Orthopaedics

Question 1

what are red flags for lower back pain?

Answer 1

1) age <20 or >50
2) hx previous malignancy
3) night pain
4) hx trauma
5) systemically unwell (fever, weight loss)

Question 2

what are some causes of lower back pain?

Answer 2

1) MSK- sprains, strains, trauma
2) degenerative changes- OA, spinal stenosis
3) herniated disc/sciatica, kidney stones, peripheral arterial disease

Question 3

which nerve is most likely to be damaged during knee arthroplasty?

Answer 3

common peroneal nerve (one of the terminal branches of sciatic nerve)

Question 4

how is sciatica managed?

Answer 4

1) conservative
- analgesia (NSAID + PPI) and physio
2) if symptoms persist 4-6 weeks then consider MRI

Question 5

what are the different types of hip fracture?

Answer 5

1) intracapsular (femoral head or neck)

2) extracapsular (intertrochanteric, subtrochanteric)

Question 6

which system is used to classify hip fractures?

Answer 6

Garden Classification
types 1-4

I- stable
II- complete but undisplaced
III- displaced but still has bony contact
IV- complete bony disruption

Question 7

how is an intracapsular hip fracture treated?

Answer 7

1) undisplaced- internal fixation or hemiarthroplasty

2) displaced- total hip replacement or hemiarthroplasty (total is preferred if patient has good baseline function i.e. could walk independently, no cognitive impairment, med fit for procedure)

Question 8

how is an extracapsular hip fracture treated?

Answer 8

1) stable intertrochanteric- dynamic hip screw

2) subtrochanteric, oblique, transverse- intermedullary device

Question 9

what are risk factors for osteoporosis?

Answer 9

• systemic steroids
• low BMI
• smoking
• previous fragility fracture or falls
• malabsorption (IBD, coeliac, chronic pancreatitis)
• RA and other inflammatory arthropathies
• higher alcohol intake
• endocrine conditions- diabetes, Cushing’s, hyperthyroidism
• older age

Question 10

when assessing somebody for osteoporosis, it is always important to have certain causes on your radar, including …

Answer 10

myeloma
Paget’s disease
bony metastases

Question 11

postitive McMurray’s test indicates what?

Answer 11

meniscal tear

Question 12

what are the Ottowa rules (ankle) used for?

Answer 12

criteria to determine if a patient with an ankle injury should have an XR

Question 13

what are the criteria for the ankle Ottowa rules?

Answer 13

Pain in malleolar zone PLUS:
- bony tenderness at lateral malleolar zone
or
- bony tenderness at medial malleolar zone

(from tip of malleolus to include lower 6cm of posterior fibula)

or

inability to walk more than 4 steps

Question 14

what examinations can you do to test for carpal tunnel syndrome?

Answer 14

1) thenar wasting
2) weak thumb abduction
1) tinel’s (tapping nerve causes paraesthesia)
2) phalen’s (flexion of wrists replicates symptoms)

Question 15

what are some causes of carpal tunnel syndrome?

Answer 15

idiopathic
oedema
pregnancy
repetitive strain
trauma
acromegaly
diabetes
hypothryoidism

Question 16

how is carpal tunnel syndrome treated?

Answer 16

1) analgesia, wrist splint at night trial 6 weeks
2) corticosteroid injection
3) surgical decompression (divide flexor retinaculum)

Question 17

what does positive Foucher’s sign indicate?

Answer 17

Baker’s cyst
(cyst becomes firm on leg extension)

note for Baker’s cyst, should always ensure you rule out DVT (low threshold for USS as they can co-exist)

Question 18

posterior heel pain with morning pain and stiffness are characteristic of what?

Answer 18

Achilles tendinitis

Question 19

what is the treatment for frozen shoulder?

Answer 19

1) analgesia
2) physio
3) steroid injections

(stepwise)

Question 20

what is cubital tunnel syndrome?

Answer 20

compression of the ulnar nerve as it passes through the cubital tunnel

gives rise to tingling of fourth and fifth finger

often hx of OA or trauma to the area

Question 21

what are potential complications of hip replacement?

Answer 21

1) perioperative
- VTE
- infection
- fracture
- nerve injury

2) post-op
- leg length discrepancy
- dislocation
- aseptic loosening
- prosthetic joint infection