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OSCE - Scott's Notes COPY not copied > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

What are the different types of bone?

A

Woven - Disorganised bone that forms calluses

Lamellar - Mature bone which takes one of two forms:
Cortical: Dense outer layer
Trabecular: Porous central layer

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2
Q

By which method do most bones form?

A

Endochondral ossification (mesenchyme -> cartilage -> bone)

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3
Q

What are the phases and timings of fracture healing?

A 
Reactive phase (0-48hrs): 
Haematoma forms and local inflammation leads to granulation tissue formation
Reparative phase (2d-2w):
Proliferaiton of osteoblasts and fibroblasts which form cartilage and woven bone, which is then consolidated into lamellar bone
Remodelling phase (1wk-7y):
Remodelling of lamellar bone to cope with mechanical forces according to Wolff's Law
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4
Q

What is the difference between a stress fracture and a pathological fracture?

A

Stress fractures are due to bone fatigue due to repetitive strain, e.g. marathon runners feet

Pathological fractures are due to normal forces applied to diseased bone

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5
Q

When radiographing a fracture, what images must be requested?

A

AP and lateral film of the fracture site, as well as images of the joint above and below the #

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6
Q

How would you describe a fracture?

A

PAIDS

Pattern; transverse, oblique, spiral, multifragmentary, crush, greenstick, avulsion

Anatomical location

Intra/extra articular, dislocation or subluxation

Deformity (distal relative to proximal); Translation, angulation, rotation, impaction

Soft tissues; open or closed, neurovascular status, compartment syndrome

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7
Q

What are the four ‘R’s of fracture management?

A

Resuscitate
Reduction
Restriction
Rehabilitation

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8
Q

What are the principles of ‘Resuscitation’ in # management?

A 
ATLS
# usually in 2ary survey
Assess neurovascular status
Consider reduction and splinting before imaging
Manage pain and bleeding
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9
Q

What are the 6As of open fracture management?

A 
Analgesia: M+M
Assess: NIV status, soft tissues
Antisepsis: wound swab, irrigation, dressing
Alignment
Anti-tetanus - check status
Abx: Fluclox + Benpen
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10
Q

What is the most concerning complication of an open fracture?

A

C. perfringens infection

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11
Q

What are the methods of fracture reduction?

A

Manipulation/Closed reduction: under local/regional anaesthesia, use traction to disimpact and manipulation to align

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12
Q

What are the principles of fracture restriction?

A

The interfragmentary strain hypothesis dictates that tissue formed at the # site depends on the strain it experiences. Fixation also reduces pain and increases functionality

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13
Q

What are the different methods of fracture restriction?

A

Non rigid - slings, elastic supports
Plaster
Functional bracing - joints free to move but bone shafts supported in cast segments
Continuous traction - e.g. collar and cuff

External fixation - useful in open #s, burns and tissue loss

Internal fixation - pins, plates, screws, IM nails. Perfect anatomical alignment which improve stability and aid early mobilisation

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14
Q

What are the methods of # rehabilitation?

A

Physio
OT
Social services

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15
Q

What are the possible complications following #?

A

General vs specific

General:
Tissue damage (haemorrhage, infection, rhabdomyolysis)
Anaesthesia (anaphylaxis, aspiration)
Bed rest (infections, pressure sores, muscle wasting, DVTs, reduced BMD)

Specific:
Immediate (NV damage, visceral damage)
Early (Compartment syndrome, infection, fat embolism ->ARDS)
Late (malunion, AVN, growth disturbance, post traumatic osteoarthritis, Complex regional pain syndrome, myositis ossificans)

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16
Q

How might an axillary nerve palsy form and present?

A

Following anterior shoulder dislocation -> Numb regimental badge area, weak abduction

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17
Q

How might a radial nerve palsy form and present?

A

Following # humeral shaft ->waiters tip

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18
Q

How might an ulnar nerve palsy form and present?

A

Elbow dislocation-> Claw hand

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19
Q

How might a sciatic nerve palsy form and present?

A

Hip dislocation -> foot drop

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20
Q

How might a fibular nerve palsy form and present?

A

neck of fibula or knee dislocation -> foot drop

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21
Q

How does compartment syndrome present and how is it treated?

A

Pain on passive muscle stretching of a warm, erythematous, swollen limb with weak pulses

Rx by elevation, removal of bandage/cast and fasciotomy

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22
Q

What are the causes of delayed/non-union?

A

5Is

Ischaemia
Infection
Interfragmentary strain
Interposition of tissue between fracments
Intercurrent disease
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23
Q

What are the different types of non-union?

A

Hypertrophic - rounded, dense bone

Atrophic - osteopoenic ends

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24
Q

What is myositis ossificans?

A

Formation of bone within muscle/soft tissue

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25
Q

What is the presentation of complex regional pain syndrome type 1?

A 
Presents weeks - months after injury in a neighbouring area to the #site
Hyperalgia, lancing pain, allodynia
Vasomotor Fx
Skin is swollen or atrophic
neuromuscular features
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26
Q

What are the grades of growth plate injury according to the Salter Harris Classification?

A

SALT CRUSH

Straight across
Above
Lower
Through
CRUSH
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27
Q

What are the risk factors for osteoporosis?

A

AGE + SHATTERED

Steroids
Hyperpara/thyroidism
Alcohol & cigarettes
Thin
Testosterone low
Early menopause
Renal/liver failure
Erosive bone disesae
Dietary calcium deficiency
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28
Q

What questions should you ask in a hip fracture pt?

A 
Mechanism
Osteo RFs
Premorbid mobility
Premorbid independence
Comorbidities
MMSE
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29
Q

How would you manage a hip fracture pt?

A

Resuscitate
Analgesia
NV status
Image

Prep for theatre: ABCDEFG
Anaesthetist
Bloods
CXR
DVT prophylaxis
ECG
Films
Get consent
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30
Q

What are the different types of hip fracture?

A

Intercapsular: Subcapital, transcervical, basicervical
Extracapsular: Intertrochanteric/subtrochanteric

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31
Q

What is the Garden classification?

A

Used for intracapsular fractures (incomplete undisplaced, complete undisplaced, complete partially displaced, complete completely displaced)

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32
Q

What is the difference between a hemiarthroplasty and a total hip replacement/

A

Hemiarthroplasty involves only replacing the femoral head, while total hip replacement also replaces the acetabulum (/part of it)

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33
Q

What is the surgical management of intracapsular hip fractures?

A

<55 yos: ORIF
55-75yos: total hip replacement
>75: hemiarthroplasty

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34
Q

What is the surgical management of extracapsular hip fractuers?

A

ORIF with dynamic hip screw

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35
Q

What is the prognosis following hip fracture?

A

30% mortality in 1 year
50% never gain full function
Majority will have some residual pain/disability

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36
Q

What are the radiographic features of Colle’s fracture?

A

Extra articular # of distal radius
Dorsal displacement and angulation of distal fragment
+-impaction

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37
Q

What are the specific complications of a Colle’s fracture?

A 
Median nerve injury
Adhesive capsulitis
Tendon rupture
Carpal tunnel syndrome
non/malunion
Sudek's atrophy
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38
Q

What are the radiological features of a Smith’s fracture?

A

Distal radius fracture with volar displacement and angulation of the distal fragment

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39
Q

If clinical Hx and exam suggest scaphoid fracture but X-ray normal, what should you do?

A

Treat anyway as #may only show after 10 days

Plaster cast

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40
Q

What is a Monteggia fracture?

A

of proximal 3rd of ulna shaft

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41
Q

What is a Galleazzi fracture?

A

of radial shaft between mid and distal 3rds

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42
Q

When might you see a posterior shoulder dislocation?

A

Direct trauma

Epileptic seizures

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43
Q

What is a Bankart lesion?

A

Damage to anteroinferior glenoid labrum

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44
Q

What is a Hill Sachs lesion?

A

Cortical depression of the posterolateral part of the humeral head following impaction against the anteroinferior glenoid rim.
V common

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45
Q

What is the rate of dislocation recurrence following traumatic dislocation?

A

90% in 20 years

46
Q

What is the pathology of Impingement syndrome/Painful arc?

A

Entrapment of the supraspinatus tendon and subacromial bursa between the acromion and greater tuberosity of the humerus

47
Q

How does Impingement Syndrome present?

A

Painful arc between 60-120 degrees
Weakness
Reduced range of movement

48
Q

What is the management of a painful arc?

A

Supportive - rest, physio
Medical - NSAIDs, steroid injection
Surgical - Arthroscopic acromioplasty

49
Q

What is the presentation of adhesive capsulitis?

A

Progressive impairment of active and passive ROM
Significantly reduced external rotation
Shoulder pain esp at night

50
Q

What is the classic sign of a rotator cuff tear?

A

Able to abduct actively following possive abduction to 90 degrees. Lowering past this point leads to a sudden drop

51
Q

What structure is most commonly damaged in a supracondylar fracture?

A

Brachial artery

52
Q

What demographic are supracondylar fractures most commonly seen in?

A

Children after FOOSH

53
Q

What specific complications might occur following a supracondylar fracture?

A

Neurovascular injury to brachial artery, radial nerve, median nerve
Compartment syndrome
Gunstock deformity

54
Q

How much blood should be Xmatched for the following fractures?
Tibial
Femoral

A

Tibial - 2 units

Femoral - 4 units

55
Q

What are the specific complications following lower limb long bone fractures?

A

Hypovolaemic shock
Neurovascular (sciatic nerve, superficial femoral artery)
Compartment syndrome
PE/ARDS from Fat emboli

56
Q

What might the following features of a knee injury indicate?

i) Swelling
ii) Pain
iii) Locking
iv) Giving way

A

i) Haemarthrosis due to fracture or torn cruciates (80% ACL)
ii) Meniscal or collateral tear
iii) Meniscal tear
iv) Ligament injury

57
Q

What is the Unhappy triad of O’donoghue?

A

ACL tear
Medial collateral tear
Medial meniscus tear

58
Q

What is the management of a ruptured ACL?

A

Conservative - Rest, physio strengthening quads and hammies

Surgical - Autograft repair using semitendinosus +-gracilis held in place with screws

59
Q

What is the definition of osteoarthritis?

A

Degenerative joint disorder where there is progressive loss of hyaline cartilage and new bone formation at the joint surface and its margin

60
Q

What are the two main risk factors for OA?

A

Age

Obesity

61
Q

Which joints does OA typically affect?

A 
Hips 
Knees
DIPS
PIPS
Thumb CMC
62
Q

What are the symptoms and signs of OA?

A 
Pain at end of day 
Stiffness after rest
Joint deformity
Reduced ROM
Pouchards and Heberdips
Fixed flexion deformity
63
Q

What Xray changes are associated with OA?

A 
Subchondral sclerosis
Loss of joint space
Osteophytes
Deformity
Subchondral cysts
64
Q

What is the management of OA?

A

Supportive - Physio, weight loss, walking aids/home mods

Medical - Para, NSAIDs, Tramadol, joint injections

Surgical - Arthroscopic washout, arthroplasty

65
Q

What is the presentation of the most common disc prolapse?

A

Most commonly affecting the L5 and S1 nerve roots, presenting with lumbago and sciatica.

Signs include limited flexion/extension with free lateral flexion, pain on straight leg raise.

66
Q

What does S1 root compression cause??

A

Weak plantarflexion and eversion with loss of ankle jerk and reduced sensation over sole of foot and back of calf

67
Q

What is the commonest surgical procedure for disc prolapse?

A

Lumbar microdiscectomy

68
Q

What is spondylolisthesis and where does it commonly affect?

A

Displacement of one lumbar vertebra over another, usually anterior displacement of L5 over S1.

69
Q

What are the common causes of spondylolisthesis?

A

congenital malformation
Spondylosis
Osteoarthritis

70
Q

How does spoondylolisthesis commonly present?

A

Usual onset in adolescence with pain worse on standing +- sciatica

71
Q

What is the presentation of spinal stenosis?

A

Spinal claudication - aching buttoch and lower limb pain on walking usually rapid onset +-parasthesia. Pain eased by sitting forwards and worsened by spine extension.

72
Q

What is the presentation of acute cord compression (Neurosurgical emergency)

A

Bilateral back and radicular pain
LMN signs at compression level
UMN signs at sensory level and below compression
Sphincter disturbance

73
Q

What is the presentation of acute cauda equina?

A

Radicular leg pain
Saddle anaesthesia
Loss of anal tone
Bladder +-bowel incontinence

74
Q

What is the management of acute cord/cauda equina compression?

A

Large prolapse - laminectomy/discectomy
Tumour - Radiotherapy and steroids
Abscesses - decompression and Abx

75
Q

What is osteochondritis?

A

Idiopathic temporary softening of bone centre in adolescents due to necrosis followed by rehardening of bone in deformed position.

76
Q

What are some examples of osteochondritic disorders?

A 
Seheuermann's disease
Kohler's disease
Friedberg's disease
Panners sidsease
Perthe's disese
77
Q

What are some examples of traction apophysitis?

A

Osgood Schlatter’s
Siding Larsen’s disease (tibia)
Sever’s disease (Calcaneal)

78
Q

What is osteochondritis dissecans, how does it present and what is the management?

A

When a piece of articular bone breaks off into the joint space.
As well as pain and swelling, locking is a classical feature.
Mx: Arthroscopic removal

79
Q

How would you investigate and manage an acute osteomyelitis?

A

Ix: ESR/CRP, WCC, cultures, Xray (changes take 2 weeks to develop), MRI is sensitive and specific

Mx: Vanc + cef empiriaclly, drainage, analgesia

80
Q

What additional investigation might you for a septic arthritis that you wouldnt do for an osteomyelitis?

A

Joint aspirate MCnS

81
Q

What are the complications of septic arthritis/

A

Osteomyelitis
Post infective arthritis
Ankylosis (fusion)

82
Q

What are the commonest tumours which metastasise to the bone?

A

Breast, lung, prostate, thyroid, kidney

83
Q

What is the typical presentation of fibrous dysplasia/

A

A young female presents with fractures of the long bones. Also affecting the ribs and skull.

84
Q

What syndrome is fibrous dysplasia associated with, and what other features does it present with?

A

McCune Albright
Precocious puberty in females
Cafe au lait spots

85
Q

When and where might you see a Shepherds crook deformity?

A

In a patient with fibrous dysplasia in the proximal femur

86
Q

What is the commonest benign bone tumour and which joint does it typically affect?

A

Osteochondroma

Knee

87
Q

What is the most common malignant cartilagenous neoplasm and how does it present?

A

Chondrosarchoma

Presents in older patients with a painful lump typically of the pelvis or axial skeleton

88
Q

What are the Xray findings of a chondrosarcoma?

A

Popcorn calcification

89
Q

Name three benign bone forming neoplasms

A

Osteoma
Osteoid osteoma
Osteoblastoma

90
Q

Which benign bone neoplasm typically has pain which responds to aspirin?

A

Osteoid osteoma

Osteoblastomas are classically unresponsive to aspirin

91
Q

What is the commonest primary malignant bone tumour and how does it typically presnet?

A

Osteosarcoma

Presents in male teenagers with warm painful bone typically at the knee

92
Q

What are the Xray findings in osteosarcoma/

A

Pereosteal elevation leading to Codman’s triangle

93
Q

What is the classical presentation of Ewing’s sarcoma/

A

<20 year old with a painful warm enlarging mass with systemic signs (Fever, anaemia, raised WCC) typically affecting long bone diaphysis

94
Q

Ewings sarcoma X ray findings?

A

Onion skin periosteal reaction

95
Q

Which nerve roots are affected in Erbs and Klumpkes palsies?

A

Erbs: C5,6
Klumpkes: C8, T1

96
Q

What are the different presentations of a radial nerve injury?

A

at elbow/forearm: Loss of CMC extension, no sensory loss

at humeral shaft: wrist drop, loss of sensation to snuff box

Axilla (crutches/sat night palsy): paralysis of triceps and wrist drop

97
Q

What are the features of an ulnar nerve palsy?

A

Intrinsic hand paralysis -> Claw hand
Weak finger ab/adduction due to interossei paralyss
Sensory loss over little finger

98
Q

What is the ulnar paradox?

A

Lesions at the elbow cause less clawing than more distal lesions, as the flexor digitalis profundus is also denervated, meaning IP flexion is weakened.

99
Q

What are the different presentations of median nerve injury?

A

Above ACF: Cant flex index IJPs, cant flex terminal thumb phalynx, loss of sensation in median distribution

Injury at wrist: Typically affects abductor pollicis brevis

CTS

100
Q

What forms the carpal tunnel and what is its contents?

A

Formed by flexor retinaculum and carpal bones

Contents: Tendons of flexor digitalis profundus and superficialis, flexor pollicis lungus and the median nerve.

101
Q

Which hand muscles does the median nerve supply?

A

LLOAF

Lateral lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis

102
Q

What are the causes of carpal tunnel syndrome?

A 
Primary idiopathic
Pregnancy
Oedema
Radial #
RA
Gout
Soft tissue swelling
DM
EtOH
103
Q

What are the featuers of CTS?

A

Painful parasthesia of lateral 3.5 fingers worse at night or after repeated actions
Relieved by shaking
Clumsiness
Reduced 2 point discrimination (irreversible damage)
Thenar eminence wasting
Tinels and Phalens +ve

104
Q

What is the management of CTS?

A 
Treat underlying pathology
Wrist splints in neutral position
Analgesia
Steroid injections
Surgical decompression by division of flexor retinaculum
105
Q

Risk of CTS surgery?

A

Hypertrophic scar formation actually worsens symptoms

106
Q

What associated features might be seen in Dupuytrens contracture?

A

BAD FIBRES

Bent penis
AIDS
DM
FH
Idiopathic (commonest)
Booze
Epilepsy (phenytoin)
Reidels thyroiditis
Smoking
107
Q

What is the anatomical cause of trigger finger?

A

Tendon nodule catching on the proximal side of a tendon sheath trigggering manual extension

108
Q

What is a Baker’s Cyst and what is associated with?

A

Popliteal swelling between the medial head of gastrocnemius and semitendinosus muscle.
Usually 2ary to OA
May rupture causing calf pain and swelling

109
Q

What is the commonest complication of hallux valgus/

A

Bunion at MTP

110
Q

What is Morton’s metatarsalgia?

A

Pain from pressure on an interdigital neuroma between the metatarsals. Pain radiates to the medial side of one to and lateral side of another.

OSCE - Scott's Notes COPY not copied (21 decks)

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