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Year 6 Cross Section > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

signs of fracture

A

pain
swelling
crepitus
deformity

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2
Q

management of fractures

A
  1. reduce (closed or open)
  2. hold (closed - plaster or traction, fixation - internal or external)
  3. rehab
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3
Q

when do you do external fixation?

A

when extensive soft tissue injury/complex periarticular fracture

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4
Q

general fracture complications

A

fat embolus
DVT
infection
prolonged immobility –> infections

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5
Q

specific fracture complications

A

NV injury
muscle/tendon injury
non-union/mal-union
local infection
degenerative change

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6
Q

OA management

A

conservative: analgesic, physio, walking aids, avoidance of exacerbating activity, injection
operative: replace, realign

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7
Q

shoulder conditions - 15-45yo

A

dislocation, fracture

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8
Q

shoulder conditions - 45-60yo

A

impingement
dislocation
ACJ OA
rotator cuff tears
fractures

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9
Q

shoulder conditions - >60yo

A

glenohumeral OA
impingement
cuff tears
fracture

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10
Q

hip conditions, 15-45yo

A

DDH
leg length discrepancy
impingement

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11
Q

hip conditions, 45-60yo

A

OA
avascular necrosis
impingement

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12
Q

hip conditions, >60yo

A

OA
post THR

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13
Q

knee conditions, 15-45yo

A

patellofemoral maltracking
ACL/PCL
meniscal tears
fractures

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14
Q

knee conditions, 45-60yo

A

OA
patellofemoral maltracking
ACL/PCL
meniscal tears
fractures

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15
Q

knee conditions, >60yo

A

OA

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16
Q

management of septic arthritis

A

immobilize joint in acute phase
physio onceover acute phase

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17
Q

testing supraspinatus tendon

A

empty can test

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18
Q

testing infraspinatus

A

external rotation against resistance

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19
Q

testing teres meinor

A

horn blower test

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20
Q

testing subscapularis

A

internal rotation against resistance

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21
Q

4 stages to fracture healing

A
  1. reactive: first 48 hrs
    reparative phase = 2 days to 2 weeks
  2. proliferation: reparative phase part 1
  3. consolidation: reparative phase part 2
  4. remodelling: 1 week - 7 years
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22
Q

managing open fractures

A

analgesia
assess: NV status, soft tissues, photograph
alignment: align fracture, splint
anti-sepsis
anti-tetanus
abx

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23
Q

open fractures classification

A

Gustilo

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24
Q

complication of fracture management

A

anaesthetic: anaphylaxis, damage to teeth, aspiration
intra-operative: bleeding, damage to local structures, tx failure
early post-op: compartment syndrome, infection, VTE, abx colitis
late post-op: scarring, function loss, neuropathy, pain

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25
Q

what are the fracture sites most associated with compartment syndrome?

A

suprachondylar fractures
tibial shaft fractures

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26
Q

what are the Ottawa knee rules?

A

<55yo
isolated patellar tenderness
cannot flex to 90 degrees
inability to weight bear >4 steps

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27
Q

what are the Ottawa foot tules?

A

malleolar zone pain +
1. lateral or medial mallelous tenderness
2. no weight bearing
mid foot pain +
1. 5th metatarsal base pain
2. unable to weight bear
3. navicular tenderness

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28
Q

risk factors for NOF fracture

A

SHATTERED
Steroids
Hyperthyroid/hyperparathyroid
Alcohol/smoking
Thin (BMI <22)
Testosterone low
Erosive bone disease
Renal failure
Early menopause
Dietary Ca low, DM

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29
Q

how do you classify degree of displacement of intracapsular NOF fracture/

A

Garden classification (grades I-IV)

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30
Q

what nerve is damaged by suprachondylar fracture?

A

median nerve damage

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31
Q

Colle’s fracture definition

A

posterior displacement and angulation of distal radius fragment

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32
Q

Lisfranc injury

A

injury of foot
one or more of metatarsal bones are displaced from tarus

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33
Q

Subacromial impingement cause

A

supraspinatus tendon catches on acromion

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34
Q

management of subacromial impingement

A

cons: rest, physio
medical: NSAIDs, subacromial bursa steroid
surgical: athroscopic acromioplasty

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35
Q

partial vs complete rotator cuff tear

A

partial: painful arc
complete: shoulder tip pain, full range of passive movement but can’t abduct arm. can abduct once past 90 degrees

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36
Q

what is adhesive capsulitis?

A

condition characterized by loss of active AND passive movement
no clear cause

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37
Q

lateral vs medial epicondyltiis

A

lateral: worse on wrist extension (Tennis)
medial: worse on wrist flexion (Golfers)

38
Q

what is the cause of radial tunnel syndrome

A

posterior interosseous branch of radial nerve
symptoms similar to lateral epicondylitis (worse on wrist extension, decreased grip strength)

39
Q

ix for carpel tunnel

A

EMG

40
Q

ulnar nerve entrapment symptoms

A

pins and needles in 4th and 5th digit
claw hand

41
Q

what causes De Quervain’s tenosynovitis?

A

sheath containing extensor pollicis brevis and abductor pollicis longus tendons becomes inflamed

42
Q

test used to investigate De Quervain’s?

A

Finkelstein’s test

43
Q

management of Ganglions

A

50% disappear
aspiration +/- steroid and hyalurounic injection
surgical excision

44
Q

knee locking differentials

A

obstructive causes:
meniscal/cruciate tear
osteochondritis dissecans
osteophytes

45
Q

symptoms of torn meniscus in knee

A

delayed knee swelling
joint locking
recurrent pain/effusion
McMurray’s test +ve

46
Q

osgood schlatter’s disease, what happens?

A

tibial tuberosity apophysis
patellar tendonitis

47
Q

what special test for Chondromalacia patellae?

A

Clarke’s test
pain on patellofemoral compression

48
Q

Simmond’s triad

A

for Achille’s tendon rupture
1. Thomas’s test does not elicit plantar flexion
2. Angle of declination (greater dorsiflexion of injured foot)
3. Gap in tendon path

49
Q

features of Charcot foot

A

deformity
debris
density change
destruction
dislocation

50
Q

features of Brown-Sequard syndrome

A

ipsilateral paralysis
ipsilateral loss of proprioception and fine touch
contralateral loss of pain and temp

51
Q

indications for bisphosphonates

A

fragility fracture and age >75
fragility fracture and T score 65y and on/about to start long term steroids

52
Q

when do you need to give immediate bisphosphonates to pt on/about to start long term steroids?

A
  • > 65
  • < 65, do a DEXA, give if score < -1
53
Q

2nd line treatment after bisphosphonate

A

SC denosumab

54
Q

complications of TKR

A

immediate: vascular/nerve injury
early: DVT, prosthesis infection
late: loosening, instability from ACL

55
Q

septic arthritis RFs

A

modifiable: crystal arthropathies
non-modifiable: age >90, RA, chronic renal failure, prosthetic joint

56
Q

non-neoplastic bone tumours

A

fibrous dysplasia
simple bone cyst

57
Q

muscles affected in Erb’s palsy

A

abductors and external rotators paralysed
= waiter’s tip

58
Q

Fracture healing in general

A
  1. Reactive phase (injury - 48hrs)
  2. Reparative phase (2 days - 2 weeks)
  3. Remodelling (1 week - 7 years)
59
Q

Reactive phase

A
  1. Bleeding into fracture site = haematoma
  2. Inflammation = cytokine release to cause granulation tissue
60
Q

Reparative phase

A
  1. Proliferation of osteoblasts and fibroblasts = callous formation
  2. Consolidation: woven bone to lamellar bone
61
Q

X rays needed in a fracture

A

AP and lateral
Images of joint above and below fracture

62
Q

Describing a fracture (PAID)

A
  1. Demographics
  2. Pattern: transverse, oblique, spiral, multifragmentary, avlusion
  3. Anatomical: location
  4. Intra / extra articular: dislocation or subluxation
  5. Deformity (distal): translation, angulation, rotation, impaction
  6. Soft tissues: open/closed, NV status, compartment syndrome
  7. Amy specific classification
63
Q

Methods of fracture reduction

A

Closed reduction
Open reduction (and internal rotation)
Traction (not common now )

64
Q

Methods of restriction

A

Non-rigid (sling)
Plaster
Functional bracing
Ex-fix
Internal fixation

65
Q

Late complications of fracture

A

Problems with union
AVN
Growth disturbance
Complex regional pain syndrome

66
Q

Nerve damage and effect of anterior shoulder dislocation/numeral surgical neck

A

Axillary nerve
Numb axillary patch
Weak abduction

67
Q

Nerve damage and effect of Humeral shaft fracture

A

Radial nerve
Waiters tip

68
Q

Nerve damage and effect of elbow dislocation

A

Ulnar nerve
Claw hand

69
Q

Nerve damage and effect of Hip dislocation

A

Sciatic nerve
Foot drop

70
Q

Nerve damage and effect of Fracture of neck of fibula/knee dislocation

A

Fibular nerve
Foot drop

71
Q

Union problems

A
  1. Delayed union: union takes longer than expected
  2. Non-union: fracture fails to unite
72
Q

Causes of non union

A

Ischaemia
Infection
Inter current disease (malignancy/malnutrition)

73
Q

Salter Harris Classification

A

SALT Crush
1. Straight across
2. Above (goes across and above growth plate)
3. Lower (goes across and below growth plate)
4. Through (straight through GP)
5. CRUSH

74
Q

Management of low grade intracapsular hip fractures

A

ORIF with screws

75
Q

Extracapsular management

A

ORIF with DHS

76
Q

Management of unstable fractures

A

ORIF

77
Q

Signs of shoulder impingement

A

Painful arc
Dec ROM
Weakness

78
Q

Cause of shoulder impingement

A

Entrapment of supraspinatus tendon and subacromial bursa between acromion and greater tuberosity of humerus

79
Q

Management of shoulder impingement

A

Rest/physio
NSAIDs
Injection
Acromioplasty

80
Q

Signs of suorachondylar fracture of humerus

A

Elbow swollen and hand semi flexed

81
Q

Management of suprachondylar fracture

A

Collar and cuff if no displacement
MUA and K wires if displacement

82
Q

Weber classification of ankle injuries

A

A: below joint line
B: at joint line
C: above joint line

83
Q

Problem with Weber B and C

A

Possible injury to syndesmosis so instability

84
Q

Management of Weber fractures

A

A: boot
B/C: POP/ surgery

85
Q

What is used in ACL repair ?

A

Autograft repair
Semitendinosus +/- gracillis tendon

86
Q

What is spondyliothesis?

A

Displacement of one lumbar vertebrae on another
Usually L5 forward onto S1

87
Q

Common causes of body mets

A

Bronchus
Thyroid
Breast
Kidney
Prostate

88
Q

Commonest benign bone tumour

A

Osteochondroma

89
Q

What is chondrosarcoma? Location? Appearance

A

Malignant cartilage tumours
Pelvis and axial skeleton
Popcorn calcification

90
Q

X-ray changes on Osteosarcoma

A

Sunburst appearance
Cod man’s triangle

Year 6 Cross Section (23 decks)

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