Orthopaedics Flashcards
Osteomyelitis investigation of choice?
MRI
How to manage an undisplaced intracapsular hip frature?
Internal fixation or hemiarthroplasty if unfit
What to give if rib fracture pain not controlled by simple analgesia?
Nerve block
L3 nerve root compression?
Sensory loss over anterior thigh
Weak hip flexion, knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test
L4 nerve root compression?
Sensory loss anterior aspect of knee and medial malleolus
Weak knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test
L5 nerve root compression?
Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test
S1 nerve root compression?
Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test
Late stage sign of cauda equina?
Urinary dysfunction
Late stage sign of cauda equina?
Urinary dysfunction
Acetabular labral tear features?
hip/groin pain
snapping sensation around hip
there may occasionally be the sensation of locking
Features of iliotibial band syndrome?
tenderness 2-3cm above the lateral joint line
Most likely shoulder disloacation with seizures and electric shock?
Posterior
Salter harris stages
I- Fracture through the physis only
II- fracture through the physis and metaphysis
III- Fracture through the physis and epiphysis to include the joint
IV- Fracture through the physis, metaphysis and epiphysis
V- Crush injury involving the physis
What does a postivie lachman test suggest?
ACL injury
Rupture of the proximal tendon causes what?
‘Popeye’ deformity; this is when the muscle bulk results in a bulge in the middle of the upper arm. Seen more easily in muscular individuals and less obvious in overweight or cachectic patients
What is an iliopsoas abscess?
collection of pus in iliopsoas compartment
What is an iliopsoas abscess?
collection of pus in iliopsoas compartment
Causes of dupytren’s contracture?
manual labour
phenytoin treatment
alcoholic liver disease
diabetes mellitus
trauma to the hand
What is a colles fracture?
Dorsally Displaced Distal radius → Dinner fork Deformity
What is a potts fracture?
Bimalleolar ankle fracture
Forced foot eversion
What are osler’snodes?
Osler’s nodes are painful, red, raised lesions found on the hands and feet. They are the result of the deposition of immune complexes.
What are bouchard’s nodes?
Hard, bony outgrowths or gelatinous cysts on the proximal interphalangeal joints (the middle joints of fingers or toes.) They are a sign of osteoarthritis, and are caused by formation of calcific spurs of the articular cartilage.
What are herbeden’s nodes?
Typically develop in middle age, beginning either with a chronic swelling of the affected joints or the sudden painful onset of redness, numbness, and loss of manual dexterity. This initial inflammation and pain eventually subsides, and the patient is left with a permanent bony outgrowth that often skews the fingertip sideways.
Complications of discitis?
sepsis
epidural abscess
Management of achilles tendon rupture?
simple analgesia
reduction in precipitating activities
calf muscle eccentric exercises: this may be self-directed or under the guidance of physiotherapy
Management of extracapsular hip fracture?
stable intertrochanteric fractures: dynamic hip screw
if reverse oblique, transverse or subtrochanteric fractures: intramedullary device
Management of a displaced intracapsular hip fracture?
Arthroplasty (total hip replacement or hemiarthroplasty)
CNS findings of fat embolism?
Confusion and agitation
Retinal haemorrhages and intra-arterial fat globules on fundoscopy
What does a positive posterior draw test indicate?
Posterior cruicate ligament rupture
Motor conduction study results of carpal tunnel syndrome?
motor + sensory: prolongation of the action potential
What is a galezzi fracture?
dislocation of the distal radioulnar joint with an associated fracture of the radius
Mugger
What is talipes equinovarus?
inverted (inward turning) and plantar flexed foot. It is usually diagnosed on the newborn exam.
What is de quervian’s tenosynovitis?
sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed
Pagets features in bloods
Focal bone resorption followed by excessive and chaotic bone deposition
Serum alkaline phosphatase raised (other parameters normal)
Inital imaging modality for achilles tendon rupture?
US
Thumbs in OA?
Squaring of the thumbs: Deformity of the carpometacarpal joint of the thumb resulting in fixed adduction of the thumb.
Painless nodes (bony swellings) in OA?
Heberden’s nodes at the DIP joints
Bouchard’s Nodes at the PIP joints
these nodes are the result of osteophyte formation.
What does leg look like in posterior hip dislocation?
The affected leg is shortened, adducted, and internally rotated.
What does the leg look like in anterior hip dislocation?
The affected leg is usually abducted and externally rotated. No leg shortening.
What is syringomyelia?
selectively affects the spinotholamic tracts. Syringomyelia is a disorder in which a cystic cavity forms within the spinal cord. The commonest variant is the Arnold- Chiari malformation in which the cavity connects with a congenital malformation affecting the cerebellum
What is brown sequard syndrome
hemisection of the spinal cord. It may result from stab injuries or lateral vertebral fractures. It results in ipsilateral paralysis (pyramidal tract) , and also loss of proprioception and fine discrimination (dorsal columns). Pain and temperature sensation are lost on the contra-lateral side. This is because the fibres of the spinothalamic tract have decussated below the level of the cord transection.
Red flags for lower back pain?
age < 20 years or > 50 years
history of previous malignancy
night pain
history of trauma
systemically unwell e.g. weight loss, fever
What is Lachman’s test?
dentify ACL injuries. Lachman’s test is more sensitive than the anterior draw test. Thus, this is the correct answer as the question asks what would most reliably diagnose the injury.
X-ray findings of osteoarthritis of the hand?
Radiologically there are osteophytes and joint space narrowing. Often signs may be visible on X-ray, before symptoms develop
Salter harris I?
Injury through the physis only
Most common site of metatarsal stress fracture?
2nd metatarsal
structure divided in surgical management of carpal tunnel syndrome
Flexor retinaculum
What is a monteggia fracture?
dislocation of the proximal radioulnar joint in association with an ulnar fracture
What is meralgia parasthetica?
causes pain in the lateral cutaneous nerve of the thigh distribution
Management of sublixation of the radial head?
Passive supination of the elbow joint whilst flexed to 90 degrees
Management of undisplaced fractures of the scaphoid waist?
cast for 6-8 weeks
union is achieved in > 95%
certain groups e.g. professional sports people may benefit from early surgical intervention
What is Galeazzi fracture?
Radial shaft fracture with associated dislocation of the distal radioulnar joint
Occur after a fall on the hand with a rotational force superimposed on it.
On examination, there is bruising, swelling and tenderness over the lower end of the forearm.
X Rays reveal the displaced fracture of the radius and a prominent ulnar head due to dislocation of the inferior radio-ulnar joint.
Presentation of a radial head fracture?
Fracture of the radial head is common in young adults.
It is usually caused by a fall on the outstretched hand.
On examination, there is marked local tenderness over the head of the radius, impaired movements at the elbow, and a sharp pain at the lateral side of the elbow at the extremes of rotation (pronation and supination).
An ankle x-ray is required only if there is any pain in the malleolar zone and any one of the following findings:
bony tenderness at the lateral malleolar zone (from the tip of the lateral malleolus to include the lower 6 cm of posterior border of the fibular)
bony tenderness at the medial malleolar zone (from the tip of the medial malleolus to the lower 6 cm of the posterior border of the tibia)
inability to walk four weight bearing steps immediately after the injury and in the emergency department
What is the postenti method?
manipulation and progressive casting which starts soon after birth. The deformity is usually corrected after 6-10 weeks. An Achilles tenotomy is required in around 85% of cases but this can usually be done under local anaesthetic
How does a meniscal tear present?
Rotational sporting injuries
Delayed knee swelling
Joint locking (Patient may develop skills to ‘unlock’ the knee
Recurrent episodes of pain and effusions are common, often following minor trauma
Management of carpal tunnel syndrome?
6-week trial of conservative treatments if the symptoms are mild-moderate
corticosteroid injection
wrist splints at night
if there are severe symptoms or symptoms persist with conservative management:
surgical decompression (flexor retinaculum division)
Management of scaphoid fractures?
dependent on the patient and type of fracture
undisplaced fractures of the scaphoid waist
cast for 6-8 weeks
union is achieved in > 95%
certain groups e.g. professional sports people may benefit from early surgical intervention
displaced scaphoid waist fractures- requires surgical fixation
proximal scaphoid pole fractures- require surgical fixation
Microbiology causes of osteomyleitis?
Staph. aureus is the most common cause except in patients with sickle-cell anaemia where Salmonella species predominate
What is a supracondylar fracture?
Injury to the humerus, or upper arm bone, at its narrowest point, just above the elbow
Most common fractures associated with compartment syndrome?
supracondylar fractures and tibial shaft injuries.
Nerve and action of the tibialis anterior
Nerve and action of the extensor digitorum longus?
Nerve and action of the peroneus tertius
Nerve and action of the peroneus tertius
Nerve and action of the extensor hallucis longus?
Nerve and action of these?
Nerves and action of these?
Nerve and action of these?
What is a colles fracture?
a type of broken wrist (fracture). It’s also called a distal (away from the center of the body) fracture with dorsal angulation (an upward angle).
What is acromioclavicular joint dislocation?
The AC joint is the only bony connection of your shoulder blade and it is important for maintaining normal dynamics in your shoulder.
The AC joint relies on three main structures for stability: Your AC joint capsule, the coraco-clavicular ligaments and the delto-trapezial fascia. These structures are illustrated below
Dislocation normally occurs secondary to direct injury to the superior aspect of the acromion. Loss of shoulder contour and prominent clavicle are key features. Note; rotator cuff tears rarely occur in the second decade.
What is a hill-sachs lesion?
when the cartilage surface of the humerus is in contact with the rim of the glenoid. About 50% of anterior glenohumeral dislocations are associated with this lesion.
Graph for anaemia types
