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Final Year Defintions > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

Pathological fracture

A

fracture due to cancer.

There will be tumours evident within the bone which weaken it and cause the fracture, tumours can be primary or more commonly due to mets

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2
Q

Fragility fracture

A

fracture due to osteoporosis.

DEXA scan will show diffuse demineralisation

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3
Q

Burst fracture (definition, mechanism, consequence)

A

Type of compression fracture.

Caused by high-energy axial loading spinal trauma.

Results in disruption of the posterior vertebral body cortex with retropulsion into the spinal canal

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4
Q

TSF (Taylor Spatial Frame) - what is it, how does it work, what is it used for?

A

orthopaedic device (circular frame with various rods into the bone) used to externally fix severe fractures where the bones need realignment.

It is used when the wound is not appropriate for internal fixation.

It is continually adjusted to realign the bones and then eventually removed and the bone is internally fixed.

A very specialised procedure and an alternative to amputation

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5
Q

Most common cause of death following NOF surgery

A

pneumonia, heart failure

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6
Q

Back slab

A

A half cast - put on when there is risk of swelling

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7
Q

Peg fracture

A

Odontoid process fracture (aka peg or dens fracture) - fracture through the odontoid process of C2.

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8
Q

Is an intra trochanteric fracture intra or extra capsular? How do you repair it?

A

Extra capsular therefore can do a dynamic hip screw (DHS) because there is no compromise to head of femur blood supply

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9
Q

What is the Gardeners classification of NOF # ?

A

1 - incomplete fracture of NOF.
2 - complete fracture of NOF, no displacement. Clinical determination for DHS or THR
3 - complete fracture of NOF WITH PARTIAL displacement. Risk of necrosis. Total Hip Replacement
4 - complete fracture of NOF WITH COMPLETE displacement. Risk of necrosis. Total Hip Replacement

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10
Q

What are the 4 signs of OA on radiograph? (HINT: think LOSS)

A

Loss of joint space
Osteophytes
Subchondral scleorsis
Subchondral cysts

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11
Q

Fracture

A

A fracture is loss of continuity of the cortex of the bone +/- soft tissue injury

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12
Q

List the clinical signs of a fracture

A 
Pain
Swelling
Crepitus
Deformity
\+/- adjacent structural injury
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13
Q

Outline the 3 stages of fracture healing

A

1) Reactive phase (first 48 hours) - bleeding into fracture site and inflammation forming granulation teaching

2) Reparative phase (first 2 weeks) -
- proliferation of osteoblasts and fibroblasts resulting in callus formation
- consolidation of the women bone forming lamellar bone

3) Remodelling phase (from 1 week) - remodelling of lamellar bone to cope with mechanical forces

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14
Q

What is the average healing time for an uncomplicated fracture?

A

3 weeks

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15
Q

What constitutes an uncomplicated fracture?

A

Closed, paediatric, metaphyseal, upper limb

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16
Q

What constitutes a complicated fracture?

A

Adult, lower limb, diaphyseal, open

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17
Q

What i the average healing time for a complicated fracture?

A

> 6 weeks

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18
Q

Stress fracture

A

Fracture due to bone fatigue due to repetitive strain

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19
Q

List the “6 As” of open fracture management

A 
Analgesia
Asses 
Antisepsis - swab, irrigation, cover
Alignment 
Anti-tetanus 
Antibiotics
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20
Q

What is the most severe complication of an open fracture?

A

Infection with clostridium perfringes which can cause wound infection, gas gangrene, shock, renal failure and death

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21
Q

List the general complications of fractures

A

Tissue damage - haemorrhage, shock, infection, rhabdomyolysis, fat emboli

Anaesthesia - anaphylaxis, aspiration

Prolonged bed rest - pneumonia, UTI, pressure sores, muscle wasting, DVT, PE

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22
Q

List the specific complications of fractures (HINT: split into immediate, early and late)

A

Immediate - neurovascular damage, visceral damage

Early - compartment syndrome, infection, fat embolism, ARDS

Late - problems with union, AVN, growth disturbance (children), post-traumatic osteoarthritis, regional pain syndromes

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23
Q

Name a neurovascular complication following a humeral shaft fracture (name the nerve and the pathology)

A

Radial nerve –> waiters tip

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24
Q

Name a neurovascular complication following an elbow dislocation (name the nerve and the pathology)

A

Ulnar nerve –> claw hand

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25
Q

Name a neurovascular complication following an hip dislocation (name the nerve and the pathology)

A

Sciatic nerve –> foot drop

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26
Q

Define compartment syndrome

A

when the pressure in one of the muscle compartments increases to the amount that it obstructs blood flow

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27
Q

What pressures are (a) suggestive and (b) diagnostic of compartment syndrome?

A

(a) 20 mmHg

(b) 40 mmHg OR within 30 mmHg of BP

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28
Q

Name the three classifications of problems with fracture union

A

Delayed union
Non-union
Malunion

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29
Q

List the causative factors of problems with fracture union (HINT: think “5 Is”)

A 
Infection
Ischaemia
Increased interfragmentary strain
Interposition of tissue between fragments
intercurrent disease (eg: malignancy)
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30
Q

Define malunion of a fracture

A

Fracture has healed in an imperfect position resulting in poor appearance and/or function

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31
Q

Define AVN following a fracture

A

Death of bone due to deficient blood supply

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32
Q

Which three sites are most at risk from AVN following a fracture?

A

Femoral head
Scaphoid
Talus

33
Q

What are the signs of AVN on XR?

A

Sclerosis

Deformity

34
Q

What are the two main causes of a #NOF?

A

Osteoporosis with minor trauma

Major trauma

35
Q

List the risk factors of osteoporosis (HINT: think A SHATTERED)

A 
Age
Steroids
Hyperthyroid / hyperparathyroid
Alcohol and cigarettes
Thin (BMI < 22)
Testosterone low 
Early menopause
Renal failure / liver failure
Erosive bone disease (eg: RA) 
DM / dietary (low calcium, low vitamin D)
36
Q

What will you see on examination in a #NOF?

A

Affected leg is shortened and externally rotated

37
Q

With regards to shoulder examination - which findings are positive in adhesive capsulitis (frozen shoulder)?

A

Decreased external rotation (<30 degrees on both passive and active movement)

38
Q

With regards to shoulder examination - which findings are positive in impingement syndrome?

A

Positive Hawkin’s test

39
Q

With regards to shoulder examination - which findings are positive in rotator cuff injuries?

A

Positive Jobes test
Painful / limited external rotation
Painful / limited internal rotation

40
Q

Name the muscles that make up the rotator cuff - list their function

A

Supraspinatus - abduction

Infraspinatus - external rotation -

Teres minor - external rotation

Subscapularis - internal rotation

41
Q

Explain how you would test each rotator cuff muscle

A

Supraspinatus - ABduction against resistance (passive abduction tests deltoid)

Infraspinatus - external rotation against resistance whilst isolating joint at elbow

Teres minor - external rotation - as above

Subscapularis - internal rotation: hand behind back and get patient to push against hand

42
Q

Which direction does the arm move with horiztonal ABduction of the shoulder?

A

AWAY from midline

43
Q

Which direction does the arm move with horizontal ADduction of the shoulder?

A

TOWARDS midline

44
Q

Which fractures are most likely to cause compartment syndrome?

A 
Tibial fractures
Supracondylar fractures (elbow)
45
Q

What are the Ottowa Rules for ankle XR

A

XR the angle if there is pain in malleolar zone PLUS
(a) tenderness along posterior tib/fib
OR
(b) unable to weight bear

46
Q

List some conditions associated with Dupuytren’s contracture (HINT: think BAD FIBRES)

A

Bent penis (peryronies disease)
AIDS
Diabetes

Family history 
Idiopathic 
Booze (alcoholic liver disease)
Reidel's thyroiditis
Epilepsy 
Smoking
47
Q

Define osteoarthritis

A

Degenerative joint disorder in which there is progressive loss of hyaline cartilage and new bone formation at the joint surface

48
Q

What is Lesague’s sign?

A

Back pain on straight leg raise - sign of disc prolapse

49
Q

Define: spondylolistehsis

A

Displacement of one lumbar vertebra on another

50
Q

Describe the presentation of acute cord compression

A

bilateral back and radicular pain
LMN signs are compression level
UMN signs below compression
Sphincter disturbance

51
Q

Describe the presentation of acute cauda equina

A

Alternating radicular pain (legs)
Saddle anaesthesia
Loss of anal tone
Incontinence

52
Q

List some causes of AVN

A

Fracture
Dislocation
Perthes disease and other developmental joint pathologies
Systemic disease - sickle cell, DM, pancreatitis, Gaucher’s, HIV/AIDS
Drugs - steroids

53
Q

What is the difference between osteomyelitis and septic arthritis?

A

Osteomyelitis = infection of the bone

Septic arthritis = infection of the joint

54
Q

List XR changes with osteomyelitis

A

Decreased bone density
Sub-periosteal reaction
Sequestrum

55
Q

Which organisms are most commonly responsible for osteomyelitis?

A

S aureus

Streptococcus

56
Q

Which organisms are most commonly responsible for septic arthritis?

A

S aureus

Gonococcus

57
Q

Which primary tumours most commonly metastasise to bone?

A 
Thyroid 
Lung
Breast
Kidney 
Prostate
58
Q

How are bony mets usually treated?

A

Radiotherapy

59
Q

Name three primary malignant bone tumours

A

Chondrosarcoma - tumour of the cartilage
Osteosarcoma - tumour of the bone (metaphysis)
Ewing’s sarcoma - tumour of the bone (diaphysis)

60
Q

What age group do the following bone tumours present in most commonly?

(a) Chondrosarcoma
(b) Osteosarcoma
(c) Ewing’s sarcoma

A

(a) Adults > 40
(b) Adolescents
(c) Children

61
Q

What forms the carpal tunnel?

A

Flexor retinaculum and carpal bones

62
Q

What does the carpal tunnel contain

A

all the flexor tendons and the median nerve

63
Q

What does the median nerve supply? (HINT: think LOAF)

A

Lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis

Essentially - lumbricals + thenar muscles

64
Q

Which muscles supplied by the median nerve make up the thenar eminance? (HINT: think OAF)

A

Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis

65
Q

List some of the causes of carpal tunnel syndrome

A

Primary - idiopathic

Secondary - pregnnacy, hypothyroidism, acromegaly, inflammatory joint disease (gout, RA), soft tissue swelling (eg: lipoma), diabetes, EtOH

66
Q

Outline the pathology of carpal tunnel syndrome

A

Compression of the median nerve due to reduced space within the carpal tunnel

67
Q

Explain a POSITIVE trendelenberg’s test

A

If there is abductor weakness, pelvis will drop to the contralateral side on leg raise

Eg: L abductor weakness causes R drop - this is felt in the examiners L hand (so if you feel drop in your left hand, the patient has a L sided weakness)

68
Q

What causes an apparent leg length discrepancy?

A

Spinal or hip pathology

69
Q

What causes a true leg length discrepancy?

A

Difference in length of long bones

70
Q

What is Thomas’ test looking for?

A

Fixed flexion deformity

71
Q

What is the most common cause of a fixed flexion deformity?

A

Osteoarthritis

72
Q

List the complications of hip arthroplasty (HINT: split into immediate, early and late)

A

Immediate - nerve injury, fracture, cement reaction, haemorrhage

Early - DVT, infection, dislocation

Late - loosening, infection, leg length discrepancy, revision

73
Q

List the complications of knee arthroplasty (HINT: split into immediate, early and late)

A

Immediate - fracture, cement reaction, vascular injury, haemorrhage, nerve injury

Early - DVT, deep infection

Late - loosening, peri-prosthetic fractures, decreased ROM, instability (ACL is sacrificed during surgery)

74
Q

List some differentials for knee locking

A

Meniscal tear
Cruciate ligament injury
Loose body

75
Q

Outline the presentation of an ACL tear

A

Associated with declaration or rotational movement
Inability to continue with activity / sport
Hearing a pop / feeling a tearing sensation
Haemarthrosis within 6 hours
Instability / sensation of giving way

76
Q

List the most common cause of the following gait abnormalities:

(a) antalgic
(b) trendenlenberg
(c) parkinsonian
(d) broad based
(e) high stepping
(f) spastic

A

(a) antalgic = pain
(b) trendenlenberg = weak abductors
(c) parkinsonian = PD
(d) broad based = cerebellar
(e) high stepping = common peroneal nerve injury
(f) spastic = UMN, eg: stroke

77
Q

List some differentials for popliteal swelling

A 
Popliteal aneurysm
Bakers cyst 
Enlarged bursae
Skin pathology (eg: lipoma) 
Neruoma
78
Q

What is a Baker’s cyst?

A

Posterior herniation of knee joint capsule

Final Year Defintions (13 decks)

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