Orthopaedics Flashcards
How does fat embolism present?
Fever
Petechial rash
Respiratory distress
Cerebral involvement
After fracture of long bone
What are signs of a scaphoid fracture?
Tenderness over the anatomical snuffbox Pain on ulnar deviation Pain on telescoping of the thumb Wrist joint effusion Loss of grip/pinch strength
What is a subtrochanteric hip fracture and how is it managed?
Fracture below the lesser trochanter
managed with intramedullary screw
What is seen on XR in osteomyelitis?
Periosteal reaction
Local osteopenia
Cortical loss
Bone lysis
How is sciatica managed?
1) NSAIDs/codeine
2) Amitriptyline/Duloxetine
What are causes of spinal stenosis?
Herniated disc
Degenerative changes
Spinal fracture
Which nerve is compressed in meralgia paraesthetica?
Lateral femoral cutaneous nerve
What is Osgood-Schlatter disease?
Growth of the tibial tuberosity due to multiple minor avulsion fractures
Leads to tender lump on tibial tuberosity
What are RF for achilles tendinopathy?
Quinolone abx
Sports
Increased cholesterol (due to tendon xanthomata)
What is Morton’s neuroma and how does it present?
Benign neuroma in between toes
Most commonly in between 3rd and 4th toes
Burning/shooting worse when walking
Mulder’s click – painful click when MTP squeeze
How does lateral epicondylitis present?
Pain on resisted Supination + extension
How does medial epicondylitis present?
Pain on resisted pronation + flexion
How can you tell the diff between trigger finger and Dupuytren’s?
Trigger finger = painful, can be passively moved
Dupuytren’s contracture = no pain, cannot be passively straightened
What are RF for carpal tunnel syndrome?
Pregnancy Obesity Diabetes Acromegaly Hypothyroidism
What are features of carpal tunnel syndrome?
Sensory: Pain and pins and needles in the thumb/index/middle finger
Motor: weakness of thumb abduction. Wasting of thenar eminence.
How do you manage a patella fracture?
If undisplaced can be managed conservatively
If displaced needs surgery
Which movement is reduced in SUFE?
Internal rotation
What is the management of hip dislocation?
x
What is the management of shoulder dislocation?
Reduction - may not need analgesia/sedation
What is sublaxation of the radial head?
Most common upper limb injury in children under the age of 6
Analgesia + passively supination of the elbow joint whilst elbow flexed to 9 degrees
What is the initial management of an ankle fracture?
Prompt closed reduction to remove pressure
What are causes of cauda equina syndrome?
Herniated disc Tumour/metastases Spondylolisthesis Abscess Trauma
What are causes of trochanteric bursitis?
Friction
Trauma
Inflammatory conditions
Infection
What XR sign is pathognomonic for a posterior shoulder dislocation?
Lightbulb sign
Posterior vs. anterior hip dislocation
anterior dislocation- abducted + externally rotated. no leg shortening!
posterior dislocation - adducted + internally rotated. leg shortening!
Posterior = most common!
What is cubital tunnel syndrome and how does it present?
Compression of the ulnar nerve as it passes through the cubital tunnel
Tingling and numbness of the 4th + 5th fingers
Pain worse on leaning on elbow
What is a Charcot foot?
AKA Neuropathic jont
joint body is damaged/disrupted due to loss of sensation
usually largely swollen, loss of sensation
Destruction of the bones
Most commonly seen in diabetics
What are signs of osteogenesis imperfecta?
Several fractures during childhood
Long bowing
Short stature
Hearing loss
Blue sclerae
When does pain in the ankle warrant an x-ray?
Bony tenderness at the posterior edge of the medal or lateral malleolus
Inability to bear weight for 4 steps
Management of a scaphoid fracture
Initial management =
Immobilisation with either a Futuro splint or a below elbow backstab
Then refer to orthopaedics
Orthopaedic management =
Undisplaced = cast for 6-8 weeks
Displaced = surgical fixation
What is Finkelstein’s test?
Test for DeQuervain’s tenosynovitis
Examiner pulls the thumb of the patient in ulnar deviation + longitudinal traction
In tenosynovitis - pain over the radial syloid process and along the extensor pollicis breves and abductor pollicis longs
What two tendons are affected in DeQuervain’s tenosynovitis?
Extensor pollicis brevis
Abductor pollicis longus
What imaging can be used to confirm a Morton’s neuroma?
Ultrasound
What Is the ulnar paradox?
proximal lesions of the ulnar nerve produce a less prominent deformity than distal lesions
Ulnar nerve damaged at wrist —> claw appearance
Ulnar nerve damaged at elbow —> less marked clawing. Gets worse before getting better.
What is the most common type of shoulder dislocation?
Anterior dislocation - glenohumeral
Which artery supplies the scaphoid bone?
Dorsal carpal branch of the radial artery
