orthopaedics 2 Flashcards
Weakness of hip abduction and foot drop, no specific reflex lost
positive straight leg test.
indicative of:
L5 radiculopathy
- usually due to slipped disc compressing the nerve root
A 50-year-old man is admitted after falling from scaffolding. He has an open fracture of his tibia with a 15 cm wound. He is neurovascularly intact. What is the best initial course of action?
- intravenous antibiotics
- photography
- saline soaked gauze with impermeable dressing
67 y/o
pc: progressive pain in R hip joint
OE: movement painful in all directions, no evidence of limb shortening or external rotation.
DX: taking prednisolone for polymyalgia rheumatica.
likely diagnosis?
avascular necrosis of femoral head
- long term steroid use is a key risk factor
During a NIPE you note baby has
- inverted + plantar flexed foot which is not passively correctable
this is known as:
club foot
talipes equinovarus
management of club foot , talipes equinovarus
- move from surgical intervention to a more conservative method
- e.g. Ponseti method : manipulation and progressive casting with starts soon after birth
Undisplaced fractures of the scaphoid wrist are typically managed with a….
cast for 6 - 8 weeks
Simmond’s triad of tests consists of:
- Gap
- ankle of declination
- calf squeeze
used to test for achilles tendon rupture
A 23-year-old man complains of severe groin pain several weeks after a difficult inguinal hernia repair.
what nerve has been affected:
ilioinguinal nerve
may have been entrapped in the mesh causing a neuroma
A 40-year-old woman complains of a permanent ‘funny-bone’ sensation in her right elbow. This is accompanied by tingling in the little and ring finger. Her symptoms are worse when the elbow is bent for prolonged periods. What is the most likely diagnosis?
cubital tunnel syndrome
- due to compression of ulnar nerve
features:
- intermittent tingling in the 4th and 5th finger
- may be worse when elbow flexed for long periods of time
- later numbness in 4th and 5th digits
32 y/o mother
- presents with 7 day hx of pain in right wrist.
- pain on radial side of wrist.
- there is tenderness over the radial styloid process
indicative of:
De Quervain’s tenosynovitis
- sheath contianing extensor pollicis brevis and abductor pollicus longus tendons are inflammed
Ligamentous injuries of the knee joint are best confirmed through….
MRI
A 28-year-old professional footballer is admitted to the emergency department. During a tackle he is twisted with his knee flexed. He hears a loud crack and his knee rapidly becomes swollen.
indicative of:
anterior cruciate ligament rupture
- rapid swelling also supports diagnosis
34 y/o female in car accident where her knee hit dashboard.
OE: tibia looks posterior compared to non injured knee
indicative of:
posterior cruciate ligament rupture
most likely treatment option for diagnosed sub capital fracture of femur with partial displacement:
hemiarthroplasty
blood supply is threatened in which type of fracture: intracapsular or extracapulsar femoral fractures?
intracapsular fractures
as blood supply is threatened in intracapsular femoral fracturs, what is the management?
hemiarthroplasty
what is the management for extracapsular femoral fracture?
dynamic hip screw
a patient undergoes dynamic hip screw surgery.
what instructions for weight bearing would you give to the patient?
- full weight bearing immediately post-op
- aim of hip fracture surgery to allow patient to fully weight bear, unrestricted, immediately following surgery
A 70-year-old man attends his GP with loss of mobility in his ring and little finger of his left hand. On examination, there is thickening of the palm and an inability to full extend the metacarpophalangeal joints.
diagnosis of:
dupuytren’s contracture
the following features would point to a diagnosis of:
- low back pain
- bilateral sciatic
- reduced sensation in perianal area
- decreased anal tone
- urinary dysfunction
cauda equina
- patient should have urgent MRI spine within 6 hours
Garden classification system to classify neck of femur fractuers
- Incomplete stable fracture
- Complete but non-displaced
- Complete and partially displaced
- Complete and completed displaced
investigation of choice for suspected psoas abscess
CT abdomen
29 y/o male
- ED with RHS abdo pain
- radiating to anterior hip
- relieved by flexing hips to touch knees to chest
OE
- 38.2 temp
- has limp on walking
- pain on extension and internal rotation of hips
pmh
- Crohns
indicative of:
psoas abscess
which nerve innervates the triceps muscle?
radial
- from C7 nerve root
6 y/o boy with limp.
- steadily worse over last few weeks
- pain in right groin / hip region
- XR shows widening right hip joint space with flattening of femoral head
indicative of:
Perthes disease
5 times more common in males
typically presents in children aged 4-8 years
X-ray rindings
Acute hip pain associated with systemic upset e.g. pyrexia. Inability/severe limitation of affected joint
could be indicative of:
septic arthritis
the following findings are consistent for a diagnosis of
middle aged man with right shoulder pain
- external rotation most affected
- active and passive movements limited
adhesive capsulitis
An 82-year-old female presents to A&E after tripping on a step. She complains of shoulder pain. On examination there is pain to 90o on abduction.
indicative of what tear:
supraspinatour
most common rotator cuff tears.
occurs as a result of degeneration and is rare in younger adults
A 52-year-old woman develops pain shooting down the posterior aspect of the left leg. On examination she has reduced sensation on the lateral aspect of the left foot and weakness of left foot plantar flexion.
which nerve root affected?
S1
In a child with an asymptomatic, fluctuant swelling behind the knee the most likely diagnosis is a…
BAKERS CYST
The x-ray shows extensive bone remodeling / fragmentation involving the midfoot. In combination with the presence of a swollen, red, warm joint in a patient with a history of poorly controlled diabetes is highly suggestive of
Charcot’s joint
preferred surgical management for intertrochanteric (extracapsular) proximal femoral fracture
dynamic hip screw (DHS)
surgical management for patients presenting with a subtrochanteric femoral fracture
INTRAMEDULLARY NAIL
