ORTHOPAEDICS Flashcards
What are the classic signs of a hip fracture?
shortened and externally rotated leg
What are the classic signs of a hip fracture?
shortened and externally rotated leg
What is the classification of hip fractures?
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)
Describe the Garden classification of hip fractures.
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
Which types of hip fracture are most likely to disrupt blood supply?
Type III and IV
What is the management of an undisplaced intracapsular hip fracture?
internal fixation
hemiarthroplasty if unfit.
What is the management of a displaced intracapsular hip fracture?
total hip replacement
What is the management of stable extracapsular hip fractures?
dynamic hip screw
What is the management of an unstable extracapsular hip fracture?
Intramedullary device
What is the management of open fractures?
- IV broad spectrum antibiotics
- 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
Which classification system is used to distinguish open from closed injuries?
Gustilo and Anderson classification system
What is a comminuted fracture?
> 2 fragments
What is a segmental fracture?
More than one fracture along a bone
What is a transverse fracture?
Perpendicular to long axis of the bone
What is a spiral fracture?
Severe oblique fracture with rotation along long axis of bone
Which classification system is used to assess paediatric fractures?
Salter-Harris
What is a type I Salter-Harris fracture?
Fracture through the physis only (x-ray often normal)
What is a type II Salter-Harris fracture?
Fracture through the physis and metaphysis
What is a Salter-Harris III fracture?
Fracture through the physis and epiphyisis to include the joint
What is a Salter-Harris IV fracture?
Fracture involving the physis, metaphysis and epiphysis
What is a Salter-Harris V fracture?
Crush injury involving the physis (x-ray may resemble type I, and appear normal)
What is a greenstick fracture?
Unilateral cortical breach only
What is a Buckle fracture?
Incomplete cortical disruption resulting in periosteal haematoma only
What is a Toddler’s fracture?
Oblique tibial fracture in infants
What are the Ottawa ankle rules?
These state that x-rays are only necessary if there is pain in the malleolar zone and:
- Inability to weight bear for 4 steps
- Tenderness over the distal tibia
- Bone tenderness over the distal fibula
Describe the Weber classification.
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
What is the syndesmosis?
fibrous joint between two bones e.g. distal tibiofibular syndesmosis
What is the management of a Weber A fracture?
Allow weight bearing as tolerated in controlled ankle motion (CAM) boot
What are the risk factors for adhesive capsulitis?
Women
Diabetes
How long does adhesive capsulitis typically last?
6 months –> 2 years
How is movement affected in adhesive capsulitis?
external rotation is affected more than internal rotation
active AND passive movement is affected
How is adhesive capsulitis diagnosed?
Clinically
What is the management of adhesive capsulitis?
NSAIDs
Physiotherapy
Oral corticosteroids and intra-articular steroids
What is seen on XR in avascular necrosis?
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
Which imaging technique is most appropriate for avascular necrosis?
MRI
What is the management of avascular necrosis?
Joint replacement
What is 1st line management for trigger finger?
steroid injection
What is the imaging of choice in osteomyelitis?
MRI
What is Hornblower’s sign?
Inability to keep the arm externally rotated - teres minor pathology or axiliary nerve lesion
What are the four rotator cuff muscles?
S - supraspinatus
I - infraspinatus
T - teres minor
S - subscapularis
What is indicated by a patient being unable to perform the lift-off test?
subscapularis muscle (e.g. tendonitis/tear) or a subscapular nerve lesion.
What is assessed in the Scarf test?
Acromioclavicular joint - pain suggests pathology e.g. osteoarthritis
What is the management of a rotator cuff injury?
Conservative - rest, analgesia, physio
Surgery - if young
What is the common name for lateral epiconylitis?
Tennis elbow
What are the features of tennis elbow?
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
What are the features of golfer’s elbow?
pain and tenderness localised to the medial epicondyle
pain is aggravated by wrist flexion and pronation
What is cubital tunnel syndrome?
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
What are the features of olecranon bursitis?
Swelling over the posterior aspect of the elbow. There may be associated pain, warmth and erythema. It typically affects middle-aged male patients.
What are the features of a Colles’ fracture?
Distal radius fracture
Dinner fork deformity
FOOSH
Describe the features of Scaphoid fracture
Anatomical snuffbox tenderness
FOOSH
XR 80% sensitive
What is the management of a scaphoid fracture?
Futuro splint/back slab & refer to ortho
Ortho - undisplaced = cast 6-8 weeks, displaced = surgical
Which bones are susceptible to avascular necrosis?
Femoral head Scaphoid Tallus Humeral head Navicular Fifth metacarpal (thumb)
What is a Smith’s fracture?
Reverse Colles’ fracture
What is a Bennet’s fracture?
1st metacarpal fracture (thumb)
Fist fighting
What is a Monteggias fracture?
Ulnar fracture
Proximal radio-ulnar displacement
What is a Gelazzi fracture?
Ulnar fracture
Distal radio-ulnar displacement
What is a Pott’s fracture?
Bimalleolar fracture of the ankle
Forced eversion
What is a Barton’s fracture?
Colles’/Smith’s fracture
PLUS radiocarpal dislocation
Name some early complications of fractures
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
Name some late complications of fractures
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
What is a fat embolism?
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.
How is fat embolism syndrome diagnosed?
Gurd’s criteria:
- Respiratory distress
- Petechial rash
- Cerebral involvement
Minor: jaundice, thrombocytopenia, fever, tachycardia
How can osteomyelitis be classified?
Haematogenous
Non-haematogenous (spread from adjacent tissues)
What is the most common cause of osteomyelitis in patients with sickle-cell?
Salmonella
What is the most common cause of osteomyelitis?
S.aureus
Which abx is used for treating osteomyelitis?
Flucloxacillin 6 weeks