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Surgery > Orthopaedics > Flashcards

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
Q

Where is elastic firbo-cartilage found?

A

Nose and ear

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26
Q

What are the symptoms of compartment syndrome?

A 
Pain out of proportion to the injury
Pain on (passive) stretching
Paraesthesia
Feeling of tightness
Pallor
Numbeness
Muscle weakness
Paralysis
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27
Q

Give three causes of compartment syndrome

A 
Fractures
Reperfusion injury
Crush injury
Anabolic steroid use
Constrictive dressings
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28
Q

How is compartment syndrome diagnosed?

A

Measure intracompartmental pressures using manometer. If >40mmHg is diagnostic. (>20mmHg is abnormal)

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29
Q

Which fractures most commonly cause compartment syndrome?

A

Supracondylar of humerus

Tibial shaft

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30
Q

How can compartment syndrome cause renal failure?

A

On fasciotomy there is a massive release of myoglobin, potentially causing myoglobinuria, which causes renal injury

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31
Q

Name 5 causes of carpal tunnel syndrome

A 
Hypothyroidism
Diabetes mellitus
Idiopathic
Acromegaly
Neoplasia
Trauma
Rheumatoid or osteoarthritis
Amyloidosis
Pregnancy
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32
Q

What are the contents of the carpal tunnel?

A

Flexor pollicis longus
Median nerve
4 tendons of flexor digitorum profundus
4 tendons of flexor digitorum superficialis

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33
Q

What special tests are positive in a hand examination of someone with carpal tunnel syndrome?

A

Tinel’s test = lightly tapping on median nerve

Phalen’s test = symptoms on flexing wrist for 60 seconds

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34
Q

How is carpal tunnel syndrome managed?

A

Lifestyle advice eg avoid repetitive movements
Wrist splinting
Local corticosteroid injection
Surgery

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35
Q

What is neuropraxia?

A

Nerve injury from compression or blunt trauma where axons remain continuous

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36
Q

What is axonotmesis?

A

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

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37
Q

What is neuronotmesis?

A

Complete division of a nerve with disinegration of the axon and myelin sheath. Sometimes recovers if two nerve endings are in apposition

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38
Q

After a nerve injury, how can its regeneration be tested?

A

Tinel’s test of tapping along its length. If there is tingling/paraesthesia then it is regenerating

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39
Q

What has been injured in Erb’s palsy?

A

Roots of C5 and C6

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40
Q

What are the features of an injury to the roots of C5 and C6?

A

Paralysis of supraspinatus, infraspinatus, subclavius, biceps brachii, biceps brachialis, coracobrachialis, deltoid and teres minor.
Reduced shoulder abduction, lateral rotation, forearm supination and shoulder flexion

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41
Q

What are the features of an injury to the root of T1?

A

Paralysis of small muscles of the hand with hyperextension of MCP joints and flexion of IP joints with medial arm sensory loss

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42
Q

What is the difference in the features of an ulnar nerve palsy at the wrist and the elbow?

A

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

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43
Q

How is an ulnar nerve palsy tested for?

A

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

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44
Q

What nerve may be damaged in a medical epicondyle fracture?

A

Ulnar nerve

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45
Q

What is the prominent feature of a radial nerve palsy and why does it happen?

A

Wrist drop. Extensor muscles of forearm are paralysed so there is unopposed flexion

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46
Q

What nerve is affected if there is foot drop?

A

Common peroneal nerve

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47
Q

What are the spinal roots of the sciatic nerve?

A

L4-S3

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48
Q

Describe the route of the sciatic nerve?

A

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

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49
Q

What are the motor innervations of the sciatic nerve?

A

Posterior compartment of the thight
Muscles of the lower leg
Hamstring portion of adductor magnus
Muscles of the foot

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50
Q

What are the sensory innervations of the sciatic nerve?

A

Lateral lower leg and the foot

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51
Q

Give 3 possible causes of sciatica

A 
Herniated intervertebral disc
Sponylolisthesis
SPinal stenosis
Malignancy
Infection
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52
Q

What are the symptoms of sciatica?

A

Lower back pain radiating to and increasing down one leg to below the knee
Parasthesia, numbness and weakness

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53
Q

What signs may be found on examination of someone with sciatica?

A

Positive straight leg raise test

Reduced tenson reflex

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54
Q

What are the complications of sciatica?

A 
Permanent nerve damage
Psychosocial impact
Anxiety
Depression
Time off work and reduced productivity
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55
Q

How is sciatica managed in primary care?

A

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

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56
Q

When should someone with sciatica be referred?

A

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

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57
Q

What factors predict a worse prognosis in sciatica?

A

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

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58
Q

What is a salter-harris type 1 fracture?

A

Fracture occurs along epiphyseal growth plate only

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59
Q

What is a salter-harris type 2 fracture?

A

Fracture through the growth plate and passing obliquely to form a metaphyseal fragment

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60
Q

What is a salter-harris type 3 fracture?

A

Displaced fragment of epiphysis formed as fracture occurs through growth plate and epiphysis to include the joint surface

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61
Q

What is a salter-harris type 4 fracture?

A

Fracture through epiphysis and metaphysis to form a displaced fragment

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62
Q

What is a salter-harris type 5 fracture?

A

Crush fracture of the epiphyseal growth plate

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63
Q

Which salter-harris fracture types are most likely to result in long term damage?

A

Type 4 and 5

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64
Q

Give three physical signs of a fracture

A 
Tenderness
Deformity
Swelling +/- skin blistering
Local temperature increase
Crepitus or abnormal mobility
Loss of function
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65
Q

What antibiotic should be used for treating open fractures?

A

Co amoxiclav or meropenem or clindamycin

Gentamicin at definitive closure

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66
Q

Give 3 indications for fracture fixation

A

External splinting not adequate eg joint surface involved
Pathological fracture or reduced life expectancy
Early mobility important
To avoid prolonged immobilisation
Multiple trauma

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67
Q

Give three advantages of plaster or paris

A 
Cheap
Versatile
Easy to mould
Comfortable
Strong
Radio translucent
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68
Q

Give three disadvantages of plaster of paris

A 
Reduced mobility
May cause problems with pressure
Heavy
Difficult to inspect limb
Not water proof
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69
Q

Give three advantages of internal fixation

A 
Allows accurate reduction
Increases joint moblity
Encourages rehab
May encourage union
Reduces length of hospital stay
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70
Q

Give three disadvantages of internal fixation

A

May introduce infection
May delay union
Needs to be technically accurate and strong enough
May need further surgery to remove device

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71
Q

Give three immediate complications of fractures

A

Haemorrhage
Neurovascular injury
Organ injury
Skin loss or damage

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72
Q

Give 5 intermediate complications of fractures

A 
VTE
Fat embolism
Crush syndrome
COmpartment syndrome
Gangrene
Pressure sores
Nerve palsy
Infection
Wound breakdown
Loss of alignment
Tetanus
Chest infection
Urinary disorder
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73
Q

How does a fat embolism present?

A

Usually 3-10 days after a fracture of a long bone.

Confusion, petechial rash and respiratory difficulty

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74
Q

What is ‘crush syndrome’?

A

Acute tubular necrosis and renal failure after ischaemia of a large volume of soft tissue or extensive soft tissue damage

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75
Q

Give 5 late complications of fractures?

A 
Psychological disturbance
Infection
Wound break down
Delayed and non-union
Failure of internal fixation
Joint stiffness
Contracture
Regional pain syndrome
Osteoarthritis
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76
Q

What is regional pain syndrome?

A

Pain, swelling, discolouration and circulatory changes

Patchy porosis on x ray

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77
Q

Give 3 factors that increase the risk of non-union

A

Infection
Open fracture
Fracture of bone with reduced blood supply
Cortical bone fracture

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78
Q

What are the two types of fracture non-union?

A 
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.
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79
Q

What is malunion of a fracture?

A

Ends are united but it an unsatisfactory position

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80
Q

What is an ASIA muscle grading 0?

A

Total paralysis

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81
Q

What is an ASIA muscle grading 1?

A

Palpable or visible contractions

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82
Q

What is an ASIA muscle grading 2?

A

Active movement with full ROM when gravity is eliminated

83
Q

What is an ASIA muscle grading 3?

A

Active movement with full ROM against gravity but offering no resistance

84
Q

What is an ASIA muscle grading 4?

A

Active movement with full ROM against gravity, offering some resistance

85
Q

What is an ASIA muscle grading 5?

A

Active movement with full ROM against gravity, offering normal resistance

86
Q

Give 7 red flag symptoms of back pain

A 
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
Q

Give 5 yellow flag symptoms of back pain

A

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
Q

How is developmental dysplasia of the hip diagnosed?

A

Usually at new born examination. Positive ortolani’s and barlow’s sign = restriction, clunking and palpation of femoral head on abduction

89
Q

Give three risk factors for developmental dysplasia of the hip

A

Female
Family history
Tight swaddling
Breech delivery

90
Q

What is developmental dysplasia of the hip?

A

Ability of femoral head to slip out of acetabulum due to capsular laxity

91
Q

How is developmental dysplasia of the hip managed?

A

Splint with hip in abduction eg pavlik harness

Later may require closed or open reduction

92
Q

What is the typical presentation of a slipped upper femoral epiphysis?

A

Obese, hypogonadal adolescent boy with knee or distal thigh pain and loss of internal rotation on flexion

93
Q

How is a slipped upper femoral epiphysis managed?

A

Surgical stabilisation

Counselling on likelihood of bilateral displacement so to return if symptoms occur on other side

94
Q

What is perthes’ disease?

A

A degenerative disease caused by avascular necrosis of the femoral head, more common in young boys

95
Q

What are the symptoms of perthes’ disease?

A 
Progressive hip pain
Limp
Stiffness
Reduced hip ROM
Knee pain
96
Q

What are the findings on x ray in perthes’ disease?

A

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
Q

How should perthes’ disease be managed?

A

Conservatively with analgesia, avoidance of high impart activities, and physiotherapy
Cast or brace or surgical osteotomy

98
Q

How does transient synovitis of the hip present?

A 
Acute pain in the hip
Viral illness
Stiffness of hip joint
Systemically well 
Effusion on USS
99
Q

What is osteogenesis imperfecta?

A

A disorders of metabolism of type 1 collagen resulting in reduced bone density so bony fragility and propensity to fractures

100
Q

Give 3 features of the most common type of osteogenesis imperfecta?

A 
Blue sclerae
Fractures from minor trauma
Deafness from osteosclerosis
Autosomal dominant
Dental imperfections
101
Q

Give 3 complications of paget’s disease?

A 
Sarcoma
Deafness
Pathological fractures
Osteoarthritis
Paraplegia
Visual disturbance
102
Q

How is paget’s disease treated?

A

Only if symptomatic/deformed

Bisphosphonates reduce bone pain

103
Q

How is osteoarthritis characterised?

A

Mild synovitis
Focal damage of articular cartilage
Remodelling of underlying bone
Osteophyte formation

104
Q

When can a diagnosis of osteoarthritis be made without investigations?

A

If at least 45 and
activity related pain and
stiffness after rest and
Any morning stiffness resolving within 30 mins

105
Q

What are the x ray findings in osteoarthritis?

A

Loss of joint space
Osteophyte formation
Subchondral sclerosis
Subchondral cyst formation

106
Q

How is osteoarthritis managed conservatively?

A 
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
Q

How is osteoarthritis managed pharmacologically?

A 
Paracetamol +/- topical NSAID
If not sufficient pain relief then:
Codeine
Oral NSAID
Topical capsaicin
Intraarticular corticosteroid
108
Q

What are the 3 surgical options to treat osteoarthritis?

A

Osteotomy
Arthrodesis
Arthroplasty

109
Q

When would arthrodesis be used for osteoarthritis?

A

In small joints of hands and feet

Especially in younger people

110
Q

What is a gustilo anderson type 1 open fracture?

A

Wound less than 1 cm

111
Q

What is a gustilo anderson type 2 open fracture?

A

WOund 1 - 10 cm

112
Q

What is a gustilo anderson type 3A open fracture?

A

Wound >10cm of high energy
Farm wound
COmminuted fracture
Adequate tissue for coverage

113
Q

What is a gustilo anderson type 3B open fracture?

A

Extensive periosteal stripping

Requires soft tissue transfer

114
Q

What is a gustilo anderson type 3C open fracture?

A

Vascular injury requiring vascular repair

115
Q

What are the features of tendinopathy?

A

Swelling
Tenderness
Loss of function

116
Q

How are tendinopathies managed?

A 
Rest
Immobilisation
Splinting
Corticosteroid injection
Surgery
117
Q

What is tenosynovitis?

A

Inflammation of a tendon sheath

118
Q

What are the features of tendinopathy?

A

Pain on movement
Crepitus
Tenderness

119
Q

What is a ganglion?

A

A cystic swelling related to a joint or tendon sheath

120
Q

What are the features of a ganglion?

A 
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
Q

What cancers commonly metastasise to bone?

A 
Bronchus
Breast
Thyroid
Kidney
Prostate
122
Q

What is osteosarcoma?

A

Malignancy of osteoblastic mesenchymal cells

123
Q

What are the most common sites of osteosarcoma?

A

Femur
Humerus
Upper tibia

124
Q

What radiological features indicate bony malignancy?

A

Periosteal reaction
New bone formation
Bone destruction
Soft tissue swelling

125
Q

What are the characteristic X ray features of osteosarcoma?

A

Translucent metaphyseal lesion

Rays of ossification in sunburst pattern

126
Q

Where do bony malignancies commonly metastasise to?

A

Lung

127
Q

How are osteosarcomas managed?

A

Neoadjuvant chemo
Surgical resection
Reconstruction/prostheses

128
Q

What is a chondrosarcoma?

A

Malignancy of chondroblasts forming collagen

129
Q

What are the common sites of chondrosarcoma?

A

Pelvis
Trunk bones
Hips
Proximal long bones

130
Q

What are the characteristic radiological features of chondrosarcoma?

A

Crisscrossing of calcification spicules

131
Q

How are chondrosarcomas managed?

A

Surgical resection only

132
Q

How are soft tissue sarcomas managed?

A

Surgical excision with wide margin

Adjuvant chemotherapy

133
Q

What is Ewing’s Sarcoma?

A

Malignancy arising from bone marrow

134
Q

What are the characteristic radiological features of Ewing’s sarcoma?

A

Periosteal reaction

Onion skin formation

135
Q

What is the biopsy appearance of Ewing’s sarcoma?

A

Necrotic, liquefied centre

Small round cells with areas of degeneration

136
Q

How are Ewing’s sarcomas managed?

A

Neoadjuvant chemo
Surgical resection
Adjuvant radiotherapy

137
Q

What is myeloma?

A

Malignancy of plasma cells with bone marrow infiltration and bony destruction and marrow failure

138
Q

What are the features of myeloma?

A 
Bone pain
Osteolytic bone lesions
Renal impairment
Immunodeficiency
Hypercalcaemia
Anaemia
Raised ESR
Raised paraproteins
139
Q

What features of a soft tissue lump increase the likelihood of malignancy?

A 
>5cm in size
Deep to fascia
Increasing in size
Painful
Recurrence after previous excision
140
Q

What antibiotics are used for cellulitis?

A

If mild then oral flucloxacillin of doxycycline

If severe then IV flucloxacillin or vancomycin

141
Q

What is a sequestrum?

A

In osteomyelitis, when a portion of dead bone is separated from healthy bone. Can become a foci of ongoing infection

142
Q

What is an involucrum?

A

In osteomyelitis when viable perisoteum is separated from underlying bone, forming new bone around it

143
Q

Give 5 risk factors for the development of osteomyelitis

A 
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
Q

What is the most common organism causing osteomyelitis?

A

Staph aureus

145
Q

How might haematogenous acute osteomyelitis present?

A

An acutely febrile patient developing an acutely painful limb
Swelling and extreme tenderness and pain increases with movement
Sympathetic effusions of neighbouring joints

146
Q

How might osteomyelitis of the vertebra present?

A 
Insidious onset, after acute septicaemia
Localised oedema and tenderness
Fever
Muscle spasm
Pain on walking
Back pain also worse at rest
147
Q

What sign may indicate diabetic foot osteomyelitis?

A

Recalcitrant hyperglycaemia may be only sign

148
Q

Give 5 features of chronic osteomyelitis

A 
Previous acute infection
Localised bone pain
Swelling
Erythema
Non-healing ulcer
Draining sinus
Reduced ROM
Chronic fatigue
Malaise
149
Q

What are the radiological features of chronic osteomyelitis?

A

Patchy osteopenia

Bone destruction

150
Q

How is acute osteomyelitis managed?

A

Extensive debridement
IV flucloxacillin or vancomycin for 4-6 weeks (oral after first fortnight)
Analgesia
Stabilsation of bone if necessary

151
Q

How is chronic osteomyelitis managed?

A 
Extensive debridement
Removal of implant if applicable
Antibiotics according to sensitivities for 3-6 months
Analgesia
Stabilisation of bone
152
Q

Give 3 complications of osteomyelitis

A 
Bone abscess
Bacteraemia
Fracture
Frowth arrest
Septic arthritis
Loosening of prosthesis
Overlying cellulitis
Chronic infection
153
Q

What is a monteggia fracture?

A

Fracture of ulnar shaft with proximal dislocation of radial head

154
Q

How should monteggia and galeazzi fractures be managed?

A

Prompt alignment

155
Q

What are the features of a colles fracture?

A

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
Q

How are colles’ fractures managed?

A

Manipulation Under Anaesthetic and reduction if there’s backwards tilt of radial articular surface
Back slab
Instruct patient on importance of mobilising joints

157
Q

What is a smiths fracture?

A

Volar angulation of distal radius after transverse fracture of shaft

158
Q

How should a smiths fracture be managed?

A

ORIF and plate

159
Q

What is at risk of damage in a fracture of the humeral surgical neck?

A

Axillary nerve

Posterior circumflex artery

160
Q

What is volkmann’s ischaemic contracture?

A

Fibrosis of flexor muscles of the forearm due to interruption of brachial artery, causing a fixed flexion deformity

161
Q

How is trigger finger managed?

A

Steroid injection
Finger splinting
Maybe surgery

162
Q

Give 3 risk factors for the development of dupuytren’s contracture

A 
Family history
Cirrhosis/alcoholic liver disease
Manual labour
Diabetes
Phenytoin use
Hand trauma
163
Q

Which hand joints are primary affected in osteoarthritis?

A

DIP
PIP
Carpometacarpal

164
Q

Which hand joints are primarily affected in rheumatoid arthritis?

A

MCP

PIP

165
Q

Which hand joint are primary affected in psoriatic arthritis?

A

DIP

166
Q

What are the features of tennis elbow?

A

= lateral epicondylitis
Pain over lateral epicondyle
Pain on gripping and increased on wrist extension and supination, against resistance

167
Q

How should epicondylitis be managed?

A

Avoid muscle overload
Analgesia
Steroid injection
Physio

168
Q

What are the features of golfer’s elbow?

A

Pain and tenderness over the medial epicondyle
Pain on wrist flexion and pronation
May be signs of ulnar nerve involvement

169
Q

What structures may be damaged in shoulder dislocation?

A

Axillary nerve
Axillary artery
Brachial plexus

170
Q

What is the characteristic physical sign of rotator cuff degeneration?

A

Sudden drop of limb at around 90 degrees of abduction

Inability to initiate abduction

171
Q

What is the characteristic physical sign of rotator cuff tendinitis?

A

Painful arc syndrome

172
Q

Which movement is particularly affected in adhesive capsulitis of the shoulder?

A

External rotation

173
Q

How should adhesive capsulitis of the shoulder be managed?

A

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
Q

What is the most likely infectious organism in a dog bite?

A

Pasteurella multocida

175
Q

What antibiotics should be used in bite injuries?

A

Coamoxiclav or metronidazole + doxycycline if signs of infection or if injury within 72 hours

176
Q

What investigations should be done for a bite injury?

A

X ray in case of embedded teeth or fracture

Deep wound swab for culture

177
Q

In a bite injury, what tetanus vaccination is required if patient has completed course of vaccination?

A

Human tetanus immunoglobulin if high risk wound

178
Q

In a bite injury, what tetanus vaccination is required if patient is up to date with vaccination but has not completed course?

A

Human tetanus immunoglobulin if high risk wound

179
Q

In a bite injury, what tetanus vaccination is required if patient is not up to date or hasn’t completed vaccination program?

A

Booster vaccine

Human tetanus immunoglobulin if high risk wound

180
Q

In a bite injury, what tetanus vaccination is required if patient is not immunised or status is uncertain?

A

Immediate dose of vaccine

Human tetanus immunoglobulin if high risk wound

181
Q

Where is pain from a hip injury usually felt?

A

Groin
Anterolateral thigh
Knee

182
Q

What deformity may be found in osteoarthritis of the hip?

A

Fixed flexion

Fixed adduction

183
Q

In general, what is a varus deformity?

A

When the end of a bone is deviating towards the midline, compared to the proximal part

184
Q

In general, what is a valgus deformity?

A

When the distal bone of a joint is deviating away from the midline, relative to the proximal part

185
Q

Give 3 causes of avascular necrosis of the femoral head

A 
Excess alcohol
Idiopathic
Long term steroid use
Working in pressurised environment eg deep sea
Sickle cell disease
Malignancy
Fractured NOF
186
Q

What are the features of avascular necrosis of the femoral head?

A

Joint effusion with pain and stiffness

Flattening of the femoral head

187
Q

What deformity is seen in a posterior hip dislocation?

A

Limb is shortened and medially rotated

188
Q

Which muscles are damaged in a superior gluteal nerve injury?

A

Gluteus medius

Gluteus minimis

189
Q

Give three risk factors for hip fracture

A 
Increasing age
Osteoporosis
Osteomalacia
History of falls
Lack of core strength
Gait abnormalities
Instability
Sensory impairment
190
Q

What deformity is found in hip fractures?

A

LImb in shorteded, adducted, and externally rotated

191
Q

What surgery is used for intracapsular hip fractures?

A

If undisplaced then screw fixation

If displaced then usually arthroplasty

192
Q

What surgery is used for extracapsular hip fractures?

A

Fixation. Dynamic hip screw if trochanteric

193
Q

When is a full arthroplasty used in #NOF?

A

If person doesn’t have any cognitive impairment, can mobilised with no more than a stick and are medically fit for surgery

194
Q

Give 5 complications of surgery for hip fractures

A 
Pneumonia
DVT
PE
Infection
Avascular necrosis
Haemorrhage
Problems with union
MI
Stroke
Pressure ulcers
195
Q

Give a risk factor for patellar dislocation

A

Genu valgum
TIbial torison
High riding patella
Female

196
Q

What is the common presentation of an ACL rupture?

A

History of twisting injury
Loud crack or pop
Pain
Rapid swelling

197
Q

When is an ACL rupture operated on?

A

Immediately if locked ie cannot extend
If affecting quality of life
If long term symptoms of giving way

198
Q

What are the components of the unhappy triad?

A

ACL rupture
Medial Collateral ligament rupture
Lateral meniscal tear

199
Q

What is the common presentation of a meniscal tear?

A

Twisting injury
Pain and a feeling of tearing
Swelling develops over hours
Joint may lock

200
Q

Give three risk factors for plantar fasciitis

A 
Obesity
Job involving sustained standing
Ankle or achilles stiffness
Pes cavus
Pes plantus
Heel injury
Rheumatoid conditions
Running
201
Q

What are the features of charcot foot?

A

Hot, red, swollen, deformed foot that is unexplained

Occurs after minor trauma

202
Q

Give 3 risk factors for foot ulceration in diabetes?

A 
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
Q

How can a diabetic foot ulcer be distinguished as primary neuropathic or primary ischaemic?

A

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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