Orthopaedics 2 Flashcards by Andrea Jayawardena

32 y/o basketball player.

he reports hearing a ‘popping’ sound then experienced sudden onset severe pain in back of his left leg.

swelling of left calf
no movement of his left foot whilst squeezing corresponding calf

indicatie of:

achilles tendon rupture

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risk factors fo tendinitis

quinolone use (e.g. ciprofloxacin)

- hypercholesterolaemia (predisposes to tendon xanthomata)

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which imaging is used for suspected achilles tendon rupture?

USS

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describe achilles tendinopathy?

aka tendinitis

features

gradual onset
posterior heel pain
worse post activity
morning pain and stiffness common

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management of achilles tendinopathy

typically supportive

simple analgesia
reduction in precipitating activities
calf muscle eccentric exercises

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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)

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What is leriche syndrome?

atheromatous disease
involving iliac vessels
blood flow to pelvic viscera compromised

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50 y/o diabetic lady pc left shoulder pain.

stiff shoulder, more painful at night, difficulty dressing, doing bra

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

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management of adhesive capsulitis

NSAIDS

physio

oral corticosteroids

intra-articular corticosteroids

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what type of fracture typically arises as a result of fall onto an outstretched hand

scaphoid fracture

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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

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blood supply to scaphoid bone

retrograde
via dorsal carpal branch
of radial artery

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majority of simple rib fractures are managed…

conservatively

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fracture of distal radius aka

Colle’s fracture

dinner fork deformity

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volar angulation of distal radius fragment

garden spade deformity

Smith’s fractures

caused by falling backwards onto palm of outstretched hand

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dislocation of the proximal radioulnar joint in association with an ulnar fracture

conteggia fracture

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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

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distal radius fracture with associated radiocarpal dislocation

Barton’s fracture

fall onto extended and pronated wrist

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leg is shortened and externally rotated with :

hip fracture

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leg shortened, internally rotated with:

hip dislocation

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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