Orthopaedics

Question 1

Name the rotator cuff muscles

Answer 1

• Subscapularis - positioned anteriorly on your chest, helps with internal rotation of shoulder
• Supraspinatus - positioned on top of your shoulder and runs parallel to your deltoid. Needed for the first 20° of shoulder abduction, then the rest of abduction is done by the deltoid
• Infraspinatus - positioned posteriorly on the superior aspect of your back, helps with external rotation of shoulder
• Teres minor - positioned posteriorly on the superior aspect of your back, helps with external rotation of shoulder

Question 1

What scoring system is used to measure the disease activity in rheumatoid arthritis?

Answer 1

DAS28

Question 2

What is the trama triad of death?

Answer 2

Hypothermia
Coagulopathy - of which cold fluids will make worse
Acidosis

Question 3

Smith’s vs Colle’s fracture

Answer 3

Smith’s fracture: fracture of the distal radius with volar (anterior) displacement. The distal fragment of the radius is displaced toward the palm - wrist is flexed

Colles’ fracture: fracture of the distal radius with dorsal (posterior) displacement. The distal fragment of the radius is displaced toward the back of the hand - wrist is extended

Question 4

Name benign and metastatic bone tumours

Answer 4

Benign:
* Osteoma
* Osteochondroma
* Giant cell tumour

Metastatic:
* Osteosarcoma
* Ewing’s sarcoma
* Chondrosarcoma

Question 5

What is the management of an intracapsular hip fracture?

Answer 5

Undisplaced Fracture:
* internal fixation, or hemiarthroplasty if unfit.

Displaced Fracture:
* Replacement arthroplasty: Total hip replacement or hemiarthroplasty)
* Total hip replacement is favoured to hemiarthroplasty if patients: are 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.

Question 6

What is the management of an extracapasular hip fracture?

Answer 6

• Stable intertrochanteric fractures: dynamic hip screw
• If reverse oblique, transverse or subtrochanteric fractures: intramedullary device

Question 7

What is a buckle fracture?

Answer 7

Buckle, or torus, fractures are incomplete fractures of the shaft of a long bone that is characterised by bulging of the cortex. They typically occur in children aged 5-10 years.

As they are typically self-limiting they do not usually require operative intervention and can sometimes be managed with splinting and immobilisation rather than a cast.

Question 8

How do you immobilise a scaphoid fracture?

Answer 8

Futuro splint or below-elbow backslab

Question 9

What should you do in an ankle fracture before seeking specialist help?

Answer 9

Reduce the fracture - will remove pressure from the underlying skin and prevent any subsequent necrosis