Orthopaedics Flashcards
What are muscles and joints?
Muscles allow movement of bone across joints. Joints include hinge, ball and socket, pivot and gliding. Classifications include fibrous, cartilaginous or synovial.
What are ligaments and tendons?
Ligaments join bone to bone to contribute to joint stability. Muscles attach to bones using tendons.
What is osteomyelitis?
Presents like septic arthritis but often more indolent, subacute presentation following on the background of local infection. This is often the case in a diabetic foot ulcer which if not appropriately managed, can erode into nearby bone and cause osteomyelitis.
Osteomyelitis secondary
Usually secondary to embolic phenomenon so have a low threshold for suspecting it alongside infective endocarditis and new onset back pain.
What would a lower limb neck of femur fracture look like?
Shortened and externally rotated.
This is due to the relative strength of the psoas muscle pulling the femur upwards. Due to its medial insertion, there is an external rotational component.
How do you deal with a fracture?
- Reduce fracture (functional reduction)
- Stabilise fracture - non-surgical (splint) or surgery (external and internal fixation)
- Rehabilitate
What is a mechanical fracture?
Fall due to the environment e.g. trip
What is a non-mechanical fracture?
Result of something pathological e.g. stroke
How do you treat intra-capsular fractures?
- Undisplaced: internal fixation or hemiarthroplasty if unfit
- Displaced: replacement arthroplasty (total hip replacement or hemiarthroplasty) to all patients with a displaced intracapsular hip fracture
Total hip replacement is favoured to hemiarthroplasty if patients: - were able to walk independently out of doors with no more than the use of a stick and
- are not cognitively impaired and
- are medically fit for anaesthesia and the procedure.
How would you examine a hip dislocation?
Inspection:
- Posterior: limb is shortened, adducted and internally rotated
- Anterior: abducted and externally rotated
Move: ask patient to move legs up (active movement)
What is an oblique fracture?
Transmitted from further away, not a direct hit
What is a transverse fracture?
Direct hit, more soft tissue damage
What is a pathological fracture?
Pre-existing bone disease e.g. cancer, osteoporosis
How would you treat an intra-capsular hip fracture?
Undisplaced: fix
Displaced: replace
How would you treat an extra-capsular hip fracture?
- Stable intertrochanteric fractures: dynamic hip screw
- Reverse oblique, transverse or subtrochanteric fracture: intramedullary device
