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Finals > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

Osteoarthritis signs hands

A

Heberden’s nodes (in the DIP joints)

Bouchard’s nodes (in the PIP joints)

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2
Q

VTE prophylaxis post joint replacement

A

28 days post elective hip replacement

14 days post elective knee replacement

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3
Q

Most common prosthetic joint infection organism

A

Staphylococcus aureus

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4
Q

Prosthetic Joint Infections mx

A

joint irrigation, debridement or complete replacement.

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5
Q

compound fracture

A

skin is broken and the broken bone is exposed to the air

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6
Q

stable fracture

A

sections of bone remain in alignment

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7
Q

pathological fracture

A

bone breaks due to an abnormality within the bone

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8
Q

Fractures specific to children

A

Greenstick and buckle fractures typically occur in children

Salter-Harris fractures only occur in children (adults do not have growth plates).

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9
Q

Colle’s fracture

A

transverse fracture of the distal radius

posteriorly (upwards), causing a “dinner fork deformity”

fall onto an outstretched hand (FOOSH).

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10
Q

scaphoid fracture

A

sign of a scaphoid fracture is tenderness in the anatomical snuffbox

scaphoid has a retrograde blood supply, with blood vessels supplying the bone from only one direction. This means a fracture can cut off the blood supply, resulting in avascular necrosis and non-union.

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11
Q

fall onto an outstretched hand (FOOSH) fractures

A

Colle’s fracture

scaphoid fracture

Smith’s fracture

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12
Q

Bones with vulnerable blood supply

A

scaphoid bone

the femoral head

the humeral head

the talus, navicular and fifth metatarsal in the foot.

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13
Q

Ankle fracture classification

A

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

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14
Q

Pathological fracture cancers

A 
Po – Prostate
R – Renal 
Ta – Thyroid
B – Breast
Le – Lung
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15
Q

first-line medical treatments for reducing the risk of fragility fractures

A

Calcium and vitamin D

Bisphosphonates (e.g., alendronic acid)

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16
Q

Principles of Fracture Management

A

Mechanical alignment

Relative stability

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17
Q

Methods to achieve mechanical alignment

A

Closed reduction via manipulation of the limb

Open reduction via surgery

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18
Q

Methods to achieve relative stabiliy

A 
External casts (e.g., plaster cast)
K wires
Intramedullary wires
Intramedullary nails
Screws
Plate and screws
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19
Q

fat embolism syndrome diagnosis

A

Gurd’s criteria
Gurd’s major criteria:

Respiratory distress
Petechial rash
Cerebral involvement

Many Gurd’s minor criteria, including:

Jaundice
Thrombocytopenia
Fever
Tachycardia

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20
Q

fat embolism syndrome

A

supportive while the condition improves.

The mortality rate is around 10%.

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21
Q

Hip fracture categorisation

A

Intra-capsular fractures

Extra-capsular fractures

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22
Q

Intracapsular hip fracture categorisation

A

Garden classification

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)

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23
Q

Non-displaced vs displaced management

A

Non-displaced can fix femoral head by internal fixation

If displaced, may mean blood supply compromised - sp head of femur must be replaced

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24
Q

Extra-capsular management

A

Intertrochanteric fractures - dynamic hip screw/sliding hip screw.

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25
Q

Hip Fracture Presentation

A

Shortened, abducted and externally rotated leg

26
Q

Reverse oblique/ transverse / Subtrochanteric fractures mx

A

intramedullary nail/device

27
Q

Compartment syndrome presentation

A

P – Pain “disproportionate” to the underlying injury, worsened by passive stretching of the muscles
P – Paresthesia
P – Pale
P – Pressure (high)
P – Paralysis (a late and worrying feature)

28
Q

Compartment syndrome management

A

Needle manometry to measure pressure

Escalating to the orthopaedic registrar or consultant
Removing any external dressings or bandages
Elevating the leg to heart level
Maintaining good blood pressure (avoiding hypotension)

Emergency fasciotomy

debride any necrotic muscle tissue

29
Q

Compartment syndrome definition

A

pressure within a fascial compartment is abnormally elevated, cutting off the blood flow to the contents of that compartment.

30
Q

acute osteomyelitis: abx mx

A

6 weeks of flucloxacillin, possibly with rifampicin or fusidic acid added for the first 2 weeks

Alternatives to flucloxacillin are:

Clindamycin in penicillin allergy
Vancomycin or teicoplanin when treating MRSA

31
Q

Acute osteomyelitis mx

A

Surgical debridement of the infected bone and tissues

Antibiotic therapy

32
Q

potential signs of osteomyelitis on an x-ray

A 
Periosteal reaction (changes to the surface of the bone)
Localised osteopenia (thinning of the bone)
Destruction of areas of the bone
33
Q

osteomyelitis presentation

A

Fever
Pain and tenderness
Erythema
Swelling

34
Q

osteomyelitis Mechanisms

A

Haematogenous osteomyelitis

direct contamination

35
Q

osteomyelitis most common causative organism`

A

Staphylococcus aureus

36
Q

Sciatica nerve roots

A

L4 – S3

  • greater sciatic foramen
  • divides into the tibial nerve and the common peroneal nerve. at the knee
37
Q

Sciatica mx

A

Amitriptyline
Duloxetine

advanced:

Epidural corticosteroid injections
Local anaesthetic injections
Radiofrequency denervation
Spinal decompression

38
Q

Rotator cuff muscles

A

S – Supraspinatus – abducts the arm
I – Infraspinatus – externally rotates the arm
T – Teres minor – externally rotates the arm
S – Subscapularis – internally rotates the arm

39
Q

Underlying causes of bilateral carpal tunnel syndrome

A

rheumatoid arthritis, diabetes, acromegaly or hypothyroidism

40
Q

Special tests for carpal tunnel syndrome

A

Phalen’s test

Tinnel’s test

41
Q

Surgical management of carpal tunnel

A

flexor retinaculum incision for tension relief

42
Q

Adhesive capsulitis

(frozen shoulder) aetiology and symptoms

A

(frozen shoulder) Common in middle-age and diabetics

Characterised by painful, stiff movement

Limited movement in all directions, with loss of external rotation and abduction in about 50% of patients

43
Q

Supraspinatus tendonitis

A

Rotator cuff injury

Painful arc of abduction between 60 and 120 degrees

Tenderness over anterior acromion

44
Q

cubital tunnel syndrome description

A

compression of the ulnar nerve and can present with tingling/numbness of the 4th and 5th finger

45
Q

De Quervain’s tenosynovitis presentation

A

pain on movement of the thumb/wrist. The radial styloid may be hardened and thickened.

46
Q

Radial tunnel syndrome presentation

A

tingling/numbness/pain along the back of the hand and forearm.

47
Q

Oblique fracture

A

Fracture lies obliquely to long axis of bone

48
Q

Comminuted fracture

A

> 2 fragments

49
Q

Segmental fracture

A

More than one fracture along a bone

50
Q

Transverse fracture

A

Perpendicular to long axis of bone

51
Q

Spiral fracture

A

Severe oblique fracture with rotation along long axis of bone

52
Q

Open vs Closed fracture classification system

A

Gustilo and Anderson classification system

53
Q

Gustilo and Anderson classification system

A

1 Low energy wound <1cm

2 Greater than 1cm wound with moderate soft tissue damage

3 High energy wound > 1cm with extensive soft tissue damage

3 A (sub group of 3) Adequate soft tissue coverage

3 B (sub group of 3) Inadequate soft tissue coverage

3 C (sub group of 3) Associated arterial injury

54
Q

Lateral pain in keen runners

A

iliotibial band syndrome

55
Q

locking and swelling of the knee joint

A

Osteochondritis dissecans

56
Q

anterior knee pain worsened by going up or down stairs

A

Patellofemoral pain syndrome

57
Q

pain in the lateral cutaneous nerve of the thigh distribution

A

Meralgia parasthetica

58
Q

Triad of symptoms for fat embolism

A

Gurd’s criteria

Respiratory
Neurological
Petechial rash (tends to occur after the first 2 symptoms)

59
Q

Ottowa knee rules

A

Inability to weight bear both immediately and during the consultation for four steps (inability to transfer weight twice onto each lower limb regardless of limping).

Inability to flex the knee to 90 degrees.

Tenderness of the head of the fibula.

Isolated tenderness of the patella (no bone tenderness of the knee other than the patella).

Age 55 years or older.

60
Q

Weber Classification for fibula fracture

A

Type A is below the syndesmosis

Type B fractures start at the level of the tibial plafond and may extend proximally to involve the syndesmosis

Type C is above the syndesmosis which may itself be damaged

Finals (18 decks)

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