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Year 6 Medicine > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

What are some causes of hip pain in adults?

A

osteoarthritis
inflammatory arthrits
referred lumbar spine pain
avascular necrosis
pubic symphysis dysfunction
trochanteric bursitis
transient idiopathic osteoporosis
meralgia paraesthetica

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2
Q

what is meralgia paraesthetica?

A

Caused by compression of lateral cutaneous nerve of thigh
Typically burning sensation over antero-lateral aspect of thigh

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3
Q

features of referred lumbar spine pain?

A

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

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4
Q

features of trochanteric bursitis?

A

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

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5
Q

features of transient idiopathic osteoporosis?

A

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

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6
Q

Causes of avascular necrosis of the hip?

A

long-term steroid use
chemotherapy
alcohol excess
trauma

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7
Q

Investigation findings for avascular necrosis of hip?

A

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

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8
Q

what is a monteggia fracture?

A

a fracture of the proximal ulna in association with a dislocation of the proximal head of the radius.

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9
Q

what is a galeazzi fracture?

A

fracture of the distal radius with an associated dislocation of the distal radioulnar joint

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10
Q

what is a colles fracture?

A

distal radius fracture with dorsal displacement

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11
Q

what is a smiths fracture?

A

distal radius fracture with volar displacement

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12
Q

what is a bennetts fracture?

A

a fracture of the base of the first metacarpal, that extends into the carpometacarpal joint

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13
Q

what is a bartons fracture?

A

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

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14
Q

Management of AVN of the hip?

A

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)

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15
Q

Indications for surgical management of AVN of hip?

A

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

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16
Q

how is risk of femoral head collapse estimated?

A

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

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17
Q

Complications of supracondylar humeral fracture?

A

brachial artery injury
median nerve injury (anterior interosseous branch - deep flexors (FPL, FDP, pronator quadrates))
radial nerve

compartment syndrome

gunstock deformity (cubitus varus)

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18
Q

why is the scaphoid prone to AVN?

A

Retrograde blood supply
80% from dorsal carpal branch of radial artery

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19
Q

Classification for NOF fractures?

A

gardner

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20
Q

Classification for supracondylar fractures?

A

gartland

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21
Q

Classification for scaphoid fractures?

A

Mayo classification

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22
Q

Classification for perilunate instability?

A

Mayfield classification

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23
Q

Classification for tibial plateau fracture?

A

Schatzker

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24
Q

what is out common long bone fracture?

A

tibial
(also most common long bone open fracture)

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25
What is a pott's fracture?
bimalleolar fracture
26
What is a cotton's fracture?
trimalleolar fracture
27
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
28
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
29
What is weber classification?
talar shift/fibular fracture A: below syndesmosis B: at syndesmosis C: above syndesmosis
30
Mx lower back pain?
1. self mx, physical exercise 2. NSAIDs 1st line + PPI, neuropathic pain agent for sciatica 3. exercise programme, radio frequency denervation, epidural injections of LA and steroid
31
What does positioning patient in the Lloyd Davies position increase risk of?
peroneal nerve neuropraxia foot drop
32
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
33
what is seen on imaging of a fat embolism?
May be normal Fat emboli tend to lodge distally and therefore CTPA may not show any vascular occlusion, a ground glass appearance may be seen at the periphery
34
Treatment of fat embolism?
Prompt fixation of long bone fractures Some debate regarding benefit Vs. risk of medullary reaming in femoral shaft/ tibial fractures in terms of increasing risk (probably does not). DVT prophylaxis General supportive care
35
What is compartment syndrome most associated with?
supracondylar and tibial shaft fractures
36
Features of compartment syndrome?
Pain, especially on movement (even passive) - excessive use of breakthrough analgesia should raise suspicion for compartment syndrome Parasthesiae Pallor may be present Arterial pulsation may still be felt as the necrosis occurs as a result of microvascular compromise Paralysis of the muscle group may occur
37
What is Finkelstein test +ve?
pain over radial styloid on forced abduction/flexion of the thumb = tenosynovitis
38
Features of De Quervain's tenosynovitis?
pain on the radial side of the wrist tenderness over the radial styloid process abduction of the thumb against resistance is painful Finkelstein's test +VE
39
Mx of De Quervain's tenosynovitis?
analgesia steroid injection immobilisation with a thumb splint (spica) may be effective surgical treatment is sometimes required
40
What are some causes of subacromial impingement?
Intrinsic: Muscular weakness Shoulder overuse Degenerative tendinopathy Extrinsic: Scapular muscle dysfunction Glenohumeral instability Anatomical variation
41
What is subacromial impingement?
anything that reduces subacromial space [supraspinatus]
42
what is subcoracoid impingement?
narrowing at the coracohumeral interval impinges the ligaments of: - subscapularis - the long head of the biceps - the middle glenohumeral ligament
43
RF for Achilles tendon disorders?
quinolone use (e.g. ciprofloxacin) is associated with tendon disorders hypercholesterolaemia (predisposes to tendon xanthomata)
44
What is cubital tunnel syndrome?
Cubital tunnel syndrome is caused by compression of the ulnar nerve and can present with tingling/numbness of the 4th and 5th finger Caused by ulna nerve entrapment at the elbow
45
Causes of carpal tunnel syndrome?
idiopathic pregnancy oedema e.g. heart failure lunate fracture rheumatoid arthritis
46
Mx of carpal tunnel?
corticosteroid injection wrist splints at night surgical decompression (flexor retinaculum division)
47
S/S carpal tunnel?
pain/pins and needles in thumb, index, middle finger unusually the symptoms may 'ascend' proximally patient shakes his hand to obtain relief, classically at night weakness of thumb abduction (abductor pollicis brevis) wasting of thenar eminence (NOT hypothenar) Tinel's sign: tapping causes paraesthesia Phalen's sign: flexion of wrist causes symptoms
48
What are anterior and posterior shoulder dislocations associated with?
Anterior shoulder dislocation is associated with FOOSH; while posterior shoulder dislocation is more likely associated with seizures and electric shock
49
what movement is impaired in adhesive capsulitis?
External rotation (on both active and passive movement) is classically impaired both active and passive movement is affected
50
associations of adhesive capsulitis?
diabetes
51
what muscles of the hand does the median nerve supply?
LOAF lateral two lumbricals opponens pollicis abductor pollicis brevis flexor pollicis brevis FDP lateral and FCR
52
What are the contents of the carpal tunnel?
medial nerve flexor pollicis longus (FPL) flexor carpi radialis (FCR) FDP (flexor digitorum profundus) FDS (flexors digitorum superficialis)
53
What muscles does the ulnar nerve supply?
hypothenar medial lumbricals interossei adductor pollicis FDP (medial) FCU
54
Associations of Dupuytren's contracture?
BAD FIBERS Bent penis(Peyronie's) AIDS DM FHx (AD) Idiopathic (MOST COMMON) Booze Epilepsy and epilepsy meds (phenytoin) Reidel's thyroiditis and other fibromatoses Smoking
55
difference between common peroneal nerve palsy and L5 radiculopathy?
Common peroneal nerve lesion can cause weakness of foot dorsiflexion and foot eversion (in L5 radiculopathy, eversion tends to be spared while inversion is weak and sensory involvement tends to be greater)
56
Features of common peroneal nerve palsy?
weakness of foot dorsiflexion weakness of foot eversion weakness of extensor hallucis longus sensory loss over the dorsum of the foot and the lower lateral part of the leg wasting of the anterior tibial and peroneal muscles
57
What is a Colles fracture?
Fall onto extended outstretched hands Described as a dinner fork type deformity
58
What are the 3 typical features of Colles fracture?
Transverse fracture of the radius 2. 1 inch proximal to the radio-carpal joint 3. Dorsal displacement and angulation
59
What is a Bennett's fracture?
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
60
What is a Smith's fracture?
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
61
What is a Monteggia fracture?
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
62
What is a Galaezzi fracture?
Radial shaft fracture with associated dislocation of the distal radioulnar joint Occur after a fall on the hand with a rotational force superimposed on it. On examination, there is bruising, swelling and tenderness over the lower end of the forearm. X Rays reveal the displaced fracture of the radius and a prominent ulnar head due to dislocation of the inferior radio-ulnar joint.
63
Normal femur neck shaft angle?
130 +/- 7 degrees, and 10 +/- 7 degrees of neck anteversion.
64
Typical presentation of a NOF fracture?
pain in the hip/groin, a shortened, abducted, externally rotated leg inability to straight-leg-raise
65
Best imaging for NOF?
XR first line but if inconclusive: mri gold standard (CT if more appropriate)
66
How are extra capsular NOF fractures classified?
pertrochanteric or subtrochanteric (within 5cm distal to the lesser trochanter)
67
Causes of avascular necrosis?
P ancreatitis L upus A lcohol S teroids T rauma I diopathic, infection C aisson disease, collagen vascular disease R adiation, rheumatoid arthritis A myloid G aucher disease S ickle cell disease
68
What is the best classification for open fractures?
Gustillo and Anderson
69
Clinical features of perthes?
Males 4x's greater than females Age between 2-12 years (the younger the age of onset, the better the prognosis) Limp Hip pain Bilateral in 20%
70
What staging system is used for Perthes?
Catterall staging
71
Diagnosis of perthes?
Plain x-ray, Technetium bone scan or magnetic resonance imaging if normal x-ray and symptoms persist.
72
Mx of perthes?
-To keep the femoral head within the acetabulum: cast, braces -If less than 6 years: observation -Older: surgical management with moderate results -Operate on severe deformities
73
What is Scheuermann's disease?
Epiphysitis of the vertebral joints is the main pathological process Predominantly affects adolescents Symptoms include back pain and stiffness
74
Xray and clinical features of scheuermann's ?
X-ray :epiphyseal plate disturbance and anterior wedging Clinical features: progressive kyphosis (at least 3 vertebrae must be involved)
75
what is scoliosis?
curvature of the spine in the coronal plane
76
Types of structural scoliosis?
idiopathic, congential and neuromuscular
77
Three categories of spina bifida?
myelomeningocele, spina bifida occulta and meningocele
78
What is Spondylolysis?
Congenital or acquired deficiency of the pars interarticularis of the neural arch of a particular vertebral body, usually affects L4/ L5 - maybe be asymptomatic - affects 5% of population
79
What is Spondylolisthesis?
-One vertebra is displaced relative to its immediate inferior vertebral body - can be due to stress fracture or spondylolysis Traumatic cases may show the classic 'Scotty Dog' appearance on plain films
80
Mx of spondylolisthesis?
spinal decompression and stabilisation
81
Early and late evidence of avascular necrosis on X-ray?
Early: area appearing as being more radio-opaque due to hyperaemia and resorption of the neighboring area. Late: Radiolucency and subchondral collapse

Year 6 Medicine (18 decks)

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