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Surgery Finals > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

How do you manage an open fracture?

A

6 A’s:

  • Analgesia
  • Assess: NV status, soft tissues, photograph
  • Antisepsis: wound swab, copious irrigation, cover with betadine soaked dressing
  • Alignment (and splint)
  • Anti-tetanus: check status (booster lasts 10 years)
  • Antibiotics
    • Fluclox 500mg IV/IM + benpen 600mg IV/IM
    • Or augmentin 1.2g IV
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2
Q

How do you classify open fractures?

A

Gustillo:

  1. Wound <1cm in length
  2. Wound ≥1cm with minimal soft tissue damage
  3. Extensive soft tissue damage
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3
Q

Which organism causes gas gangrene?

A

Clostridium perfringens

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4
Q

How do you manage gas gangrene?

A

Debride, ben pen, clindamycin

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5
Q

What are the indications for open reduction of fractures?

A
  • Intra articular fractures
  • Open fractures
  • 2 fractures in one limb
  • Failed conservative treatment
  • Bilateral identical fractures
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6
Q

What are the complications of fractures?

A
  • Immediate
    • Neurovascular damage
    • Visceral damage
  • Early
    • Compartment syndrome
    • Infection (worse if associated with metalwork)
    • Fat embolism -> ARDS
  • Late
    • Problems with union
    • AVN
    • Growth disturbance
    • Post traumatic osteoarthritis
    • Complex regional pain syndromes
    • Myositis ossificans
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7
Q

How do you classify neurological complications of fractures?

A

Seddon classification:

  • Neuropraxia = temporary interruption of conduction without loss of axonal continuity
  • Axonotmesis = disruption of nerve axon with distal Wallerian degeneration
    • Connective tissue framework of nerve preserved
    • Regeneration occurs and recovery is possible
  • Neurotmesis = disruption of entire nerve fibre
    • Surgery usually required and recovery not usually complete
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8
Q

What are the causative factors of problems with union?

A

5 I’s:

  • Ischaemia: poor blood supply or AVN
  • Infection
  • Increased interfragmentary strain
  • Interposition of tissue between fragments
  • Intercurrent disease: e.g. malignancy or malnutrition
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9
Q

What is Pellegrini-Stieda disease?

A

Form of myositis ossificans where there is calcification of the superior attachment of MCL at the knee following traumatic injury

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10
Q

How do you classify intracapsular #NOFs?

A

Garden Classification:

  1. Incomplete #, undisplaced
  2. Complete #, undisplaced
  3. Complete #, partially displaced
  4. Complete #, completely displaced
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11
Q

How do you manage an intracapsular #NOF?

A
  • Garden 1, 2: ORIF with cancellous screws
  • Garden 3, 4:
    • <55: ORIF with screws, follow up in OPD and arthroplasty if AVN develops (30%)
    • 55-75: total hip replacement
    • >75: hemiarthroplasty
      • Mobilises: cemented Thompsons
      • Non mobiliser: uncemented Austin Moore
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12
Q

What is a Colles’ fracture?

A

Extra articular fracture of the distal radius with dorsal displacement and angulation of the distal fragment

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13
Q

What are the complications of a Colles’ fracture?

A
  • Median nerve injury
  • Frozen shoulder/adhesive capsulitis
  • Tendon rupture especially EPL
  • Carpal tunnel syndrome
  • Mal-/non-union
  • Sudek’s atrophy/CRPS
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14
Q

What is a Smith’s fracture?

A

Fracture of the distal radius with volar displacement and angulation of the distal fragment (fall onto back of flexed wrist)

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15
Q

What is a Barton’s fracture?

A

Oblique intra-articular fracture involving the dorsal aspect of distal radius and dislocation of the radio-carpal joint

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16
Q

What is a Monteggia fracture?

A

proximal 3rd of ulna shaft with anterior dislocation of radial head at the capitellum

17
Q

What is a Galeazzi fracture?

A

radial shaft between the mid and distal 3rds with dislocation of the distal radio-ulnar joint

18
Q

How do you classify extension supracondylar fractures of the humerus?

A

Gartland:

  1. Nondisplaced
  2. Angulated with intact posterior cortex
  3. Displaced with no cortical contact
19
Q

What are the Ottawa Ankle rules?

A

X ray ankle if pain is in the malleolar zone + if any of:

  • Tenderness along distal 6cm of posterior tib/fib including posterior tip of the malleoli
  • Inability to bear weight both immediately and in ED
20
Q

What is the Weber classification?

A

Ankle fractures: relation of fibula # to joint line:

  • A: below joint line
  • B: at joint line
  • C: above joint line
  • Weber’s B and C represent possible injury ot the syndesmotic ligaments between tib and fib -> instability
21
Q

Causes of avascular necrosis

A
  • # or dislocation
  • SCD, thalassaemia
  • SLE
  • Gaucher’s
  • Drugs: steroids, NSAIDs
22
Q

What are buckle fractures?

A

incomplete fractures of the shaft of a long bone that is characterised by bulging of the cortex. They typically occur in children aged 5-10 years.

23
Q

Features of chondromalacia patellae

A
  • Softening of the cartilage of the patella
  • Common in teenage girls
  • Characteristically anterior knee pain on walking up and down stairs and rising from prolonged sitting
  • Usually responds to physiotherapy
24
Q

Features of common peroneal nerve lesion

A

The most characteristic feature of a common peroneal nerve lesion is foot drop

Other features include:

  • weakness of foot dorsiflexion
  • weakness of foot eversion
  • weakness of extensor hallucis longus
  • sensory loss over the dorsum of the foot and the lower lateral part of the leg
  • wasting of the anterior tibial and peroneal muscles
25
Q

Which nerve is saturday night palsy

A

Radial

26
Q

Features of De Quervain’s tenosynovitis

A
  • pain on the radial side of the wrist
  • tenderness over the radial styloid process
  • abduction of the thumb against resistance is painful
  • Finkelstein’s test: with the thumb is flexed across the palm of the hand, pain is reproduced by movement of the wrist into flexion and ulnar deviation
27
Q

Features of trochanteric bursitis

A

Due to repeated movement of the fibroelastic iliotibial band
Pain and tenderness over the lateral side of thigh
Most common in women aged 50-70 years

28
Q

What are the features of osteochondritis dissecans

A

Pain after exercise
Intermittent swelling and locking

29
Q

Features of L3 nerve root compression

A

Sensory loss over anterior thigh
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test

30
Q

Features of L4 nerve root compression

A

Sensory loss anterior aspect of knee
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test

31
Q

Features of L5 nerve root compression

A

Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test

32
Q

Features of S1 nerve root compression

A

Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test

33
Q

Features of cubital tunnel syndrome?

A

initially intermittent tingling in the 4th and 5th finger

may be worse when the elbow is resting on a firm surface or flexed for extended periods

later numbness in the 4th and 5th finger with associated weakness

Ulnar nerve compression

34
Q

Features of frozen shoulder

A

external rotation is affected more than internal rotation or abduction

both active and passive movement are affected

patients typically have a painful freezing phase, an adhesive phase and a recovery phase

bilateral in up to 20% of patients

the episode typically lasts between 6 months and 2 years

35
Q

Features of meralgia paraesthetica

A

Caused by compression of lateral cutaneous nerve of thigh
Typically burning sensation over antero-lateral aspect of thigh

36
Q

features of referred lumbar spine pain

A

Femoral nerve compression may cause referred pain in the hip
Femoral nerve stretch test may be positive - lie the patient prone. Extend the hip joint with a straight leg then bend the knee. This stretches the femoral nerve and will cause pain if it is trapped

37
Q

Features of morton’s neuroma

A

forefoot pain, most commonly in the third inter-metatarsophalangeal space

worse on walking. May be described as a shooting or burning pain. Patients may feel they have a pebble in their shoe

Mulder’s click: one hand tries to hold the neuroma between the finger and thumb. The other hand squeezes the metatarsals together. A click may be heard as the neuroma moves between the metatarsal heads

there may be loss of sensation distally in the toes

38
Q

How do you interpret a DEXA?

A

<-1 is normal

  1. 0-2.5 is osteopaenia
  2. 5 and up is osteoporosis
39
Q
A

Surgery Finals (12 decks)

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