Orthopaedics

Question 1

What nerve injury can occur with a neck of fibula injury + features

Answer 1

Common peroneal nerve injury
Leads to foot drop- weakness dorsiflexion, eversion and great toe extension. Sensory loss dorsum foot and lower lat part of leg

Question 2

Management of intracapsular hip fractures

Answer 2

Undisplaced:
- internal fixation

Displaced:
- total or hemi hip replacement
total hip replacement is favoured to hemiarthroplasty if patients:
-> were 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 3

Management of extracapsular hip fractures

Answer 3

stable intertrochanteric fractures: dynamic hip screw

if reverse oblique, transverse or subtrochanteric fractures: intramedullary device

Question 4

adverse effects of bisphosphonates

Answer 4

• oesophagitis/ulcers
• osteonecrosis of the jaw- increased risk if poor dentition or on IV bisphos for cancer
• increased risk atypical proximal femoral shaft #s with alendronate use

Question 5

How long should pts be on bisphosphonates?

Answer 5

Varies according to risk. Some authorities recommend stopping bisphosphonates at 5 years if the following apply:
- patient is < 75-years-old
- femoral neck T-score of > -2.5
- low risk according to FRAX/NOGG

Question 6

When to start bisphosphonates

Answer 6

Pts aged >75 with fragility fracture should be started without scan

Pts aged <75y with fragility # should be referred for DEXA scan with reuslts used for a FRAX assessement to determine ongoing # risk

Question 7

Features of polymyalgia rheumatica

Answer 7

• > 60y
• rapid onset (<1month)
• aching morning stiffness in proximal limb muscles (hips//shoulders) \
• mild polyarthralgia, lethargy, depression, low-grade fever, anorexia, night sweats
• raised inflamm markers ie ESR

Treated with pred

Question 8

Nerves

Answer 8

S1,S2 buckle the shoe (ankle)
L3,L4 kick the door (knee)
C5,C6 pick up sticks (biceps)
C7,C8 close the gate (triceps)

Question 9

proper name for frozen shoulder

Answer 9

Adhesive capsulitis

Question 10

Adverse effects of hydroxychloroquinine?

Answer 10

Bulls eye retinopathy - all pts need ophthalmology assessment before starting and annual check up

Question 11

What are the clinical features of pagets disease?

Answer 11

• the stereotypical presentation is an older male with bone pain and an isolated raised ALP
• bone pain (e.g. pelvis, lumbar spine, femur)
• classical, untreated features: bowing of tibia, bossing of skull