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Stage 3 > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

What is a Baker’s cyst?

A

Synovial outpouching found behind the knee (not malignant)

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2
Q

What is hypertrophic osteoarthropathy (syndrome) characterised by?

A

Periosteal reaction of long bones without an underlying bone lesion (associated with a wide range of conditions)

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3
Q

What is hypertrophic osteoarthropathy called when it is associated with pulmonary conditions?

A

Hypertrophic pulmonary osteoarthropathy (HPOA)

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4
Q

What lung conditions can hypertrophic pulmonary osteoarthropathy (HPOA) be associated with?

A

Lung cancer, bronchiectasis

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5
Q

What is an acute rupture of the ulnar collateral ligament of the thumb called?

A

Skier’s thumb

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6
Q

How is a Skier’s thumb classically sustained?

A

When falling on an outstretched thumb e.g. while skiing

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7
Q

What does an x-ray show in Skier’s thumb?

A

Normal or a small avulsion fracture from the ulnar aspect of the first metacarpal

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8
Q

What is Paget’s disease of the bone?

A

A disease affecting the normal bone remodelling system

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9
Q

Which bones does Paget’s disease of the bone most commonly affect and how?

A

1) Skull - cotton wool skull
2) Spine - square vertebrae
3) Pelvis - enlarged pubic rami
4) Proximal lone bones - lateral bowing of femur + anterior bowing of tibia (most common)

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10
Q

Which joints in the hands are most commonly affected in osteoarthritis?

A

1) DIP joints - Heberden’s nodes
2) PIP joints - Bouchard’s nodes

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11
Q

What are two key differences between osteoarthritis and rheumatoid arthritis?

A

1) Pain usually asymmetrical (vs symmetrical)
2) Pain usually worse in evenings (vs mornings)

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12
Q

What is a hip fracture?

A

A break in the proximal femur (distal from the femoral head to ~5cm below the lesser trochanter)

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13
Q

What is the main blood supply to the hip affected in hip fractures?

A

Profunda femoris artery → medial and lateral circumflex femoral arteries → retinacular vessels (retrograde blood supply)

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14
Q

What imaging do you do in for suspected hip fracture?

A

1) Pelvic XR
2) AP and lateral hip XR

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15
Q

What imaging investigation do you need to do preoperatively for hip fracture?

A

CXR

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16
Q

What are second line imaging investigations done for hip fractures?

A

1) If XR inconclusive but fracture is suspected conduct MRI
2) If MRI not available within 24h or if MRI is contraindicated conduct CT

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17
Q

What does intra or extra capsular hip fractures relate to?

A

The insertion of the hip joint capsule (which inserts at the intertrochanteric line)

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18
Q

What is an intracapsular hip fracture?

A

Fracture above the intertrochanteric line (subcapital, transcervical, basicervical)

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19
Q

What is an extracapsular hip fracture?

A

Fracture above the intertrochanteric line (intertrochanteric, subtrochanteric)

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20
Q

What are patients with intracapsular hip fractures at increased risk of?

A

Avascular necrosis

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21
Q

What is Shenton’s line?

A

An imaginary curved line drawn along the inferior border of the superior pubic ramus (superior border of the obturator foramen) and along the inferomedial border of the neck of femur

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22
Q

How does Shenton’s line relate to hip fractures?

A

1) This line should be continuous and smooth
2) A disruption to the line can indicate fracture neck of femur
3) However an intact line does not 100% guarantee no fracture

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23
Q

Which classification system is used to classify intracapsular NOF fractures?

A

Garden classification

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24
Q

What are the 4 Garden classification types?

A

1) Garden type I - incomplete fracture, undisplaced
2) Garden type II - complete fracture, undisplaced
3) Garden type III - complete fracture, partially displaced
4) Garden type IV - complete fracture, fully displaced

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25
Q

How do you manage an undisplaced intracapsular hip fracture (Garden I/II)?

A

Internal fixation with dynamic hip screw

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26
Q

How do you manage a displaced intracapsular hip fracture (Garden III/IV)?

A

Hemi-arthroplasty OR total hip replacement

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27
Q

For which patients would you consider total hip replacement over hemi-arthroplasty for a displaced intracapsular hip fracture?

A

MORE ABLE
1) Able to walk independently out of doors with no more than the use of a stick AND
2) Do not have a condition or comorbidity that makes the procedure unsuitable for them AND
3) Are expected to be able to carry out activities of daily living independently beyond 2 years

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28
Q

How do you manage an extracapsular intertrochanteric hip fracture?

A

Internal fixation with dynamic hip screw

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29
Q

How do you manage an extracapsular subtrochanteric hip fracture?

A

Intramedullary nail

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30
Q

Which type of hip dislocation is more common?

A

Posterior

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31
Q

What are causes of hip dislocation?

A

1) Trauma
2) Total hip replacement
3) Congenital

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32
Q

How is the hip positioned in an anterior hip dislocation?

A

Abducted + externally rotated

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33
Q

How is the hip positioned in a posterior hip dislocation?

A

Adducted + internally rotated

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34
Q

Which imaging do you do for a suspected hip dislocation?

A

AP and lateral hip XR

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35
Q

How do you manage a hip dislocation?

A

Hip reduction

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36
Q

What is the MOI for a femoral shaft fracture?

A

1) High force impact (RTC)
2) Low force impact (pathological fracture)

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37
Q

What would a femoral shaft fracture after low force impact indicate?

A

Pathological fracture

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38
Q

How do you manage a femoral shaft fracture?

A

Depends on the cause/polytrauma
1) Stabilise patient
2) Pain relief
3) ± traction splint
4) Definitive Mx = intramedullary nail

39
Q

What is the definitive management of a femoral shaft fracture?

A

Intramedullary nail

40
Q

What imaging investigations would be done for a femoral shaft fracture?

A

1) Isolated = AP and lateral hip XR
2) ± whole body CT in trauma

41
Q

Which XR views do you do for the hip?

A

AP and lateral

42
Q

When would you do a traction splint for a femoral shaft fracture?

A

Isolated injury

43
Q

What are CI to a traction splint for a femoral shaft fracture?

A

1) Hip/pelvic fractures
2) Supracondylar fractures
3) Foot/ankle fractures

44
Q

What are distal femoral fractures?

A

Supracondylar fractures - extend from the distal metaphyseal-diaphyseal junction of the femur to the articular surface of the femoral condyles

45
Q

What are causes of distal femoral fractures?

A

1) Trauma
2) Frailty
3) Pathological fractures

46
Q

What imaging investigation do you do for distal femoral fractures?

A

AP and lateral XR of the knee and entire femur

47
Q

How do you manage distal femoral fractures?

A

1) Proximal extra-articular fracture/simple intra-articular fracture - retrograde intramedullary nailing
2) Distal extra-articular fracture/complex intra-articular fracture - ORIF (open reduction internal fixation)

48
Q

What is the MOI for a tibial plateau fracture?

A

Trauma - from impaction of the femoral condyle onto the tibial plateau

49
Q

How does a tibial plateau fracture present?

A

1) Pain
2) Unable to weight bear
3) Swelling

50
Q

What can swelling indicate in a tibial plateau fracture?

A

Liphaemoarthrosis

51
Q

What investigations do you do for a tibial plateau fracture?

A

1) AP and lateral XR
2) Definitive treatment requires CT

52
Q

How do you manage a tibial plateau fracture?

A

1) Surgical open reduction internal fixation (ORIF)
2) Non-operative = hinged knee brace for 8-12 weeks

53
Q

What is a long term complication of a tibial plateau fracture?

A

Post-traumatic osteoarthritis to the knee joint

54
Q

What is lipohaemoarthrosis?

A

1) Fat and blood in the joint space
2) This occurs due to fracture and escape of blood and bone marrow into the joint cavity
3) It commonly occurs in fractures of large joints e.g. knee and can be identified on plain x-ray by the presence of a fluid-fat level

55
Q

What does lipohaemarthrosis look like on XR?

A

Presence of a fluid-fat level

56
Q

What are the features of an uncomplicated tibial plateau fracture?

A

1) No ligament damage
2) < 2mm articular step
3) No subluxation (misalignment)

57
Q

Which tibial plateau fractures can be managed non-operatively?

A

Uncomplicated tibial plateau fractures

58
Q

Which criteria are used to decide if an ankle injury needs to be XR OR a foot injury needs a foot XR?

A

Ottawa rules

59
Q

What are the Ottawa rules for ankle XR?

A

Pain in the malleolar zone AND
1) Bony tenderness at the posterior edge/tip of the medial/lateral malleolus OR
2) Inability to weight bear both immediately and in the ED (no more than 4 steps)

60
Q

What is the structure of the ankle?

A

The ankle is composed of two joints:
1) Subtalar joint (consists of calcaneus and talus to facilitate eversion/inversion)
2) ‘True’ ankle joint (consists of tibia, fibula, and talus to facilitate dorsi- and plantar flexion).

61
Q

What is the most likely MOI of an ankle sprain?

A

Inversion injury

62
Q

Which structure is most commonly injured in an ankle inversion injury?

A

Anterior talofibular ligament

63
Q

What is the management for an ankle sprain?

A

1) RICE
2) Analgesia
3) Early mobilisation
4) Safetynetting - if neurovascular compromise or cannot weight bear by 24h or not full weight bearing by 4 days come back

64
Q

What are the 4 types of an ankle fracture?

A

1) Isolated lateral malleolar fracture
2) Isolated medial malleolar fracture
3) Bimalleolar fracture
4) Trimalleolar fracture (medial + lateral + posterior malleolar fracture)

65
Q

What type of injury is the Weber classification used to classify?

A

Lateral malleolar fracture (there is another classification called the Lauge-Hansen classification which is based on the ankle position at the time of injury, the deforming force involved and is much more detailed than the weber classification)

66
Q

What are the parts of the Weber classification?

A

Compares level of fibular fracture relative to tibiofibular syndesmosis
1) A = below the syndesmosis
2) B = at the level of the syndesmosis
3) C = above the syndesmosis (higher likelihood of ankle instability)

67
Q

How do you manage a stable or minimally displaced ankle fracture?

A

Conservative management with cast

68
Q

How do you manage a displaced, unstable or open ankle fracture?

A

Surgical management with ORIF

69
Q

What is a Maisonneuve injury?

A

Spiral fracture of the proximal fibula (Weber type C) + unstable ankle injury (e.g. fracture of medial malleolus, widening of ankle joint space due to ligament stretch)

70
Q

What is the MOI of Maisonneuve injury?

A

External rotation + pronation of the foot

71
Q

What is the management of a Maisonneuve injury?

A

Surgical

72
Q

What are the Ottawa rules for foot XR?

A

Pain in the midfoot zone AND
1) Bony tenderness at the navicular OR
2) Bony tenderness at the base of the 5th metatarsal OR
3) Inability to weight bear immediately and in the ED (no more than 4 steps)

73
Q

What is a Lisfranc injury?

A

Tarsometatarsal fracture-dislocation between the medial cuneiform and the base of the 2nd metatarsal

74
Q

What is a potential complication of a Lisfranc injury?

A

Compartment syndrome - so prompt treatment required

75
Q

How do you manage a minimally displaced Lisfranc injury?

A

1) Case immobilisation/air-cast boot
2) Non-weight bearing mobilisation for 6-12 weeks

76
Q

How do you manage a Lisfranc injury with severe displacement?

A

Screw fixation or arthrodesis (fusion of bones)

77
Q

Which injury should you check for if there is a fracture in the 2nd metatarsal?

A

Lisfranc injury

78
Q

Where is the Lisfranc joint?

A

Between the medial cuneiform and the base of the 2nd metatarsal

79
Q

What is the MOI of a talus fracture?

A

Forced dorsiflexion

80
Q

What is the most common type of talus fracture?

A

Neck of the talus

81
Q

What is the risk with a talus fracture?

A

Avascular necrosis of the talus

82
Q

How do you manage an undisplaced talus fracture?

A

1) Cast
2) Monitor for union and avascular necrosis

83
Q

How do you manage a displaced talus fracture?

A

ORIF

84
Q

What is the second most fractured bone of the foot?

A

Talus

85
Q

Why is the talus at high risk of avascular necrosis?

A

The talus is reliant predominantly on extra-osseous arterial supply, which is highly susceptible to interruption in the context of fractures

86
Q

What is the MOI of a calcaneus fracture?

A

Trauma e.g. fall from height or RTC

87
Q

What other type of fracture is a calcaneus fracture associated with?

A

Spinal fracture

88
Q

What is the gold standard for assessing calcaneal fracture?

A

CT scan

89
Q

What are the two types of calcaneal fracture?

A

1) Intraarticular (75%)
2) Extrarticular (25%)

90
Q

How are calcaneal fractures managed?

A

ORIF if requires surgical intervention

91
Q

What is the most commonly fractured bone in the foot?

A

Calcaneus

92
Q

What is a Jones fracture?

A

Fracture of the base of the 5th metatarsal

93
Q

What is the problem with Hones fracture?

A

Predisposed to poor healing due to limited blood supply

94
Q

How do you manage a Jones fracture?

A

1) Protected weight bearing
2) Immobilisation or surgery depending on the location of fracture, degree of displacement and athletic level of patient

Stage 3 (61 decks)

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