Orthopaedics

Question 1

Fracture management: Methods of restriction

Answer 1

Non-rigid
Plaster of Paris (beware compartment syndrome)
Functional bracing (joint free to move but bone shafts supported in cast segments)
Continuous traction
External fixation
Internal fixation

Question 2

What is Shenton’s Line?

Answer 2

Shenton line is an imaginary line drawn along the inferior border of the superior pubic ramus (superior border of the obturator foramen) and along the inferomedial border of the neck of femur. This line should be continuous and smooth.

Interruption of the Shenton line can indicate (in the correct clinical scenario):
Developmental dysplasia of the hip (DDH)
Fractured neck of femur

Question 3

Describe Garden’s classification

Answer 3

Classification of intracapsular NOF fracture

1: Incomplete and undisplaced
2: Complete and displaced
3: Complete and partially displaced
4: Complete and completely displaced

Question 4

Management of Gardens Classification 1-2 NOF fracture

Answer 4

ORIF with cancellous screws

Question 5

Management of Gardens Classification 3-4 NOF fracture

Answer 5

<55 years: ORIF
55-75: Total hip replacement
>75: Hemiarthroplasty

Question 6

Features of Colles Fracture

Answer 6

FOOSH 
Radial fracture 
Dinner fork deformity 
Dorsal displacement of distal fragment 
\+/- ulnar styloid avulsion 
\+/- impaction 
Risk of injury to radial artery and median nerve.

Question 7

Features of Smith’s fracture

Answer 7

Fall onto back of outstretched wrist
Radial fracture
Volar displacement of distal fragment

Question 8

Reimage … days after suspected scaphoid fracture

Answer 8

10 days

Question 9

Features of Monteggia fracture

Answer 9

Fracture proximal 3rd of ulna fracture
Anterior dislocation of radial head at capitellum
May cause palsy of deep branch of radial nerve, no sensory loss. Weak thumb

Question 10

Features of Galleazi fracture

Answer 10

Fracture radial shaft between mid and distal 3rds

Dislocation of distal radius at radio-ulnar joint

Question 11

Most stable position for forearm fracture

Answer 11

Proximal: supination
Mid shaft: neutral
Distal: pronation

Question 12

Describe Salter-Harris classification

Answer 12

SALT Crush

1: Straight across
2: Above: so physis and metaphysis
3: Lower: physis and epiphysis
4: Through: all 3
5: Crush injury (uncommon)

Crush injury: growth arrest
Type 4: may interfere with bone growth
1-3: normal growth

Question 13

What is a Bankart lesion

Answer 13

Damage to anteroinferior glenoid labrum

Question 14

What is Lesagues sign?

Answer 14

Pain on straight leg raise

Due to disc prolapse

Question 15

Describe the carpal tunnel anatomy

Answer 15

Formed by flexor retinaculum and carpal bones
Contains: 
4 tendons of FDS 
4 tendons of FDP 
1 tendon of FPL 
Median nerve

Question 16

Causes of carpal tunnel syndrome

Answer 16

Primary (idiopathic) 
Secondary: WRIST
Water: pregnancy, hypothyroidism
Radial fracture
Inflammation: RA, gout 
Soft tissue swelling (lipoma, amyloidosis, acromegaly)
Toxic: DM, Alcohol

Question 17

Conditions associated with Dupuytrens contracture

Answer 17

Mnemonic: BAD FIBRES

Bent penis (Peyronies) 
AIDS
DM
Family Hx: autosomal dominant 
Idiopathic (commonest) 
Booze (ALD)
Reidel's thyroiditis and other fibromatoses (Ledderhose disease) 
Epilepsy and epilepsy meds e.g. phenytoin
Smoking

Question 18

What is a Baker’s cyst

Answer 18

Also known as a popliteal cyst
Benign swelling of the semimembranosus or more rarely some other synovial bursa found behind the knee joint
Can rupture leading to calf swelling
DVT is an important differential

Question 19

Features of De Quervains tenosynovitis

Answer 19

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

Question 20

What structure is inflamed in De Quervain’s tenosynovitis

Answer 20

The sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed