Orthopaedics Flashcards
How should acute osteomyelitis be managed?
- Analgesia
- Rest and splintage
- Fluclox and Benpen for 4-6 weeks
- Surgery
How can chronic osteomyelitis be managed?
- Long term antibiotics (local: gentamicin cement or systematic)
- Surgery
- ?Amputation
How can acute septic arthritis be managed?
- Supportive
- Flucloxacillin (3-4 weeks)
- Surgical drainage and lavage
- Infected joint replacements (one or two stages)
How does compartment syndrome present?
- PAIN
- Pulselessness
- Pale
- Perishingly cold
- Paralysed
How should compartment syndrome be managed initially?
- Keep limb at neutral level
- Oxygen if needed
- Stabilise blood pressure
- Remove splints, casts and dressings
- Analgesia
What is the definitive management for compartment syndrome?
-Emergency fasciotomy
What are the complications of compartment syndrome?
- Acute limb ischaemia
- Rhabdomyolysis
- Hyperkalaemia
How can an open fracture be managed?
- Realignment and splinting
- Broad spectrum antibiotics
- Tetanus vaccine
- Debridment
Which tests are used to diagnose carpal tunnel syndrome?
- Phalen (flexing the wrist for 60 seconds)
- Tinels (tapping lightly over the median nerve)
How can carpal tunnel syndrome be managed?
- May resolve on its on
- Splint
- NSAIDs
- Corticosteroids
- Surgical release of the nerve
- Physiotherapy
Which nerve is affected in cubital tunnel syndrome?
Ulnar nerve
How does a cubital tunnel syndrome present?
- Wasting and weakness of the small muscles of the hand
- Clawing of the ring and little finger
- Numbness and tingling along the little finger
- Pain and tenderness at the cubital tunnel
- Tinels sign and elbow flexion test
How can cubital tunnel syndrome be managed?
- Physiotherapy
- Splinting
- Painkillers
- Surgical decompression and surgical transposition
What is the most common type of shoulder dislocation?
Anterior
How can shoulder dislocations be managed?
- Reduction, immobilisation and rehabilitation
- Assess neurovascular status
- Broad arm sling
- Physiotherapy
What is a Colle’s fracture?
An extra-articular fracture of the distal radius with dorsal angulation and displacement
What is a Smith’s fracture?
An extra-articular fracture of the distal radius with volar angulation
What is a Barton’s fracture?
An intra-articular fracture of the distal radius with associated dislocation of the radio-carpal joint
How can distal radial fractures be managed?
- Traction and manipulation under anaesthesia
- ORIF with K wire fixation for displaced or unstable fractures
- Below elbow backslab cast
- Physiotherapy
Which nerve can be damaged in humeral shaft fractures?
Radial nerve
How can humeral shaft fractures be managed?
- Realignment
- Humeral brace (high elbow casts for distal fractures)
- ORIF
- Intramedullary nails for pathological fractures
Which neurovascular structures can be damaged in proximal humeral fractures?
- Axillary nerve
- Circumflex vessels
How can proximal humeral fractures be managed?
- Early mobilisation
- Pendular exercises
- Polysling
- Surgical management: displaced, open or NV compromised
How does an achilles tendon rupture present?
- Sudden onset severe pain
- Popping sound
- Loss of plantarflexion
How can an achilles tendon rupture be managed?
- Analgesia
- Ankle splinted in plaster
- Surgical tendon repair
How can ankle lateral ligament injury be managed?
- Rest, ice, compression and elevation
- NSAIDs
- Surgery
How can an anterior cruciate ligament tear be managed?
- X-ray and MRI
- Rest, ice, compression and elevation
- Physio to strengthen the quads to support the knee
- Surgical reconstruction
How can MCL tears be managed?
- Grade 1: RICE, analgesia and strength training
- Grade 2: Analgesia, knee brace and weight bearing
- Grade 3: knee brace and crutches
How does a posterior dislocation of the hip present?
A shortened and internally rotated hip which is flexed and adducted
How can a dislocation of the hip be managed?
- Analgesia
- Reduction under general anaesthetic`
How does an anterior dislocation of the hip present?
- Pain in the hip
- Inability to weight bear or adduct the leg
- Externally rotated, abducted and extended
What is a central dislocation of the hip?
The head of the femur is driven through the acetabular floor
How can meniscal tears be managed?
- RICE
- Small tears will heal in their own
- Larger tears may need arthroscopic surgery
How can neck of femur fractures be managed?
- Displaced subcapital: hemiarthroplasty
- Inter-trochanteric: dynamic hip screw
- Intra-capsular: (non-displaced) cannulated hip screws
- Displaced intra-capsular: arthroplasty
- Sub-trochanteric: intramedullary nail
How can pelvic fractures be managed?
- Primary survey
- Resuscitation
- Pelvic binder
- Surgical or conservative management
How does subacromial impingement present?
- Progressive pain in the anterior superior shoulder
- Pain exacerbated by abduction
- Weakness and stiffness
How can subacromial impingement be managed?
- NSAIDs
- Physiotherapy
- Steroid injections
- Injections
How does a frozen shoulder present (adhesive capsulitis)?
- Deep pain
- Joint stiffness
- Loss of arm swing
- External rotation and flexion most affected
How can a frozen shoulder be managed?
-Analgesia
-Steroid injections
-Joint manipulation under
GA
-Surgical release of the glenohumeral joint capsule
How do rotator cuff tears present?
- Lateral pain
- Inability to abduct the arm above 90 degrees
- Tenderness over the greater tuberosity
How can rotator cuff tears be managed?
- Analgesia
- Physiotherapy
- Steroid injections
- Surgical repair
How can elbow dislocations be managed?
- Closed reduction
- Elbow backslab
- Open fixation (fractures or NV compromise)
How does tennis elbow present?
- Pain and tenderness over the lateral epicondyle of the humerus
- Pain on resisted dorsiflexion of the wrist
How does Golfer’s elbow present?
- Pain and tenderness at the medial epicondyle
- Aggravated by wrist flexion and pronation
How can Tennis and Golfer’s elbow be managed?
- Modify activites
- Steroid injection
- Orthotics
- Physiotherapy
- Surgery (if refractory to a long period of conservative management)
How does Dupuytren’s disease present?
- Painless
- Loss of finger extension
How can Dupuytren’s disease be managed?
- Observe
- NO splints
- Radiotherapy
- Partial fasciectomy
- Collagenase
How does trigger finger present?
- Clicking sensation with movement
- Lump in palm
- Locking
How can trigger finger be managed?
- Splintage
- Steroid
- Percutaneous release
- Open surgery
How does De Quervain’s syndrome present?
- Pain localised to radial side of the wrist
- Aggravated by movement of the thumb
How can De Quervain’s syndrome be managed?
- Splints
- Steroid injection
- Decompression
How does a radial nerve injury present?
- Wrist drop
- Sensory loss to the dorsal surface of the lateral three digits
How does a hand flexor tendon injury present?
Loss of active flexion strength
How should scaphoid fractures be managed?
- Undisplaced: immobilisation
- Displaced: operatively
- All fractures of the proximal pole should be surgically fixed
How do osteosarcomas show on X-rays?
- Codman’s triangle
- Sunburst pattern
How do Ewing’s sarcomas show on x-rays?
- Paediatric
- Lytic lesion with periosteal reactions
- Onion skin appearance
How do chondrosarcomas show on x-rays?
- Lytic lesions
- Calcification
- Cortical remodelling
- Endosteal scalloping
