Orthopaedics

Question 1

what is osteosarcoma

Answer 1

most common bone cancer in teenage males
warm painful swelling in the knee

has a ‘sunburst’ appearance in the x ray

Question 2

what is Ewings sarcoma

Answer 2

it presents as painful warm growing swelling
patient will have anaemia

‘onion skin’ on x ray

Question 3

what is Chondrosarcoma

Answer 3

Chondrosarcoma is cartilaginous malignancy at occurs in older patients (>40) with pain and a lump. Many of these arise from previous chondromas that have undergone malignant change. X-ray shows a lytic lesion with ‘fluffy popcorn calcification’.

Question 4

what is Osteochondritis dissecans

Answer 4

Osteochondritis dissecans is a condition where the blood supply of bone is interrupted, leading to bone and cartilage detaching from the area and being able to move freely in the joint space. It commonly occurs in young adults at the knee, elbow and ankle.

Question 5

What is the Ottawa rule

Answer 5

It is an x-ray requirement for malleolar pain

1. If there is bone tenderness at the posterior lateral malleolus
2. Bone tenderness, at the posterior medial malleolus
3. Oh, if the patient is unable to bear weight for four steps

Question 6

what does the T score show from the DEXA scan

Answer 6

if the score is less than -0.2 = osteopenia (less severe osteoporosis)

less than -0.25 then it is osteoporosis

Question 7

what is a risk factor for osteoporosis

Answer 7

taking steroids for a long time
menopause

Question 8

what is osteoporosis characterised by

Answer 8

It is characterised by low bone density without actually changing the formation of the bone having less oestrogen levels can cause pores in the bone which make it weaker.

Question 9

what is the most common fracture in children

Answer 9

Supracondylar fracture, there are three different types of it

1. This is when the fracture is undisplaced
2. The fracture has moved back slightly
3. This is when the fracture is displaced

Question 10

What is the most common complication of a supracondylar fracture in children

Answer 10

They can be a disruption to the artery or nervous apply
The most common one being at the median artery

Question 11

What is a greenstick fracture?

Answer 11

It is a type of fracture that is seen in younger children, especially in the radius and ulna.

It is when the radius or the ulna bone does not completely break instead it bends because children bones are more malleable - harder to snap in half.

Question 12

What is a Monteggia fracture?

Answer 12

It is the fracture of the ulna bone which also causes displacement of the Radiohead from the socket. It is the most common in children.

Question 13

What is a Monteggia fracture?

Answer 13

It is the fracture of the ulna bone which also causes displacement of the Radial head from the socket. It is the most common in children.

Question 14

What is a bakers cyst?

Answer 14

Most common cause of swelling behind the knee, common in osteoarthritis
hard

Question 15

what are osteophytes

Answer 15

This is seen in osteoarthritis and is when there is abnormal bone growth

and his bone is around to help and support and these bones start producing more fluid which then becomes a cyst which is called a bakers cyst which is found behind the knee.

Question 16

What is a popliteal aneurysm?

Answer 16

This is when does an aneurysm in the popliteal artery, and this will produce a pulsating compressible lump under the skin

Question 17

what is a galizzia fracture

Answer 17

This is a fracture of the radius and dislocation of the distal ulna, or a fracture of both bones

Question 18

What is a Smith’s fracture?

Answer 18

This is a radial fracture that moves towards the front

Question 19

What is a baton fracture/knightstick fracture

Answer 19

• This is a fracture that goes through the joint
  ulna fracture

Question 20

What is a colles fracture?

Answer 20

This is a radial fracture that moves backwards

Question 21

What is the management of a displaced Coles fracture?

Answer 21

Close reduction, immobilise with wrist splint

Question 22

In which population is a colles fracture, most commonly seen

Answer 22

It is most commonly seen in elderly patients to the wrist fracture

Question 23

Why is carpal tunnel syndrome worse at night

Answer 23

The increase production of ADH in the night to Prevent urination during the night causes water retention, and this can cause a pressure on the nerves, which makes carpal tunnel syndrome worse

Question 24

klumpes palsy what is it?

Answer 24

It is clawhand due to damage at C8 and T1 brachioplexus

Question 25

What is the most common side effect of bisphosphate used for

Answer 25

They can cause stomach issues hence why they are taken with a PPI. The best way to take a bisphosphonate is on an empty stomach first thing in the morning and sit up for half an hour.

Question 26

What nerve is most commonly damaged in a mid shaft humerus fracture?

Answer 26

The radial nerve is most likely to be damaged, causing risk drop

Question 27

What is a waiters tip?

Answer 27

Also, known as Erbs palsy, it is the paralysis of the brachial plexus at C5 and C6, and is when the arm is internally rotated it is commonly associated with shoulder dystocia

Question 28

What criteria is used for the classification of a intracapsular fracture?

Answer 28

Garden classification

Question 29

What is the complication of an intracapsular fracture of the neck of femur?

Answer 29

It can affect the deep, femoral artery and affect blood supply to the proximal part of the bone

This can cause two complications

Non-union, this is when the bone does not heal and cannot join back to the hip socket

Avascular necrosis this is when even if the bone heals it will have replaced and changed in shape and so therefore can no longer fit with the hip socket

Question 30

What is the management of an intracapsular fracture in a young person?

Answer 30

Use screws or a dynamic hip screw

Question 31

What is the management of a intracapsular fracture in an older patient?

Answer 31

Because these are harder to heal, it is easier to do a partial or total hip replacement the total hip replacement is done in a patient who is fit and healthy

Question 32

What is the management for an intertrochanteric fracture?

Answer 32

Use a dynamic hip screw, and sometimes a rod can be used

Question 33

What is a management for a subtrochanteric fracture?

Answer 33

Intramedullary nail

Question 34

What is the management of a extracapsular fracture?

Answer 34

Dynamic hip, screw

Question 35

What is the garden of classification?

Answer 35

1. undisplaced partial fracture
2. undisplaced but full fracture
3. displaced fracture partial displacement
4. full displaced fracture

For the undisplaced fracture do fixation and replacement, but for a displaced fracture do full replacement

Question 36

what is a common complication of a hip replacement? causes shortness of breath and a red petechiae rash on the chest?

Answer 36

fat embolism