Orthopaedics Flashcards
What is the most sensitive test for meniscal tear?
Thessaly’s Test (not McMurray’s Test)
What are the special tests for ACL injury?
- Anterior Drawer Test (best done within 30 mins of injury)
- Lachman’s Test (most sensitive)
Which tendon can cause an avulsion fracture of the lesser trochanter?
Iliopsoas
Which muscle(s) can cause an avulsion fracture of the following?
- Ischial Tuberosity
- Greater Trochanter
- Lesser Trochanter
- Pubic Symphysis
- Iliac Crest
- ASIS
- AIIS
- Fifth Metatarsal Head
- Hamstrings
- Gluteals
- Iliopsoas
- Adductors
- Abdominals
- Sartorius
- Rectus Femoris
- Peroneas Brevis
What structures make up Shenton’s line?
- Inferior border of superior pubic ramus
- Neck of femur
What portion of the bone does cancer most commonly metastasise to?
Diaphysis
What are the 6 most common sources of bone metastases?
- Lungs
- Colon
- Prostate
- Thyroid
- Kidney
- Bladder
Should biopsies of bone tumours be fine before specialised imaging?
No
Which nerve is injured in posterior hip dislocation?
Sciatic nerve
When does the subacromial space communicate with the glenohumeral joint?
In a full thickness rotator cuff tear
What is a dinner fork deformity?
Malunited distal radius fracture with dorsal displacement of wrist (i.e. Colles fracture)
What is a Colles fracture?
Distal radius fracture with dorsal displacement (FOOSH)
What is a Smith’s fracture?
Distal radius fracture with volar displacement (reverse Colles)
In which part of bones do metastases commonly occur?
- Diaphysis of long bones
- Vertebral bodies
- Pelvis
What is the 11-22-11 rule of the wrist?
In regard to plain x-rays
- Radial styloid process is 11mm above ulnar styloid process on AP
- Angle of inclination is 22 degrees on AP
- Volar tilt on lateral view is 11 degrees
Name 4 orthopaedic emergencies.
- Septic Arthritis
- Compound (open) Fractures
- Compartment Syndrome
- NOF # (in some cases)
What is the blood supply to the femoral head?
- 25% - Fovea Artery
- 25% - Intramedullary Arteries
- 50% - Lateral + Medial Circumflex Femoral Arteries (anastomose to give off cervical, then reticular branches)
Explain the Weber Classification.
Regarding ankle fractures:
- A - below syndesmosis (stable, don’t fix)
- B - at syndesmosis (sometimes fix)
- C - above syndesmosis (unstable, always fix)
What fracture may be associated with an ankle fracture?
Maisonneurve # of proximal fibula
What are the three types of pattern seen in bone tumours and what do they indicate?
- Localised / geographic: benign
- Moth-Eaten: slow malignant or aggressive benign
- Permeative: malignant
What makes up the:
- Medial (deltoid) Ligament of the Ankle
- Lateral Ligament of the Ankle
- Anterior + posterior tibiotalar ligaments + talocalcaneal ligament + tibionavicular ligament
- Anterior + posterior talofibular ligaments + calcaneofibular ligament
What are the stages of adhesive capsulitis?
- Freezing, painful (6w - 9m)
- Frozen, stiff, pain improves (4-9m)
- Thawing, recovery (5-26m)
Which muscles comprise the rotator cuff and what is their innervation?
- S - Supraspinarus (suprascapular nerve)
- I - Infraspinatus (suprascapular nerve)
- T - Teres Minor (axillary nerve)
- S - Subscapularis (upper + lower subscapular nerve)
What are the phases of bone healing?
- Haematoma formation + inflammation
- Soft callus formation
- Hard callus formation (endochondral ossification)
- Remodelling
What is the significance of the zone of transition in a bone tumour?
The transition zone is the distance between abnormal and normal tissue.
Narrow = less aggressive.
What is this spot diagnosis?
Adamantinoma
When is the fallen leaf sign commonly seen?
In a bone cyst
(pieve of cortical bone broken off and floating in fluid)
What is this spot diagnosis?
Neurofibromatosis
What can cafe au lait spots indicate?
Neurofibromatosis Type I
What is the most likely diagnosis?
Osteosarcoma
List 3 types of benign bone tumour.
Non-ossifying fibroma
Fibrous dysplasia
Osteoid osteoma
Chondroma
Osteochondroma
Simple bone cyst (not really a tumour)
Giant cell tumour (33%)
What are the Ottawa ankle rules?
X-ray indicated if:
- Tenderness over distal 6cm fibula or lateral malleolus OR
- Tenderness over distal 6cm tibia or medial malleolus OR
- Inability to weight bear for 4 steps
What are the Ottawa foot rules?
X-ray indicated if:
- Tenderness at base of 5th metatarsal OR
- Tenderness over navicular OR
- Inabilility to weight bear for 4 steps
What is the general management of soft tissue injuries?
Apply RICE: rest, ice compression, elevation
Avoid HARM: heat, alcohol, running*, massage
*mild exercise is helpful
What is neuralgia paraesthetica?
Lateral cutaneous nerve of thign compression over AIIS causing numbness over lateral thigh
What are pes planus and pes cavus?
Pes planus = flat-footed
Pes cavus = high-arched foot
What is Jones’ fracture?
Avulsion fracture of 5th metatarsal head where peroneus brevis inserts
What is the Garden classification of hip fracture?
1 - incomplete
2 - complete, nondisplaced
3 - complete, <50% displaced
4 - complete, >50% displaced
What are genu varus and genu valgum?
Valgum = knocked-knees
Varus = bowed legs
How does Trendelenberg gait occur?
Weak gluteus medius and minimus (abductors) supplied by superior gluteal nerve: when standing on the affected side, the non-affected hip will drop
Are anterior or posterior dislocations more common in the hip and shoulder?
Hip - posterior
Shoulder - anterior
What is shown here?
Lipohaemarthosis (fat entering joint via fracture of bone medulla)
What nerves arise from the brachial plexus?
- Musculocutaneous Nerve
- Axillary Nerve
- Radial Nerve
- Median Nerve
- Ulnar Nerve
What are the most common types of wrist fractures in:
(a) Young child
(b) Young adult
(c) Older adult
(a) Greenstick #
(b) Scaphoid #
(c) Colles # (distal radius, dinner fork deformity)
What does this sign indicate?
Fat pad sign (always pathological) - likely radial head #
Which nerve is affected in Saturday night palsy?
Radial nerve
What type of fracture is this?
Smith’s # of distal radius
What is this fracture?
Colles # of distal radius (dinner fork deformity)
What is DeQuervain’s tenosynovitis?
Entrapment of extensor pollicis brevis + abductor pollicis longus in first compartment of wrist
(pain + tenderness over radial wrist + thumb e.g. when playing piano, Finkelstein’s test used for diagnosis)
What are the differential diagnoses for shoulder pain?
- Rotator cuff tear
- Impingmeent (supraspinatus in subacromial space)
- Tendonitis
- Bursitis
- Adhesive capsulitis
- Osteoarthritis
What is thoracic outlet syndrome?
When arms move overhead, venous drainage is occluded causing facial plethora (due to extra cervical rib, tumour, etc.)
What is a SLAP lesion?
Superior labral tear from anterior to posterior (biceps tendon inserts into glenoid labrum and pulls away cartilage)
Where is pain from the hip joint commonly felt?
Groin and anterior thigh, may be referred to the knee
(pain in posterior hip is likely originating from lower back)
How may compartments are there in the knee?
- Medial
- Lateral
- Patellofemoral
Pain from which structures can be referred to the shoulder?
Cervical spine
Mediastium / chest
Diaphragm irritation
What is myositis ossificans?
Calcification formation in soft tissue following surgery or injury causing restricted, painful movement (most common site is elbow)
What type of fracture is this?
Pertrochanteric neck of femur fracture (not intertrochanteric)
A patient presents with 4 hours of snuffbox tenderness and a normal x-ray. How should they be managed?
Treat as scaphoid # (x-ray can be normal until 10 days after injury):
- Immobilise with plaster, return for repeat x-ray in 10 days
- If normal x-ray and tender: plaster for 2 weeks
- If normal x-ray and nontender: reassurance
- If confirmed #: plaster for minimum 6 weeks
- If complicated, plaster for further 6 weeks or ORIF (with screw)
Which x-ray views should be ordered to investigate shoulder dislocation?
AP + trans-scapular
What is periosteal reaction?
Increased activity or irritation of periostium causing it to lay down new bone. May cause the cortex to look fuzzy. Often due to bone tumours, fracture or infection.
What is the classical positioning of the leg in a displaced #NOF?
Shortened and externally rotated
What is the classical positioning of the leg following posterior hip dilocation?
Shortened and internally rotated
How many bones are there in the adult human body?
213 bones (excluding sesamoid bones)
What are the functions of RANK, RANK-L and OPG?
RANK-L is secreted by osteoblasts and binds to RANK on osteoclasts to activate them.
OPG binds to RANK-L to prevent binding of RANK and reduce osteoclast action.
At what age is peak bone mineral density reached?
30 years
Which muscles are involved in shoulder abduction?
Supraspinatus (to 40 degrees)
Deltoid (from 40 degrees)
Name the parts of a long bone.
What is tennis elbow?
Lateral epicondylitis (extensor tendon)
What is golfer’s elbow?
Medial epicondylitis (flexor tendon)
What clinical test is performed in suspected Archilles tendon rupture?
Simmons’ Test (squeeze calf while kneeling on chair)
What is Trendelenberg’s Sign?
When standing on the affected leg, the hip on the unaffected side will drop (due to abductor weakness from superior gluteal nerve injury)
Which artery is predominant in supplying the femoral head?
The medial circumflex femoral artery
What are the Ottawa knee rules?
- Patient aged 55 or older
- Isolated tenderness of the patella
- Tenderness of the head of the fibula
- Inability to flex to 90 degrees
- Immediate inability to weight bear for four steps
Which nerve supplies the posterior compartment of the thigh?
Sciatic Nerve
What does the femoral nerve supply?
Anterior compartment of the thigh
What test is positive in superior gluteal nerve injury?
Trendelenberg’s sign
(supplies gluteus medius and minimus)
What is the order of the sections of the brachial plexus?
- Roots
- Trunks
- Divisions
- Chords
- Branches
What are the contents of the carpal tunnel?
- Median nerve
- 4 x tendons of FDS
- 4 x tendons of FDP
- 1 x tendon of flexor pollicis longus
When are the following slings used?
- Collar and cuff
- Triangle sling
- Upper arm injuries
- Forearm injuries
