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Surgery Block > Orthopaedic Surgery > Flashcards

Orthopaedic Surgery Flashcards

1
Q

Which classification is used to describe intracapsular neck of femur fractures?

A

Garden classification

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2
Q

What are the four different stages in the garden classification?

A

1- incomplete fracture of the neck
2- complete without displacement
3- complete with partial displacement
4- complete femoral neck fracture with full displacement

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3
Q

In the <60 age group are neck of femur fractures more common in men or women?

A

Men

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4
Q

What is Homan’s sign?

A

Assesses presence of DVT by forcing dorsiflex ion of the foot

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5
Q

What are some X-ray findings with early and late rheumatoid arthritis?

A

Early: loss of joint space, juxta-articular osteopenia, soft tissue swelling

Late: periarticular erosions, subluxation

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6
Q

What is a compound fracture?

A

Where the skin is broken and the broken bone is exposed to air

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7
Q

What is a pathological fracture?

A

When a fracture occurs due to an abnormality within the bone

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8
Q

Which fractures typically occur in children rather than adults?

A

Green stick, buckle and salter-Harris (growth plate fracture)

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9
Q

What is a key sign on examination indicating scaphoid fracture?

A

Tenderness in anatomical snuffbox

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10
Q

Which bones are at risk of avascular necrosis when they fracture?

A

Femoral head, scaphoid, humeral head, talus, navicular, 5th metatarsal

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11
Q

How is the distal portion of bone displaced in a Colle’s fracture? Which deformity does this give rise to?

A

The potion of bone distal to the fracture will be displaced posteriorly, causing a dinner fork deformity

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12
Q

Where will a Weber’s A ankle fracture be located?

A

Below the syndemosis

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13
Q

Where will a Weber’s B ankle fracture be located?

A

At the level of the syndesmosis

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14
Q

Where will a Weber’s C ankle fracture be located?

A

Above the level of the syndesmosis,

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15
Q

What are the main cancers which metastasise to the bones? (PoRTaBLe)

A 
P-prostate
R- renal
T- thyroid
B- breast
L- lung
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16
Q

What investigation is used to measure bone density?

A

DEXA scan

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17
Q

What tool helps us predict a patient’s risk of a fragility fracture?

A

FRAX tool

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18
Q

What are the first line medications used to reduce risk of fragility fractures?

A

Calcium and vitamin D, Bisphophonates (alendronic acid)

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19
Q

Into which two groups can extracapsular be broken down into?

A

Inter-trochanteric, sub-trochanteric

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20
Q

What bloods would you request for a patient with suspected neck of femur fracture?

A

FBC, U+Es, clotting, group and save, CK (if a long lie)

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21
Q

What would be the chosen surgical management for a displaced sub capital/ intracapsular neck of femur fracture?

A

Total or hemiarthroplasty

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22
Q

What would be the chosen surgical management for a inter-trochanteric neck of femur fracture?

A

Dynamic hip screw

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23
Q

What would be the chosen surgical management for a non-displaced intracapsular neck of femur fracture?

A

Cannulated hip screws

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24
Q

What would be the chosen surgical management for a sub trochanteric neck of femur fracture?

A

Intermedullary femoral nail

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25
Q

What is a neck of femur fracture classified using Garden classification as grade 1?

A

Non-displaced, incomplete fracture

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26
Q

What is a neck of femur fracture classified using Garden classification as grade 2?

A

Non-displaced, complete fracture

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27
Q

What is a neck of femur fracture classified using Garden classification as grade 3?

A

Complete fracture, partially displaced

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28
Q

What is a neck of femur fracture classified using Green classification as grade 4?

A

Full displacement

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29
Q

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?

A

Total hip replacement

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30
Q

How will a neck of femur fracture typically present?

A

Shortened, abducted and externally rotated leg
Pain in hip which may radiate to hip
Unable to weight bear

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31
Q

Valgus deformity of the knee associated with chronic pain makes you consider which differential?

A

Rheumatoid arthritis

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32
Q

Varus deformity of the knee associated with chronic pain makes you consider which differential?

A

Osteoarthritis

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33
Q

What sign of X-ray is an indication of pseudo gout?

A

Chondrocalcinosis

E.g in the knee this will appear as linear calcifications of menisci and articular cartilage

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34
Q

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?

A
  • 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
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35
Q

What is pathophysiology of dupuytren’s contracture?

A

Fibroplastic hyperplasia and altered collagen matrix of the longitudinal palmar fascia causing it to thicken and contract

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36
Q

What are the main risk factors for dupuytren’s contracture?

A

Smoking, alcoholic liver cirrhosis, diabetes, occupational exposure (vibration tools, manual work)

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37
Q

Which digits are most commonly involved in dupuytren’s contracture?

A

Little finger and ring finger

38
Q

What is Hueston’s test? (Tabletop test)

A

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

39
Q

What non-surgical management options are available for dupuytren’s contracture?

A

Hand therapy, injectable CCM (collagenase clostridium histolyticum)

40
Q

What is the surgical treatment of dupuytren’s contracture?

A

Fasciectomy

41
Q

What is the pathophysiology of trigger finger?

A

Localised nodal formation on the tendon after following tenosynivitis

42
Q

How can trigger finger present?

A

Painless clicking/snapping/catching of the affected digit on extension, as node gets pulled through the pulley

43
Q

How can trigger finger be managed?

A

Splinting at night, steroid injections, surgery

44
Q

What type of cell is responsible for repairing and maintaining cartilage?

A

Chondrocytes

45
Q

At what age do NICE suggest a diagnosis of osteoarthritis can be made without any investigations, provided there are symptoms and no red flags?

A

Over 45

46
Q

What are the options for elective joint replacement surgery?

A

Total joint replacement, hemiarthroplasty, partial joint resurfacing

47
Q

What medication may be used during an elective joint replacement surgery to minimise blood loss?

A

Tranexamic acid

48
Q

What duration of LMWH do the NICE guidelines recommend after an elective hip replacement?

A

28 days

49
Q

What duration of LMWH do the NICE guidelines recommend after an elective knee replacement?

A

14 days

50
Q

What organism is the most common cause of prosthetic joint infections?

A

Staphylococcus aureus

51
Q

What is the key complication associated with scaphoid fractures?

A

Avascular necrosis and non-union

52
Q

What monoclonal antibody reduces the risk of fractures relating to osteoporosis? How does it work?

A

Denosumab, blocks the activity of osteoclasts

53
Q

What are the options for achieving the mechanical alignment of a fracture?

A

Open or closed reduction

54
Q

What term is used to describe the slow healing of a fracture?

A

Delayed union

55
Q

What criteria are used to establish a diagnosis of a fat embolism?

A

Gurd’s criteria

56
Q

What is the target timeline for operating on a hip fracture?

A

Within 48 hours

57
Q

What does disruption to Shenton’s line indicate?

A

Neck of femur fracture

58
Q

What are the two most notable types of acute injury that lead to compartment syndrome?

A

Crush injuries and bone fractures

59
Q

What are the presenting features of compartment syndrome?

A

Disproportionate pain, pale, paraesthesia, paralysis, high pressure

60
Q

What bacteria most commonly causes osteomyelitis?

A

Staphylococcus aureus

61
Q

What antibiotic would you give for acute osteomyelitis in patiets with diabetes? For how long?

A

Flucloxacillin for 6 weeks

62
Q

What type of cancer causes typical red/purple skin lesions and is most often seen in patients with end-stage HIV?

A

Kaposi’s sarcoma

63
Q

What condition causes waking up with a unilaterally stiff and painful neck due to muscle spasm?

A

Torticollis

64
Q

What are the top three causes of unilateral sciatica?

A

Herniated disc, Spondylolithesis, spinal stenosis

65
Q

Why would a bladder scan be indicated in a patient with back pain?

A

To assess for urinary retention in suspected cauda equina

66
Q

What type of analgesia is first line for acute lower back pain?

A

NSAIDs

67
Q

What medication options are available for persistent sciatica symptoms?

A

Amitriptyline, duloxetine

68
Q

What tool can be use to stratify the risk of a patient presenting with acute back pain developing chronic back pain?

A

STarT Back Screening tool

69
Q

What is the most common cause of cauda equina?

A

Herniated disc

70
Q

What are the three types of spinal stenosis?

A

Central stenosis- narrowing of central spinal canal
Lateral stenosis- narrowing of the nerve root canals
Foramina stenosis- narrowing of intervertebral foramina

71
Q

What is the key presenting feature of central lumbar spinal stenosis?

A

Intermittent neurogenic claudication

72
Q

What movements make lumbar spinal stenosis better/worse?

A

Better on leaning forward

Worse on standing straight and waking

73
Q

What are bursae?

A

Sacs made of synovial membrane filled with a small amount of synovial fluid

74
Q

What resisted movements can be used to establish a diagnosis of trochanteric bursitis?

A

External and internal rotation, abduction of hip

75
Q

What two special tests are traditionally used to assess for meniscal tears?

A

McMurray’s test and Apley grind test

76
Q

What is Foucher’s sign?

A

When a baker’s cyst is most apparent when the knee is extended but disappears on flexion

77
Q

What will be seen on analysis of fluid aspirated from a joint affected by gout?

A

Needle shaped crystals which are negatively birefringent of polarised light- mono sodium urate crystals

78
Q

What is the usual first line treatment in an acute flare of gout?

A

NSAIDs

79
Q

What medication may be used for an acute flare of gout in a patient with chronic kidney disease?

A

Colchicine

80
Q

What is allopurinol used for?

A

Gout prophylaxis

81
Q

What is allopurinol mechanism of action?

A

Xanthine oxidase inhibitor which reduces Uric acid levels in the body

82
Q

Which muscles are supplied by the axillary nerve?

A

Deltoid and teres minor

83
Q

What would a milky fluid on aspiration of a swollen olecranon bursa suggest?

A

Gout or pseudogout

84
Q

What two clinical tests can be used to assess for tennis elbow?

A

Mill’s test and Cozen’s test

85
Q

Which tendons are affected in De Quervain’s tenosynovitis?

A

Extensor pollicis brevis and abductor pollicis longus

86
Q

What clinical test is used to assess DE Quervain’s tenosynovitis?

A

Finkelstein’s

87
Q

On ankle X-ray what size would be normal for the medial clear space and tibio-fibular overlap?

A

Medial clear space <4mm

Tibio-fibular overlap >1mm

88
Q

What are some complications specific to hip replacement surgery?

A

Damage to neurovascular structure, limb length discrepancy, loosening of prosthesis, malignment

89
Q

What are some red flags for back pain?

A 
Age <20 or >50
History of previous malignancy
Night pain
History of trauma
Systemically unwell
90
Q

What may been seen on examination in a patient with facet joint pathology causing back pain?

A

Pain worse on extension of spine

Tenderness over the facets

Surgery Block (6 decks)

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