Orthopaedics 3 Flashcards
Ganglion
- What is it?
- How are they managed?
- cyst arising from joint tendon or sheath
- most common on back of wrist
- 3x more common in women - nil - disappear spontaneously after several months
Greater trochanteric pain syndrome
AKA trochanteric bursitis
- Who is it common in?
- What clinical features are seen?
- women in 50s + 60s
- pain over lateral hip + thigh
- tenderness on palpation of greater trochanter
What should you suspect in a runner with lateral knee pain and tenderness 2-3cm above lateral joint line?
iliotibial band syndrome
Describe the following hand lumps
- Osler’s nodes
- Bouchard’s nodes
- Heberden’s nodes
- painful, red, raised lesions on hands or feet
- caused by deposition of immune complexes - hard bony outgrowths or gelatinous cysts on proximal interphalangeal joints
- caused by calcific spurs of articular cartilage
- sign of OA - either chronic swelling or sudden onset pain, redness, numbness + loss of dexterity which settles
- typically middle age
- can be left with permanent bony outgrowth that can skew finger tip sideways
Hip Dislocation
- What clinical features are seen in
a) posterior dislocation (90% of cases)
b) anterior dislocation - How is it managed?
- What complications can be seen?
- a) affected leg shortened, adducted + internally rotated
b) affected leg abducted + externally rotated (not shortened)
THINK: so literally the exact opposite of one another
- reduction under general anaesthetic within 4 hours to prevent avascular necrosis
+ analgesia
+ physio - avascular necrosis
- sciatic or femoral nerve injury
- OA
- recurrent dislocation (due to damage to surrounding ligaments)
Hip Fracture
- What clinical features are seen?
- What types are there?
- When would one be worried about damage to blood supply and hence avascular necrosis?
- What is the management for
a) intracapsular fracture
b) extra capsular fracture
NOTE: weight bear asap after fracture to reduce VTE risk
- What is the best analgesia to give?
- pain
- shortened + externally rotated leg
NOTE: patients with non-displaced or incomplete fractures may be able to weight bear
- intracapsular - neither trochanter involve
extra capsular - can be either trochanteric or subtrochanteric (lesser trochanter dividing line) - displaced fractures
- a)
undisplaced: internal fixation or hemiarthroplasty
displaced: arthroplasty (total hip replacement or hemiarthroplasty)
total hip replacement favoured if
- medically fit
- can walk well with a stick or no support
- not cognitively impaired
b)
intertrochanteric fracture: dynamic hip screw
reverse oblique, transverse or subtrochanteric fracture: intramedullary device
- iliofascial nerve block
Iliopsoas Abscess
1.
a) What is the most common cause of primary Iliopsoas Abscess?
b) What secondary causes are there?
- a) What clinical features are seen?
b) What should be done on examination? - What is the investigation of choice?
- How is it managed?
- a) staph aureus
b)
- GI: Crohn’s (most common cause), diverticulitis, colorectal cancer
- GU: UTI, GU cancers
- vertebral osteomyelitis
- endocarditis
- IVDU
- femoral catheter, lithotripsy
- a)
- fever
- back / flank pain
- limp
- weight loss
b)
- flexing hip against resistance - causes pain as contracts poses muscle
- turn patient onto painfree side and hyperextend effected hip - causes pain as stretches poses muscle
- CT abdomen
- ABx
- percutaneous drainage (successful in 90%)
surgery required if drainage fails
Anterior Cruciate ligament damage
- What mechanisms of injury can be seen?
- What clinical features can be seen?
- non contact injuries: twisting / awkward landing
- lateral blow to knee
- skiing
- sudden popping sound followed by rapid knee swelling - haemarthrosis
- instability / feeling knee will give way
remember swelling over hours = haemarthrosis - associated with ligament injuries
days = general swelling
Meniscal tear
- What is the typical mechanism of injury?
- What clinical features can be seen?
- twisting injury
- straightening: pain +/-locking
- knee may give way
- tenderness along joint lines
- Thessaly’s test: patient weight wears with knee at 2 degree flexion (doctor supporting)
- > +ve if pain on twisting knee
What is often the mechanism of injury for
- posterior cruciate ligament injury
- medial collateral ligament injury
NOTE: lateral collateral ligament rarely injured in isolation
- hyperextension injuries
- dashboard injuries
- > tibia sulks into femur on examination
- skiing / valgus stress injuries
- > knee unstable in valgus position
Chondromalacia patella
- Who does it tend to happen in?
- What clinical features are seen?
- teenage girls following injury to the knee
- pain: going downstairs, at rest
- tenderness
- quadriceps wasting
Dislocation of the patella
- What is often the mechanism of injury?
- What are the risk factors?
- What investigation is required?
- direct trauma
- tensed quadriceps, pressure on valgus and external rotation
- genu valgus
- tibial torsion
- high riding patella
- skyline XR of patella
- What are the 2 main types of patella fracture?
2. How is patella fracture managed?
- direct blow with undisplaced fragments
- avulsion fracture
- > fracture where small chunk of bone attached to ligament or tendon gets pulled away from the main part of the bone
- undisplaced: knee brace for 6 weeks
displaced or loss of extensor mechanism: surgery and then knee brace for 6 weeks
Tibial Plateau fracture
- What is the mechanism of injury?
- Who can they be seen in?
- knee forced into varus / valgus but bone gives way before ligaments
varus pressure causes medial tibial fracture
valgus pressure causes lateral tibial fracture
- either elderly or significant trauma
What should you suspect in knee pain in a patient with a history of
- kneeling
- upright kneeling
- infra patellar bursitis (Clergyman’s knee)
2. pre-patellar bursitis
housemaid’s knee
