Orthopaedics Flashcards

Question

Cauda equina syndrome

Answer 1

Lumbar sacral nerve roots that extend beyond the spinal cord are compressed

Answer 2

Disc prolapse (L4/5, L5/S1) Tumours Infection Trauma Haematoma

Answer 3

Lower back pain Bilateral sciatica Reduced perianal sensation Reduced anal tone (do a DRE) Urinary incontinence (late stage sign- insensate) Inability to maintain an erection/numb genitals

Answer 4

Urgent MRI Surgical decompression

Answer 5

Fall onto an outstretched hand Distal radius fracture with dorsal displacement of fragments (and angulation)- think of the MOI (hit ground with outstretched hand, it will get bent back/dorsally) Dinner fork type deformity

Answer 6

2 main fractures causing this are supracondylar and tibial shaft injuries

Answer 7

Pain on passive movement (excessive use of breakthrough analgesia is worrying, pain out of keeping with clinical signs) 6 P’s (presence of pulse doesn’t rule it out however) Death of muscle group in 4-6 hours

Answer 8

MSK exam, observations Bloods- CK, FBC, UE (kidney involvement), CRP Intracompartmental pressures (20+ bad, 40+ diagnostic), nothing on XRay Prompt and extensive fasciotomy, IV fluids (kidneys), consider amputation

Answer 9

Compression of ulnar nerve through the cubital tunnel Tingling and numbness in 4/5th finger, intermittent, then constant Weakness and muscle wasting Pain worse on leaning on affected elbow History of OA or trauma

Answer 10

Avoid aggravating activity Physiotherapy Steroid injections Surgery

Answer 11

Pain on radial side of wrist Tenderness over radial styloid Abduction of thumb against resistance is painful Finkelsteins test- examiner pulls thumb in ulnar deviation and causes pain

Answer 12

Conservative- Immobilisation with thumb splint, physiotherapy Medical- analgesia, steroid injections Surgery- cut the extensor retinaculum, releasing the pressure and creating more space for the tendons (Abductor pollicis longus (APL), Extensor pollicis brevis (EPB))

Answer 13

Back pain Systemic upset- pyrexia, rigors, sepsis Neurological features- changing lower limb neurology if epidural abscess develops

Answer 14

Bacteria- staph aureus (endocarditis) Viral TB Aseptic

Answer 15

Bedside- MSK exam, observations, Mantoux test Bloods- FBC, UE, LFT, CRP, ABG Imaging- echocardiogram (endocarditis vegetation), MRI, CT guided biopsy (to determine effective treatment)

Answer 16

6-8 weeks of IV ABX therapy Complications- sepsis, epidural abscess

Answer 17

Manual labour Phenytoin treatment ALD DM Hand trauma FH, male gender risks

Answer 18

Surgical treatment when MCP’s cannot be straightened and hand cannot be placed flat on a table ie. needle fasciotomy, Limited fasciectomy, Dermofasciectomy (remove skin as well as fascia)

Answer 19

lungs- Tachycardia, tachypnoea, dyspnoea, hypoxia, pyrexia, 72 hours after injury skin- Red brown impalpable petechiae rash, subconjunctival and oral haemorrhage or petechiae brain/eyes- Confusion and agitation, retinal haemorrhages and intra arterial fat globules on fundoscopy May see peripheral ground glass appearance on CTPA NB- diagnosis of exclusion (eg. if D-dimer was negative, CTPA was clear, and symptoms depend on where the embolus travels)

Answer 20

Reduce, stabilise (surgery), preserve blood supply, rehabilitate Immobilise including proximal and distal points Monitor neuro vascular status Manage infection esp. open fractures eg. IV broad spectrum ABX and tetanus prophylaxis Closed- internal fixation device Open- IV ABX, imaging, cover with wet dressing, debrided, lavaged and external fixation within 6 hours Physio, occupational health, pathological- address underlying disease

Answer 21

Women 50-70 Pain over lateral side of hip/thigh Tenderness on palpation of greater trochanter

Answer 22

Haematogenous spread of bacteria eg. Staph aureus Crohns (most common secondary cause) Diverticulitis CRC UTI Endocarditis IVDU

Answer 23

Fever Back/flank pain Limp Weight loss

Answer 24

Supine- knee flexed and hip externally rotated. Place hand on affected side knee and get patient to push (pain) Lie on unaffected side- hyperextend the affected hip (pain)

Answer 25

Usual tests (esp. blood cultures, septic screen) CT abdomen is investigation of choice ABX Percutaneous drainage initial approach Surgery if this fails or intra abdominal pathology

Answer 26

Cause of lateral knee pain in runners Physio referral if activity modification doesn’t work

Answer 27

Mechanism: high twisting force applied to a bent knee (PCL- hyperextension) sudden 'popping' sound knee swelling instability, feeling that knee will give way Anterior drawer test (90 degrees) Lachmann test-30 degrees- better (3mm more than uninsured side) Rapid swelling

Answer 28

Twisting injuries Pain worse on straightening knee Knee may give way Knee locking Delayed swelling Tenderness along joint line (medial or lateral tenderness suggests M/L meniscus) Thessalys test- weight bearing, 20 degrees knee flexion, positive if pain on twisting knee May report popping sensation during injury NB- MRI is initial imaging modality of choice, arthroscopy is gold standard

Answer 29

Age <20 or 50+ Previous malignancy Night pain Pain at rest Radicular, band like pain History of trauma Systemically unwell eg. Weight loss, fever Thoracic pain Cauda equina signs/symptoms

Answer 30

Observations and MSK exam No XRay (unless AS suspected), and only MRI if results may change management and where malignancy/infection/fracture/CES

Answer 31

NSAIDs first line (with PPI) Exercise eg. Physiotherapy Epidural injections of steroids if acute/severe sciatica

Answer 32

Back pain , neuropathic pain, symptoms mimicking claudication How to differentiate from vascular claudication- sitting better than standing, patients find it easier to walk uphill than downhill Treat with laminectomy, always do ABPI to exclude vascular claudication NB- due to degeneration, trauma, iatrogenic (ie. previous surgery), congenital

Answer 33

Lateral femoral cutaneous nerve (LCFN) Obesity Pregnancy Ascites Trauma Iatrogenic (abdominal surgery) Idiopathic

Answer 34

Upper lateral thigh Burning tingling, coldness, shooting pain Numbness Deep muscle ache Aggregated by standing and extending hip, relieved by sitting Mild, may resolve spontaneously, or may be severe Hair loss Signs; Reproduce symptoms by deep palpation belie ASIS or extension of hip Altered sensation over upper lateral aspect of thigh No motor weakness

Answer 35

Nerve conduction studies USS- possible cause

Answer 36

Most commonly fractured and most common mid foot fracture Often follows inversion injury of the ankle

Answer 37

Runners 2nd metatarsal shaft

Answer 38

Usually bilateral CMC and DIP’s affected more than PIP’s Episodic joint pain- worse with movement, relieved by rest Stiffness esp. morning but not as long as RA Swellings eg Heberdens (DIP), Bouchard (PIP)- bony osteophyte formation Squaring if the thumb (fixed adduction) Weak grip Reduced range of motion

Answer 39

Chronic history of groin ache following exercise and relieved by rest

Answer 40

VTE (TED stockings, LMWH 4 weeks after hip replacement, started 6 hours post-op) Intraoperative fracture Nerve injury (sciatic)

Answer 41

Children and young adults Knee pain and swelling typically after exercise Knee catching, locking or giving away Feeling a clunk when flexing or extending the knee Joint effusion Tenderness on palpation of the articular cartilage Wilson’s sign- internal rotation causes pain

Answer 42

Haematogenous- bacteraemia. Sickle cell, IVDU, immunosuppression eg. Steroids or HIV, infective endocarditis Non Haematogenous- spread of infection from adjacent soft tissue or direct injury to bone. Diabetic foot ulcers, DM, PAD, pressure sores, open fractures, joint surgery etc. Staph aureus most common, except in sickle cell where it’s salmonella

Answer 43

MRI Flucloxacillin for 6 weeks (clindamycin if allergic)

Answer 44

Undisplaced with intact extensor mechanisms can be managed non operatively with a hinged brace for 6 weeks Displaced or loss of extensor mechanism- surgery and then knee brace

Answer 45

Caused by 2 or more rib fractures along 3 or more consecutive ribs (anteriorly) Flail segment moves paradoxically during respiration and impairs ventilation of lung on side of injury Surgery and invasive ventilation NB- predisposes to a tension pneumothorax

Answer 46

Conservative- analgesia to ensure breathing isn’t affected by pain, as inadequate ventilation may predispose to chest infection

Answer 47

Shoulder pain worse on abduction Painful arc of abduction (subacromial impingement, between 60 and 120, with tear, may be in first 60) Tenderness over anterior acromion Acute rupture- acute severe pain and loss of strength ie. inability to abduct arm

Answer 48

FOOSH Contact sport eg. Rugby

Answer 49

Dorsal carpal branch (branch of radial artery) retrograde- liable to necrosis if this is damaged

Answer 50

Maximal tenderness over anatomical snuffbox (sensitive but not specific) Wrist joint effusion Pain via telescoping of thumb Tenderness of scaphoid tubercle Pain on ulnar deviation of the wrist

Answer 51

Would do plain film radiographs, but MRI is actually what NICE recommend first line after clinical examination (but not common practice)

Answer 52

Immobilise with futuro splint or standard below elbow backslab before X ray Refer to orthopaedics (if inconclusive- further imaging 7-10 days later) Undisplaced- cast for 6-8 weeks Displaced of proximal scaphoid pole fractures- surgical fixation

Answer 53

Anterior- 95% of cases arm is abducted and externally rotated Posterior- seizure or electric shock Recent dislocation- reduction can be attempted without analgesia/sedation (may require analgesia however) MRI findings (damaged glenoid labrum)- Bankart and Hill-Sachs lesions

Answer 54

Most common upper limb injury in children under 6 Child often refuses examination due to the pain Management- analgesia, passive supination of elbow whilst elbow is flexed at 90 degrees

Answer 55

Spina bifida Cerebral palsy Edwards syndrome (Trisomy 18) Oligohydroamnios

Answer 56

Abnormal flexion of the digits Idiopathic, but associated with women, RA, DM Stiffness and snapping when extending a flexed digit, a nodule may be present Steroid injections, finger splints, surgery if no response

Answer 57

Older age, long term bisphosphanate or corticosteroid use, bone tumour, osteoporosis, low BMI, prior fracture, trauma

Answer 58

A-E, physical exam (neuro vascular), observations Booods Imaging- XRay (2 planes 90 degrees to one another, pre reduction and post reduction)

Answer 59

DVT Acute limb ishcaemia Rhabdomyolysis (crush injury, seizure- causes myalgia and generalised weakness)

Answer 60

Radial nerve

Answer 61

Common peroneal nerve

Answer 62

Median nerve

Answer 63

Axillary nerve

Answer 64

Sciatic nerve

Answer 65

External casts K wires Intramedullary wires Intramedullary nails Screws Plate and screws

Answer 66

X-Ray to rule out fracture Physio, reduced overhead lifting, ICD packs NSAIDs, intrarticular corticosteroid injection, nerve blocks Surgical repair

Answer 67

Think, could it be inflammatory ie. Do I need to check CRP and antibodies to rule out RA or another joint disease (rather than just thinking, okay, this is definitely adhesive capsulitis, think about what to say in OSCE- good to use them as differentials)

Answer 68

Inflammation of hip affecting young children Occur within a week of viral illness, gradual onset of limp, refusal to weight bear, groin or hip pain, positive leg roll, abducted and externally rotated hip, low or mild fever, otherwise well

Answer 69

Ibuprofen and paracetamol Rest Follow up in a few days time with GP NB- safety netting, if they develop fever and symptoms worsen, straight to AE (septic arthritis) NB- child less than 3 with a new onset limp, urgent assessment

Answer 70

Bedside- examination, observations Bloods- FBC ESR CRP VBG UE LFT blood cultures and sensitivities Imaging- X ray (nothing for 2 weeks, then sequestrum, destruction, periostea, reactions), MRI (most sensitive- 5 days) Specialist- bone biopsy (culture and sensitivities)

Answer 71

Local hospital guidelines for IV ABX (2 weeks IV, 4 weeks oral)- flucloxacillin, possibly with rifampicin or fuscidic acid added for the first 2 weeks Consider surgical debridement

Answer 72

Idiopathic a vascular necrosis of the femoral head (unilateral or bilateral, between ages of 4-10)

Answer 73

Slow onset of worsening symptoms (not acute or traumatic), with pain in hip or groin, limp (antalgic gait), restricted hip movements, referred pain to knee

Answer 74

Same as osteomyelitis, but also do MRI if x ray is normal and symptoms persist

Answer 75

Analgesia Mobilisation and physiotherapy Non surgical containment (cast splint) Surgical intervention Regular X rays (assess healing)

Answer 76

Where head of femur is displaced along the growth plate

Answer 77

Typically an obese, adolescent male undergoing a growth spurt (may also be history of minor trauma) Hip, groin, thigh, or knee pain, restricted range of hip movement, antalgic gait, externally rotated hip, restricted movement in hip (internal rotation), trendelenburgs gait, obese

Answer 78

Analgesia Physiotherapy Treat endocrinopathy if relevant Surgical repair

Answer 79

Represents a spectrum of conditions affecting the proximal femur and acetabulum, ranging from acetabula immaturity to hip subluxation and frank hip dislocation (The most common congenital abnormality of skeletal development)

Answer 80

Picked up during newborn examinations or when child presents with hip asymmetry (length/shape), limp, reduced range of movement in hip, asymmetric skin folds, buttock flattening

Answer 81

Looked at during neonatal examination at birth and 6-8 weeks old Findings that suggest it; Different leg lengths Restricted hip abduction on one side Bilateral restriction in abduction Difference in knee level when hips flexed Clunking of hips on special tests (USS)

Answer 82

Conservative- most will heal normally Less than 6 months- Pavlik harness More than 6 months- surgery with hip spica cast

Answer 83

MSK exam Bloods- ESR CRP rheumatoid factor and anti CCP (all to exclude RA), FBC UE LFT (before giving diclofenac) Imaging- XRay affected area

Answer 84

OA of the cervical vertebrae Neck pain, complications- Radiculopathy and myelopathy (carpal tunnel, imbalance, limb stiffness)- refer to neurosurgery immediately Think JW

Answer 85

Avoid flexing hip at 90 degrees Avoid low chairs Don’t cross legs Sleep on back for 6 weeks

Answer 86

LMWH 28 days post elective hip replacement 14 days post elective knee replacement

Answer 87

Trousseaus- hypocalcaemia, carpal spasm when BP cuff inflated above systolic Phalen- carpal tunnel syndrome Chvostek- hypocalcaemia, tapping parotid causes facial muscles to twitch Froments- ulnar nerve palsy Finklesteins- de Quervains tenosynovitis Tinnels- tapping wrist causes pain (carpal tunnel)

Answer 88

Aseptic loosening is the most common reason total hip replacements need to be revised

Answer 89

Conservative- watch and wait, wrist splints Medical- NSAIDs, corticosteroid injections Surgery- surgical carpal tunnel release

Answer 90

Vitamin D is low (this causes osteomalacia) Serum calcium is low Serum phosphate is low Serum alkaline phosphatase may be high Parathyroid hormone may be high (secondary hyperparathyroidism) Xrays may show osteopenia (more radiolucent bones) DEXA scan shows low bone mineral density

Answer 91

Treatment is with supplementary vitamin D (colecalciferol). There are various regimes suggested by the NICE CKS on vitamin D deficiency. They involve correcting the initial vitamin D deficiency with one of the following: 50,000 IU once weekly for 6 weeks 20,000 IU twice weekly for 7 weeks 4000 IU daily for 10 weeks A maintenance supplementary dose for of 800 IU or more per day should be continued for life after the initial treatment. Patients with vitamin D insufficiency can be started on the maintenance dose without the initial treatment regime.

Answer 92

Conservative- rest, weight loss, physiotherapy Medical- paracetamol, NSAID, neuropathic painkillers, steroid injections Surgical- decompression or transection of the nerve (lateral femoral cutaneous nerve)

Answer 93

Inflammation of a bursa over the greater trochanter on the outer hip.

Answer 94

Conservative- Rest, Ice Medical- Analgesia (e.g., ibuprofen or naproxen), Physiotherapy, Steroid injections

Answer 95

Age 55 or above Patella tenderness (with no tenderness elsewhere) Fibular head tenderness Cannot flex the knee to 90 degrees Cannot weight bear (cannot take 4 steps – limping steps still count)

Answer 96

Conservative- RICE, physiotherapy, knee brace Medical- NSAIDs Surgical- repair or reconstruction (arthroscopy) using quadriceps/hamstring tendon

Answer 97

Meniscal- knee locking Collateral ligament- knee instability

Answer 98

Conservative- RICE, physiotherapy, knee brace Medical- NSAIDs Surgical- repair (arthroscopy)

Answer 99

Inflammation at the tibial tuberosity where the patella ligament inserts. Visible or palpable hard and tender lump at the tibial tuberosity

Answer 100

Conservative- Modified activity to avoid exacerbating symptoms, Physiotherapy Medical- Analgesia (e.g., NSAIDs), Steroid injections Further- Ultrasound-guided aspiration

Answer 101

Students elbow Swollen Warm Tender Fluctuant (fluid-filled) It is important to identify where bursitis is caused by infection. Features of infection are: Hot to touch More tender Erythema spreading to the surrounding skin Fever Features of sepsis (e.g., tachycardia, hypotension and confusion) NB- in septic arthritis, it is the elbow joint, not the bursae, that is swollen and erythematous (and reduced ROM)

Answer 102

Students elbow Swollen Warm Tender Fluctuant (fluid-filled) It is important to identify where bursitis is caused by infection. Features of infection are: Hot to touch More tender Erythema spreading to the surrounding skin Fever Features of sepsis (e.g., tachycardia, hypotension and confusion) NB- in septic arthritis, it is the elbow joint, not the bursae, that is swollen and erythematous (and reduced ROM)

Answer 103

Conservative- Rest, Ice, Compression, Protecting the elbow from pressure or trauma Medical- Analgesia (e.g., paracetamol or NSAIDs), Steroid injections may be used in problematic cases (where infection has been excluded) Further- Aspiration of fluid may be used to relieve pressure NB- where infected bursae is suspected, aspirate fluid for miscopy, culture, and sensitivities, and then give flucloxacillin

Answer 104

Conservative- rest, adapt activities, physiotherpay, orthotics Medical- Analgesia (e.g., NSAIDs), Steroid injections Surgical and specialist- Extracorporeal shockwave therapy or surgery to release tendons

Answer 105

Pain in the groin or hip, which may radiate to the knee Not able to weight bear Shortened, abducted, and externally rotated leg

Answer 106

Disruption of blood supply leading to avascular necrosis of the hip

Answer 107

Grade I – incomplete fracture and non-displaced Grade II – complete fracture and non-displaced Grade III – partial displacement (trabeculae are at an angle) Grade IV – full displacement (trabeculae are parallel) III onwards is displaced

Answer 108

Appropriate analgesia Investigations to establish the diagnosis (e.g., x-rays) Venous thromboembolism risk assessment and prophylaxis (e.g., low molecular weight heparin) Pre-operative assessment (including bloods and an ECG) Orthogeriatrics input

Answer 109

Injury of nerve between the 3rd-4th metatarsals Burning, numbness or “pins and needles” felt in the distal toes

Answer 110

Ganglion cysts can appear rapidly (over days) or gradually. Patients present with a visible and palpable lump. It is not usually painful Can disappear on their own, or be drained via needle aspiration

Answer 111

A condition in which the vertebral bodies slip forward in relation to the vertebrae beneath.

Answer 112

Acute onset of severe back pain Stabbing or resembling electric shock (most commonly of the lower back, called lumbago) Radiates to the legs (sciatic pain) or the arms Paraesthesia of affected dermatome Muscle weakness and atrophy Loss of deep tendon reflexes in the indicator muscles Pain increases with pressure (e.g., from coughing or sneezing) Short walks and changing position reduce the pain

Answer 113

Conservative- physiotherapy, modification of activity, TENS device Medical- analgesia, intraarticular steroids Surgical- last resort (often a discectomy)

Answer 114

Mechanical back pain is an umbrella term that covers a range of conditions. These include lumbar muscle sprain/strain, which typically cause spasms on movement, and sometimes stiffness lasting less than 30 minutes. Mechanical back pain is usually aggravated by movements, and certain postures. You would expect it to last 2-4 weeks (longer- think of another diagnosis)

Answer 115

Sudden onset of severe central spinal pain which is relieved by lying down. There may be a history of major trauma (such as a road traffic collision or fall from a height), minor trauma, or even just strenuous lifting in people with osteoporosis or those who use corticosteroids (vertebral wedge fracture) Structural deformity of the spine (such as a step from one vertebra to an adjacent vertebra) may be present. There may be point tenderness over a vertebral body.

Answer 116

The person being 50 years of age or more. Gradual onset of symptoms. Severe unremitting pain that remains when the person is supine, aching night pain that prevents or disturbs sleep, pain aggravated by straining (for example, at stool, or when coughing or sneezing), and thoracic pain. Localised spinal tenderness. No symptomatic improvement after four to six weeks of conservative low back pain therapy. Unexplained weight loss. Past history of cancer — breast, lung, gastrointestinal, prostate, renal, and thyroid cancers are more likely to metastasize to the spine.

Answer 117

X ray not helpful, unless ankylosing spondylitis MRI is imaging modality of choice

Answer 118

Safety net ie. what red flags to look out for, present to AE immediately

Answer 119

The initial management of sciatica is mostly the same as acute low back pain. The NICE clinical knowledge summaries (updated 2020) state not to use medications such as gabapentin, pregabalin, diazepam or oral corticosteroids for sciatica. They state not to use opioids for chronic sciatica. They suggest considering a neuropathic medication if symptoms are persisting or worsening at follow up, but not gabapentin or pregabalin, leaving at the main choices of: Amitriptyline Duloxetine Also physio, intra articular steroids, decompression etc.

Answer 120

The initial management of sciatica is mostly the same as acute low back pain. The NICE clinical knowledge summaries (updated 2020) state not to use medications such as gabapentin, pregabalin, diazepam or oral corticosteroids for sciatica. They state not to use opioids for chronic sciatica. They suggest considering a neuropathic medication if symptoms are persisting or worsening at follow up, but not gabapentin or pregabalin, leaving at the main choices of: Amitriptyline Duloxetine

Answer 121

Young children- rickets Adults- Bone pain, tenderness and proximal myopathy (waddling gait)

Answer 122

Inverted + plantar flexed foot

Answer 123

Injury to the AC joint is relatively common and typically occurs during collision sports such as rugby following a fall on to the shoulder or a FOOSH (falls on outstretched hand). Grade I and II injuries are very common and are typically managed conservatively including resting the joint using a sling. III- case-by-case assessment Grade IV, V and VI are rare and require surgical intervention.

Answer 124

USS or MRI

Answer 125

Conservative- activity modification, home exercises, referral to a physiotherapist Medical- analgesia, intraarticular steroids

Answer 126

Volar angulation of distal radius fragment (Garden spade deformity) Caused by falling backwards onto the palm of an outstretched hand or falling with wrists flexed

Answer 127

Intra-articular fracture of the first carpometacarpal joint Impact on flexed metacarpal, caused by fist fights X-ray: triangular fragment at ulnar base of metacarpal

Answer 128

Dislocation of the proximal radioulnar joint in association with an ulna fracture Fall on outstretched hand with forced pronation Needs prompt diagnosis to avoid disability

Answer 129

Radial shaft fracture with associated dislocation of the distal radioulnar joint Direct blow

Answer 130

Bimalleolar ankle fracture Forced foot eversion

Answer 131

Distal radius fracture (Colles'/Smith's) with associated radiocarpal dislocation Fall onto extended and pronated wrist

Answer 132

Teenage girls, following an injury to knee e.g. Dislocation patella Typical history of pain on going downstairs or at rest Tenderness, quadriceps wasting

Answer 133

More common in athletic teenage boys Chronic anterior knee pain that worsens after running Tender below the patella on examination

Answer 134

Undisplaced- internal fixation, or hemiarthroplasty if unfit. Displaced- arthroplasty (total hip replacement or hemiarthroplasty) NB- 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 -are not cognitively impaired -are medically fit for anaesthesia and the procedure. NB- #NOF is intracapsular (so internal fixation or arthroplasty) NB- X-ray first line, MRI for occult fractures not seen on xray

Answer 135

Stable intertrochanteric fractures: dynamic hip screw Reverse oblique, transverse or sub trochanteric fractures: intramedullary device NB- mobility not a factor

Answer 136

Posterior dislocation: Accounts for 90% of hip dislocations. The affected leg is shortened, adducted, and internally rotated. Anterior dislocation: The affected leg is usually abducted and externally rotated. No leg shortening.

Answer 137

Sciatic or femoral nerve injury Avascular necrosis Osteoarthritis: more common in older patients. Recurrent dislocation: due to damage of supporting ligaments

Answer 138

Prominent clavicle Step deformity

Answer 139

1+2= dynamic hip screw 3+4= throw the joint on the floor ie. arthroplasty

Answer 140

An iliofascial nerve block

Answer 141

Flat feet (pes planus)- resolves 4-8 years In toeing- resolves Out toeing- resolves by 2 years Bow legs (genu varum)- resolves by 4-5 years Knock knees (genu valgum)- resolves

Answer 142

While a meniscal tear can present similar to an ACL injury, you can differentiate the two by the timing of the swelling. ACL injuries swell immediately due to haemarthrosis, meniscal tears typically swell over time.

Answer 143

pass med page

Answer 144

Sciatica; Pain that radiates around the lower back, buttocks and/or leg(s) A tingling sensation in the affected areas Numbness in the affected areas Generalised lower back pain Muscle weakness in the legs Cauda equina. Same Sx as sciatica but also; Bladder/bowel disturbance Numbness around the buttocks, perineum and genitals (saddle anaesthesia) Reduced anal tone Foot drop and poor reflexes in the lower limbs

Answer 145

no findings (OA- LOSS signs)

Answer 146

can cause excessive bleeding

Answer 147

Definitive surgical fixation can be done initially only if it can be followed by definitive soft tissue coverage. However more often than not an external fixation device is used as an interim measure while soft tissue coverage is achieved (which should be done within 72 hours).