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Orthopaedics Flashcards

1
Q

Give 5 risk factors for development of osteoporosis?

A 
Increasing age
Family history
Steroid use long term
Hyperthyroidism
Hyperparathyroidism
Hypercalcuria
Alcohol use
Smoking
BMI <22
Reduced testosterone
Early menopause
Renal failure
Liver failure
Erosive or inflammatory bone disease
Low dietary calcium
Malabsorption
Immobility
Previous fragility fracture
Type 1 diabetes
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2
Q

What is the DXA cut off for diagnosing osteoporosis?

A

T score of -2.5 or less

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3
Q

What are the indications for performing a DXA scan?

A

Over 50 years old and a history of fragility fractures
Less than 40 years old with a major risk factor for fragility fracture
10 year fracture risk of 10% or more

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4
Q

How is osteoporosis managed?

A

Lifestyle advice eg stop smoking, do more exercise, reduce alcohol intake, do balance exercises
Bisphosphonate treatment
Calcium and vitamin D supplements if appropriate
HRT if premature menopause to reduce fracture risk

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5
Q

What are the main features of joint hypermobility syndrome?

A

Joint hypermobility with chronic pain related to exercise

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6
Q

What is the pathology involved in Paget’s bone disease?

A

Abnormal, increased, osteoclast activity with increast bone resorption
Followed by abnormal osteoblast activity with excess bone formation with bone that is less organised, less compact, more vascular and weaker with increased risk of fractures

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7
Q

Which bones are most affected by Paget’s disease?

A

Axial skeleton inc. pelvis
Long bones
Skull

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8
Q

Give three common complications of Paget’s disease?

A 
Bone pain
Bone deformity
Pathological fractures 
Increased bleeding from fractures
Osteoarthritis
Deafness and tinnitus
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9
Q

Give three uncommon complications of Paget’s disease

A 
Paraplegia
Spinal stenosis
Nerve compression
Hypercalcaemia
Hydrocephalus
High output cardiac failure
Osteosarcoma
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10
Q

What are the features of a bone profile blood test in Paget’s disease?

A

Normal calcium, phosphate and PTH

Increased Alkaline Phosphatase

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11
Q

What are the features of Paget’s disease on X ray?

A

Multiple multifocal sclerotic patches giving a cotton wool appearance
Osteolysis
Excess bone formation
Patchy cortical thickening
V shape at boundary of healthy and abnormal bone

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12
Q

How is Paget’s disease managed?

A

Analgesia
mobility aids
Bisphosphonates with vit D and calcium deficiency correction
Surgery if deformity, nerve compression or fractures

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13
Q

How does renal failure cause bone disease?

A 
Reduced production of 1,25-vitamin D
Reduced resorption of calcium and reduced absorption of dietary calcium
Reduced phosphate excretion
Raised PTH due to hypocalcaemia
These act to increase bone reabsorption
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14
Q

What biochemical abnormalities are present in osteomalacia?

A 
Reduced calcium
Low phosphate
High Alk Phos
High PTH
Low vitamin D
\+/- anaemia
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15
Q

What are the radiological features of osteomalacia?

A

Coarsened trabelculae
Osteopenia
Pseudofractures of low density with sclerotic border

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16
Q

Give 3 risk factors for the development of osteomalacia

A 
Dark skin
>65
House bound or institutionalised
Pregnancy
Obesity
Routine covering of face and body
Poverty
Vegetarianism
Alcoholism
Family history
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17
Q

What is osteomalacia?

A

Inadequate mineralisation of bone matrix due to vitamin D deficiency

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18
Q

What are the main symptoms of osteomalacia?

A

Persistent fatigue
Bone pain and tenderness
Proximal myopathy
Costochondral swelling

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19
Q

How is osteomalacia managed?

A 
Dietary advice and increased sunlight exposure
Treat any underlying condition
Analgesia
Calciferol Vit D supplements 
Monitor calcium, vit d and PTH
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20
Q

What is the difference between the diaphysis, metaphysis and epiphysis?

A 
Diaphysis = shaft of long bone
Metaphysis = area of spongy bone adjacent to epiphysis
Epiphysis = place of secondary ossification and bone growth
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21
Q

Where does haemopoiesis take place in adults?

A

In interstitium of short bones and metaphyseal ends of some long bones

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22
Q

Name a bone which develops by intramembranous ossification?

A

Clavicle

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23
Q

Where is hyaline cartilage found?

A

Articular surfaces

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24
Q

Where is white fibro-cartilage found?

A

Midline structures eg intervertebral discs and symphyses

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25
Where is elastic firbo-cartilage found?
Nose and ear
26
What are the symptoms of compartment syndrome?
``` Pain out of proportion to the injury Pain on (passive) stretching Paraesthesia Feeling of tightness Pallor Numbeness Muscle weakness Paralysis ```
27
Give three causes of compartment syndrome
``` Fractures Reperfusion injury Crush injury Anabolic steroid use Constrictive dressings ```
28
How is compartment syndrome diagnosed?
Measure intracompartmental pressures using manometer. If >40mmHg is diagnostic. (>20mmHg is abnormal)
29
Which fractures most commonly cause compartment syndrome?
Supracondylar of humerus | Tibial shaft
30
How can compartment syndrome cause renal failure?
On fasciotomy there is a massive release of myoglobin, potentially causing myoglobinuria, which causes renal injury
31
Name 5 causes of carpal tunnel syndrome
``` Hypothyroidism Diabetes mellitus Idiopathic Acromegaly Neoplasia Trauma Rheumatoid or osteoarthritis Amyloidosis Pregnancy ```
32
What are the contents of the carpal tunnel?
Flexor pollicis longus Median nerve 4 tendons of flexor digitorum profundus 4 tendons of flexor digitorum superficialis
33
What special tests are positive in a hand examination of someone with carpal tunnel syndrome?
Tinel's test = lightly tapping on median nerve | Phalen's test = symptoms on flexing wrist for 60 seconds
34
How is carpal tunnel syndrome managed?
Lifestyle advice eg avoid repetitive movements Wrist splinting Local corticosteroid injection Surgery
35
What is neuropraxia?
Nerve injury from compression or blunt trauma where axons remain continuous
36
What is axonotmesis?
Nerve injury from trauma or stretching where axons are damaged but sheath is intact. Axons regenerate from centre out. Increased recovery time in longer nerves
37
What is neuronotmesis?
Complete division of a nerve with disinegration of the axon and myelin sheath. Sometimes recovers if two nerve endings are in apposition
38
After a nerve injury, how can its regeneration be tested?
Tinel's test of tapping along its length. If there is tingling/paraesthesia then it is regenerating
39
What has been injured in Erb's palsy?
Roots of C5 and C6
40
What are the features of an injury to the roots of C5 and C6?
Paralysis of supraspinatus, infraspinatus, subclavius, biceps brachii, biceps brachialis, coracobrachialis, deltoid and teres minor. Reduced shoulder abduction, lateral rotation, forearm supination and shoulder flexion
41
What are the features of an injury to the root of T1?
Paralysis of small muscles of the hand with hyperextension of MCP joints and flexion of IP joints with medial arm sensory loss
42
What is the difference in the features of an ulnar nerve palsy at the wrist and the elbow?
In both, the interossei and lateral two lumbricals are paralysed but in injuries at the elbow, flexor digitorum profundus is also paralysed. In wrist injuries, there's hyperextension of MCP and flexion at IP but at the elbow, IP joints aren't flexed as FDP is paralysed
43
How is an ulnar nerve palsy tested for?
Ask patient to grip a piece of paper between their fingers. If ulnar nerve is damaged, they won't be able to do this as interossei are paralysed
44
What nerve may be damaged in a medical epicondyle fracture?
Ulnar nerve
45
What is the prominent feature of a radial nerve palsy and why does it happen?
Wrist drop. Extensor muscles of forearm are paralysed so there is unopposed flexion
46
What nerve is affected if there is foot drop?
Common peroneal nerve
47
What are the spinal roots of the sciatic nerve?
L4-S3
48
Describe the route of the sciatic nerve?
Leaves lumbosacral plexus and travels through the greater sciatic foramen into the gluteal region From there travels to posterior thigh, deep to biceps femoris. From there, gives off branches to hamstring and adductor magnus and enters popliteal fossa, where it divides into the tibial and common fibular nerve
49
What are the motor innervations of the sciatic nerve?
Posterior compartment of the thight Muscles of the lower leg Hamstring portion of adductor magnus Muscles of the foot
50
What are the sensory innervations of the sciatic nerve?
Lateral lower leg and the foot
51
Give 3 possible causes of sciatica
``` Herniated intervertebral disc Sponylolisthesis SPinal stenosis Malignancy Infection ```
52
What are the symptoms of sciatica?
Lower back pain radiating to and increasing down one leg to below the knee Parasthesia, numbness and weakness
53
What signs may be found on examination of someone with sciatica?
Positive straight leg raise test | Reduced tenson reflex
54
What are the complications of sciatica?
``` Permanent nerve damage Psychosocial impact Anxiety Depression Time off work and reduced productivity ```
55
How is sciatica managed in primary care?
Stepwise analgesia, starting at paracetamol and going up to gapapentin etc if not controlled Lifestyle advice eg local heat and staying active Benzodiazepine if muscles spasms occur
56
When should someone with sciatica be referred?
If there are any red flag signs If there is progressive, persistent or severe neurological deficit Refer to physiotherapy if no improvement in pain of functional ability in 2 weeks Refer to specialist centre for assessment and imaging if no improvement in 6-8 weeks Refer to pain clinic if pain is severe and unresponsive
57
What factors predict a worse prognosis in sciatica?
Being female Severe pain and functional impairment from the outset Psychosocial risk factors eg unsupportive work, belief that pain and activity are harmful, depression and anxiety, pessimistic or unrealistic expectations
58
What is a salter-harris type 1 fracture?
Fracture occurs along epiphyseal growth plate only
59
What is a salter-harris type 2 fracture?
Fracture through the growth plate and passing obliquely to form a metaphyseal fragment
60
What is a salter-harris type 3 fracture?
Displaced fragment of epiphysis formed as fracture occurs through growth plate and epiphysis to include the joint surface
61
What is a salter-harris type 4 fracture?
Fracture through epiphysis and metaphysis to form a displaced fragment
62
What is a salter-harris type 5 fracture?
Crush fracture of the epiphyseal growth plate
63
Which salter-harris fracture types are most likely to result in long term damage?
Type 4 and 5
64
Give three physical signs of a fracture
``` Tenderness Deformity Swelling +/- skin blistering Local temperature increase Crepitus or abnormal mobility Loss of function ```
65
What antibiotic should be used for treating open fractures?
Co amoxiclav or meropenem or clindamycin | Gentamicin at definitive closure
66
Give 3 indications for fracture fixation
External splinting not adequate eg joint surface involved Pathological fracture or reduced life expectancy Early mobility important To avoid prolonged immobilisation Multiple trauma
67
Give three advantages of plaster or paris
``` Cheap Versatile Easy to mould Comfortable Strong Radio translucent ```
68
Give three disadvantages of plaster of paris
``` Reduced mobility May cause problems with pressure Heavy Difficult to inspect limb Not water proof ```
69
Give three advantages of internal fixation
``` Allows accurate reduction Increases joint moblity Encourages rehab May encourage union Reduces length of hospital stay ```
70
Give three disadvantages of internal fixation
May introduce infection May delay union Needs to be technically accurate and strong enough May need further surgery to remove device
71
Give three immediate complications of fractures
Haemorrhage Neurovascular injury Organ injury Skin loss or damage
72
Give 5 intermediate complications of fractures
``` VTE Fat embolism Crush syndrome COmpartment syndrome Gangrene Pressure sores Nerve palsy Infection Wound breakdown Loss of alignment Tetanus Chest infection Urinary disorder ```
73
How does a fat embolism present?
Usually 3-10 days after a fracture of a long bone. | Confusion, petechial rash and respiratory difficulty
74
What is 'crush syndrome'?
Acute tubular necrosis and renal failure after ischaemia of a large volume of soft tissue or extensive soft tissue damage
75
Give 5 late complications of fractures?
``` Psychological disturbance Infection Wound break down Delayed and non-union Failure of internal fixation Joint stiffness Contracture Regional pain syndrome Osteoarthritis ```
76
What is regional pain syndrome?
Pain, swelling, discolouration and circulatory changes | Patchy porosis on x ray
77
Give 3 factors that increase the risk of non-union
Infection Open fracture Fracture of bone with reduced blood supply Cortical bone fracture
78
What are the two types of fracture non-union?
``` Hypertrophic = non-union with excess callus formation. Usually due to excess mobility Atrophic = non-union with no obvious callus. Usually due to poor blood supply. ```
79
What is malunion of a fracture?
Ends are united but it an unsatisfactory position
80
What is an ASIA muscle grading 0?
Total paralysis
81
What is an ASIA muscle grading 1?
Palpable or visible contractions
82
What is an ASIA muscle grading 2?
Active movement with full ROM when gravity is eliminated
83
What is an ASIA muscle grading 3?
Active movement with full ROM against gravity but offering no resistance
84
What is an ASIA muscle grading 4?
Active movement with full ROM against gravity, offering some resistance
85
What is an ASIA muscle grading 5?
Active movement with full ROM against gravity, offering normal resistance
86
Give 7 red flag symptoms of back pain
``` Non-mechanical Mid thoracic Fevers/rigors Difficulty passing urine New faecal incontinence Bilateral sciatica History of malignancy New onset <16 years or >50 years Unexplained weight loss Long term steroid use Recent significant infection Saddle anaesthesia Reduced anal tone Widespread neurology Progressive neurology Urinary retention ```
87
Give 5 yellow flag symptoms of back pain
Pessimism or unrealistic expectations about outcome even with treatment and self management Catastrophisation Belief that there's a serious underlying cause Awaiting payment for injury at work or RTA Inappropriate communication of the diagnosis Depression Anxiety Over bearing family Unsupportive family Poor work life
88
How is developmental dysplasia of the hip diagnosed?
Usually at new born examination. Positive ortolani's and barlow's sign = restriction, clunking and palpation of femoral head on abduction
89
Give three risk factors for developmental dysplasia of the hip
Female Family history Tight swaddling Breech delivery
90
What is developmental dysplasia of the hip?
Ability of femoral head to slip out of acetabulum due to capsular laxity
91
How is developmental dysplasia of the hip managed?
Splint with hip in abduction eg pavlik harness | Later may require closed or open reduction
92
What is the typical presentation of a slipped upper femoral epiphysis?
Obese, hypogonadal adolescent boy with knee or distal thigh pain and loss of internal rotation on flexion
93
How is a slipped upper femoral epiphysis managed?
Surgical stabilisation | Counselling on likelihood of bilateral displacement so to return if symptoms occur on other side
94
What is perthes' disease?
A degenerative disease caused by avascular necrosis of the femoral head, more common in young boys
95
What are the symptoms of perthes' disease?
``` Progressive hip pain Limp Stiffness Reduced hip ROM Knee pain ```
96
What are the findings on x ray in perthes' disease?
At first, widening of the joint space and increased intensity of the epiphysis Gradual flattening of the femoral head and widening of the metaphysis Eventually healing and remodelling
97
How should perthes' disease be managed?
Conservatively with analgesia, avoidance of high impart activities, and physiotherapy Cast or brace or surgical osteotomy
98
How does transient synovitis of the hip present?
``` Acute pain in the hip Viral illness Stiffness of hip joint Systemically well Effusion on USS ```
99
What is osteogenesis imperfecta?
A disorders of metabolism of type 1 collagen resulting in reduced bone density so bony fragility and propensity to fractures
100
Give 3 features of the most common type of osteogenesis imperfecta?
``` Blue sclerae Fractures from minor trauma Deafness from osteosclerosis Autosomal dominant Dental imperfections ```
101
Give 3 complications of paget's disease?
``` Sarcoma Deafness Pathological fractures Osteoarthritis Paraplegia Visual disturbance ```
102
How is paget's disease treated?
Only if symptomatic/deformed | Bisphosphonates reduce bone pain
103
How is osteoarthritis characterised?
Mild synovitis Focal damage of articular cartilage Remodelling of underlying bone Osteophyte formation
104
When can a diagnosis of osteoarthritis be made without investigations?
If at least 45 and activity related pain and stiffness after rest and Any morning stiffness resolving within 30 mins
105
What are the x ray findings in osteoarthritis?
Loss of joint space Osteophyte formation Subchondral sclerosis Subchondral cyst formation
106
How is osteoarthritis managed conservatively?
``` Encourage exercise Weight loss Local heat or cold application Aids and devices for mobility Assess for impact on quality of life, mood etc and manage appropriately ```
107
How is osteoarthritis managed pharmacologically?
``` Paracetamol +/- topical NSAID If not sufficient pain relief then: Codeine Oral NSAID Topical capsaicin Intraarticular corticosteroid ```
108
What are the 3 surgical options to treat osteoarthritis?
Osteotomy Arthrodesis Arthroplasty
109
When would arthrodesis be used for osteoarthritis?
In small joints of hands and feet | Especially in younger people
110
What is a gustilo anderson type 1 open fracture?
Wound less than 1 cm
111
What is a gustilo anderson type 2 open fracture?
WOund 1 - 10 cm
112
What is a gustilo anderson type 3A open fracture?
Wound >10cm of high energy Farm wound COmminuted fracture Adequate tissue for coverage
113
What is a gustilo anderson type 3B open fracture?
Extensive periosteal stripping | Requires soft tissue transfer
114
What is a gustilo anderson type 3C open fracture?
Vascular injury requiring vascular repair
115
What are the features of tendinopathy?
Swelling Tenderness Loss of function
116
How are tendinopathies managed?
``` Rest Immobilisation Splinting Corticosteroid injection Surgery ```
117
What is tenosynovitis?
Inflammation of a tendon sheath
118
What are the features of tendinopathy?
Pain on movement Crepitus Tenderness
119
What is a ganglion?
A cystic swelling related to a joint or tendon sheath
120
What are the features of a ganglion?
``` Most common in dorsum of hand/wrist and around ankle. Can also be on palmar aspect of fingers. Insidious onset Localised aching Localised swelling Fluctuant swelling Transilluminable ```
121
What cancers commonly metastasise to bone?
``` Bronchus Breast Thyroid Kidney Prostate ```
122
What is osteosarcoma?
Malignancy of osteoblastic mesenchymal cells
123
What are the most common sites of osteosarcoma?
Femur Humerus Upper tibia
124
What radiological features indicate bony malignancy?
Periosteal reaction New bone formation Bone destruction Soft tissue swelling
125
What are the characteristic X ray features of osteosarcoma?
Translucent metaphyseal lesion | Rays of ossification in sunburst pattern
126
Where do bony malignancies commonly metastasise to?
Lung
127
How are osteosarcomas managed?
Neoadjuvant chemo Surgical resection Reconstruction/prostheses
128
What is a chondrosarcoma?
Malignancy of chondroblasts forming collagen
129
What are the common sites of chondrosarcoma?
Pelvis Trunk bones Hips Proximal long bones
130
What are the characteristic radiological features of chondrosarcoma?
Crisscrossing of calcification spicules
131
How are chondrosarcomas managed?
Surgical resection only
132
How are soft tissue sarcomas managed?
Surgical excision with wide margin | Adjuvant chemotherapy
133
What is Ewing's Sarcoma?
Malignancy arising from bone marrow
134
What are the characteristic radiological features of Ewing's sarcoma?
Periosteal reaction | Onion skin formation
135
What is the biopsy appearance of Ewing's sarcoma?
Necrotic, liquefied centre | Small round cells with areas of degeneration
136
How are Ewing's sarcomas managed?
Neoadjuvant chemo Surgical resection Adjuvant radiotherapy
137
What is myeloma?
Malignancy of plasma cells with bone marrow infiltration and bony destruction and marrow failure
138
What are the features of myeloma?
``` Bone pain Osteolytic bone lesions Renal impairment Immunodeficiency Hypercalcaemia Anaemia Raised ESR Raised paraproteins ```
139
What features of a soft tissue lump increase the likelihood of malignancy?
``` >5cm in size Deep to fascia Increasing in size Painful Recurrence after previous excision ```
140
What antibiotics are used for cellulitis?
If mild then oral flucloxacillin of doxycycline | If severe then IV flucloxacillin or vancomycin
141
What is a sequestrum?
In osteomyelitis, when a portion of dead bone is separated from healthy bone. Can become a foci of ongoing infection
142
What is an involucrum?
In osteomyelitis when viable perisoteum is separated from underlying bone, forming new bone around it
143
Give 5 risk factors for the development of osteomyelitis
``` Surgery or trauma Orthopaedic prosthesis Immunosuppression Diabetes Peripheral arterial disease Chronic joint disease Alcoholism IVDU HIV and AIDS TB Sickle cell Catheter related blood infection ```
144
What is the most common organism causing osteomyelitis?
Staph aureus
145
How might haematogenous acute osteomyelitis present?
An acutely febrile patient developing an acutely painful limb Swelling and extreme tenderness and pain increases with movement Sympathetic effusions of neighbouring joints
146
How might osteomyelitis of the vertebra present?
``` Insidious onset, after acute septicaemia Localised oedema and tenderness Fever Muscle spasm Pain on walking Back pain also worse at rest ```
147
What sign may indicate diabetic foot osteomyelitis?
Recalcitrant hyperglycaemia may be only sign
148
Give 5 features of chronic osteomyelitis
``` Previous acute infection Localised bone pain Swelling Erythema Non-healing ulcer Draining sinus Reduced ROM Chronic fatigue Malaise ```
149
What are the radiological features of chronic osteomyelitis?
Patchy osteopenia | Bone destruction
150
How is acute osteomyelitis managed?
Extensive debridement IV flucloxacillin or vancomycin for 4-6 weeks (oral after first fortnight) Analgesia Stabilsation of bone if necessary
151
How is chronic osteomyelitis managed?
``` Extensive debridement Removal of implant if applicable Antibiotics according to sensitivities for 3-6 months Analgesia Stabilisation of bone ```
152
Give 3 complications of osteomyelitis
``` Bone abscess Bacteraemia Fracture Frowth arrest Septic arthritis Loosening of prosthesis Overlying cellulitis Chronic infection ```
153
What is a monteggia fracture?
Fracture of ulnar shaft with proximal dislocation of radial head
154
How should monteggia and galeazzi fractures be managed?
Prompt alignment
155
What are the features of a colles fracture?
Distal transverse fracture of the radial shaft Distal fragment is dorsally displaced and dorsally angulated with dinner form deformity Shortening and radial deviation of the wrist May be avulsion of styloid process
156
How are colles' fractures managed?
Manipulation Under Anaesthetic and reduction if there's backwards tilt of radial articular surface Back slab Instruct patient on importance of mobilising joints
157
What is a smiths fracture?
Volar angulation of distal radius after transverse fracture of shaft
158
How should a smiths fracture be managed?
ORIF and plate
159
What is at risk of damage in a fracture of the humeral surgical neck?
Axillary nerve | Posterior circumflex artery
160
What is volkmann's ischaemic contracture?
Fibrosis of flexor muscles of the forearm due to interruption of brachial artery, causing a fixed flexion deformity
161
How is trigger finger managed?
Steroid injection Finger splinting Maybe surgery
162
Give 3 risk factors for the development of dupuytren's contracture
``` Family history Cirrhosis/alcoholic liver disease Manual labour Diabetes Phenytoin use Hand trauma ```
163
Which hand joints are primary affected in osteoarthritis?
DIP PIP Carpometacarpal
164
Which hand joints are primarily affected in rheumatoid arthritis?
MCP | PIP
165
Which hand joint are primary affected in psoriatic arthritis?
DIP
166
What are the features of tennis elbow?
= lateral epicondylitis Pain over lateral epicondyle Pain on gripping and increased on wrist extension and supination, against resistance
167
How should epicondylitis be managed?
Avoid muscle overload Analgesia Steroid injection Physio
168
What are the features of golfer's elbow?
Pain and tenderness over the medial epicondyle Pain on wrist flexion and pronation May be signs of ulnar nerve involvement
169
What structures may be damaged in shoulder dislocation?
Axillary nerve Axillary artery Brachial plexus
170
What is the characteristic physical sign of rotator cuff degeneration?
Sudden drop of limb at around 90 degrees of abduction | Inability to initiate abduction
171
What is the characteristic physical sign of rotator cuff tendinitis?
Painful arc syndrome
172
Which movement is particularly affected in adhesive capsulitis of the shoulder?
External rotation
173
How should adhesive capsulitis of the shoulder be managed?
Avoid aggravating movements whilst in painful phase Analgesia Physio if tolerable Consider steroid injection Refer on if no response to treatment in 6 months
174
What is the most likely infectious organism in a dog bite?
Pasteurella multocida
175
What antibiotics should be used in bite injuries?
Coamoxiclav or metronidazole + doxycycline if signs of infection or if injury within 72 hours
176
What investigations should be done for a bite injury?
X ray in case of embedded teeth or fracture | Deep wound swab for culture
177
In a bite injury, what tetanus vaccination is required if patient has completed course of vaccination?
Human tetanus immunoglobulin if high risk wound
178
In a bite injury, what tetanus vaccination is required if patient is up to date with vaccination but has not completed course?
Human tetanus immunoglobulin if high risk wound
179
In a bite injury, what tetanus vaccination is required if patient is not up to date or hasn't completed vaccination program?
Booster vaccine | Human tetanus immunoglobulin if high risk wound
180
In a bite injury, what tetanus vaccination is required if patient is not immunised or status is uncertain?
Immediate dose of vaccine | Human tetanus immunoglobulin if high risk wound
181
Where is pain from a hip injury usually felt?
Groin Anterolateral thigh Knee
182
What deformity may be found in osteoarthritis of the hip?
Fixed flexion | Fixed adduction
183
In general, what is a varus deformity?
When the end of a bone is deviating towards the midline, compared to the proximal part
184
In general, what is a valgus deformity?
When the distal bone of a joint is deviating away from the midline, relative to the proximal part
185
Give 3 causes of avascular necrosis of the femoral head
``` Excess alcohol Idiopathic Long term steroid use Working in pressurised environment eg deep sea Sickle cell disease Malignancy Fractured NOF ```
186
What are the features of avascular necrosis of the femoral head?
Joint effusion with pain and stiffness | Flattening of the femoral head
187
What deformity is seen in a posterior hip dislocation?
Limb is shortened and medially rotated
188
Which muscles are damaged in a superior gluteal nerve injury?
Gluteus medius | Gluteus minimis
189
Give three risk factors for hip fracture
``` Increasing age Osteoporosis Osteomalacia History of falls Lack of core strength Gait abnormalities Instability Sensory impairment ```
190
What deformity is found in hip fractures?
LImb in shorteded, adducted, and externally rotated
191
What surgery is used for intracapsular hip fractures?
If undisplaced then screw fixation | If displaced then usually arthroplasty
192
What surgery is used for extracapsular hip fractures?
Fixation. Dynamic hip screw if trochanteric
193
When is a full arthroplasty used in #NOF?
If person doesn't have any cognitive impairment, can mobilised with no more than a stick and are medically fit for surgery
194
Give 5 complications of surgery for hip fractures
``` Pneumonia DVT PE Infection Avascular necrosis Haemorrhage Problems with union MI Stroke Pressure ulcers ```
195
Give a risk factor for patellar dislocation
Genu valgum TIbial torison High riding patella Female
196
What is the common presentation of an ACL rupture?
History of twisting injury Loud crack or pop Pain Rapid swelling
197
When is an ACL rupture operated on?
Immediately if locked ie cannot extend If affecting quality of life If long term symptoms of giving way
198
What are the components of the unhappy triad?
ACL rupture Medial Collateral ligament rupture Lateral meniscal tear
199
What is the common presentation of a meniscal tear?
Twisting injury Pain and a feeling of tearing Swelling develops over hours Joint may lock
200
Give three risk factors for plantar fasciitis
``` Obesity Job involving sustained standing Ankle or achilles stiffness Pes cavus Pes plantus Heel injury Rheumatoid conditions Running ```
201
What are the features of charcot foot?
Hot, red, swollen, deformed foot that is unexplained | Occurs after minor trauma
202
Give 3 risk factors for foot ulceration in diabetes?
``` Increasing time since diagnosis Increasing age Previous ulceration Previous amputation Peripheral vascular disease Peripheral neuropathy Presence of callus Joint deformity Visual impairment Reduced mobility Male T2DM ```
203
How can a diabetic foot ulcer be distinguished as primary neuropathic or primary ischaemic?
If neuropathic, foot is generally warm with dry skin, bounding pulses, distended veins, reduced sensation and has a surrounding calluc If ischaemic, foot is generally cool and pale with atrophic skin and absent pulses. Frequently occur together so ischaemic foot may be pink/red

Surgery (4 decks)

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