Orthopaedics Flashcards
Describe the joint affected in anterior shoulder dislocation.
The glenohumeral joint is affected in anterior shoulder dislocation.
What muscle is affected in anterior shoulder dislocation causing inability to raise the arm above the head?
The deltoid muscle is affected.
How is reduction done in anterior shoulder dislocation?
Closed reduction followed by sling treatment is used.
Define the nerve affected in anterior shoulder dislocation leading to loss of sensation over the shoulder.
The axillary nerve is affected.
Describe the common causes of posterior shoulder dislocation.
It occurs in epileptics, electrical shock, or eclampsia.
What are the characteristic movements in posterior shoulder dislocation?
Adduction and internal rotation are characteristic movements.
What nerve is affected in a fracture of the surgical neck of the humerus?
The axillary nerve is affected.
How is a fracture of the surgical neck of the humerus typically treated?
It is treated with a triangular sling.
Describe the risk associated with humerus shaft fracture.
Wrist drop due to radial nerve injury is a risk.
What is the treatment for humerus shaft fracture?
A hanging arm cast is used for treatment.
When should child abuse be suspected in fractures?
Child abuse should be suspected.
cases of spiral fracture
What vascular impairment is associated with dislocated elbow?
Brachial artery impairment is associated.
How is a dislocated elbow typically treated?
Reduction under anesthesia is the typical treatment.
Describe the management approach for a green fracture in an adult involving the wrist and elbow.
Plaster cast
Define Colles’ fracture.
Fracture in old age postmenopausal females caused by a fall on an outstretched hand
How is reduction done for a stable fracture of the radius and ulna?
Disimpaction then traction the hand in a flexed position with ulnar deviation
What is the risk factor associated with Colles’ fracture?
Osteoporosis
Describe the shape associated with a Colles’ fracture.
Posterolateral displacement and angulation
What is the treatment for unstable fractures of the radius and ulna?
Surgery
For unstable fractures of the radius and ulna, particularly in older children where remodeling potential is minimal, the recommended treatment involves the following steps:
- Orthopaedic Advice and/or Referral: It is essential to seek orthopaedic advice or refer the patient to an orthopaedic service. This is especially important for greenstick and complete fractures, as well as for growth plate injuries and suspected Monteggia and Galeazzi injuries.
- Reduction and Immobilization: Unstable fractures often require reduction (realignment) of the bone fragments. Following reduction, immobilization is necessary to maintain the correct alignment. This is typically achieved using a well-molded cast or splints, sometimes extending above the elbow in younger children to prevent slippage.
- Follow-Up X-Rays: After reduction and cast application, follow-up X-rays are necessary to ensure that the fracture remains in the correct position. This usually includes one X-ray immediately after cast application if manipulation was required, and another follow-up X-ray after 7-10 days.
- Monitoring for Complications: Regular follow-up visits are needed to monitor for potential complications such as loss of reduction, growth disturbances, or improper healing.
For severe or complicated cases, surgical intervention may be required to stabilize the fracture using pins, plates, or screws.
Reference: AJGP-11-2020-Clinical-Selvakumaran-Buckled-Bent-Broken-WEB.pdf oai_citation:1,AJGP-11-2020-Clinical-Selvakumaran-Buckled-Bent-Broken-WEB.pdf.
How is a plaster cast positioned for a stable fracture of the radius and ulna?
Below elbow with pronated semi-flexed hand and ulnar deviation
Describe a scaphoid fracture.
It is the most common fractured carpal bone usually resulting from a fall on the outstretched hand.
What is the typical presentation of a scaphoid fracture?
Tenderness in the anatomical snuff box, with radiological changes appearing around 2 weeks after the injury.
What are the risks associated with a scaphoid fracture?
Avascular necrosis, proximal necrosis, and non-union.
How is a stable scaphoid fracture treated?
With a thumb spica cast.
What is the treatment for an unstable scaphoid fracture?
Open reduction and internal fixation (OR+IF).
Describe a clavicular fracture.
It typically occurs from a fall on an outstretched hand or is birth-related, commonly affecting the middle third of the clavicle.
What is the recommended treatment for a clavicular fracture?
A figure of eight sling.
What is the most common complication of a clavicular fracture?
Malunion.
When is surgery indicated for a clavicular fracture?
If vessel injury is suspected, or there is marked displacement, deformity, fullness, or crepitation.
How are birth-related clavicular fractures usually managed?
They are managed conservatively with no specific treatment.
Describe the cause of nursemaid’s elbow (radial head dislocation).
Strong pulling of the child’s arm.
What age group is commonly affected by nursemaid’s elbow?
Toddlers.
How is nursemaid’s elbow typically treated?
Manual reduction by supination in 90-degree flexion.
What is a potential risk associated with supracondylar fractures?
Brachial artery injury.
Define Volkmann contracture.
A condition that occurs in the chronic stage of supracondylar fractures, leading to muscle and nerve damage.
The supracondylar fracture is the most common elbow fracture in children and usually occurs due to an extension force. The most serious complication is the Volkmann contracture, which occurs as a result of a forearm compartment syndrome and subsequent muscle and nerve necrosis. Undisplaced supracondylar fractures with normal neurological and vascular supply can be managed in a flexion cast. Orthopaedic intervention is required where there is vascular compromise and for significantly displaced and/or angulated fractures. It is important to always check the neurological and vascular integrity distal to the fracture.
What nerve is at risk of injury in cases of supracondylar fractures?
Median nerve.
What is the recommended treatment if a cast is suspected to be too tight?
Remove the cast immediately.
What should be done if a vessel injury is suspected in a case of supracondylar fracture?
Immediate exploration.
Describe the cause of mallet finger.
Trauma is the cause of mallet finger.
How is mallet finger treated?
Mallet finger is treated by hyperextension of the DIP joint for 6 weeks using non-adhesive tape.
When is surgery recommended for mallet finger?
Surgery is recommended for mallet finger in cases of instability, subluxation, or avulsed bony fragments.
Define lateral epicondylitis.
Lateral epicondylitis, also known as tennis elbow, is inflammation at the point of attachment of the extensor muscles on the outer part of the elbow.
What are the risk factors for lateral epicondylitis?
Risk factors for lateral epicondylitis include repeated bending and twisting movements, as well as excessive use of the wrist especially when unfit.
Describe the clinical picture of lateral epicondylitis.
Patients with lateral epicondylitis, such as tennis players, carpenters, or violinists, typically present with pain at the outer bony projection of the elbow.
What is the treatment for lateral epicondylitis?
The treatment for lateral epicondylitis includes rest and NSAIDs. Band
Define medial epicondylitis.
Medial epicondylitis, also known as golfer’s elbow, involves inflammation at the point of attachment of the flexor group on the inner part of the elbow.
How does medial epicondylitis differ from lateral epicondylitis?
Medial epicondylitis is less common and less severe compared to lateral epicondylitis.
Describe the most common form of hip dislocation.
Posterior dislocation
What is the cause of hip dislocation in car accidents?
Short leg with internal rotation
Which nerve is affected in hip dislocation leading to sciatica?
Nerve affected is sciatic nerve
What is the treatment for hip dislocation?
Closed reduction
In elderly individuals, what is considered an emergency related to the femur?
Femoral fracture
How is the leg typically positioned in femoral fracture with external rotation?
Short leg with external rotation
What is the risk associated with femoral fracture related to fat embolism?
Risk of embolism
What is the common treatment for femoral fracture involving intramedullary nail fixation?
Intramedullary nail fixation
What is the common cause of tibial fracture?
Direct trauma
What is the compartmental risk associated with tibial fracture?
Compartment syndrome risk
What is the typical treatment for tibial fracture?
Casting
Which nerve is commonly affected in fibula fracture?
Common peroneal nerve
What is the recommended treatment for fibula fracture?
No specific treatment, just NSAIDs
Describe the common sites for stress fractures.
The most common site is the second metatarsal bone, followed by the proximal tibia and the navicular bone.
What are the risk factors for stress fractures?
Risk factors include being a runner or jumper.
How does pain in stress fractures typically behave?
Pain increases with activity and decreases with rest.
Define the typical presentation of stress fractures.
Localized tenderness is a common presentation.
What is the usual appearance of stress fractures on X-ray?
X-rays are usually normal in cases of stress fractures.
What is the main treatment for stress fractures?
Rest and analgesics are the main treatment, with casting aiding in rapid healing and surgery rarely needed.
Describe the age group commonly affected by Osgood-Schlatter disorder.
Osgood-Schlatter disorder typically affects adolescents.
Do boys or girls tend to be more affected by Osgood-Schlatter disorder?
Boys are more commonly affected than girls.
What is the main risk factor for Osgood-Schlatter disorder?
Engaging in sports, especially running and jumping, is a significant risk factor.
Explain the mechanism behind Osgood-Schlatter disorder.
It involves traction on the immature tibial tubercle by the patellar tendon.
What are the common symptoms of Osgood-Schlatter disorder?
Patients may experience pain at the knee joint or at the patella.
How is Osgood-Schlatter disorder typically managed?
Treatment involves rest, restriction of activities, and the use of NSAIDs.
What is the usual prognosis for Osgood-Schlatter disorder?
It is self-limited and usually resolves within 12-18 months.
Describe multiple myeloma.
It is a cancer of plasma cells, commonly affecting older individuals, with a higher incidence in men than women.
What are some common clinical symptoms of multiple myeloma?
Bone pain, anemia, weight loss, symptoms of hypercalcemia (constipation, polyuria, excessive thirst, nausea), kidney failure, impaired immunity, weakness or numbness in legs.
What are some key investigations for multiple myeloma?
Increased calcium level, increased plasma cells, increased M proteins, presence of Rouleux cells, and osteolytic lesions on X-ray.
How does multiple myeloma affect the kidneys?
High levels of abnormal monoclonal proteins (M proteins), such as Bence Jones proteins, can damage the kidneys leading to renal failure.
Define the treatment for multiple myeloma.
Treatment typically involves chemotherapy.