Orthopaedics Flashcards
Management of buckle fracture?
Typically self limiting - splinting and immobilization
What movement causes the pain in lateral epicondylitis (tennis elbow)?
Pain worse on wrist extension against resistance with the elbow extended or supination of the forearm with the elbow extended
Definition of osteoporosis
Bone mineral density of less than 2.5 SD below the young adult mean density
What areas of the body does the DEXA scan look at?
Hip and lumbar spine
What does the FRAX or QFracture Score assess?
The 10 year risk of a patient developing a fragility fracture
Blood test results in osteoporisis
Normal
Management of osteoporosis
Calcium + Vitamin D supplements
Oral Bisphosphonates are first line
Denosumab is second line
What movement is most affected when patients have a frozen shoulder?
External rotation
What is the most common reason for total hip replacement revision?
Aseptic loosening
What nerve is compressed in carpal tunnel syndrome
Median
Describe the examination findings in carpal tunnel syndrome
Weakness of thumb abduction
Wasting of the thenar eminence
Tinnels sign (tapping causes paraesthesia)
Phalens sign (flexion of the wrist causes symptoms)
X Ray changes in rheumatoid arthirits
Loss of joint space
Juxta articular osteoporosis
Soft tissue swelling
Periarticular erosions
Subluxation
X ray appearance of psoriatic arthritis
Periostitis
Erosive changes and new bone formation
Pencil in cup appearance
X Ray findings in osteosarcoma
Codman triangle (a triangluar area of new subperiosteal bone) with an associated sunburst appearance
What is the most common primary malignant bone tumour
Osteosarcoma
Conditions associated with ankolysing spondylitis
Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilled tendonitis
AV node block
Amyloidosis
Antobodies assictaed with limited cutaneous systemic sclerosis
Anti centromere antibodies
Symptoms of limited cutaneous systemic sclerosis
Raynauds
Scleroderma affecting face and distal limbs predominately
CREST syndrome - Calcinosis, Raynauds, Oesophageal dysmotility, sclerodactyly and talangiectasia
Antibodies associated with diffuse cutaneous systemic sclerosis
ANti SCL 70
Most common cause of death in cutaneous systemic sclerosis
Respiratory involvement (ILD and pulmonary hypertension)
Compression of what nerve causes cubital tunnel syndrome
Ulnar nerve
Clinical examination findings in ankolysiing sponydlitis
Reduced lateral flexion
Reduced forward flexion (schobers test)
Reduced chest expansion
HLA type associated with ankolysisng spondylitis
HLA B27
What blood needs o be regularaly checked when patients are taking methotrexate? What is the monitoring schedule
FBC, U & E, LFTs before starting treatment and then weekly unil therapy stabilised.
What drus must be avoided when people are taking methotrexate?
Trimethoprim and Co trimoxazole
What are the ottowa ankle rules?
Ankle X Ray is only required if there is pain in the malleolar zone + any one of the following findings
1. Bony tenderness at the lateral malleolar zone
2. Bony tenderness at the medial malleolar zone
3. Inability to walk 4 weight bearing steps immediately after the injury and in the emergency department.
When should urate lowering therapy be started?
Should be offered to all patients after their first attack of gout
What symptoms does L3 root compression cause?
Sensory loss over anterior thigh
Weak hip flexion, knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test
What symptoms does L4 nerve root compression cause?
Sensory loss over anterior aspect of the knee and medial malleolus
Weak knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test
What symptoms does L5 nerve root compression cause?
Seonsory loss over dorsum of foot
Weakness in foot and big toe dorsiflexion
Normal reflexes
Positive sciatic nerve stretch test
What symptoms does S1 nerve root compression cause?
Seonsory loss of the posterolateral aspect of the leg and lateral aspect of the foot
Weakness in plantar flexion of the foot
Reduced ankle reflex
Positive sciatic nerve stretch test
What is de quervains tenosynovitis?
The sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed. Causes pain on the radial side of the wrist.
How is spinal stenosis diagnosed?
MRI scan
Blood results in pagets disease
Normal calcium and phosphate
Significantly raised ALP
What is pagets disease of bone?
A disease of increased but uncontrolled bone turnover. Excessive osteoclastic resorption followed by increased osteoblastic activity.
Treatment of pagets disease?
Bisphosphonates
Most sensitive antibody for rheumatoid arthritis
Anti CCP
What nerve is most likely to be accidentally damaged during a total knee replacement?
Common peroneal nerve
How long do symptoms have to have been present to make a diagnosis of chronic fatique syndrome?
3 months
What does the radial nerve control?
Forearm, wrist, finger and thumb extension
What nerve is most likely to be damaged in a humeral midshaft fracture?
Radial nerve
If damaged will cause a wrist drop
What nerve is most likely to be damaged in a humeral neck fracture/dislocation
Axillary nerve.
What muscles does the median nerve do?
Innervates LOAF muscles (Lateral 2 lumbricals, opponens pollis, abductor pollic brevis, flexor pollis brevis)
Sensation to the palmar aspect of the lateral 3.5 fingers (Thumb, index, middle and half of the ring finger)
What does the ulnar nerve do?
Innervates the intrinsic hand muscles except LOAF
Wrist flexion
Sensation to medial 1.5 fingers (pinky and half of ring finger)
Damage to which nerve causes a winged scapula?
Long thoracic
What is the treatment for proximal scaphoid pole fractures?
Surgical fixation
What is a mallet finger?
An injury to the extensor tendon mechanism at the DIP joint usually caused by forced flexion while attemmpting to extend the fingertip
What is trigger finger?
Abnormal flexion of the digits caused by a disparity between the size of the tendons and pulley through which they pass
What position is the hip in following a posterior dislocation?
Shortened, adducted and internally rotated
What blood tests need to be checked before starting azathioprine?
TPMT levels. If levels are low of absent the the patient is as risk of bone marrow supression
Antibody associated with dermatomyositis
Anti Jo 1
Treatment for ankolysing spondylitis
Regular exercise
Physiotherapy
DMARDS - only useful if there is peripheral joint involvement.
Anti TNF medications if there is persistently high disease activity
Definition of an intracapsular hip fracture
Fracture from the edge of the femoral head to the insertion of the capsule hip joint
Management of a stable intertrochanteric hip fracture
Dynamic hip screw
What is pseudogout?
Deposition of calcium pyrophosphate dihydrate crystals in the synovium.
What is seen on an x ray of pseudogout?
Chondrocalcinosis - linear calcifications of the meniscus and articular cartilage
What is seen in the joint aspiration of a patient with pseudogout?
Weakly positively birefringent rhomboid shaped crystals
What is chondromalacia patellae?
Anterior knee pain caused by abnormal softening of the cartilage on the underside of the patella. Causes anterior knee pain worse after sitting for a prolonged period of time.
What is osgood schlatter disease?
Common cause of knee pain in adolscents. Caused by the overuse of the quadriceps putting strain on the patellar ligament attachment to the tibia. Main symptoms is pain inferior to the patella which is worse for activity and better for rest.
What is a colles fracture?
A fracture of the distal radius within 2.5cm of the wrist joint. Distal radius is dorsally displaced and dorsally angulated.
What is a smith fracture?
Fracture of the distal radium that occurs due a fall on the back of the hand. Distal fragment is displaced anteriorly (to the volar aspect)
What is a bennets fracture?
Fracture to the base of the metacarpal of the thumb. It causes pain and swelling to the thenar eminence and an inability to move the thumb.
What do X rays show in osteomalacia?
Linear areas of low density (loosers zones)
What are the blood results in osteomalacia?
Low calcium
Normal phosphate
Raised ALP
What is cANCA associated with?
Granulomatosis with polyangitis
What is pANCA associated with?
Eosonophillic granulomatosis
Ulcerative colitis
Primary sclerosis cholangitis
Anti GBM disease
Crohns disease
What does PTH do?
- Stimulated bone to break down minerals - increased Ca and Phosphate
- Activated Vitamin D - This also stimulates the bone. Inhibits PTH. Increases calcium and phosphate absoprtion from the gut. Increases reabsoprtion from the kidneys.
What is the management of a displaces intracapsular hip fracture?
Intramedullary nail or hemiarthroplasty
What is the management of an intertrochanteric hip fracture?
Dynamic hip screw
What is the management of subtrochanteric hip fracture?
Intramedullary nail
What does the femoral nerve do?
Knee extension, thigh flexion
Sensory innervation to the anterior and medial aspect of the thigh and lower leg.
What doe sthe obturator nerve do?
Thigh adduction. Sensory innervation of the medial thigh.
How is the femoral nerve damaged?
Hip and pelvic fractures
How is the obturator nerve damaged?
Anterior hip dislocation
What does the tibial nerve do?
Foot plantarflexion and inversion. Sensory to the sole of food
What does the common peroneal nerve do?
Foot doriflexion and eversion. Extensor hallucus longus. Sensory innervation to the dorsum of the foot and lower lateral part of the leg.
How is the common peroneal nerve injured?
Injury often occurs at the neck of the fibula. (eg tightly applied lower limb plaster cast)
Injury causes foot drop
