Orthopaedics Flashcards
What is haematogenous osteomyelitis?
When a pathogen is carried through the blood and is seeded in the bone
What is the most common cause of osteomyelitis?
Staphlococcus aureus
What is the presentation of ostoemyelitis?
Fever
Pain and tenderness
Erythema
Swelling
What are the X-ray changes in osteomyelitis?
Periosteal reaction
Localised osteopenia
Destruction
What is the best form of imaging to establish a diagnosis of osteomyelitis?
MRI
What is the management of osteomyelitis?
Surgical debridement
Antibiotic therapy
(6 weeks of flucloxacilin)
What is a compound fracture?
when the skin is broken and the broken bone is exposed to the air
What is a salter harris fracture?
Growth plate fracture
Which 3 types of fractures occur more commonly in children
greenstick and buckle. Salter harris can only happen in children
What is the colle’s fracture? What is its common mechanism of injury?
Transverse fracture of the distal radius near the wrist. This causes the distal portion to displace posteriorly causing a “dinner fork deformity”
Usually causes by fall onti outstretched hand (FOOSH)
What is the key sign of a scaphoid fracture?
Tenderness in the anatomical snuffbox
What is the classification system used to grade ankle fractures?
Weber classification
What are the 3 levels of weber classification?
Type A – below the ankle joint – will leave the syndesmosis intact
Type B – at the level of the ankle joint – the syndesmosis will be intact or partially torn
Type C – above the ankle joint – the syndesmosis will be disrupted
What are the most common sites for pathological fracture?
femur and vertebral bodies
Which cancers can commonly metastasise to bone?
My PB KTL
Myeloma Prostate Breast Kidney Thyroid Lung
What does a T score of >-1 correlate to?
Normal bone
What does a T score of -1 to -2.5 correlate to?
osteopenia
What does a T score of less than -2.5 correlate to?
Osteoporosis
What are the first line medical treatments for reducing the risk of fragility fractures?
Calcium and vitamin D
Bisphosphonates
What are the potential side effects of bisphosphonates?
Reflux and oesophageal erosions
Atypical fractures
Osteonecrosis of the jaw
Osteonecrosis of the external auditory canal
What is the first line investigation of a suspected fracture?
X ray from 2 views
Which criteria are used to diagnose fat embolism syndrome?
Gurd’s criteria
What are Gurd’s major criteria?
Resp distress
Petechial rash
Cerebral involvement
What is the time target for surgery when someone has been diagnosed with a hip fracture?
Within 48 hours
What are the two categories of hip fractures?
Intra-capsular and extra- capsular
What is a complication of fracturing the intra-capsular neck of femur?
Avascular necrosis
Which classification system is used to describe intra-capsular hip fractures?
The garden classification
What are the grades of garden classification?
Grade I- incomplete and non displaced
Grade II- complete and non-displaced
Grade III- partially displaced (trabuclae are at an angle
Grade IV- fully displaced
How can non-displaced intra-capsular fractures be managed?
Internal fixation
How should displaced intracapsular fractures be managed?
If low mobility/ high morbidity then hemiarthroplasty
if good health, total hip replacement
How are intertrochanteric fractures managed?
Dynamic hip screw
How are subtrochanteric fractures managed?
Intermedullary nail
What is the classic sign on presentation with NOF fracture?
Shortened, abducted and externally rotated leg
What is a key sign of fractured NOF on X-ray?
Disruption of shentons line
What is compartment syndrome?
Pressure within a fascial compartment is abnormally high which cuts off blood flow to the contents of that compartment
How does acute compartment syndrome present?
5 Ps- Pain Paresthesia Pale Pressure Paralysis
How can the pressure in a compartment be measured?
Needle manometry
What is the initial management of compartment syndrome? (pre-surgical)
Escalating to ortho consultant
Removing external dressing and bandages
Elevating the leg to heart level
Avoid hypotension
What is the definitive management of compartment syndrome?
Emergency fasciotomy
Where is the most common site for sarcoma to metastasise to?
The lungs
What is torticollis?
Waking up with a unilaterally stiff and painful neck due to muscle spasm
Where do the spinal nerves come together to form the sciatic nerve?
L4-S3
Where does the sciatic nerve exit?
Greater sciatic foramen
What does the sciatic nerve divide into at the back of the knee?
Tibial nerve and common peroneal nerve
What does the sciatic nerve supply?
Sensation to the lateral lower leg and motor to the posterior thigh, lower leg and foot.
What is bilateral sciatica a red flag for?
Cauda equina syndrome
Which test can be done on examination to aid a diagnosis of sciatica?
Sciatic stretch test
Where does the spinal cord terminate?
L2/L3
What do the nerves of cauda equina supply?
Sensation to perineum, bladder and rectum
Motor innervation to lower limbs
What is the management of cauda equina?
immediate hospital admission
Emergency MRI
Lumbar decompression
What is a feature of metastatic cord compression which differentiates it from cauda equina?
Back pain is worse on coughing or straining
What is spondylolisthesis?
Anterior displacement of a vertebra out of line with one below
What is the key feature of spinal stenosis and what are its features?
Pseudoclaudication
Symptoms of lower back pain, buttock and leg pain and leg weakness are absent at rest but occur with standing and walking. Bending forward improves the symptoms
What are the investigations for spinal stenosis?
MRI is the primary imaging investigation
Other investigations to rule out peripheral arterial disease should be done
What is the management of spinal stenosis?
Exercise and weight loss
Analgesia
Physiotherapy
Decompression surgery
Which nerve is compressed in meralgia paraesthetica?
lateral femoral cutaneous nerve
What is the presentation of meralgia paraesthetica?
Sensation of the skin on the upper-outer thigh is affected. Patients may describe burning, numbness, pins and needles and cold sensation.
Worsens with extension of the hip
What is the presentation of trochanteric bursitis?
Resisted abduction, internal and external rotation of the hip
Pain- worsens with activity or with sitting for a long time
What are the management options of trochanteric bursitis?
Rest Ice Analgesia Physio Steroid therapy
Which type of movement most commonly causes meniscal tears?
Twisting movements
What are the two special tests for meniscal tears?
McMurray’s and Apley grind test
What are the ottowa knee rules for X-ray?
Age 55 or above Patella tenderness Fibular head tenderness Cannot flex knee to 90 degrees cannot weight bear
Any= xray
What is the gold standard for diagnosing meniscal tear?
Arthroscopy
What are the classic symptoms of meniscal tear?
A “pop”
Rapid swelling
Instability
Locking
In an ACL injury, how does the instability of the joint present?
The tibia can move anteriorly below the femur
Which test can be performed on examination which can assess for ACL damage?
Anterior drawer test
What is the first line investigation for ACL damage?
MRI
What is the management of ACL injury?
RICE
NSAIDs
Crutches and braces
Arthroscopic surgery
What is Osgood-Schlatter disease caused by?
Inflammation of the tibial tuberosity
What is the presentation of osgood schlatter disease?
Visible or palpable lump at tibial tuberocity
Pain on the anterior aspect of the knee
Pain is exacerbated by physical activity
What is Foucher’s sign?
When a patient with a Baker’s cyst flexes their knee to 45 degrees, the cyst becomes lest apparent
Which test can be performed on examination to confirm achilles tendon rupture?
Simmonds’ calf squeeze test
Which medication has a strong association with achilles tendinopathy and rupture?
Fluroquinalone antibiotics
What is the typical presentation of achilles tendon rupture?
Sudden onset calf pain
Snapping sensation
Feeling as though something has hit them in the back of the leg
What is the management of achilles tendon rupture?
RICE
VTE prophylaxis
Immobilise for 6-12 weeks or reattach the achilles in theatre
What type of crystals cause gout?
Urate
What does joint fluid aspiration in gout show?
Needle shaped crystals which are negatively bifringent of polarised light
What is the other name for frozen shoulder?
Adhesive capsulitis
What causes frozen shoulder?
Inflammation and fibrosis in the joint which leads to adhesions which binds to the capsule and causes it to tighten around the joint
What are the 3 phases of the course of disease in frozen shoulder?
- Painful phase
- Stiff phase
- Thawing phase
What is the management of frozen shoulder?
Analgesia Physio Steroid injections (intra-articular) Hydrodilatation Athroscopy
Which pathology is the empty can test positive in?
Supraspinatus tedinopathy
Which muscles make up the rotator cuff?
S- supraspinatus
I- infraspinatus
T- teres minor
S- Subscapularis
How does a rotator cuff tear present?
Shoulder pain
Weakness and pain associated with the specific muscle which is related to the site of tear
What are the diagnostic tests for rotator cuff tear?
X rays dont show soft tissue tears
Ultrasound or MRI scans are diagnostic
What are the management options for rotator cuff tears?
rest, analgesia and physio
or
surgery
What is subluxation?
Partical dislocation of the shoulder. The ball does not fully come out of the socket and pops back into place
Which type of shoulder dislocation makes up ~90% of cases?
Anterior
Which mechanisms of injury are usually associated with a posterior shoulder dislocation?
Electric shocks and seizures
Which nerve can be damaged in shoulder dislocation and what is the presentation of this?
Axillary nerve damage
Loss of sensation in the “regimental badge area” and motor weakness in the deltoid and teres minor
Which special test can be used to assess for shoulder instability?
The apprehension test
What is “student’s elbow”?
Olecranon bursitis
What is the management of olecranon bursitis?
Aspiration, microscopy and culture.
Flucloxacillin (clarithromycin as an alternative)
What is lateral epicondylitis?
Tennis elbow
What is medial epicondylitis?
Golfer’s elbow
What is DeQuervain’s tenosynovitis?
Inflammation and swelling of the tendon sheaths in the wrist
Which two tendons are primarily affected in DeQuervain’s tenosynovitis?
Abductor pollicis longus
Extensor pollicis brevis
Which test can confirm DeQuervain’s tenosynovitis?
Finkelstein’s test.
How does trigger finger present?
When the finger is extended from a flexed position, the finger locks or gets stuck in a bent position. It then may release suddenly with a painful pop or click
What is a test for dupuytren’s contracture on examination?
Table-top test
What is the management of dupuytren’s contracture?
Needle fasciotomy
Limited fasciectomy
Which nerve is compressed in carpal tunnel syndrome?
Median nerve
What are the 2 special tests for carpal tunnel syndrome?
Phalen’s test and Tinnel’s test
