Orthopaedics 2 Flashcards
Colles’ Fracture
- What clinical features are seen?
- What causes it?
- What is seen on XR?
- dorsally displaced distal radius
when patient lays arm flat can see dinner fork deformity
mnemonic: CD
colles causes Dorsally Displaced Distal radius, Dinner fork Deformity
- FOOSH
- transverse fracture of distal radius 1 inch from wrist joint
Compartment syndrome
- What is it?
- What can cause it?
- What clinical features are seen?
- What investigation is done?
- How is it managed?
- raised pressure in a closed anatomical space causing perfusion compromise
- fractures: most commonly supracondylar (distal humerus and femur) and tibial shaft
- reperfusion following ischaemia
3.
- pain (made worse by movement [active or passive])
- pallor
- parathesiae
- paralysis
+/- pulseless - pulse often present compartment syndrome more a part of microvascular compromise
mnemonic: think 6 Ps of limb ischaemia from vasc. surg. but no perishingly cold and often not pulseless
4. intracompartmental pressure measurements
- prompt + extensive fasciotomy
- fasciotomy may lead to myoglobinaemia which results in myoglobinuria and renal failure -> therefore aggressive IV fluids are required
[do not give anticoagulation]
Cubital Tunnel Syndrome
- What is it?
- What can cause it?
- What clinical features are seen?
- How is it treated?
- compression of the ulnar nerve as it passes through the cubital tunnel
- OA
- previous trauma
- tingling and numbess of 5th + medial 4th finger
- pain - worse on leaning on effected elbow
- over time can develop weakness and muscle wasting
Tinel’s sign: tapping of tunnel illicits symptoms
mnemonic: Tinel’s for tunnels
- physiotherapy
- avoid triggers
- steroid injections
if resistant to management then surgery
De Quervain’s tensosynovitis
- What is it?
- Who does it typically effect?
- What clinical features are seen?
- How is it managed?
- inflammation of sheath containing extensor polliscis brevis and abductur polliscus longus tendons
- females in 30s+40s
- pain on radial wrist
- tenderness on styloid process of distal radius
examination:
- abduction of thumb against resistance is painful
- finkelstein’s test: pulling thumb in ulnar deviation and longitudinal traction causes pain at radial styloid process and along extensor polliscis brevis and abductur polliscus longus
NOTE: think you are just stretching these muscles to elicit the pain
4.
- steroid injection
- thumb splint (AKA spica)
Discitis
- What is it?
- What clinical features are seen?
- What can cause it?
- a) How is it diagnosed?
b) What further investigations are required - How it is treated?
- What complications can be seen?
- inflammation of intervertebral disc
- back pain
- pyrexia + rigors
- neurological features
- bacterial (most common staph aureus)
- viral
- TB
- aseptic
- a)
- MRI most sensitive
- CT guided biopsy to discover cause
b)
- cause could be discovered on blood culture
- echo - discitis often starts with bacteraemia so check seeding has not also taken place in heart
- 6-8 weeks IV ABx
- sepsis
- epidural abscess
Dupuytren’s contracture
- What is it?
- What can cause it?
- How is it managed?
- knots of tissue form under the skin causing a thick cord to pull fingers into a bent position (most often 4th + 5th digits)
- manual labour
- trauma
- phenytoin
- alcoholic liver disease
- diabetes
mnemonic: skin PAD and obvious causes of skin thickening of overuse or scarring
- surgery when metacarpophalangeal joints cannot be straightened
I.e. hand cannot be placed flat on table
Elbow Pain
State the location of
a) pain and tenderness
b) movements which aggravate symptoms
- Lateral epicondylitis (tennis elbow)
- medial epicondylitis (golfer’s elbow)
- radial tunnel syndrome
- a) lateral epicondyle
b) elbow extended with resisted wrist extension or supination of forearm - a) medial epicondyle
b) wrist flexion and pronation
NOTE: can also present with ulnar nerve involvement
- a) 4-5cm distal to lateral epicondyle
b) extending elbow and pronating the forearm
What can cause a painful, warm and erythematous swelling on the posterior aspect of the elbow?
olecranon bursitis
Bennett’s Fracture
- What is it?
- What causes it?
- What is seen on XR?
- intra-articular fracture of first carpometacarpal joint
- impact on flexed joint - fist fight
mnemonic: Mark Bennett - scotland rugby centre - rugby player so he’s always getting in fist fights - trianglar fragment at ulnar base of metacarpal
Smith’s fracture
- What is it?
- What can cause it?
- What is Barton’s fracture?
- volarly displaced distal radius fracture
“garden spade deformity” - falling backwards onto palm of outstretched hands / falling onto flexed wrist
- distal radius fracture (colles’ or smith’s) with radiocarpal dislocation
mnemonic: if Joey Barton is involved its not just gonna be a fracture there’s gonna be a dislocation as well
Monteggia’s v Galeazzi fracture
State
a) What is
b) What can cause
- Monteggia’s fracture
- Galeazzi fracture
- a) ulna fracture with dislocation of proximal radioulnar joint
b) FOOSH with forced pronation
2
a) radial fracture with dislocation of the distal radioulnar joint
b) direct blow
mnemonic (ish) the broken bone causes dislocation of the joint they’re most in charge of
What is a bimalleolar ankle fracture known as?
Pott’s fracture
Fat embolism
- When do they occur?
- What clinical features can be seen in:
a) respiratory
b) ophthalmology
c) CNS
d) dermatology - How is it treated?
- following fracture - most often pelvic and long bone
2. a) - breathlessness - tachypnoea - tachycardia - hypoxia - pyrexia
b)
- front: subconjunctival haemorrhage
- back: retinal haemorrhages / intra-arterial fat globules on fundoscopy
c) agitation + confusion
d) petechial rash
- prompt fixation of fracture
- DVT prophylaxis
Fracture types
What is meant by the following:
- oblique fracture
- comminuted
- segmental
- transverse
- spiral
- fracture lies obliquely to long axis of bone (neither parallel or perpendicular)
- > 2 fragments of bone
- > 1 fracture in bone
- perpendicular to long axis of bone
- high energy oblique fracture with rotation along long axis of bone
How should open fractures be managed?
- IV ABx prophylaxis +/- tetanus prophylaxis
- thoroughly debride and lavage (6L of saline to irrigate) within 6 hours of injury
mnemonic: 6 and 6
