Orthopaedics

Question 1

Hip fractures

Answer 1

• Extracapsular - Trochanter or sub trochanter
• Intracapsular - Femoral head

Question 2

Intracapsular Mx

Answer 2

Displaced - Arthroplasty
- either hemi or full -
* Full recommended if patient is well

Non displaced - Internal fixation via screws

Question 3

Extracapsular

Answer 3

• Intertrochanteric - Internal fixation with dynamic hip screw
• Subtrochanteric - Intramedually nail through greater trochanter and into medial shaft of femur

Question 4

Osteoporotic fracture

Answer 4

• Commence on bisphosphates - no need for scan

Question 5

• Achillies tendon rupture

Answer 5

Cx - sport in juries
* fluoroquinolone casa cause spontaneous rupoture in 48hrs of commencing*

Sx - sudden onset pain, feeling like something has hit them in back of calf, snapping sound and sensation

Ix - Simmons calf squeeze - absence of plantar flexion
- US

Mx - conservative, same day referral to orthodontist
- may need surgery

Question 6

Adhesive capsultis

Answer 6

• Frozen shoulder. causing reduced shoulder movement - can be due to trauma or idiopathic

Cx - fibrosis and scars tissue of joint casuing reduced movement

Sx - Active and passive movement limited
- External rotation more affected
* Pain for a day, stiffness, thawing phase
*Symptoms last 6 months and can persisted for 3 years

Mx - Physio, NSAIDs, steroids
- may need surgery to remove adhesions

Question 7

Epicondylitis

Answer 7

• Inflammation where tendons meet the forearms at the epicondyles
• Tennis elbow and golf elbow

Cx - repeat strain to tendons

Sx - Lateral/tennis - pain down forearms, grip affected, numbness, affects pronation

Sx - medial/golf - Pain down forearms, affects grip, numbness, affects supination

Mx - NSAID, rest,

Question 8

Compartmet syndrome

Answer 8

• Pressure in fascia compartment is elevated >40mmHg - cutting of blood supply

Cx - Post acute injury
- fractures, crush injuries

Sx - pallor, pain, parasthesia, pressure, paralysis, pulseless
- passive stretch makes pain worse

Ix - needle manometry for pressure

Mx - emergency fasciotomy

• Can be chronic - episodic sx^ on exertion

Question 9

Sarcomas

Answer 9

• Cancers originating in muscles, bones or connective tissue

Osteo… - most common bone
Chondro - most common cartilage
Ewing - bone and soft tissue - usually kids or young adults

Sx - soft tissue lump, growing, painful, large
- bone swelling
- Persistent pain

Ix - X ray, US, biopsy, CT

Mx - Surgery, radio, chemo

Question 10

Spinal stenosis

Answer 10

• Compression of the spine canal causing compression of cord and nerve roots

Cx - congenital, degeneration of tissue, herniation, thickened ligaments, fractures, tumours

Sx - GRADUAL (compared to herniation and cauda equina), INTERMITENT
- lower back pain, bum and leg pain, leg weakness
* Can presents with sx of caudal equina when severe
Sx of peripheral cluadication

Absent when seated, come on standing and walking, bending forward makes it better and standing straight makes it worse.

Ix - Rule put PAD - ABPI, CTA
MRI for cx

Mx - Exercise, weightless, physio
- surgery to remove disc or bone compression

Question 13

Meralgia paraesthetica

Answer 13

• Mononeuropathy - numbness, tingling, burning in outer thigh

Cx - compression of lateral femoral cutaneous nerve (L1,2,3)

Sx - burning, tingling, numbness, outer thigh
- localised hair loss
- aggravated by standing or walking
- worse on hip extension

Mx - conservation
- decompression

Question 14

Osgood schlatter disease

Answer 14

• Inflammation at the tibial tuberosity where tendons insert
• Common in adolescents

Cx - patella ligament pulling away bone causing tiny avulsion fractures of tibia

Sx - Hardened lump over time, painful tibial tuberosity
- worse on activity, extension of the knee

Mx - Reduce, Ice, NSAIDs

Question 15

Bakers cyst

Answer 15

• Usually 2nd to degenerative changes in the knee
  Collection of synovial fluid - not own cyst - stay in soft tissue

Cx - MENISCAL TEARS**, OA, injuries, rheumatoid, idiopathic

Sx - localised to politest fossa
- pain, fullness, pressure, palpable lump, restricted range off motion

**Rule out DVT

Ix - US 1st line
MRI

Mx - NSAID, physio, steroid injections….

Question 16

Plantar fasciitis

Answer 16

• Inflammation of the plantar fascia - thick fascia attached to calcaneus

Sx - gradual onset pain at heel, tender and worse when walking

Mx - Rest, ICE, NSAIDs,

Question 17

Rotator cuff tears

Answer 17

• Full or partial tear or rotator cuff tendons
• Supraspinatus, infraspinatus, teres minor, subscapularis

Sx - Shoulder pain, weakness accruing to moment of muscle affected
- difficult to sleep at night

Ix - US or MRI for soft tissue

Mx - Rest, analgesia, physio
- surgery if failure^^

Question 18

De Quervain’s tenosynovitis

Answer 18

• Inflammation of tendons at the wrist - primarily: APL and EPB

Cx - REACTIVE STRAIN

Sx - pain, tingling, itching, swelling, redness, weakness

Mx - Rest, analgesia, physio…

Question 19

Dupuytren’s contracture

Answer 19

• Shortening of the soft tissue that leads to the joint have restricted movement
• Thickened fascia

Cx - microtrauma repat

Sx - Flexed position, cannot fully extent, hard nodules, ring finger most likely, no pain

Ix -

Mx - Conservative or surgery via fasciotomy

Question 20

Ganglion cyst

Answer 20

• Collection of synovial fluid from tendons and joints. causing cysts
• Wrists and fingers mostly

Sx - can be rapid progression, up to 5cm, firm, smooth, non tender, transilluminates,

Ix - Clinically diagnosed

Mx - Conservatively, needle aspiration or excision

Question 21

Meniscal tear

Answer 21

• Twisting whilst playing sport

Sx - tender on joint line, unstable, locking and giving way, flexion and extension reduced

Question 22

Carpal tunnel

Answer 22

• Wrist splinting for moderate
• Steropids for serve

Question 23

Hip dislocations

Answer 23

• Posterior - Shortened and internally rotated

Question 24

Neck of femur fracture

Answer 24

• Shortened and externally rotated

Question 25

OSTEOMYELITIS

Answer 25

• Bone biopsy