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FINALS > ORTHOPAEDICS > Flashcards

ORTHOPAEDICS Flashcards

1
Q

What are the classic signs of a hip fracture?

A

shortened and externally rotated leg

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1
Q

What are the classic signs of a hip fracture?

A

shortened and externally rotated leg

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2
Q

What is the classification of hip fractures?

A

intracapsular (subcapital): from the edge of the femoral head to the insertion of the capsule of the hip joint

extracapsular: these can either be trochanteric or subtrochanteric (the lesser trochanter is the dividing line)

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3
Q

Describe the Garden classification of hip fractures.

A

Type I: Stable fracture with impaction in valgus (oblique displacement)

Type II: Complete fracture but undisplaced

Type III: Displaced fracture, usually rotated and angulated, but still has boney contact

Type IV: Complete boney disruption

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4
Q

Which types of hip fracture are most likely to disrupt blood supply?

A

Type III and IV

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5
Q

What is the management of an undisplaced intracapsular hip fracture?

A

internal fixation

hemiarthroplasty if unfit.

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6
Q

What is the management of a displaced intracapsular hip fracture?

A

total hip replacement

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7
Q

What is the management of stable extracapsular hip fractures?

A

dynamic hip screw

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8
Q

What is the management of an unstable extracapsular hip fracture?

A

Intramedullary device

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9
Q

What is the management of open fractures?

A
  1. IV broad spectrum antibiotics
  2. Debridement (and internal fixation devices avoided or used with extreme caution)

Open fractures constitute an emergency and should be debrided and lavaged within 6 hours of injury

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10
Q

Which classification system is used to distinguish open from closed injuries?

A

Gustilo and Anderson classification system

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11
Q

What is a comminuted fracture?

A

> 2 fragments

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12
Q

What is a segmental fracture?

A

More than one fracture along a bone

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13
Q

What is a transverse fracture?

A

Perpendicular to long axis of the bone

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14
Q

What is a spiral fracture?

A

Severe oblique fracture with rotation along long axis of bone

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15
Q

Which classification system is used to assess paediatric fractures?

A

Salter-Harris

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16
Q

What is a type I Salter-Harris fracture?

A

Fracture through the physis only (x-ray often normal)

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17
Q

What is a type II Salter-Harris fracture?

A

Fracture through the physis and metaphysis

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18
Q

What is a Salter-Harris III fracture?

A

Fracture through the physis and epiphyisis to include the joint

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19
Q

What is a Salter-Harris IV fracture?

A

Fracture involving the physis, metaphysis and epiphysis

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20
Q

What is a Salter-Harris V fracture?

A

Crush injury involving the physis (x-ray may resemble type I, and appear normal)

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21
Q

What is a greenstick fracture?

A

Unilateral cortical breach only

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22
Q

What is a Buckle fracture?

A

Incomplete cortical disruption resulting in periosteal haematoma only

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23
Q

What is a Toddler’s fracture?

A

Oblique tibial fracture in infants

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24
Q

What are the Ottawa ankle rules?

A

These state that x-rays are only necessary if there is pain in the malleolar zone and:

  1. Inability to weight bear for 4 steps
  2. Tenderness over the distal tibia
  3. Bone tenderness over the distal fibula
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25
Q

Describe the Weber classification.

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

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26
Q

What is the syndesmosis?

A

fibrous joint between two bones e.g. distal tibiofibular syndesmosis

27
Q

What is the management of a Weber A fracture?

A

Allow weight bearing as tolerated in controlled ankle motion (CAM) boot

28
Q

What are the risk factors for adhesive capsulitis?

A

Women

Diabetes

29
Q

How long does adhesive capsulitis typically last?

A

6 months –> 2 years

30
Q

How is movement affected in adhesive capsulitis?

A

external rotation is affected more than internal rotation

active AND passive movement is affected

31
Q

How is adhesive capsulitis diagnosed?

A

Clinically

32
Q

What is the management of adhesive capsulitis?

A

NSAIDs
Physiotherapy
Oral corticosteroids and intra-articular steroids

33
Q

What is seen on XR in avascular necrosis?

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

34
Q

Which imaging technique is most appropriate for avascular necrosis?

A

MRI

35
Q

What is the management of avascular necrosis?

A

Joint replacement

36
Q

What is 1st line management for trigger finger?

A

steroid injection

37
Q

What is the imaging of choice in osteomyelitis?

A

MRI

38
Q

What is Hornblower’s sign?

A

Inability to keep the arm externally rotated - teres minor pathology or axiliary nerve lesion

39
Q

What are the four rotator cuff muscles?

A

S - supraspinatus
I - infraspinatus
T - teres minor
S - subscapularis

40
Q

What is indicated by a patient being unable to perform the lift-off test?

A

subscapularis muscle (e.g. tendonitis/tear) or a subscapular nerve lesion.

41
Q

What is assessed in the Scarf test?

A

Acromioclavicular joint - pain suggests pathology e.g. osteoarthritis

42
Q

What is the management of a rotator cuff injury?

A

Conservative - rest, analgesia, physio

Surgery - if young

43
Q

What is the common name for lateral epiconylitis?

A

Tennis elbow

44
Q

What are the features of tennis elbow?

A

pain and tenderness localised to the lateral epicondyle

pain worse on resisted wrist extension with the elbow extended or supination of the forearm with the elbow extended

45
Q

What are the features of golfer’s elbow?

A

pain and tenderness localised to the medial epicondyle

pain is aggravated by wrist flexion and pronation

46
Q

What is cubital tunnel syndrome?

A

compression of the ulnar nerve.

• initially intermittent tingling in the 4th and 5th finger
• may be worse when the elbow is resting on a firm surface or flexed for extended periods later numbness in the 4th and 5th finger with associated weakness
47
Q

What are the features of olecranon bursitis?

A

Swelling over the posterior aspect of the elbow. There may be associated pain, warmth and erythema. It typically affects middle-aged male patients.

48
Q

What are the features of a Colles’ fracture?

A

Distal radius fracture
Dinner fork deformity
FOOSH

49
Q

Describe the features of Scaphoid fracture

A

Anatomical snuffbox tenderness
FOOSH
XR 80% sensitive

50
Q

What is the management of a scaphoid fracture?

A

Futuro splint/back slab & refer to ortho

Ortho - undisplaced = cast 6-8 weeks, displaced = surgical

51
Q

Which bones are susceptible to avascular necrosis?

A 
Femoral head
Scaphoid
Tallus
Humeral head
Navicular
Fifth metacarpal (thumb)
52
Q

What is a Smith’s fracture?

A

Reverse Colles’ fracture

53
Q

What is a Bennet’s fracture?

A

1st metacarpal fracture (thumb)

Fist fighting

54
Q

What is a Monteggias fracture?

A

Ulnar fracture

Proximal radio-ulnar displacement

55
Q

What is a Gelazzi fracture?

A

Ulnar fracture

Distal radio-ulnar displacement

56
Q

What is a Pott’s fracture?

A

Bimalleolar fracture of the ankle

Forced eversion

57
Q

What is a Barton’s fracture?

A

Colles’/Smith’s fracture

PLUS radiocarpal dislocation

58
Q

Name some early complications of fractures

A

Damage to local structures (e.g., tendons, muscles, arteries, nerves, skin and lung)
Haemorrhage leading to shock and potentially death
Compartment syndrome
Fat embolism (see below)
Venous thromboembolism (DVTs and PEs) due to immobility

59
Q

Name some late complications of fractures

A 
Delayed union (slow healing)
Malunion (misaligned healing)
Non-union (failure to heal)
Avascular necrosis (death of the bone)
Infection (osteomyelitis)
Joint instability
Joint stiffness
Contractures (tightening of the soft tissues)
Arthritis
Chronic pain
Complex regional pain syndrome
60
Q

What is a fat embolism?

A

Fat embolism can occur following the fracture of long bones (e.g., femur). Fat globules are released into the circulation following a fracture (possibly from the bone marrow). These globules may become lodged in blood vessels (e.g., pulmonary arteries) and cause blood flow obstruction.

61
Q

How is fat embolism syndrome diagnosed?

A

Gurd’s criteria:

  • Respiratory distress
  • Petechial rash
  • Cerebral involvement

Minor: jaundice, thrombocytopenia, fever, tachycardia

62
Q

How can osteomyelitis be classified?

A

Haematogenous

Non-haematogenous (spread from adjacent tissues)

63
Q

What is the most common cause of osteomyelitis in patients with sickle-cell?

A

Salmonella

64
Q

What is the most common cause of osteomyelitis?

A

S.aureus

65
Q

Which abx is used for treating osteomyelitis?

A

Flucloxacillin 6 weeks

FINALS (26 decks)

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