Orthopaedics Flashcards
Features of scaphoid fracture?
The main physical signs are swelling and tenderness in the anatomical snuff box, and pain on wrist movements and on longitudinal compression of the thumb
Cause of knee pain in runners, causing * tenderness 2-3cm above the lateral joint line?
Iliotibial band syndrome
What movement is limited in frozen shoulder
active and passive movement limited and external rotation most affected
What do you find O/E of radial head fracture
Common after FOOSH
On examination, there is marked local tenderness over the head of the radius, impaired movements at the elbow, and a sharp pain at the lateral side of the elbow at the extremes of rotation (pronation and supination).
Crescent sign on XR
avascular necrosis
Cause of De Quervain’s tenosynovitis
common condition in which the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed
it is also known colloquially as ‘texter’s thumb’ as repetitive texting motions have been associated with causing this inflammatory response.
Pain on the radial side of the wrist/tenderness over the radial styloid process
Management for intertrochanteric (extracapsular) proximal femoral fracture
Dynamic hip screws
What is Leriche syndrome
Classically, it is described in male patients as a triad of symptoms:
- Claudication of the buttocks and thighs
- Atrophy of the musculature of the legs
- Impotence (due to paralysis of the L1 nerve)
an atherosclerotic occlusive disease involving the abdominal aorta and/or both of the iliac arteries.
Management involves correcting underlying risk factors such as hypercholesterolaemia and stopping smoking. Investigation is usually with angiography.
Causes of Bakers cysts
They are more likely to develop in patients with arthritis or gout and following a minor trauma to the knee.
Foucher’s sign describes the increase in tension of the Baker’s cyst on extension of the knee.
Cause of patella tendinopathy
‘jumper’s knee’
Repeated jumping and landing on hard surfaces
It results in anterior knee pain over 2-4 weeks which comes on with exercise and worsens with jumping.
Classification of Salter-Harris fracture
S - straight through physis A - above (physis + metaphysis) L - lower (physis + epiphysis) T - through all three R - rammed i.e. crushed
Ottawa rules of ankle injury
An ankle x-ray is required only if there is any pain in the malleolar zone and any one of the following findings:
bony tenderness at the lateral malleolar zone (from the tip of the lateral malleolus to include the lower 6 cm of posterior border of the fibular)
bony tenderness at the medial malleolar zone (from the tip of the medial malleolus to the lower 6 cm of the posterior border of the tibia)
inability to walk four weight bearing steps immediately after the injury and in the emergency department
When to consider surgical treatment of Dupuytrens contracture
when the metacarpophalangeal joints cannot be straightened and thus the hand cannot be placed flat on the table
Features of different nerves affected with prolapsed disc
One, two– buckle my shoe. Three, four– kick the door. Five, six– pick up sticks. Seven, eight– shut the gate.
S1,2 = ankle jerk L3,4 = knee jerk C5,6 = biceps and brachioradialis C7,8 = triceps Three, Four -- Winks galore ;) S3,4 - Anal wink reflex
Summary of 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
Summary of Pott’s fracture
- Bimalleolar ankle fracture
* Forced foot eversion
Management of prolapsed disc
similar to that of other musculoskeletal lower back pain: analgesia, physiotherapy, exercises
- if symptoms persist e.g. after 4-6 weeks) then referral for consideration of MRI is appropriate
Management of scaphoid fracture in ED
In the emergency department, suspected scaphoid fractures should be managed with immobilisation using a Futuro splint or standard below-elbow backslab before specialist review
Fat embolism Triad of symptoms:
- Respiratory
- Neurological
- Petechial rash (tends to occur after the first 2 symptoms)
Management of open fractures
delayed until soft tissues have recovered.
more often than not an external fixation device is used as an interim measure while soft tissue coverage is achieved (which should be done within 72 hours
Cause of osteomyelitis
Staph. aureus is the most common cause except in patients with sickle-cell anaemia where Salmonella species predominate
Summary of iliotibial band syndrome
common cause of lateral knee pain in runners.
Athletes commonly present with a sharp or burning pain around the lateral knee joint line.
Summary of chondromalacia patellae
Softening of the cartilage of the patella
Common in teenage girls
Characteristically anterior knee pain on walking up and down stairs and rising from prolonged sitting
Usually responds to physiotherapy
Causes of carpal tunnel syndrome
ARMPIT
Acromegaly Rheumatoid Myxoedema (hypothyroid) Pregnancy Idiopathic Trauma
Summary of Colle’s fracture
Dorsally Displaced Distal radius → Dinner fork Deformity
Summary of psoas abscess
Primary cases often occur in the immunosuppressed and may occur as a result of haematogenous spread.
Secondary cases may complicated intra abdominal diseases such as Crohns.
Patients usually present with low back pain and if the abscess is extensive a mass that may be localised to the inguinal region or femoral triangle . Smaller collections may be percutaneously drained. If the collection is larger, or the percutaneous route fails, then surgery (via a retroperitoneal approach) should be performed.
CT abdomen is the investigation of choice
IV Abx and percutaneous drainage is the initial approach and successful in around 90% of cases
Summary of Monteggia fracture
involves dislocation of the proximal radioulnar joint in association with an ulnar fracture
What is a Hill-Sachs lesion
is when the cartilage surface of the humerus is in contact with the rim of the glenoid. About 50% of anterior glenohumeral dislocations are associated with this lesion.
Sx of pelvic fracture
present with pain on walking or palpation, instability, neurovascular deficits in the limb and signs of damage to pelvic organs e.g. haematuria or PR bleeding
Sx of posterior hip dislocation
present with a shortened and internally rotated leg
Sx of anterior hip dislocation
present as abducted and externally rotated. There may be a palpable bulge of the femoral head.
Discitis due to staphylococcus…
need to do an ECHO to look for endocarditis
Summary of Morton’s neuroma
benign neuroma affecting the intermetatarsal plantar nerve, most commonly in the third inter-metatarsophalangeal space.
Features
- forefoot pain, most commonly in the third inter-metatarsophalangeal space
- worse on walking. May be described as a shooting or burning pain. Patients may feel they have a pebble in their shoe
- Mulder’s click: one hand tries to hold the neuroma between the finger and thumb. The other hand squeezes the metatarsals together. A click may be heard as the neuroma moves between the metatarsal heads
- there may be loss of sensation distally in the toes
If there is doubt an ultrasound is used to confirm
Associations of trigger finger
(idiopathic in the majority)
- more common in women than men
- rheumatoid arthritis
- diabetes mellitus
Treatment of displaced hip fracture
Hemiarthroplasty or total hip replacement
Summary of lumbar stenosis
Patients may present with a combination of back pain, neuropathic pain and symptoms mimicking claudication.
One of the main features that may help to differentiate it from true claudication in the history is the positional element to the pain. Sitting is better than standing and patients may find it easier to walk uphill rather than downhill. The neurogenic claudication type history makes lumbar spinal stenosis a likely underlying diagnosis, the absence of such symptoms makes it far less likely.
Weber classification of ankle fracture
Related to the level of the fibular fracture.
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
A subtype known as a Maisonneuve fracture may occur with spiral fibular fracture that leads to disruption of the syndesmosis with widening of the ankle joint, surgery is required.
