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Medicine > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

What orthopaedic fracture are associated with highest mortality rate?

A

Pelvic fractures because patients can bleed to death. If patients condition is unstable, consider heroic measures such as military antishock trousers and internal fixation

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2
Q

Why should areas distal to a fracture be assessed by physical examination?

A

Areas distal should be assessed for neurological or vascular compromise, either of which may be an emergency

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3
Q

Distinguish between an open and a closed fracture

A

With an open (compound) fracture the skin is broken over the fracture site. In closed fractures the skin is closed over the fracture site.

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4
Q

Explain the difference in management between open and closed fractures

A

For closed fractures closed reduction and and casting generally can be done. For open fractures give antibiotics to cover both gram negative and gram positive bacteria (cefuroxime is appropriate) if patient is at risk of MRSA give vancomycin. Do surgical debridement, lavage fresh wound ( if less than 8 hours old)and perform orif.

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5
Q

What are the indications of open reduction other than an open fracture?

A

Inarticular fractures or articular surface mal alignment
non union or failed closed reduction
compromised blood supply
Multiple trauma
Need for perfect reduction to optomise extremety function.

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6
Q

What type of radiographs should you order if you suspect a fracture?

A

For any suspected fracture, order two views (usually AP and lateral) of the site, and consider radiographs of the joints above and below the fracture.

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7
Q

How should you treat a patient with severe pain after trauma and negative x ray?

A

Treat conservatively. Assume there is a fracture and have the patient rest the injured area. Splinting may be appropriate for distal extremety injury. Obtain radiographs 7 - 14 days after the injury if symptoms persist, many occult fractures occur around this time. Thwe exception to waiting is suspected hip fracture in an elderly patient proceed to CT or MRI to allow earlier diagnosis and treatment

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8
Q

Define compartment syndrome. What are the causes?

A

Compartment syndrome is a problem of muscle compartments, which are limited by fascia in which they are contained. It is seen in extremities (most commonly in the calf) when oedema and haemorrhage causes swelling inside a muscle compartment. Rising pressure inside the fascial compartment can result in nerve damage and muscle necrosis. The three common scenarios which fractures are seen in include fractures, burns and vascular compromise (or after vascular surgery procedures.)

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9
Q

What are the common symptoms and signs of compartment syndrome?

A

Pain, parasthesia, pallor,paralysis, elevated compartment pressure (30 - 40 mmHg).

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10
Q

How is compartment syndrome treated?

A

After exposure of skin and symptoms are not relieved within 30 minutes proceed to fasciotomy.

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11
Q

For damage to the radial nerve what motor function would you test?

A

Radial nerve is responsible for wrist extension. Look for wrist drop.

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12
Q

For damage of the radial nerve what sensory function would you test?

A

Back of forearm and back of hand (first three digits)

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13
Q

What clinical senario is related to radial nerve damage

A

Mid shaft humeral fracture.

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14
Q

What artery is at risk of injury in a midshaft humeral fracture?

A

Profunda brachii.

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15
Q

For damage to the ulnar nerve what function would you test?

A

Finger ABduction

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16
Q

Where would you test for the sensory function of the ulnar nerve?

A

Front and back of last two digits.

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17
Q

What clinical senarios are likely to cause ulnar dysfunction?

A

Elbow dislocation or fracture of the medial epicondyle of the humerous

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18
Q

How would assess the motor function of the Median nerve?

A

Pronation and thumb opposition

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19
Q

Where would you test the the sensory function of the median nerve?

A

Palmer surface of the hand first three digits.

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20
Q

What clinical senarios would give you dysfunction to the median nerve?

A

Carpel tunnel syndrome, Supracondylar fractures of the humerous.

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21
Q

How would you test the motor function of the axillary nerve?

A

ABduction of shoulder joint and lateral rotation.

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22
Q

How would you test the sensory function of the axillary nerve?

A

Lateral shoulder,

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23
Q

What is a stress fracture?

A

A small or incomplete fracture that develops due to repeated or prolonged forces on the bone.

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24
Q

What is the difference btw insufficient stress fractures and fatigue stress fractures?

A

In fatigue fractures, abnormal stressors are applied to normal bone (e.g. overuse in military recruits or marathon runners)
Insufficient stress fractures normal/physiologic stresses are applied to an abnormal bone (e.g) osteoporosis.

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25
Q

How are stress fractures diagnosed?

A

Diagnosis can be made by x-ray, MRI or nuclear medicine scan may be used if x-rays are negative however there is a strong clinical suspiscion

26
Q

How are stress fractures treated?

A

Rest to allow healing and prevent progression to a complete fracture in the setting of insufficient fractures treatment of osteoporosis is also neede to help prevent future fractures.

27
Q

What fracture is usually diagnosed in trauma pts with pain in the anatomic snuff box?

A

Scaphoid bone fracture, Classically after a fall onto an out stretched hand. X-rays may not show a fracture initially, so if a patient has fallen onto an outstretch hand and has pain in the anatomical snuffbox, treat these injuries as a fracture. Repeat x-rays 1-2weeks later.

28
Q

What are the most common locations of intervertebral disc herniation?What symptoms do they cause?

A

Lumbar disc herniation is a common, often correctable cause of low back pain. The most common location is the L5-L1 disc, which affects the S1 nerve root. Look for decreased ankle jerk, weakness of plantar flexorsin the foot, pain in the midgluteal area to the posterior calf and a positive straight leg test. (Lasegue’s test). The second most common location for hernia is the L4-L5 discthat affects the L5 nerve root. Look for decreased biceps femoris reflex, weakness of foot dorsiflexion, and pain in hip or groin.

29
Q

What is the myotome for hip flexion?

A

L2/3

30
Q

What is the myotme for knee extension?

A

L3/4

31
Q

What is the myotome for ankle dorsiflexion?

A

L4/5

32
Q

What is the myotome for large toe dorsiflexion?

A

L5

33
Q

What is the myotome for ankle planterflexion?

A

S1/S2

34
Q

What is the myotome for knee flexion?

A

L5/S1

35
Q

What is the myotome for hip extension?

A

L4/5

36
Q

After the lumbararea being the most common location for disc herniation. What is the second most common location for disc herniation. What are the clinical manifestations?

A

The second most common loaction is the cervical spine. The classic symptom of cervical disc disc disease is neck pain. Herniation is most common at the C6/7 disc which affects the C7 nerve root. Look for decreased triceps/Reflex and strength and weakness of forearm extension.

37
Q

How is invertebral disc herniation diagnosed and treated?

A

Diagnosis is made by MRI scan (preferred) or by CT scan or myelography. Initial treatment is usually conservative including bed rest and analgesics, usually attempted first because roughly 90% of cases reslove with conservative management. Epidural steroid injections may help. Surgery (discectomy) may be required if conservative treatment fails or significant neurologic deficit is present (to prevent permanent nerve damage)

38
Q

Define Charcot joint. What causes it? How is it managed?

A

Charcot joints are seen in patients with DM or other conditions causing peripheral neuropathy (e.g. tertiary syphillis). Lack of proprioception causes gradual arthritis or arthropathy and joint deformation. Pts should get radiographs for any trauma because they mat not feel even a severe fracture.

39
Q

What are the most common bacterial causes of osteomyelitis (OM)? In what clinical senarios should you think of other causes?

A

OM is most commonly caused by Straph aureus. Think of gram-negative bacteria for immunocompromised pts or IV drug abusers. Salmonella sps is the most likely cause in pts with sickle cell disease. Think Pseudomonas aerginosa if there is a puncture through a tennis shoe. Diabetis that develop a diabetic foot with subsequent OM usually have a polymicribial infection

40
Q

What bacteria are the most common cause of septic arthrits?In what senario would you think of another cause?

A

Septic arthritis is commonly caused by Staph aureus, but in sexually active adults suspect Neisseria gonorrhoea. Aspiriate the joint and order a gram stain, culture, and cell count with differentials if infection is suspected.

41
Q

What is complex regional pain syndrome? How do patients present?

A

CRPS is a poorly understood disorder of a body region usually the extremities. It is characterised by pain swelling and vasomotor instability skin changes and patchy bone demineralisation. It usually begins following an injury, surgery or vascular event e.g. stroke.
Pts classically present with severe intermittent pain, often described as burning with associated temperature changes and sweating during episodes. A minor stimulus may trigger severe pain syndromes (allodynia). The diagnoses can be made by radiographs and or nuclear medicine scan. A presumptive diagnosis is often made in the appropriate setting if a sympathetic nerve block relieves symptoms. This procedure can be repeated as part of therapy if it is initially successful.

42
Q

True or false: there is a high incidence of vascular injury with posterior knee dislocations

A

True, order an angiogram if pulses are asymmetric to check for injury.

43
Q

What is the most common type of bone tumour

A

Metastatic esp from breast lung or prostate cancer.

44
Q

What is a pathological fracture? What is the most common cause of a pathological fracture?

A

A pathological fracture is one that occurs in bone previously weakened by another disease. Osteoporosis (esp in elderly thin women) is the most common cause, but you should always think of the possibility of malignancy.

45
Q

To what site is the pain form hip inflammation or dislocation/fracture classically referred?

A

The knee esp children

46
Q

What is the specific age of presentation of DDH?

A

At birth

47
Q

What is DDH?

A

Developmental dysplasia of the hip (DDH) describes a spectrum of conditions related to the development of the hip in infants and young children. It encompasses abnormal development of the acetabulum and proximal femur and mechanical instability of the hip joint

48
Q

Who has a higher chance of DDH?

A

Females, first borns and breech delivery

49
Q

How can you test for DDH

A

Barlow and Ortolani signs

50
Q

What is the treatment for DDH

A

Observation, abduction splint, or open or closed reduction

51
Q

At what age is the usual presentation of LCPD (leg calve perthes disease)?

A

4-10 yrs old

52
Q

What is LCPD (leg calve perthes disease)?

A

It is a syndrome of idiopathic avascular necrosis of the hip. It is bilateral in 10-20% of cases

53
Q

Who has a higher chance or LCPD?

A

Short male with delayed bone age.

54
Q

What are the symptoms and signs of LCPD?

A

knee thigh groin pain and limp.

55
Q

What is the treatment of LCPD?

A

Orthoses (trying to contain the femoral head in the acetebulum)

56
Q

Who is most affected in SCFE (slipped capital femoral epiphysis)

A

9-13 year olds

57
Q

What is the epidemiology of SCFE?

A

overweight male adolescent

58
Q

What are the signs and symptoms of SCFE?

A

Knee, Thigh Groin Pain and limp.

59
Q

What is SCFE?

A

the femoral epiphysis slips posteriorly, resulting in a limp and impaired internal rotation.

60
Q

What is the treatment of SCFE?

A

Surgical pinning.

61
Q

Define Osgood-Schlatter disease.

A

Osgood-Schlatter disease is also known as osteochodritis of the tibial tubercle.

Medicine (22 decks)

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