Orthopaedics Flashcards
What are some causes of hip pain in adults?
osteoarthritis
inflammatory arthrits
referred lumbar spine pain
avascular necrosis
pubic symphysis dysfunction
trochanteric bursitis
transient idiopathic osteoporosis
meralgia paraesthetica
what is meralgia paraesthetica?
Caused by compression of lateral cutaneous nerve of thigh
Typically burning sensation over antero-lateral aspect of thigh
features of referred lumbar spine pain?
Femoral nerve compression may cause referred pain in the hip
Femoral nerve stretch test may be positive - lie the patient prone. Extend the hip joint with a straight leg then bend the knee. This stretches the femoral nerve and will cause pain if it is trapped
features of trochanteric bursitis?
Due to repeated movement of the fibroelastic iliotibial band
Pain and tenderness over the lateral side of thigh
Most common in women aged 50-70 years
features of transient idiopathic osteoporosis?
An uncommon condition sometimes seen in the third trimester of pregnancy
Groin pain associated with a limited range of movement in the hip
Patients may be unable to weight bear
ESR may be elevated
Causes of avascular necrosis of the hip?
long-term steroid use
chemotherapy
alcohol excess
trauma
Investigation findings for avascular necrosis of hip?
plain x-ray findings may be normal initially. Osteopenia and microfractures may be seen early on. Collapse of the articular surface may result in the crescent sign
MRI is the investigation of choice. It is more sensitive than radionuclide bone scanning
what is a monteggia fracture?
a fracture of the proximal ulna in association with a dislocation of the proximal head of the radius.
what is a galeazzi fracture?
fracture of the distal radius with an associated dislocation of the distal radioulnar joint
what is a colles fracture?
distal radius fracture with dorsal displacement
what is a smiths fracture?
distal radius fracture with volar displacement
what is a bennetts fracture?
a fracture of the base of the first metacarpal, that extends into the carpometacarpal joint
what is a bartons fracture?
Distal radius fracture (Colles’/Smith’s) with associated radiocarpal dislocation
Fall onto extended and pronated wrist
Management of AVN of the hip?
Non-operative -> bisphosphonates
Operative -> core decompression +/- bone grafting (relieves bleeding)
rotational osteotomy
free-fibula transfer
THR
total hip resurfacing
hip arthrodesis (can provide pain relief)
Indications for surgical management of AVN of hip?
core decompression and bone graft - early AVN
rotational osteotomy - small lesions <15 degrees
free-fibula transfer - pre/post collapse
total hip resurfacing - small focus of AVN in end disease
how is risk of femoral head collapse estimated?
modified Kerboul angle - add arc of femoral head necrosis on mid sagittal and mid coronary MRI
Low risk <190
mod risk 190-240
high risk >240
Complications of supracondylar humeral fracture?
brachial artery injury
median nerve injury (anterior interosseous branch - deep flexors (FPL, FDP, pronator quadrates))
radial nerve
compartment syndrome
gunstock deformity (cubitus varus)
why is the scaphoid prone to AVN?
Retrograde blood supply
80% from dorsal carpal branch of radial artery
Classification for NOF fractures?
gardner
Classification for supracondylar fractures?
gartland
Classification for scaphoid fractures?
Mayo classification
Classification for perilunate instability?
Mayfield classification
Classification for tibial plateau fracture?
Schatzker
what is out common long bone fracture?
tibial
(also most common long bone open fracture)
What is a pott’s fracture?
bimalleolar fracture
What is a cotton’s fracture?
trimalleolar fracture
what is a pilon fracture?
a fracture of distal tibia involving the articular surface
- excessive axial loading through feet
- falls from height
rude-allgower classification
what is a maisonneuve fracture?
where high twisting injuries disrupt syndesmosis- high fibular fracture
request long length XR if widening of syndesmosis on ankle XR
What is weber classification?
talar shift/fibular fracture
A: below syndesmosis
B: at syndesmosis
C: above syndesmosis
Mx lower back pain?
- self mx, physical exercise
- NSAIDs 1st line + PPI, neuropathic pain agent for sciatica
- exercise programme, radio frequency denervation, epidural injections of LA and steroid
What does positioning patient in the Lloyd Davies position increase risk of?
peroneal nerve neuropraxia
foot drop
What are the clinical features of a fat embolism?
Resp: Early persistent tachycardia
Tachypnoea, dyspnoea, hypoxia usually 72 hours following injury
Pyrexia
Derm: Red/ brown impalpable petechial rash (usually only in 25-50%)
Subconjunctival and oral haemorrhage/ petechiae
CNS: Confusion and agitation
Retinal haemorrhages and intra-arterial fat globules on fundoscopy