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Surgery > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

Fractures - early local complications

A

Compartment syndrome
Nerve injury
Vascular injury
Infection

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2
Q

Non-union - patient factors

A 
Smoking
Alcohol abuse
Increasing age
Steroids
Diabetes
Chronic renal failure
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3
Q

Non-union - fracture factors

A

Higher energy fracture
Open fractures
Infection
Bone loss

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4
Q

Anterior shoulder dislocation

A

Mode:fall on abducted and externally rotated arm
Neurovascular: axillary nerve, brachial plexus

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5
Q

Humoral shaft fracture

A

Neurovascular: radial nerve

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6
Q

Supracondylar fracture

A

Neurovascular: anterior interossus, median nerve

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7
Q

Monteggia fracture-dislocation

A

Ulnar shaft fracture, radial head dislocation

Neurovascular: posterior interossus, radial nerve

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8
Q

Distal radial fracture

A

Neurovascular: median nerve

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9
Q

Posterior hip dislocation

A

Neurovascular: sciatic nerve

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10
Q

Knee dislocation

A

Neurovascular: common peroneal nerve

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11
Q

Volkmann’s ischaemic contracture

A

Permanent flexion contracture of the hand at the wrist, claw-like deformity of the hand and fingers.
Passive extension of fingers is restricted and painful.
Result from undiagnosed compartment syndrome.

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12
Q

Neer’s classification

A

Proximal humeral fracture
Parts: humeral head, greater tuberosity, lesser tuberosity, shaft.
Displacement: >45 angulation, >1cm displacement

1 part: fracture lines 1-4 parts, non-displaced
2 part: fracture lines 2-4 parts, 1 displaced
3 part: fracture lines 3-4 parts, 2 displaced
4 part: fracture lines >4 parts, 3 displaced

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13
Q

Gartland classification

A

Supra-condylar fractures
Type I: undisplaced fracture
Type II: angulated fracture with intact posterior cortex
Type III: posteriorly displaced distal fragment, no cortical contact

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14
Q

Galeazzi fracture-dislocation

A

Distal radial fracture, distal radioulnar joint dislocation

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15
Q

Colles’ fracture

A

Distal radial fracture with dorsal angulation “dinner fork”

Mode: fall onto extended wrist

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16
Q

Smith’s fracture

A

Distal radial fracture with volar displacement

Mode: fall onto flexed wrist

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17
Q

Barton’s fracture

A

Distal radial fracture with partial fracture of radial head involving articular surface

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18
Q

Garden classification

A

Intracapsular femoral neck fracture

Stage 1: undisplaced, incomplete (incl valgus impacted fractures)
Stage 2: undisplaced, complete
Stage 3: complete fracture, incompletely displaced
Stage 4: complete fracture, completely displaced

Stage 3&4 higher risk of AVN

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19
Q

Schatzer classification

A

Tibial plateau fracture

Type I: wedge shape, pure cleavage of lateral plateau, 4mm depression
Type IIIa: lateral depression of lateral plateau
Type IIIb: central depression of lateral plateau
Type IV: depression of medial plateau, no fracture
Type V: involving both plateau regions
Type VI: fracture through metadiaphysis of tibia

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20
Q

Fractures - systemic complications

A

Fat embolism
DVT/PE
Sepsis
Complications of immobility

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21
Q

Complications of immobility

A

Respiratory tract infection - basal atelectasis
UTI
Pressure sores
Disuse osteoporosis and joint stiffness

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22
Q

Fat embolism - risk factors

A

Lower limb diaphysis fractures
Multiple fractures
Closed fractures
Young patients

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23
Q

Fat embolism - clinical features

A 
Tachypnoea - inflammatory response of lung parenchyma
Dyspnoea
Confusion/agitation
Petechial rash
Tachycardia
Fat in urine, retina, sputum

Low O2, low CO2, low platelets, diffuse bilateral lung infiltrates

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24
Q

Gustilo and Anderson classification

A

Open fractures, for prophylactic antibiotic regime

Types 1: wound 1cm, minimal soft tissue injury, minimal comminution
Type 2: wound 1-10cm, moderate contamination and soft tissue injury
Type 3a: extensive soft tissue damage, massive contamination, soft tissue coverage adequate
Type 3b: extensive soft tissue damage with periosteal stripping and bone exposure, massive contamination, soft tissue coverage inadequate
Type 3c: associated with arterial injury requiring limb salvage

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25
Q

Perthe’s disease

A

Idiopathic AVN of the femoral head in children

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26
Q

Ankylosing spondylitis

A

Chronic inflammatory autoimmune disease affecting spine and sacroiliac joints in young males. Features: seronegative spondyloarthropathy, “bamboo” spine

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27
Q

Paget’s disease

A

Abnormal bone architecture from abnormal osteoclastic and osteoblastic activity. Bone pain with raised ALP

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28
Q

Osteopenia

A

Decreased bone mass.

Unaffected Ca, PO, PTH. Normal ALP

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29
Q

Osteopetrosis

A

Thick dense “marbled” bone.

Unaffected Ca, PO, PTH. Elevated ALP

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30
Q

Osteoporosis

A

Brittle and fragile bone. Risk factors: postmenopause, steroids.
Treatment: bisphosphenates

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31
Q

Ewing’s sarcoma

A

Malignant round cell tumour in diaphysis of long bone or pelvis in children. X-ray: large soft tissue mass with onion-peel sign

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32
Q

Osteosarcoma

A

Cancerous bone tumour, can arise secondary from Paget’s disease.

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33
Q

Osteoclastoma

A

Giant cell tumour, common in young adults and affects epiphysis of long bones. Osteolytic, slow growing tumour, pathological fractures, soap bubble appearence.

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34
Q

Musculocutaneous nerve

C5-6

A

Motor:
Coracobrachialis
Biceps brachii

Sensory:
Lateral cutaneous nerve (lateral forearm)

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35
Q

Median nerve

C6-7

A 
Motor:
Brachialis
Pronator teres
Flexor carpi radilalis
Palmaris longus
Flexor digitorium superficialis
Thenar muscles
Lumbricals (2&3)

Sensory:
Lateral 3.5 fingers

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36
Q

Medial cutaneous nerve

T1

A

Sensory:

Medial aspect of arm

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37
Q

Ulnar nerve

C8-T1

A 
Motor:
Flexor carpi ulnaris
Flexor digitorium profundus (4&5)
Palmar interossei
Dorsal interossei
Palmar brevis
Hypothenar
Lumbricals (4&5)
Adductor pollicis

Sensory:
Medial aspect of forearm
Medial 1.5 fingers

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38
Q

Axillary nerve

C5-6

A

Motor:
Deltoids

Sensory:
Lateral upper arm

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39
Q

Radial nerve

C5-C8

A

Motor:
Triceps brachii
Brachioradialis
Extensor carpi radialis longus

Sensory:
Medial upper forearm (superficial radial nerve)
Lateral dorsum of hand

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40
Q

Posterior interosseous nerve (radial)

C7-8

A 
Motor:
Extensor carpi radialis brevis
Extensor carpi ulnaris
Extensor digiti minimi
Extensor digitorium
Supinator
Extensor indicis
Abductor pollicis longus
Extensor pollicis longus
Extensor pollicis brevis
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41
Q

Anterior interosseous nerve (median)

C5-T1

A

Motor:
Flexor policis longus
Pronator quadratus
Flexor digitorium profundus (2&3)

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42
Q

Tibial nerve

L5-S1

A

Motor:
Ankle plantar flexion
Knee flexion
Great toe flexion

Sensory:
Sole of foot

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43
Q

Superficial peroneal

L5-S1

A

Motor:
Ankle eversion

Sensory:
Dorsum of foot

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44
Q

Deep peroneal

L5-S1

A

Motor:
Ankle dorsiflexion and inversion
Great toe extension

Sensory:
1st web space

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45
Q

Sural nerve

S1-2

A

Sensory:

Lateral foot

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46
Q

Saphenous nerve

L3-4

A

Sensory:

Anteromedial ankle

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47
Q

UL Neuro Screen

A

“Thumbs up” = PIN/radial (abductor pollicis longus)
“OK sign” = AIN/median (flexor digitorium profundus)
“Spread fingers” = ulnar (dorsal interosseus)

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48
Q

Open reduction - indications (NO CAST)

A 
Non-union
Open fracture
Neurovascular compromise
intra-Articular fracture
Salter-harris 3,4,5
polyTrauma
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49
Q

Fractures - late local complications

A 
Non-union
Malunion
Osteomyelitis
Post-traumatic OA
Avascular necrosis
Joint stiffness/adhesive capsulitis
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50
Q

Orthopaedic emergencies (VON CHOP)

A 
Vascular compromise
Open fracture
Neurological compromise
Compartment syndrome
Hip dislocation
Osteomyelitis/septic arthritis
Pelvic fracture (unstable)
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51
Q

Compartment syndrome - features

A

Pain with passive stretch
Pain with active contraction of compartment
Swollen, tense compartment
Suspicious history (tibial shaft, pediatric supracondylar, forearm)

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52
Q

Compartment syndrome

5 P’s

A 
Pain: out of proportion for injury, not relieved by analgesics, increased with passive stretch
Pallor
Paresthesia
Paralysis
Pulselessness
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53
Q

Anterior hip dislocation

A

Mechanism: posteriorly directed blow to knee with hip abducted
Features: shortened, abducted, externally rotated

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54
Q

Posterior hip dislocation (more common)

A

Mechanism: force to knee while hip flexed and adducted
Feature: shortened, adducted, internally rotated

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55
Q

Osteomyelitis x-ray

A 
Soft tissue swelling
Lytic bone destruction
Periosteal reaction (seen 10 days post infection)
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56
Q

Septic joint

A

Organisms: Staph species, N. gonorrhoea

Factors: previous surgery/injury to joint, joint disease, IVDU, IA steroids

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57
Q

Anterior shoulder dislocation (more common)

A

Mechanism: abducted arm, external rotation, blow to posterior shoulder
Features: slight abduction, externally rotated, unable to internally rotate, “squared off” shoulder.

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58
Q

Anterior shoulder apprehension test + relocation

A

Gentle shoulder abduction and external rotation to 90, humeral head pushed anteriorly
Posteriorly directed pressure relieves apprehension

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59
Q

Hill-Sach lesion

A

Compression fracture of posterior humeral head against glenoid rim.
Reverse Hill-Sachs in posterior dislocation.

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60
Q

Bankart lesion

A

Avulsion of anterior glenoid labrum from glenoid rim.

Reverse Bankart in posterior dislocation.

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61
Q

Sulcus sign

A

Subacromial indentation with distal traction on humerus, inferior shoulder instability

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62
Q

Posterior shoulder dislocation

A

Mechanism: adducted, internally rotated, flexed arm (seizure, alcohol, electrocution)
Features: adducted and internally rotated arm, external rotation blocked, anterior shoulder flattening

63
Q

Posterior shoulder apprehension test

A

Apply posteriorly force on flexed, adducted, internally rotated arm.
For posterior instability

64
Q

Supraspinatous

A

Insertion: Greater tuberosity
Nerve: Suprascapular
Function: Abduction

65
Q

Infraspinatous

A

Insertion: Greater tuberosity
Nerve: Suprascapular
Function: External rotation

66
Q

Teres minor

A

Insertion: Greater tuberosity
Nerve: Axillary
Function: External rotation

67
Q

Subscapularis

A

Insertion: Lesser tuberosity
Nerve: Suprascapular
Function: Internal rotation, adduction

68
Q

Corocoid process attachment

A

Short head of biceps
Coracoid brachialis
Pectoralis minor

69
Q

Painful arc syndrome

A

Compression of supraspinatous tendon, subacromial bursa.

Pain with abduction >90 degrees

70
Q

Rotator cuff tears

A

Night pain and difficulty sleeping on affected side
Pain worse with active movement
Weakness and loss of ROM
Tenderness over greater tuberosity

71
Q

Jobe’s test

A

Supraspinatous

90 degree abduction, 30 degree forward flexion, internal rotation so thumb at ground

72
Q

Lift-off test

A

Subscapularis

Internal rotation so hand on back

73
Q

Posterior-cuff test

A

Infraspinatous and teres minor

External rotation, elbow at 90 degrees

74
Q

Neer’s test

A

Rotator cuff impingement

Passive shoulder flexion with thumb down, pain between 130-170 degrees

75
Q

Hawkins-Kennedy test

A

Rotator cuff impingement

Shoulder flexion at 90 degrees, passive internal rotation

76
Q

Frozen shoulder (adhesive capsulitis)

A

Gradual onset diffuse shoulder pain
Decreased active and passive ROM
Pain worse at night
Increased stiffness as pain subsides (6-12 months)

77
Q

Lateral epicondylitis

A

“tennis elbow”, inflammation of extensor tendon inserts

78
Q

Medial epicondylitis

A

“golfer’s elbow” inflammation of flexor tendon inserts

79
Q

Scaphoid fracture

A

Mechanism: FOOSH, impaction of scaphoid onto distal radius
Features: pain in wrist movement, tenderness in anatomical snuff box, no displaced.

80
Q

Compression fracture - spine

A

Anterior column = stable

81
Q

Burst fracture - spine

A

Anterior, midline = unstable

High energy axial loading + flexion

82
Q

Flexion dislocation - spine

A

Middle, posterior = unstable

MVA, lap belt only

83
Q

Fracture dislocation - spine

A

Anterior, middle, posterior = unstable

84
Q

Compression test (C-spine)

A

Compression on head worsens radicular pain

85
Q

Distraction test (C-spine)

A

Traction on head relieves radicular symptoms

86
Q

Valsalva test (C-spine)

A

Increased intrathecal pressure and causes radicular pain

87
Q

C5

A

Motor: deltoid, biceps, wrist extension
Sensory: axillary nerve, rhomboids
Reflex: biceps

88
Q

C6

A

Motor: biceps, brachioradialis
Sensory: thumb and index
Reflex: biceps, brachioradialis

89
Q

C7

A

Motor: triceps, wrist flexion, finger extension
Sensory: middle finger
Reflex: triceps

90
Q

C8

A

Motor: interossei, digital flexors
Sensory: ring and little fingers
Reflex: finger jerk

91
Q

Swimmer’s view

A

Lateral view with arm abducted 180 degrees to evaluate C7-T1

92
Q

Lateral flexion/extension view

A

Evaluate subluxation of C-spine

93
Q

Straight leg raise

A

Radicular pain radiating down posterior/lateral leg to knee

94
Q

Lasegue maneuver

A

Dorsiflexion of foot during straight leg raise, exacerbates pain

95
Q

Femoral stretch test

A

Prone, passive flexing of knee and extending of hip exacerbates radicular pain

96
Q

L4

A

Motor: quadriceps, tibialis anterior
Sensory: medial malleolus
Reflex: knee
Test: femoral stretch

97
Q

L5

A

Motor: extensor hallucis longus, gluteus medius
Sensory: 1st dorsal web, lateral leg
Test: straight leg raise

98
Q

S1

A

Motor: peroneus longus + brevis, gastrocnemius + soleus
Sensory: lateral foot
Reflex: ankle
Test: straight leg raise

99
Q

Red flags for BACK PAIN

A 
Bowel/bladder dysfunction
Anesthesia (saddle)
Constitutional symptoms/malignancy
Khronic disease
Paresthesias
Age >50
IV drug use
Neuromotor deficits
100
Q

Mechanical back pain - disc

A

Back pain
Flexion aggravation
Gradual onset
Weeks-months duration

101
Q

Mechanical back pain - facet

A

Back pain
Extension, standing, walking aggravation
More sudden onset
Days-weeks duration

102
Q

Direct nerve root compression - spinal stenosis

A

Leg pain
Exercise, extension, walking, standing aggravation
Congenital or acquired onset
Acute episodes (spinal claudication) on chronic history

103
Q

Direct nerve root compression - root compression

A

Leg pain
Flexion aggravation
acute leg +/- back pain onset
More constant pain (lateral disc herniation) or intermittent pain (central disc herniation

104
Q

Back Pain - differentials

A

Degenerative (disc, facet, ligament)
Peripheral nerve compression (disc herniation)
Spinal stenosis (congenital, osteophyte, central disc)
Cauda equina syndrome
Others (neoplastic, infectious, metabolic, trauma, spondyloarthropathies, referred)

105
Q

Spondylolysis

A

Defect in pars interarticularis with no movement of vertebral bodies, “collar” break in “Scottie dog” on oblique x-ray.
Acitivity related back pain

106
Q

Spondylolisthesis

A

Defect in pars interarticularis causing forward slip of vertebrae
Congenital, degenerative, traumatic

107
Q

Pelvic fracture classification

A

A: Stable avulsion fracture
Rotationally and vertically stable
A1: fracture not involving pelvic ring
A2: minimally displaced fracture of pelvic ring

B: Open book 
Rotationally unstable, vertically stable
B1: open book
B2: lateral compression - ipsilateral
B3: lateral compression - contralateral
C: Unstable vertical fracture
Rotationally and vertically unstable
C1: unilateral
C2: bilateral
C3: associated acetabular fracture
108
Q

Shenton’s line

A

Radiographic line along upper margin of obturator foramen extending along the inferiormedial side of femoral neck. Disruption indicates subcapital fracture

109
Q

Thomas test

A

Flexion of both knees and hips and eliminate lumbar lordosis, straighten out affected leg with other flexed.

Fixed flexion contracture, apparent limb shortening seen in OA

110
Q

Knee history (CLIPS)

A 
Clicking
Locking
Instability
Pain
Swelling
111
Q

Anterior/posterior draw test

A

ACL and PCL tears

112
Q

Lachmann test

A

ACL tear

Hold knee at 20 degrees flexion, sublux tibia anteriorly on femur

113
Q

Posterior sag test

A

PCL tear

114
Q

Pivot shift sign

A

ACL tear

Knee extended, apply valgus force and flex knee

115
Q

Collateral ligament stress test

A

MCL and LCL tear

Palpate for knee joint opening

116
Q

Meniscal tear

A

Joint line tenderness
Crouch compression test
McMurray test

117
Q

McMurray test

A

Meniscal tear

Knee in flexion, palpate joint line.
LM - internal rotation, varus stress and extend knee
MM - external rotation, valgus stress and extend knee

118
Q

O’Donoghue’s Unhappy Triad

A

ACL rupture
MCL rupture
Meniscal damage

119
Q

Patellar dislocation

A

Risk factors: young, female, obesity, high-riding patella, knock-knees, increased Q angle, shallow intercodylar groove, tight lateral retinaculum.

Knee catches or gives way on walking, weak knee extension, positive patellar apprehension test

120
Q

Patellar apprehension test

A

Examiner laterally displaces patella

121
Q

Patellofemoral Syndrome

A

Softening/eroision of articular cartilage in medial aspect of patella.
Features: deep aching anterior knee pain, exacerbated by prolonged sitting, stair climbing, sitting, sensation of instability,

122
Q

Anterior draw foot

A

Lateral ligament injury

Displace foot anteriorly against fixed tibia

123
Q

Talar tilt

A

Foot inverted, angle of talar rotation evaluated by x-ray

124
Q

Ottwa ankle rules

A

X-ray required if:
Pain in malleolar zone AND bony tenderness over posterior aspect of medial/lateral malleolus
OR
Inability to weight bear immediately after injury or in ED

125
Q

Danis-Weber classification

A

Ankle fracture

A: infrasydesmosis (pure inversion injury)
Avulsion of lateral malleolus below plafond/torn calcaneofibular ligament
B: trans-syndesmotic (external rotation and eversion)
Avulsion of medial malleolus or rupture deltoid ligament, spiral fracture of lateral malleolus starting at plafond
C: supra-syndesmotic (pure external rotation)
Avulsion of medial malleolus or torn deltoid ligament, posterior malleolus avulsion with posterior tibio-fibular ligament, fibular fracture above plafond

126
Q

Ankle ligaments

A

Medial: deltoid ligament
Lateral: anterior talofibular, calcaneofibular, posterior talofibular

127
Q

Talar fracture

A

Mechanism: axial loading, hyperdorsiflexion

Distal to proximal blood supply, high risk of AVN with displaced fractures

128
Q

Calcaneal fracture

A

Mechanism: axial loading

Loss of Bohler’s angle (20-40 degrees), varus heel

129
Q

Achilles tendon rupture

A

Features: palpable gap, apprehensive toe off, weak plantar flexion, Thompson test

130
Q

Thompson test

A

Achilles tendon rupture

Squeezing calf muscle to elicit passive plantar flexion of foot

131
Q

Plantar fascilitis (heel spur syndrome)

A

Mechanism: repetitive strain, aslo associated with obesity, DM, arthopathies
Radiological: heel spurs

132
Q

Bunions (hallux valgus)

A

Valgus alignment of 1st MTP, painful bursa over medial side of 1st metatarsal head

133
Q

Ottawa foot rules

A

X-ray required if:
Pain in midfoot zone AND bony tenderness over navicular or base of 5th metatarsal
OR
Inability to weight bear both immediately after injury and in ED

134
Q

Salter-Harris classification

A

Epiphyseal injury

Straight: transverse through growth plate
Above: through metaphysis and along growth plate
Low: through epiphysis to plate and along growth plate
Through: through epiphysis and metaphysis
Ram: crush injury of growth plate

135
Q

Slipped capital femoral epiphysis

A

Type 1 Salter-Harris at proximal hip. Common in adolescent, male, obese, hypothyroid.

Positive Trendelenburg sign, Whiteman’s sign (flexion with obligate external rotation at hip), bilateral involvement in 25%.

136
Q

Developmental dysplasia of hip

A

Ligament laxity, muscular underdevelopment, abnormal shallow slope of acetabulum roof.
Painless.

Tests: Barlow’s, Ortolani’s, Galeazzi’s

137
Q

DDH - 5 F’s of predisposition

A 
Family history
Female
Frank breach
First born
leFt hip
138
Q

Barlow’s test

A

DDH

Flex hips and knees at 90 degrees, grasp thighs, fully adduct thighs and push posteriorly

139
Q

Ortolani’s test

A

DDH

Reduce hips with fingertips from Barlow’s test by abducting hips

140
Q

Galeazzi’s sign

A

DDH

Knee ar unequal heights when hips and knees flexed

141
Q

Legg-Calve-Perthes Disease

A

Self limited AVN of femoral head, 4-10 yos

Features: child with hip pain and limp, tender over anterior thigh, flexion contracture

142
Q

Osgood-Schlatter Disease

A

Repetitive stress on tibial tuberosity by patella tendon, minor avulsion
Features: tender over tibial tuberosity, pain on resisted leg extension, anterior knee pain on jumping

143
Q

Congenital talipes equinovarus

A

Talipes: talus inverted and internally rotated
Equinus: ankle is plantar flexed
Varus: heel and forefoot are in varus (supinated)

144
Q

Scoliosis

A

10-14 yo

Causes: idiopathic, congenital, neuromuscular, postural

145
Q

Benign bone lesion - radiology

A

No periosteal reaction
Thick endosteal reaction
Well developed bone
Intraosseous and even calcification

146
Q

Malignant bone lesion - radiology

A

Acute periosteal reaction: Codman’s triangle, onion skin, sunburst
Broad border between lesion and normal bone
Varied bone formation
Extraosseous and irregular calcification

147
Q

Osteoid osteoma

A

20-30’s yo, tibia and femur common.
Features: severe intermittent pain, mostly night, relieved by NSAIDs
Radiology: small, round translucent nidus surrounded by dense sclerotic bone

148
Q

Osteochondroma

A

20-30’s yo, most common benign tumour, metaphysis of long bone
Feature: slow growing
Radiology: cartilage capped bony spur “mushroom”

149
Q

Ewing’s sarcoma

A

5-20 yo, metaphysis of long bone
Features: pain, mild fever, erythema, swelling, anaemia
Radiology: moth eaten appearence with onion-skinning
Rx: resection, chemotherapy, radiation

150
Q

Osteosarcoma

A

20’s, elderly with history of Paget’s disease
Features: progressive pain, night pain, decreased ROM
Radiology: periosteal reaction (Codman’s triangle or sunburst)
Rx: complete resection, bone scan, metastases

151
Q

Chondrosarcoma

A

Primary 70% or secondary 30% (malignant degeneration of pre-existing cartilage tumour)
Features: progressive pain, mass
Radiology: medullary cavity, irregular “popcorn” calcification

152
Q

Multiple myeloma

A

Most common primary malignant tumour of bone in adults
Features: bone pain, compression/pathological fractures, renal failure, infections, systemic, hypercalcaemia with pancytopenia.
Radiiological: punched out lesions
Rx: chemotherapy, radiation

153
Q

Bone metastases

A 
Breast
Prostate
Thyroid
Lung
Kidney

Surgery (5 decks)

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