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AC2 lectures > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

Classification for open fractures?

A

Gustilo

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2
Q

What can be damaged in a knee dislocation?

A

popliteal artery

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3
Q

how can a joint become septic? (2)

A

direct (traumatic)

indirect (haematogenous)

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4
Q

how does septic arthritis present?

A

Pain
Pseudoparalysis
Pyrexia

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5
Q

which joints most commonly get septic?

A

IV drug users: Sterno-claviculr

50% knee
20% hip
shoulder, elbow, ankle

basically where joint are within a joint capsule

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6
Q

DDx of septic arthritis?

A 
inflammatory arthritis
crystal arthropathy
reactive arthritis (transient synovitis) (4-8 yo boys, following URTI)
OA acute flare
trauma
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7
Q

what criteria indicates likelyhood of septic arthritis in kids

A

Kocher’s criteria (4 present, 99% probability)

  • pyrexia
  • inabiilty to weight bear
  • WCC up
  • ESR up
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8
Q

Ix for septic arthritis

A

bloods - FBC, ESR, CRP, cultures
plain film, USS
MRI, CT
joint aspirate is gold standard for MCS (delay Abx until this)

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9
Q

surgery for septic A?

A

washout/drainage

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10
Q

what is compartment syndrome?

A

increased pressure within a closed fascial compartment leading to impaired tissue perfusion

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11
Q

what percentage of tibial fractures are complicated by compartment syndrome?

A

1-9%

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12
Q

how to diagnose compartment syndrome?

A

clinical diagnosis - high index of suspicion

PAIN
- exacerbated on passive stretch of the muscles that traverse the affected compartment

with comatose patients, diagnosis confirmed by compartment pressure monitoring (>30mmHg or not within 30mmHg of diastolic pressure)

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13
Q

Mx of compartment sydnrome?

A

emergency fasciotomy of ALL compartments in the limb segment affected (full open release)

before:

  • relase all casts, slints, dressings
  • elevate limb
  • analgesia
  • prepare for theatre
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14
Q

complications of compartment syndrome
acute (7)
chronic (6)

A 
ACUTE
hyperkalaemia
hypocalcaemia
cardiac arrhythmias
rhabdomyolysis
renal failure
nerve death
death
CHRONIC
tissue loss
weakness
chronic pain
joint fusions
tendon transfers
amputation
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15
Q

what is the sail sign in elbow XR

A

haemarthrosis in elbow - anterior and posterior fat pad

due to intraarticular fracture, or spontaneous

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16
Q

what can be seen on horizontal beam lat XR, with tibial plateau fracture?

A

Lipohaemarthrosis - escape of fat and blood from the bone marrow into the joint

“FBI” sign - fat-blood interface

17
Q

what guidelines are used in the management of open fractures?

A

BOAST4

18
Q

four stages of (secondary) fracture healing in cortical bone?

A
  1. haematoma
  2. soft callus (cannot be seen on XR)
  3. hard callus (fibrocartilage ossifies and can now be seen on XR)
  4. remodelling
19
Q

intramembranous ossification?

endochondral ossifcation?

A
  1. e.g. clavicle, or after cancellous bone fractures (e.g. scaphoid)
  2. eg. femur
20
Q

Sx of “fracture disease”

A
  • joint stiffness
  • periarticular osteopenia
  • loss of function
21
Q

how do you achieve absolute stability and therefore primary bone healing?

A
  • anatomical (perfect) reduction
  • internal fixation

then no callus is formed and bone healed directly.

22
Q

how do you achieve relative stability and therefore secondary bone healing (ie with callus)?

A

casts
IM nails (internal splint)
external fixation (shanz screws, clamps)
plates

(all reduce fracture, but allow some movement)

23
Q

what do you want to do for a long bone and metaphyseal fracture?

A

maintain length, alignment and rotation

allow relative stability, as that is best for blood supply, over absolute stability.

24
Q

what do you want to do for articular fractures?

A

anatomical reduction and absolute stability

25
Q

Mx of forearm fractures?

A

anatomical reduction and absolute stability

26
Q
  • what is mortality rate on admission of patients with hip fracture?
  • with a year?
A

10%

50%

27
Q

Mx of extracapsular?

Mx of intracapsular?

A

Extracapsular:

  • intertrochanteric: Dynamic hip screw (exc reverse oblique)
  • subtrochanteric: Intramedullary nail/gamma nail

Intracapsular:
- displaced
- young: fix (with screws)
- old: hemiarthroplasty. ie acetabulum is native,
causes wear and tear and leaves reduced function
- old and good function: Total hip replacement
- undisplaced: fix

28
Q

Pros and cons of fixation?

A

Pros:

  • quick
  • noninvasive
  • preserves own hip

Cons:

  • AVN 25%
  • non-union 15%
29
Q

what is a contraindication for DHS even though its extracapsular intertraochanteric?

A

reverse oblique fracture

AC2 lectures (10 decks)

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