Orthopaedics 🦴 Flashcards
What is osteosarcoma
Malignant bone tumour found at metaphysis of distal femur or proximal tibia
Sx osteosarcoma
Dull bone pain worse at night
Localised mass
Soft tissue mass and swelling
Mx of osteosarcoma
Surgical resection and chemotherapy
Ix for osteosarcoma
X ray
Shows sunburst appearance
What is the most common primary malignancy of bone in children and adolescents
Osteosarcoma
What is Paget’s disease of bone
Increased bone turnover
Initially starts with increased osteoclastic activity then followed by increased osteoblast activity
Leads to bone deformities
What bones does Paget’s disease affect mainly
Commonly affects skull, spine, pelvis and long bones of lower extremities
Sx of Paget’s disease
Usually asx
But sx can include :
Constant achy bone pain
Warmness of bone
Hearing loss
Heart failure
Ix for Paget’s disease and their findings
Blood tests show raised ALP and normal calcium and phosphate
X RAY show osteolysis in early disease
Mx of Paget’s disease
only if symptomatic :
Bisphosphonates e.g IV pamidronate
Risk factors for Paget’s disease
Male sex
Increasing age
Anglo-Saxon descent
Family history
What is osteomyelitis
Infection of the bone
What causes osteomyelitis
Most common is staph aureus
Sx of osteomyelitis
Constant bone pain
Recent trauma
Redness and swelling
Fever
Mx of osteomyelitis
Abx
Flucloaxicillin for adults for 6 weeks
Cefazolin for children
Diagnostic imaging for osteomyelitis
MRI
What are the two ways of osteomyelitis occurring
Haemotagenous spread and non haemotagneous spread
Risk factors for haematogenous osteomyelitis
Endocarditis
IV drug use
Hickman line
Immunosuppression
Risk factors for non-haematogenous osteomyelitis
Skin ulcers
Trauma
Surgery
Presentation of Chondrosarcoma
Usually presents in 40-60 males
Axial skeleton I.e pelvis, shoulder, rib
X ray shows fluffy popcorn calcification
Gradual swelling of the knee is suggestive of effusion
Tenderness over the medial joint line suggests a medial meniscus tear
Commonly “locks” the joint - fixed flexed position
medial meniscus tear
hip fracture, how would it classically present
the leg is shortened and externally rotated
pain
mx of intracapsular hip fracture
undisplaced: internal fixation or hemiarthroplasty if unfit
displaced: total hip replacement or hemiarthroplasty
when is total hip replacement preferred to hemiarthroplasty for intracapsular hip fracture?
if patients were able to walk independently out of doors with no more than the use of a stick and
are not cognitively impaired and
are medically fit for anaesthesia and the procedure
management of intertrochanteric femoral fracture
dynamic hip screw
often associated with popping, swelling, clicking or grindings and a positive scarf test
acromioclavicular degeneration
Painful arc of abduction on examination 60-120 degrees, no weakness of muscles and often complain of pain on overhead activities
common in swimmers
subacromial impingement
common in diabetics and presents as a painful stiff shoulder with restriction of active and passive range of motion in abduction, internal and mainly external rotation
3 stages - pain, stiffness and pain improvement and then a gradual return to normal
middle-aged pts
adhesive capsulitis - frozen shoulder
Pain in the first 60 degrees of abduction
Weakness of rotator cuff muscles
Muscle wasting
Tenderness
hx: repetitive overhead movements/over use/ trauma
rotator cuff injury
how to tell the difference between rotator cuff tear and impingement
he presence of muscle weakness when compared directly to the opposite arm
management of subacromial impingement
Non-surgical:
Rest
NSAIDs
Physiotherapy
Surgical:
Arthroscopy if severe
management of adhesive capsulitis
Treatment options are quite poor- episodes usually self-limiting and lasts 6 months to 3 years
Non-surgical:
NSAIDs, oral corticosteroids
Physiotherapy
Intra-articular steroid injections
Surgical:
Manipulation under anaesthesia – forcefully stretching the capsule to improve ROM
Arthroscopy –cut the adhesions to help with the stiffness
management of rotator cuff tear
Non-surgical:
Rest
NSAIDs
Physiotherapy
Surgical:
Arthroscopic rotator cuff repair – younger/active patient or large tears
most common shoulder dislocation
hx: Sport, trauma, falls injuries
Arm position: Slightly abducted and externally rotated
anterior shoulder dislocation
hx: Seizures, electrical injuries
Arm position: Adducted, internally rotated
on x-ray: lightbulb sign
posterior shoulder dislocation
sudden twisting force on a bent knee
Common sports injury (skiing)
Sudden ‘popping’ sound
Sudden knee swelling
Lachman’s and Anterior draw positive
ACL tear
Caused by falling backwards onto the palm of an outstretched hand or falling with wrists flexed
smith’s fracture
FOOSH
colle’s fracture
loss of internal rotation of the leg in flexion
obese, male 10-15 year old
slipped upper femoral epiphysis
4-8 years old
hip pain that’s developed progressively over a few weeks
due to avascular necrosis of femoral head
perthes disease
2-10 years old
commonest cause of hip pain in children
acute hip pain associated with viral infection
limp/refusal to weight bear
transient synovitis
most often <4 years
acute hip pain associated with systemic upset - fever
swollen red joint
septic arthritis
mx SUFE
internal fixation
x-ray findings perthes disease
widening of joint space
later changes - decreased femoral head size
mx perthes disease
conservative mx
cast and braces
<6 years - observation
>6 or severe deformity - surgery
mx transient synovitis
self limiting - rest and analgesia
Bone Pain
Bone/Muscle Tenderness
Fractures- Femoral Neck
Proximal Myopathy- Waddling Gait
X-ray:
Translucent bands (Looser’s zones or pseudofractures)
osteomalacia
Pain following use, improves with rest
Unilateral symptoms
No systemic upset
Typical affected joints:
Large weight-bearing joints (hip, knee)
Carpometacarpal joint
DIP, PIP joints
osteoarthritis
