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.
Describe the diagnosis criteria for monoclonal gammopathy of undetermined significance (MGUS).
- Monoclonal paraprotein band lesser than 30 g/L (< 3g/dL)
- Plasma cells less than 10%
- No evidence of bone lesions, anemia, hypercalcemia, or renal insufficiency
- No evidence of another B-cell proliferative disorder
What is the prognosis of monoclonal gammopathy of undetermined significance (MGUS)?
It may transform into multiple myeloma.
How should the management of MGUS be approached in terms of monitoring?
Protein electrophoresis should be repeated annually.
Define the main management approach for MGUS.
Annual follow-up by serum electrophoresis.
Compare the plasma cells level in multiple myeloma and MGUS.
Multiple myeloma has more than 10% plasma cells, while MGUS has less than 10%.
Describe the difference in calcium levels between multiple myeloma and prostate cancer.
Multiple myeloma always presents with hypercalcemia, while in prostate cancer, calcium levels can be normal.
Do both multiple myeloma and prostate cancer typically affect old age males with back pain?
Yes, both conditions commonly affect old age males with back pain.
What imaging study is recommended in the management of MGUS?
A skeletal survey is recommended.
Describe carpal tunnel syndrome.
A painful disorder of the hand caused by pressure on the median nerve.
What is the typical demographic affected by carpal tunnel syndrome?
Middle-aged females are more commonly affected.
What are some risk factors for carpal tunnel syndrome?
Pregnancy, rheumatoid arthritis (RA), and hypothyroidism are risk factors.
What are common symptoms of carpal tunnel syndrome?
Pain and numbness at the thumb, index, and middle finger.
When is carpal tunnel syndrome often more pronounced?
Symptoms are often worse at night.
What can be a complication of carpal tunnel syndrome?
Permanent weakness and numbness of the hand.
What test can be used to diagnose carpal tunnel syndrome?
Phalen test.
What are some treatment options for carpal tunnel syndrome?
Analgesics, splinting, cortisone injections, and surgery.
Describe plantar fasciitis.
Pain in the foot that typically increases with the start of walking.
What imaging technique can be used to diagnose plantar fasciitis?
X-ray to detect any bony spurs.
What is a common treatment for plantar fasciitis?
Nonsteroidal anti-inflammatory drugs (NSAIDs) are often used.
What is the typical prognosis for plantar fasciitis?
Most cases heal within 18 months, with the majority resolving within 12 months.
Describe Superior Vena Cava Syndrome
It is a condition caused by obstruction of the superior vena cava, often due to lung cancer.
What is Pemperton sign?
It is the congestion of the face and neck that increases when the arm is elevated, seen in Superior Vena Cava Syndrome.
Explain the initial step in treating Superior Vena Cava Syndrome
The first step in treatment is usually irradiation.
What is the definitive treatment for Superior Vena Cava Syndrome?
Surgery is considered the definitive treatment for Superior Vena Cava Syndrome.
Describe Paget disease.
Paget disease is a remodeling disorder that is usually asymptomatic but can present with bony pain increased at night, deafness, and skull deformities. It is more common in females.
What are the typical findings in Paget disease on investigations?
In Paget disease, there is an increased alkaline phosphatase level, while serum calcium levels are usually normal. X-ray may show lytic lesions. Treatment involves the use of bisphosphonates.
What are the causes of spinal cord compression?
Spinal cord compression can be caused by acute trauma or metastasis of cancer, such as breast cancer.
What are the clinical presentations of spinal cord compression?
Clinical presentations of spinal cord compression include mid-thoracic pain and upper motor neuron signs below the level of compression.
How is spinal cord compression diagnosed?
The investigation of choice for diagnosing spinal cord compression is MRI.
What is the first step in the treatment process mentioned in the content?
Dexamethasone
Describe the long-term treatment for osteosarcoma according to the content.
Irradiation
Define the site commonly affected by osteosarcoma as per the content.
Long bones, specifically thigh near knee
What are the common clinical presentations of osteosarcoma mentioned in the content?
Painful movement
What are the investigations recommended for osteosarcoma as per the content?
Subcortical bone formation on X-ray, Biopsy, Bone Scan, CT Chest
What is the treatment mentioned for osteoclastoma (Giant cell Tumor) in the content?
Biopsy (golden standard)
Describe the appearance of osteoclastoma (Giant cell Tumor) on X-ray according to the content.
Soap bubble appearance
Describe the common causes of knee menisci injuries.
Knee menisci injuries are commonly caused by trauma, leading to symptoms such as inability to fully straighten the knee (locking) and feeling like the knee gives away.
What are the key symptoms of a cruciate ligament injury in the knee?
Key symptoms of a cruciate ligament injury in the knee include a ‘pop’ sound during a twisting movement, followed by an inability to continue participation, severe swelling, and positive results in tests like the anterior drawer test and Lachman test.
How is a knee meniscus injury different from a cruciate ligament injury in terms of symptoms?
A knee meniscus injury may cause locking or giving away of the knee, while a cruciate ligament injury is characterized by a ‘pop’ sound during twisting, followed by swelling and difficulty continuing activity.
Define the investigation of choice for knee injuries involving the cruciate ligaments.
The investigation of choice for knee injuries involving the cruciate ligaments is an MRI scan.
Do the anterior drawer test and Lachman test help diagnose anterior or posterior cruciate ligament injuries?
The anterior drawer test and Lachman test are used to diagnose anterior cruciate ligament injuries.
What are the common tests used to diagnose posterior cruciate ligament injuries in the knee?
Tests commonly used to diagnose posterior cruciate ligament injuries include the posterior drawer test and the pivot shift test.
Describe the treatment approach for a small meniscus injury.
Conservative treatment is usually recommended.
When is surgery typically considered for a severe meniscus injury?
Surgery is usually considered for severe meniscus injuries.
What factors determine the need for surgery in a cruciate ligament injury?
Factors include being young, active, an athlete, or having a complete tear.
What are the common symptoms of a partial rupture of the Achilles tendon?
Symptoms include a history of running or jumping, sudden severe pain, and no gap upon examination.
What is the recommended treatment for a complete rupture of the Achilles tendon with no gap upon examination?
Conservative treatment is usually recommended.
How is a complete rupture of the Achilles tendon with a gap upon examination typically managed?
Emergent surgery is usually required if a gap is present for more than 3 hours.
Describe the conservative treatment for an ankle fracture.
It involves using a cast for 4-6 weeks, typically considered for non-displaced fractures.
What are the recommended intervals for serial radiographs in ankle fracture cases?
Radiographs are usually taken at 48 hours, at 7 days, and then at two-weekly intervals.
When is operative treatment usually considered for ankle fractures?
Operative treatment is usually considered for displaced unstable fractures.
What is a potential consequence of vessels injury in ankle fractures?
Vessels injury can lead to the loss of distal pulse.
List some complications associated with ankle fractures.
Complications may include compartment syndrome, vascular compromise, and foot ischemia.
What is the initial step if pulsation is not felt in a fractured ankle?
The first step is reduction. If pulsation is still not felt, exploration is the next step.
What are some common causes of a fracture pelvis?
Causes include falls in old age and trauma.
What is one of the most common complications of a fracture pelvis?
One of the most common complications is bleeding, which may require tying the pelvis.
How is a fracture pelvis typically managed?
The management involves addressing complications like bleeding and may require tying the pelvis if necessary.
Describe the management approach for stable fractures.
Stable fractures are usually managed with analgesia and early mobilization after 3 to 6 weeks. Larger avulsions may require internal fixation.
What is the recommended management for avulsion fractures?
Avulsion fractures typically require rest and pain relief. Larger avulsions may necessitate internal fixation.
What actions are advised for unstable fractures?
For unstable fractures, resuscitation is crucial. Avoid catheterization if urethral injury is suspected, and surgery may be necessary.
How should prophylaxis be managed after orthopedic surgery?
Prophylaxis after orthopedic surgery should not include aspirin. Heparin or LMWH is the preferred choice, with warfarin reserved for those with a history of DVT.
Describe the sequence of management after fracture or orthopedic operations in the elderly.
In the elderly, up to 6 weeks of prophylactic LMWH is crucial. Priority should be given to a dexa scan for osteoporosis, followed by treatment with bisphosphonates as the most important therapy for osteoporosis.
Describe the symptoms of an orbital floor fracture.
Symptoms include enophthalmos, diplopia (horizontal), pain with limited eye movement, and cheek numbness.
Describe the symptoms of a zygomatic fracture.
Symptoms include diplopia (vertical), difficulty in mastication, and enophthalmos.
What is the common investigation method for evaluating a zygomatic fracture?
X-ray imaging is commonly used for investigation.
What are the possible consequences of an orbital floor fracture?
Possible consequences include enophthalmos, diplopia, pain with limited eye movement, and cheek numbness.
How can an orbital floor fracture affect eye movement?
It can result in pain with limited eye movement.
Do zygomatic fractures affect mastication?
Yes, zygomatic fractures can lead to difficulty in mastication.
Define enophthalmos in the context of facial fractures.
Enophthalmos refers to the posterior displacement of the eyeball within the orbit.
How do orbital floor fractures typically present in terms of eye appearance?
Orbital floor fractures often present with enophthalmos.
What is diplopia, and how is it related to facial fractures?
Diplopia is double vision and can be a symptom of both orbital floor and zygomatic fractures.
Describe paresthetica meralgia.
It is characterized by numbness or pain in the outer thigh.
What nerve is affected in paresthetica meralgia?
The lateral cutaneous nerve of the thigh.
What are some causes of paresthetica meralgia?
Aging, compression against underwear or outer clothing, and long periods of standing.
What is the Trendelenburg sign associated with paresthetica meralgia?
Weakness or paralysis of the gluteus minimus and medius muscles.
How can paresthetica meralgia be treated?
Treatment involves relieving weight-bearing over the hip muscles, which is very important.
Describe the effects of cranial nerve affection on the optic nerve.
Ipsilateral loss of vision and loss of direct and consensual light reflex.
What symptoms may be observed with oculomotor nerve affection?
Ptosis, mydriasis, diplopia, divergent paralytic squint, and ipsilateral loss of light reflex.
What symptoms can occur with trochlear nerve affection?
Vertical diplopia (on looking downward).
What symptoms are associated with abducent nerve affection?
Horizontal diplopia (on looking to the right or the left).
What are the effects of facial nerve affection in upper motor neuron lesions (UMNL)?
Affects the pyramidal tract above the facial nucleus, affects voluntary muscles, spares emotional movements, causes hypertonia, and hyperreflexia.
Describe the clinical manifestations of LMNL involving the facial nerve.
Hemiplegia on the same side, affection of lower half of the face on the opposite side, drop angle of the mouth, deviation of the mouth to the opposite side, dribbling saliva, inability to blow cheek.
What are some characteristics of LMNL affecting the facial nerve?
LOST emotional movements, hypotonia, hyporeflexia, hemiplegia on the opposite side, paralysis of all muscles on the same side, no raising of the eyebrow, no closure of the eye, no wrinkles of the forehead.
Describe the effect of a lesion on the hypoglossal nerve.
Deviation of the tongue to the same side of the lesion.
What reflex is associated with the L4 nerve?
Knee reflex.
What condition is associated with the L5 nerve?
Foot drop.
What reflex is linked to the S1 nerve?
Ankle reflex.
What muscles are affected by the C5, C6 nerves?
Biceps and brachioradialis.
What muscles are affected by the C6, C7 nerves?
Triceps.
What joint movement is associated with the C6, C7 nerves?
Elbow movement.
What muscles are affected by the C8 nerve?
Fingers.
What nerve is affected in anterior dislocation of the shoulder?
Axillary nerve.
What nerve is affected in a fracture of the neck of the humerus?
Axillary nerve.
What nerve is affected in a fracture of the shaft of the humerus?
Radial nerve.
Describe a fracture at the medial epicondyle of the ulna.
Fracture at the inner part of the elbow bone called ulna.
What nerves are affected in a radial Saturday nerve palsy?
The radial nerve.
Define a fracture at the snuff box of the radius.
Fracture at the anatomical snuffbox of the radius bone in the wrist.
How is an ulnar nerve lesion at the elbow manifested?
It can lead to a claw hand (complete).
Do you lose abduction ability in a C5 nerve lesion?
Yes, in a C5 lesion, abduction is lost.
Describe the motor symptoms of a radial nerve lesion.
Motor symptoms include wrist drop, weak extension, and lost triceps reflex.
What is the common symptom of a common peroneal nerve lesion?
Foot drop.
How is a posterior dislocation of the hip different from a sciatic nerve injury?
A posterior dislocation of the hip affects the hip joint, while a sciatic nerve injury affects the nerve.
Define a supracondylar fracture of the brachial artery.
A fracture above the elbow that can affect the brachial artery.
What sensory loss occurs in an axillary nerve lesion?
Sensation loss over the lateral aspect of the arm.
Describe the symptoms of median nerve paralysis in the hand.
Paralysis of small hand muscles, lost abduction and adduction, loss of adduction of thumb, flattening of hypothenar muscles, and sensory loss in specific areas.
What is a common physical manifestation of median nerve paralysis at the wrist?
Partial claw hand, lost abduction and adduction, lost adduction of thumb, flattening of hypothenar eminence, and sensory loss.
Define the term ‘Ape’s hand’ in the context of median nerve paralysis.
It refers to the loss of opposition of the thumb, wasting of thenar eminence, and sensory loss over specific areas.
How does median nerve paralysis affect hand function?
It results in weakness in thumb opposition, wasting of thenar eminence, loss of pronation, weak flexion of wrist, and no flexion of thumb.
Describe the sensory loss associated with median nerve paralysis.
Loss of sensation over the lateral three and a half fingers and the lateral two-thirds of the palm.
What are the specific motor deficits seen in median nerve paralysis?
Loss of thumb opposition, weak flexion of wrist, and no flexion of thumb.
Explain the impact of median nerve paralysis on hand muscles.
It leads to flattening of hypothenar muscles, wasting of thenar eminence, and weakness in hand movements.
How does median nerve paralysis affect hand dexterity?
It results in the inability to perform precise movements due to muscle weakness and loss of sensation.
Describe the physical appearance of a hand affected by median nerve paralysis.
It may exhibit a partial claw hand deformity, flattening of hypothenar eminence, and wasting of thenar eminence.
What functional limitations can be expected with median nerve paralysis?
Difficulty in grasping objects, performing fine motor tasks, and experiencing altered sensation in specific areas of the hand.
Describe the common peroneal nerve lesion.
It affects the anterior compartment of the leg, leading to foot drop with lost eversion and dorsiflexion.
What are some causes of common peroneal nerve lesions?
Prolonged lithotomy position, hyperflexion of the knee, ballet dancing, and fibula fractures.
Which muscle is affected by common peroneal nerve lesions, resulting in foot drop?
The extensor hallucis longus.
What functions are lost due to common peroneal nerve lesions?
Eversion and dorsiflexion of the foot.
Describe the typical nerve affected in the content.
The tibial nerve (TIP) is involved, leading to lost inversion and plantar flexion.
