Orthopaedics Flashcards
Give 5 risk factors for development of osteoporosis?
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
What is the DXA cut off for diagnosing osteoporosis?
T score of -2.5 or less
What are the indications for performing a DXA scan?
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
How is osteoporosis managed?
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
What are the main features of joint hypermobility syndrome?
Joint hypermobility with chronic pain related to exercise
What is the pathology involved in Paget’s bone disease?
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
Which bones are most affected by Paget’s disease?
Axial skeleton inc. pelvis
Long bones
Skull
Give three common complications of Paget’s disease?
Bone pain Bone deformity Pathological fractures Increased bleeding from fractures Osteoarthritis Deafness and tinnitus
Give three uncommon complications of Paget’s disease
Paraplegia Spinal stenosis Nerve compression Hypercalcaemia Hydrocephalus High output cardiac failure Osteosarcoma
What are the features of a bone profile blood test in Paget’s disease?
Normal calcium, phosphate and PTH
Increased Alkaline Phosphatase
What are the features of Paget’s disease on X ray?
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
How is Paget’s disease managed?
Analgesia
mobility aids
Bisphosphonates with vit D and calcium deficiency correction
Surgery if deformity, nerve compression or fractures
How does renal failure cause bone disease?
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
What biochemical abnormalities are present in osteomalacia?
Reduced calcium Low phosphate High Alk Phos High PTH Low vitamin D \+/- anaemia
What are the radiological features of osteomalacia?
Coarsened trabelculae
Osteopenia
Pseudofractures of low density with sclerotic border
Give 3 risk factors for the development of osteomalacia
Dark skin >65 House bound or institutionalised Pregnancy Obesity Routine covering of face and body Poverty Vegetarianism Alcoholism Family history
What is osteomalacia?
Inadequate mineralisation of bone matrix due to vitamin D deficiency
What are the main symptoms of osteomalacia?
Persistent fatigue
Bone pain and tenderness
Proximal myopathy
Costochondral swelling
How is osteomalacia managed?
Dietary advice and increased sunlight exposure Treat any underlying condition Analgesia Calciferol Vit D supplements Monitor calcium, vit d and PTH
What is the difference between the diaphysis, metaphysis and epiphysis?
Diaphysis = shaft of long bone Metaphysis = area of spongy bone adjacent to epiphysis Epiphysis = place of secondary ossification and bone growth
Where does haemopoiesis take place in adults?
In interstitium of short bones and metaphyseal ends of some long bones
Name a bone which develops by intramembranous ossification?
Clavicle
Where is hyaline cartilage found?
Articular surfaces
Where is white fibro-cartilage found?
Midline structures eg intervertebral discs and symphyses
Where is elastic firbo-cartilage found?
Nose and ear
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
Give three causes of compartment syndrome
Fractures Reperfusion injury Crush injury Anabolic steroid use Constrictive dressings
How is compartment syndrome diagnosed?
Measure intracompartmental pressures using manometer. If >40mmHg is diagnostic. (>20mmHg is abnormal)
Which fractures most commonly cause compartment syndrome?
Supracondylar of humerus
Tibial shaft
How can compartment syndrome cause renal failure?
On fasciotomy there is a massive release of myoglobin, potentially causing myoglobinuria, which causes renal injury
Name 5 causes of carpal tunnel syndrome
Hypothyroidism Diabetes mellitus Idiopathic Acromegaly Neoplasia Trauma Rheumatoid or osteoarthritis Amyloidosis Pregnancy
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
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
How is carpal tunnel syndrome managed?
Lifestyle advice eg avoid repetitive movements
Wrist splinting
Local corticosteroid injection
Surgery
What is neuropraxia?
Nerve injury from compression or blunt trauma where axons remain continuous
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
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
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
What has been injured in Erb’s palsy?
Roots of C5 and C6
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
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
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
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
What nerve may be damaged in a medical epicondyle fracture?
Ulnar nerve
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
What nerve is affected if there is foot drop?
Common peroneal nerve
What are the spinal roots of the sciatic nerve?
L4-S3
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
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
What are the sensory innervations of the sciatic nerve?
Lateral lower leg and the foot
Give 3 possible causes of sciatica
Herniated intervertebral disc Sponylolisthesis SPinal stenosis Malignancy Infection
What are the symptoms of sciatica?
Lower back pain radiating to and increasing down one leg to below the knee
Parasthesia, numbness and weakness
What signs may be found on examination of someone with sciatica?
Positive straight leg raise test
Reduced tenson reflex
What are the complications of sciatica?
Permanent nerve damage Psychosocial impact Anxiety Depression Time off work and reduced productivity
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
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
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
What is a salter-harris type 1 fracture?
Fracture occurs along epiphyseal growth plate only
What is a salter-harris type 2 fracture?
Fracture through the growth plate and passing obliquely to form a metaphyseal fragment
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
What is a salter-harris type 4 fracture?
Fracture through epiphysis and metaphysis to form a displaced fragment
What is a salter-harris type 5 fracture?
Crush fracture of the epiphyseal growth plate
Which salter-harris fracture types are most likely to result in long term damage?
Type 4 and 5
Give three physical signs of a fracture
Tenderness Deformity Swelling +/- skin blistering Local temperature increase Crepitus or abnormal mobility Loss of function
What antibiotic should be used for treating open fractures?
Co amoxiclav or meropenem or clindamycin
Gentamicin at definitive closure
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
Give three advantages of plaster or paris
Cheap Versatile Easy to mould Comfortable Strong Radio translucent
Give three disadvantages of plaster of paris
Reduced mobility May cause problems with pressure Heavy Difficult to inspect limb Not water proof
Give three advantages of internal fixation
Allows accurate reduction Increases joint moblity Encourages rehab May encourage union Reduces length of hospital stay
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
Give three immediate complications of fractures
Haemorrhage
Neurovascular injury
Organ injury
Skin loss or damage
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
How does a fat embolism present?
Usually 3-10 days after a fracture of a long bone.
Confusion, petechial rash and respiratory difficulty
What is ‘crush syndrome’?
Acute tubular necrosis and renal failure after ischaemia of a large volume of soft tissue or extensive soft tissue damage
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
What is regional pain syndrome?
Pain, swelling, discolouration and circulatory changes
Patchy porosis on x ray
Give 3 factors that increase the risk of non-union
Infection
Open fracture
Fracture of bone with reduced blood supply
Cortical bone fracture
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.
What is malunion of a fracture?
Ends are united but it an unsatisfactory position
What is an ASIA muscle grading 0?
Total paralysis
What is an ASIA muscle grading 1?
Palpable or visible contractions
What is an ASIA muscle grading 2?
Active movement with full ROM when gravity is eliminated
What is an ASIA muscle grading 3?
Active movement with full ROM against gravity but offering no resistance
What is an ASIA muscle grading 4?
Active movement with full ROM against gravity, offering some resistance
What is an ASIA muscle grading 5?
Active movement with full ROM against gravity, offering normal resistance
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
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
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
Give three risk factors for developmental dysplasia of the hip
Female
Family history
Tight swaddling
Breech delivery
What is developmental dysplasia of the hip?
Ability of femoral head to slip out of acetabulum due to capsular laxity
How is developmental dysplasia of the hip managed?
Splint with hip in abduction eg pavlik harness
Later may require closed or open reduction
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
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
What is perthes’ disease?
A degenerative disease caused by avascular necrosis of the femoral head, more common in young boys
What are the symptoms of perthes’ disease?
Progressive hip pain Limp Stiffness Reduced hip ROM Knee pain
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
How should perthes’ disease be managed?
Conservatively with analgesia, avoidance of high impart activities, and physiotherapy
Cast or brace or surgical osteotomy
How does transient synovitis of the hip present?
Acute pain in the hip Viral illness Stiffness of hip joint Systemically well Effusion on USS
What is osteogenesis imperfecta?
A disorders of metabolism of type 1 collagen resulting in reduced bone density so bony fragility and propensity to fractures
Give 3 features of the most common type of osteogenesis imperfecta?
Blue sclerae Fractures from minor trauma Deafness from osteosclerosis Autosomal dominant Dental imperfections
Give 3 complications of paget’s disease?
Sarcoma Deafness Pathological fractures Osteoarthritis Paraplegia Visual disturbance
How is paget’s disease treated?
Only if symptomatic/deformed
Bisphosphonates reduce bone pain
How is osteoarthritis characterised?
Mild synovitis
Focal damage of articular cartilage
Remodelling of underlying bone
Osteophyte formation
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
What are the x ray findings in osteoarthritis?
Loss of joint space
Osteophyte formation
Subchondral sclerosis
Subchondral cyst formation
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
How is osteoarthritis managed pharmacologically?
Paracetamol +/- topical NSAID If not sufficient pain relief then: Codeine Oral NSAID Topical capsaicin Intraarticular corticosteroid
What are the 3 surgical options to treat osteoarthritis?
Osteotomy
Arthrodesis
Arthroplasty
When would arthrodesis be used for osteoarthritis?
In small joints of hands and feet
Especially in younger people
What is a gustilo anderson type 1 open fracture?
Wound less than 1 cm
What is a gustilo anderson type 2 open fracture?
WOund 1 - 10 cm
What is a gustilo anderson type 3A open fracture?
Wound >10cm of high energy
Farm wound
COmminuted fracture
Adequate tissue for coverage
What is a gustilo anderson type 3B open fracture?
Extensive periosteal stripping
Requires soft tissue transfer
What is a gustilo anderson type 3C open fracture?
Vascular injury requiring vascular repair
What are the features of tendinopathy?
Swelling
Tenderness
Loss of function
How are tendinopathies managed?
Rest Immobilisation Splinting Corticosteroid injection Surgery
What is tenosynovitis?
Inflammation of a tendon sheath
What are the features of tendinopathy?
Pain on movement
Crepitus
Tenderness
What is a ganglion?
A cystic swelling related to a joint or tendon sheath
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
What cancers commonly metastasise to bone?
Bronchus Breast Thyroid Kidney Prostate
What is osteosarcoma?
Malignancy of osteoblastic mesenchymal cells
What are the most common sites of osteosarcoma?
Femur
Humerus
Upper tibia
What radiological features indicate bony malignancy?
Periosteal reaction
New bone formation
Bone destruction
Soft tissue swelling
What are the characteristic X ray features of osteosarcoma?
Translucent metaphyseal lesion
Rays of ossification in sunburst pattern
Where do bony malignancies commonly metastasise to?
Lung
How are osteosarcomas managed?
Neoadjuvant chemo
Surgical resection
Reconstruction/prostheses
What is a chondrosarcoma?
Malignancy of chondroblasts forming collagen
What are the common sites of chondrosarcoma?
Pelvis
Trunk bones
Hips
Proximal long bones
What are the characteristic radiological features of chondrosarcoma?
Crisscrossing of calcification spicules
How are chondrosarcomas managed?
Surgical resection only
How are soft tissue sarcomas managed?
Surgical excision with wide margin
Adjuvant chemotherapy
What is Ewing’s Sarcoma?
Malignancy arising from bone marrow
What are the characteristic radiological features of Ewing’s sarcoma?
Periosteal reaction
Onion skin formation
What is the biopsy appearance of Ewing’s sarcoma?
Necrotic, liquefied centre
Small round cells with areas of degeneration
How are Ewing’s sarcomas managed?
Neoadjuvant chemo
Surgical resection
Adjuvant radiotherapy
What is myeloma?
Malignancy of plasma cells with bone marrow infiltration and bony destruction and marrow failure
What are the features of myeloma?
Bone pain Osteolytic bone lesions Renal impairment Immunodeficiency Hypercalcaemia Anaemia Raised ESR Raised paraproteins
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
What antibiotics are used for cellulitis?
If mild then oral flucloxacillin of doxycycline
If severe then IV flucloxacillin or vancomycin
What is a sequestrum?
In osteomyelitis, when a portion of dead bone is separated from healthy bone. Can become a foci of ongoing infection
What is an involucrum?
In osteomyelitis when viable perisoteum is separated from underlying bone, forming new bone around it
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
What is the most common organism causing osteomyelitis?
Staph aureus
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
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
What sign may indicate diabetic foot osteomyelitis?
Recalcitrant hyperglycaemia may be only sign
Give 5 features of chronic osteomyelitis
Previous acute infection Localised bone pain Swelling Erythema Non-healing ulcer Draining sinus Reduced ROM Chronic fatigue Malaise
What are the radiological features of chronic osteomyelitis?
Patchy osteopenia
Bone destruction
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
How is chronic osteomyelitis managed?
Extensive debridement Removal of implant if applicable Antibiotics according to sensitivities for 3-6 months Analgesia Stabilisation of bone
Give 3 complications of osteomyelitis
Bone abscess Bacteraemia Fracture Frowth arrest Septic arthritis Loosening of prosthesis Overlying cellulitis Chronic infection
What is a monteggia fracture?
Fracture of ulnar shaft with proximal dislocation of radial head
How should monteggia and galeazzi fractures be managed?
Prompt alignment
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
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
What is a smiths fracture?
Volar angulation of distal radius after transverse fracture of shaft
How should a smiths fracture be managed?
ORIF and plate
What is at risk of damage in a fracture of the humeral surgical neck?
Axillary nerve
Posterior circumflex artery
What is volkmann’s ischaemic contracture?
Fibrosis of flexor muscles of the forearm due to interruption of brachial artery, causing a fixed flexion deformity
How is trigger finger managed?
Steroid injection
Finger splinting
Maybe surgery
Give 3 risk factors for the development of dupuytren’s contracture
Family history Cirrhosis/alcoholic liver disease Manual labour Diabetes Phenytoin use Hand trauma
Which hand joints are primary affected in osteoarthritis?
DIP
PIP
Carpometacarpal
Which hand joints are primarily affected in rheumatoid arthritis?
MCP
PIP
Which hand joint are primary affected in psoriatic arthritis?
DIP
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
How should epicondylitis be managed?
Avoid muscle overload
Analgesia
Steroid injection
Physio
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
What structures may be damaged in shoulder dislocation?
Axillary nerve
Axillary artery
Brachial plexus
What is the characteristic physical sign of rotator cuff degeneration?
Sudden drop of limb at around 90 degrees of abduction
Inability to initiate abduction
What is the characteristic physical sign of rotator cuff tendinitis?
Painful arc syndrome
Which movement is particularly affected in adhesive capsulitis of the shoulder?
External rotation
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
What is the most likely infectious organism in a dog bite?
Pasteurella multocida
What antibiotics should be used in bite injuries?
Coamoxiclav or metronidazole + doxycycline if signs of infection or if injury within 72 hours
What investigations should be done for a bite injury?
X ray in case of embedded teeth or fracture
Deep wound swab for culture
In a bite injury, what tetanus vaccination is required if patient has completed course of vaccination?
Human tetanus immunoglobulin if high risk wound
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
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
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
Where is pain from a hip injury usually felt?
Groin
Anterolateral thigh
Knee
What deformity may be found in osteoarthritis of the hip?
Fixed flexion
Fixed adduction
In general, what is a varus deformity?
When the end of a bone is deviating towards the midline, compared to the proximal part
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
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
What are the features of avascular necrosis of the femoral head?
Joint effusion with pain and stiffness
Flattening of the femoral head
What deformity is seen in a posterior hip dislocation?
Limb is shortened and medially rotated
Which muscles are damaged in a superior gluteal nerve injury?
Gluteus medius
Gluteus minimis
Give three risk factors for hip fracture
Increasing age Osteoporosis Osteomalacia History of falls Lack of core strength Gait abnormalities Instability Sensory impairment
What deformity is found in hip fractures?
LImb in shorteded, adducted, and externally rotated
What surgery is used for intracapsular hip fractures?
If undisplaced then screw fixation
If displaced then usually arthroplasty
What surgery is used for extracapsular hip fractures?
Fixation. Dynamic hip screw if trochanteric
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
Give 5 complications of surgery for hip fractures
Pneumonia DVT PE Infection Avascular necrosis Haemorrhage Problems with union MI Stroke Pressure ulcers
Give a risk factor for patellar dislocation
Genu valgum
TIbial torison
High riding patella
Female
What is the common presentation of an ACL rupture?
History of twisting injury
Loud crack or pop
Pain
Rapid swelling
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
What are the components of the unhappy triad?
ACL rupture
Medial Collateral ligament rupture
Lateral meniscal tear
What is the common presentation of a meniscal tear?
Twisting injury
Pain and a feeling of tearing
Swelling develops over hours
Joint may lock
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
What are the features of charcot foot?
Hot, red, swollen, deformed foot that is unexplained
Occurs after minor trauma
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
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
