Orthopaedics

Question 1

Most commonly sprained ligament in inversion injuries of the ankle?

Answer 1

The anterior talofibular ligament

Question 2

Preferred surgical management for intertrochanteric proximal femoral fracture?

Answer 2

This is an extra capsular fracture, so dynamic hip screw

Question 3

What are the indications for THR?

Answer 3

Severe arthritis
Displaced intracapsular fracture

Question 4

Outline treatment options of intracapsular hip fracture vs extra capsular

Answer 4

Intracapsular femoral fracture - need to replace hip or internal fixation
- Undisplaced: internal fixation, or hemiarthroplasty if unfit.
- Displaced: replacement arthroplasty (total hip replacement or hemiarthroplasty) to all patients with a displaced intracapsular hip fracture. THR preferred in those who are not cognitively impaired and who were previously mobile.

Extracapsular femoral fracture - hip screw if intertrochanteric or IM nail
- stable intertrochanteric fractures: dynamic hip screw
- if reverse oblique, transverse or subtrochanteric fractures: intramedullary device

Question 5

What is the Ottawa ankle rule?

Answer 5

Bony tenderness over the malleoli zones OR an inability to walk four weight-bearing step means you should do Xray to rule out a fracture.
Examination consists of looking for 1 of:
Bony tenderness along distal 6 cm of the posterior edge of fibula or tip of lateral malleolus
Bony tenderness along distal 6 cm of the posterior edge of tibia/tip of medial malleolus
Bony tenderness at the base of the 5th metatarsal
Bony tenderness at the navicular
Inability to bear weight both immediately after injury and for 4 steps during initial evaluation

Question 6

What sort of hand fractures are often missed (don’t show up) on X-ray immediately and therefore can go on to form avascular necrosis.

Answer 6

Scaphoid fracture

Question 7

What is the most common reason for THR surgical revision?

Answer 7

Aseptic loosening
Typically occurs many years after the operation