injury that lead to compartment syndrome?
Crush injuries and bone fractures
What are the presenting features of compartment syndrome?
Disproportionate pain, pale, paraesthesia, paralysis, high pressure
What bacteria most commonly causes osteomyelitis?
Staphylococcus aureus
What antibiotic would you give for acute osteomyelitis in patiets with diabetes? For how long?
Flucloxacillin for 6 weeks
What type of cancer causes typical red/purple skin lesions and is most often seen in patients with end-stage HIV?
Kaposi’s sarcoma
What condition causes waking up with a unilaterally stiff and painful neck due to muscle spasm?
Torticollis
What are the top three causes of unilateral sciatica?
Herniated disc, Spondylolithesis, spinal stenosis
Why would a bladder scan be indicated in a patient with back pain?
To assess for urinary retention in suspected cauda equina
What type of analgesia is first line for acute lower back pain?
NSAIDs
What medication options are available for persistent sciatica symptoms?
Amitriptyline, duloxetine
What tool can be use to stratify the risk of a patient presenting with acute back pain developing chronic back pain?
STarT Back Screening tool
What is the most common cause of cauda equina?
Herniated disc
What are the three types of spinal stenosis?
Central stenosis- narrowing of central spinal canal
Lateral stenosis- narrowing of the nerve root canals
Foramina stenosis- narrowing of intervertebral foramina
What is the key presenting feature of central lumbar spinal stenosis?
Intermittent neurogenic claudication
What movements make lumbar spinal stenosis better/worse?
Better on leaning forward
Worse on standing straight and waking
What are bursae?
Sacs made of synovial membrane filled with a small amount of synovial fluid
What resisted movements can be used to establish a diagnosis of trochanteric bursitis?
External and internal rotation, abduction of hip
What two special tests are traditionally used to assess for meniscal tears?
McMurray’s test and Apley grind test
What is Foucher’s sign?
When a baker’s cyst is most apparent when the knee is extended but disappears on flexion
What will be seen on analysis of fluid aspirated from a joint affected by gout?
Needle shaped crystals which are negatively birefringent of polarised light- mono sodium urate crystals
What is the usual first line treatment in an acute flare of gout?
NSAIDs
What medication may be used for an acute flare of gout in a patient with chronic kidney disease?
Colchicine
What is allopurinol used for?
Gout prophylaxis
What is allopurinol mechanism of action?
Xanthine oxidase inhibitor which reduces Uric acid levels in the body
Which muscles are supplied by the axillary nerve?
Deltoid and teres minor
What would a milky fluid on aspiration of a swollen olecranon bursa suggest?
Gout or pseudogout
What two clinical tests can be used to assess for tennis elbow?
Mill’s test and Cozen’s test
Which tendons are affected in De Quervain’s tenosynovitis?
Extensor pollicis brevis and abductor pollicis longus
What clinical test is used to assess DE Quervain’s tenosynovitis?
Finkelstein’s
On ankle X-ray what size would be normal for the medial clear space and tibio-fibular overlap?
Medial clear space <4mm
Tibio-fibular overlap >1mm
What are some complications specific to hip replacement surgery?
Damage to neurovascular structure, limb length discrepancy, loosening of prosthesis, malignment
What are some red flags for back pain?
Age <20 or >50 History of previous malignancy Night pain History of trauma Systemically unwell
What may been seen on examination in a patient with facet joint pathology causing back pain?
Pain worse on extension of spine
Tenderness over the facets
