Orthopaedics Flashcards
Fracture management: Methods of restriction
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
What is Shenton’s Line?
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
Describe Garden’s classification
Classification of intracapsular NOF fracture
1: Incomplete and undisplaced
2: Complete and displaced
3: Complete and partially displaced
4: Complete and completely displaced
Management of Gardens Classification 1-2 NOF fracture
ORIF with cancellous screws
Management of Gardens Classification 3-4 NOF fracture
<55 years: ORIF
55-75: Total hip replacement
>75: Hemiarthroplasty
Features of Colles Fracture
FOOSH Radial fracture Dinner fork deformity Dorsal displacement of distal fragment \+/- ulnar styloid avulsion \+/- impaction Risk of injury to radial artery and median nerve.
Features of Smith’s fracture
Fall onto back of outstretched wrist
Radial fracture
Volar displacement of distal fragment
Reimage … days after suspected scaphoid fracture
10 days
Features of Monteggia fracture
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
Features of Galleazi fracture
Fracture radial shaft between mid and distal 3rds
Dislocation of distal radius at radio-ulnar joint
Most stable position for forearm fracture
Proximal: supination
Mid shaft: neutral
Distal: pronation
Describe Salter-Harris classification
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
What is a Bankart lesion
Damage to anteroinferior glenoid labrum
What is Lesagues sign?
Pain on straight leg raise
Due to disc prolapse
Describe the carpal tunnel anatomy
Formed by flexor retinaculum and carpal bones Contains: 4 tendons of FDS 4 tendons of FDP 1 tendon of FPL Median nerve
Causes of carpal tunnel syndrome
Primary (idiopathic) Secondary: WRIST Water: pregnancy, hypothyroidism Radial fracture Inflammation: RA, gout Soft tissue swelling (lipoma, amyloidosis, acromegaly) Toxic: DM, Alcohol
Conditions associated with Dupuytrens contracture
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
What is a Baker’s cyst
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
Features of De Quervains tenosynovitis
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
What structure is inflamed in De Quervain’s tenosynovitis
The sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed
