Orthopaedics Flashcards
What is the most sensitive diagnossi for avascular necrosis of the hip
MRI of the spine
MRi findings in avascular necrosis of the hip
Bilateral joint space narrowinf
What medication can cause avascular necrosis of the hip
Steroids
First line investigation for a suspected osteoporotic vertebral fracture
X ray of the whole spine
Define a salter-harris (SH) Fracture 1
Fracture through physis only (X-Ray normal)
Define SH fracture 2
Fracture through physis and metaphysis
Define SH fracture type 3
Fracture through physis and epiphyisis to include the joint
Define SH fracture IV
Fracture involving physis, metaphysis and epiphysis
Define SH tyep V
Crush injury
What initial investigation is done for suspected achilles tendon rupture
USS
What is the GOLD standard diagnosis of achilles tendon rupture
MRI
What medication can cause dupuytren’s contracture
Phenytoin
In the pain arc, what degrees abduction is subacromial impingement sene in
60 and 120 degrees
In the pain arc, what degrees are rotator cuff tears typically seen in
First 60 degrees
First line management of lower back pain (without red flags)
NSAIDS not paracetamol
Signs of a menisceal tetar
Joint locking and joint effusions/swelling
What causes menisceal tears
Joint twisting
How should suspected scaphoid fractures be managed in A and E
Immbolise using futuro splint or standard below elbow backslab before refrral to orthopaedics
First line investigation for suspected scaphoid fractures
X-Ray
Management of a scaphoid fracture >1,5 mm displacement
Internal fixation
Management of a Scaphoid fracture <0.5 mm displaced
6 weeks immobilisation
Complication of scaphoid fractures
Avascular necrosis
Causes of a scaphoid fracture
Falling onto an outstretched hand or rugby
Signs of a scaphoid fracture
Tenderness over anatomical snuffbox
Wrist joint effusion
Tenderness between extensor pollicis longus and brevis
Gold standard of diagnosing a scahpod fracture
MRI
What classification is used to grade ankle fractures
Weber Classification
Describe the wether classification
Type A - Below syndesmosis
Type B - Fracture stards at tibial + involves syndesmosis
Type C - Above syndesmosis which might be damaged
Management of an ankle fracture
If stable (minimally displaced): weight bearing as tolerated in a boot
When shoudl reduction and external fixation be offered for an ankle fracture
If the fracture involved other parts ofthe ankle (not isolated to one)
When shoudl reduction and external fixation be offered for an ankle fracture
If the fracture involved other parts ofthe ankle (not isolated to one)
Management of an extracapsular fracture
Dynamic hip screw
Management of a subtrochanteric fracture
Intramedullary device
When is a joint replacement indicated in a hip fracture
If blood supply to the femoral head was involved
What are extracapsular femoral fractures also known as
Intertrochanteric femoral fractures
What type of fracture is seen in children with a FOOSH
Buckle fracture
What movement is affected.limited in adhesive capsulitis
External rotation
What is tenosynovitis
Where the sheath containing the extensor pollicis brevis and abductor pollicis longus is inflamed
X-Ray findings in a colle’s fracture
Transverse fracture to the radius
X-Ray findings in a Bennett fracture
Fracture of the thumb base
What causes a Bennett fracture
Forced abduction of the first metacarpal
What si a Galeazzi fracture
Fracture of teh distal third of the radius
Where is a pott’s fracture commonly seen
Bimalleolar ankle fracture from forced foot eversion
Signs of an anterior shoulder disolcation (most common type of shoulder dislocation)
RIght arm is abducted and externally rotated
What knee condition commonly results in haemarthrosis
Dislocated patella
What does a straight leg test look for
Sciatic nerve pain
Where do osteochondromas typically develop
Distal femur and proximal tibia
Where are osteoblastomas typically found
IN the mandible
Where are osteoid osteomas typically found
In the tibia
Where are osteosarcomas typically found
The femur and Tibia
Where are Ewing’s Sarcoma typically found
Pelvis and Femur
What red flag symptoms require urgent referral to orthopaedics in shoulder pain
- Sudden inability to raise the arm
- Shoulder mass or swelling
- Red, painful joint with fever
- Signs of dislocation
Management of shoulder pain with no red flags
Offer paracetamol FIRST LINE
Then NSAIDs
Symptoms of Frozen shoulder
Pain worse in bed/at night
Gradually improves but stiffness worsens
Management of frozen shoulder
Self-limiting - supportive treatment with Paracetamol
When are intrarticular steroid injections indicated in frozen shoulder
If there is no improvement in symptoms
Then refer to secondary care if it’s been over 3 months
How many steroid injections can be given in shoudler stiffness
2, 6 weeks apart and then refer.
Where should you refer to if acute shoudler dislocation is suspected
Immediately to A&E
Symptoms of trochanteric pain syndrome
Chronic hip/thigh/buttock pain taht radiates down the lateral aspect of the knee.
Pain is aggravated by pressure on that side of the body
Management of greater trochanteric pain syndrome
Supportive management
Management of a baker’s cyst
USS guided cyst aspiration + steroids
What is trigger finger
The tendons are bigger than the tunnels they pass through, causing them to get stuck and cannot unflex
Causes of trigger finger
RA
DM
Diagnosis of compartment syndrome
Intracompartmental pressure of >40 mmHg is diagnostic
20mmHg> is abnormal
Indications for a total hip replacement/hemiarthroplasty
If the intracapsular fracture is DISPLACED
Management of an undisplaced NOF intracapsular
Cannulated fix screw (internal fixation)
What antibiotic can cause achilles tendon rupture
Ciprofloxacin
What are posterior shoulder dislocations associated with
Seizures
Signs of posterior shoudler dislocation
Internal rotation locked
Main cause of an anterior shoulder dislocation
FOOSH
Examination findings in posterior cruciate ligament ruptures
The tibia lies back on the femur
Management of sciatica
4-6 weeks of physio and nsaids
Then refer to neurosurgery if symptoms do not improve
What is plantar fasciitis
Heel pain in adults: manage conservatively
What is Simmonds’ triad
Calf squeeze test
Exmaination of angle at declination
Palpate the tendon
Checks for achilles tendon rupture
Symptoms of a Hip Fracture
Shortened leg
Externally rotated leg
How do we confirm a ligament injury to the knee
MRI
Management of a shoulder dislocation
Analgesia, X-Ray and sling -> physio
Management of Clavicular fractures
Anatomical reduction and immobilisation with a sling
Graft occlusion vs compartment syndrome
Graft occlusion happens over time
Both present with the 6Ps
Define a simple fracture
Skin is intact
Define a communicated fracture
Bone is broken in several places
Define a complicated fracture
Bone injury (bone is exposed)
What is a pathological fracture
Caused by weakening of the bone due to disease