Orthopaedics 2 Flashcards
32 y/o basketball player.
he reports hearing a ‘popping’ sound then experienced sudden onset severe pain in back of his left leg.
OE
- swelling of left calf
- no movement of his left foot whilst squeezing corresponding calf
indicatie of:
achilles tendon rupture
risk factors fo tendinitis
- quinolone use (e.g. ciprofloxacin)
- hypercholesterolaemia (predisposes to tendon xanthomata)
which imaging is used for suspected achilles tendon rupture?
USS
describe achilles tendinopathy?
aka tendinitis
features
- gradual onset
- posterior heel pain
- worse post activity
- morning pain and stiffness common
management of achilles tendinopathy
typically supportive
- simple analgesia
- reduction in precipitating activities
- calf muscle eccentric exercises
Leriche syndrome characterised by what triad of symptoms:
- claudication of buttocks and thigh
- atrophy of the musculature of the legs
- impotence (due to paralysis of the L1 nerve)
What is leriche syndrome?
- atheromatous disease
- involving iliac vessels
- blood flow to pelvic viscera compromised
50 y/o diabetic lady pc left shoulder pain.
stiff shoulder, more painful at night, difficulty dressing, doing bra
OE
- no point tenderness
- weakness on external rotation
indicative of:
adhesive capsulitis
- up to 20% of diabetics may have episode of frozen shoulder
external rotation affected more than internal rotation or abduction
management of adhesive capsulitis
NSAIDS
physio
oral corticosteroids
intra-articular corticosteroids
what type of fracture typically arises as a result of fall onto an outstretched hand
- scaphoid fracture
why is it important to recognise scaphoid fractures?
- unusal bs of scaphoid bone
- 80% bs derived from dorsal carpal branch of radial artery, retrograde
- interruption of bs
- increases risk of avascular necrosis of scaphoid
blood supply to scaphoid bone
- retrograde
- via dorsal carpal branch
- of radial artery
majority of simple rib fractures are managed…
conservatively
fracture of distal radius aka
Colle’s fracture
- dinner fork deformity
volar angulation of distal radius fragment
garden spade deformity
Smith’s fractures
caused by falling backwards onto palm of outstretched hand
dislocation of the proximal radioulnar joint in association with an ulnar fracture
conteggia fracture
intra-articular fracture at base of thumb metacarpal
impact on flexed metacarpal, caused by fist fights
X-RAY: triangular fragment at base of metacarpal
indicative of:
Bennet’s fracture
distal radius fracture with associated radiocarpal dislocation
Barton’s fracture
fall onto extended and pronated wrist
leg is shortened and externally rotated with :
hip fracture
leg shortened, internally rotated with:
hip dislocation
what tool used to evaluate fracture risk in patients:
FRAX
- fracture risk assessment tool
patient with suspected caudal-equina should have an urgent:
MRI SPINE
summarise some causes of caudal-equina
- central disc prolapse (L4/5, L5/S1)
- tumours: primary or metastatic
- infection: abscess, disci tis
- trauma
- haematoma
remember surgical sieve: V: vascular I: infective T: traumatic A: autoimmune M: metabolic I: iatrogenic N: neoplastic C: congenital D: degenerative E: endocrine F: functional
rapid joint swelling, right sided knee effusion and positive Lachmans test indicates:
anterior cruciate ligament rupture
rapid joint swelling: can occur due to ACL or PCL
tackled from behind suggests ACL
what injury results most commonly due to direct blows to lateral aspect of leg:
MCL injury
- strain on MCL ligament
- joint effusion
- medial joint line tenderness
benign neuroma affecting the intermetatarsal plantar nerve, most commonly in the third inter-metatarsophalangeal space. The female to male ratio is around 4:1.
indicative of:
Morton’s neuroma
A 30-year-old intravenous drug user is diagnosed as having osteomyelitis of the right tibia. What is the most likely causative organism?
staph aureus
immediate priority for open fractures is:
urgent intravenous antibiotics and debridement in theatre
you suspect osteoarthritis in a patient: which of the following would prompt further investigations for an alternative diagnosis
- 6 month history of patients
- history of developmental dysplasia
- morning stiffness lasting 4hours
morning stiffness lasting 4 hours
- could be indicative of inflammatory arthritis
compartment syndrome 6Ps
pain, poikilothermia, pallor, paresthesia, pulselessness, and paralysis
62 y/o with poorly controlled diabetes and long standing foot ulcers presents with
- fever
- increasing pain
- redness over first MTP joint
- serum urate is normal
most likely diagnosis?
osteomyelitis
imaging modality of choice for osteomyelitis
MRI
Fracture:
Bimalleolar ankle fracture
Forced foot eversion
Pott’s fracture
76 y/o
- pain in buttocks
- pain comes on after 500 yard
- resolves when he stops walking
pmh
- COPD, IHD
neuro exam
- normal
pulses difficult to feel in both feet
indicative of :
peripheral arterial disease
pain on passive stretch could be indicative of:
compartment syndrome
tender, purple/red raised lesions with a pale centre
known as
osler nodes
osler nodes occur as a result of:
immune complex deposition
swelling of the distal interphalangeal joint with deviation of the finger tip
heberdens nodes
4 causes of avascular necrosis of the hip
- long term steroid therapy
- chemo therapy
- alcohol excess
- trauma
initial imaging modality of choice for suspected Achilles tendon rupture
ultrasound
58 y/o
pmh: T2DM, CKD3
pc: lower back pain
obs: 38.3, hr 95, rr 20, bp 140/82
OE: patient lying on left side with hips slightly flexed
- pain worse when he flexes his hip
- pain on hyperextension
- abdo SNT
indicative of:
psoas abscess
initial approach for poas abscess
percutaneous drainage
65 y/o
- bilateral leg pain
- brought on by walking
pmh: peptic ulcer disease, OA, can walk around for 5 mins before It develops
leaning forwards or crouching improves pain.
msk and vascular examination is unremarkable
likely diagnosis?
differentials
- spinal stenosis
- PAD
spinal stenosis, not PAD because vascular examination normal
which part of bone is commonly affected in children with osteomyelitis?
metaphysis
A 78-year-old man complains of a long history of shoulder pain and more recently weakness. On examination active attempts at abduction are impaired. Passive movements are normal.
indicative of:
rotator cuff tear
A 63-year-old lady undergoes an axillary clearance for breast cancer. She makes steady progress. However, 8 weeks post operatively she still suffers from severe shoulder pain. On examination she has reduced active movements in all planes and loss of passive external rotation.
adhesive capsulitis
first line investigation for suspected osteoporotic vertebral fracture
x-ray of spine
44 y/o
pc: painful ring finger, swelling of entire digit, stops at distal palmar crease. pain on palpation and passive extension of digit.
was bitten by an insect on the same hand
indicative of:
infective flexor tenosynovisitis
Kanavel’s signs of flexor tendon sheath infection are fixed flexion, fusiform swelling, tenderness and pain on passive extension
gradual onset of posterior heel pain that is worse following activity
morning pain and stiffness are common
indicative of:
achilles tendinopathy
Signs of systemic sepsis with changing lower limb neurology
may indicate
possible epidural abscess
- causing compression of caudal equina
