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Specialities > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

How are paediatric fractures involving the growth plate classified?

A

Salter-Harris System
I: Fracture through the physis only (x-ray often normal)
II: Fracture through the physis and metaphysis
III: Fracture through the physis and epiphyisis to include the joint
IV: Fracture involving the physis, metaphysis and epiphysis
V: Crush injury involving the physis (x-ray may resemble TI and appear normal)

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2
Q

In paediatric fractures, what is a complete fracture?

A

Both sides of the cortex are breached

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3
Q

In paediatric fractures, what is a toddlers fracture?

A

Oblique tibial fracture in infants

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4
Q

In paediatric fractures, what is a plastic deformity?

A

Stress on bone resulting in deformity without cortical disruption

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5
Q

In paediatric fractures, what is a greenstick fracture?

A

Unilateral cortical breach only

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6
Q

In paediatric fractures, what is a buckle fracture?

A

Incomplete cortical disruption resulting in periosteal haemotoma only

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7
Q

What types of salter-harris fractures will usually require surgery?
Which are often associated with disruption to growth?

A

Surgery: Types III, IV and V

Disruption to growth: Type V

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8
Q

What nerve root is the triceps reflex?

A

Radial C7

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9
Q

What palsy results in wrist drop?

A

Radial (C5-8)

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10
Q

What is meralgia paraesthetica?

A

Burning sensation over antero-lateral aspect of thigh due to compression of the lateral cutaneous nerve of thigh

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11
Q

What features of leg pain might make you suspect a prolapsed lumbar disk?

A

Clear dermatomal pain and neurological deficits
Leg pain worse than back
Pain often worse when sitting

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12
Q

What features would you expect in L3 nerve compression?

A

Sensory loss over anterior thigh
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test (Mackiewicz sign) - patient lies prone, the knee is passively flexed to the thigh and the hip is passively extended ; the test is positive if the patient experiences anterior thigh pain.

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13
Q

What features would you expect in L4 nerve compression?

A

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

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14
Q

What features would you expect in L5 nerve compression?

A

Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test (straight leg raise until pain in buttocks/thigh/calf, dorsiflex foot at this point of discomfort - test is positive if additional pain results)

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15
Q

What features would you expect in S1 nerve 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

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16
Q

What is the most common causative organism in osteomyelitis?

What is the patient has sickle-cell anaemia?

A

Staph aureus

If sickle, then salmonella more common

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17
Q

What conditions predispose to osteomyelitis?

A
  • DM
  • Sickle cell
  • IVDU
  • Immunosuppression
  • XS EtOH
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18
Q

What is the Ix of osteomyelitis?

A

MRI (90-100% sensitivity)

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19
Q

What is the Mx of osteomyelitis?

A

Flucloxacillin for 6 weeks

Clindamycin if penicillin allergic

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20
Q

What is Parsonage-Turner syndrome?

A

A rare peripheral neuropathy typically involving the shoulder/arm.
Rapid onset of severe pain in the shoulder and arm, followed by wasting and weakness.
May complicate viral illness and usually resolves spontaneously.

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21
Q

What is calcific tendonitis?

A

Calcium crystals (apatite crystals) deposit in tendons, causing sudden attacks of painful inflammation.

  • Painful swelling around the joint (most commonly shoulder)
  • Bulging tendons due to crystal deposits
  • Redness and tenderness around the joint.
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22
Q

What is impingement syndrome? What causes it?

A

Narrowing of the subacromial space (between anterior edge of the acromion and humeral head). Impinges the supraspinatus tendon -> inflammation.
Anything narrowing gap can cause:
- Subacromial spurs (bony projections from the acromion)
- Osteoarthritic spurs on the acromioclavicular joint
- Thickening or calcification of the coracoacromial ligament
- LOF of the rotator cuff muscles (injury or wasting) may cause the humerus to move superiorly, resulting in impingement.
- Inflammation and subsequent thickening of the subacromial bursa

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23
Q

What is Leriche syndrome?
What is the classic triad of symptoms?
What is the Ix?

A

Atherosclerotic disease of AA +/- iliac, compromising blood flow to the pelvic viscera.

  • Claudication of the buttocks and thighs
  • Atrophy of the leg muscles
  • Impotence (L1 paralysis)

Ix: Angiography (+ angioplasty/stenting as Mx)

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24
Q

What is a Colles’ fracture?

A

Commonly after FOOSH

  • Transverse fracture of the radius
  • 1 inch proximal to the radio-carpal joint
  • Dorsal displacement and angulation
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25
Q

What is a Smith’s fracture?

A

= Reverse Colles’ fracture, caused by direct blow to the dorsal forearm or falling onto flexed wrists.

Volar angulation of distal radius fragment

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26
Q

What is a Bennett’s fracture?

A

Intra-articular fracture of the 1st carpometacarpal joint (thumb)

Impact on flexed metacarpal, typically after fist fight

Triangular fragment at ulcer base of metacarpal on x-ray

27
Q

What is a Monteggia’s fracture?

A

Dislocation of the proximal radioulnar joint in association with an ulnar fracture
Caused by FOOSH with forced pronation
Needs prompt diagnosis to avoid disability

28
Q

What is a Galezzi fracture?

A

Radial shaft fracture with association dislocation of the distal radioulnar joint.
Caused by a direct blow.

29
Q

What is a Pott’s fracture?

A

Bimalleolar ankle fracture, with forced foot eversion.

30
Q

What is a Barton’s fracture?

A

Distal radius fracture (Colles’/Smith’s) with associated radoiocarpal dislocation.
Fall onto extended and pronated wrist.

31
Q

What is the most common type of shoulder dislocation?

A

Glenohumeral. Anterior.

NB. Check neuromuscular status pre and post reduction (Axillary - regimental badge)

32
Q

What is a Bankart lesion?

A

Complication of anterior shoulder dislocation.
Detachment of the anterior inferior labrum (torn capsule and labrum) from the underlying glenoid. Creates a pocket for the humeral head to dislocate into. Suspect if recurrent dislocation.

Labral only = “soft Bankart”, Bony glenoid margin (impaction fracture) = “bony Bankart”.
Soft Bankart lesions are more common.

33
Q

What is fat embolism syndrome?

Features? - Resp, Derm, CNS

A

Systemic response to fat emboli released by mechanical insult of major trauma.
Emboli occlude microvasculature, triggering an inflammatory response:

Resp:

  • Tachycardia
  • Tachypnoea, dyspnoea, hypoxia usually 72 hours following injury
  • Pyrexia

Derm:

  • Red/brown petechial rash (in 25-50%)
  • Subconjunctival and oral haemorrhage/petechiae

CNS:

  • Confusion and agitation
  • Retinal haemorrhages and intra-arterial fat globules on fundoscopy
34
Q

What nerves can be damaged in forceps delivery?

A

Femoral
Lumbosacral
Sciatic
Obturator

35
Q

How do Scaphoid fractures usually occur?

What physical signs would you expect?

A

Direct hard blow to palm or FOOSH

  • Swelling and tenderness in anatomical snuff box
  • Pain on wrist movements and longitudinal compression of the thumb
36
Q

How do radial head fractures usually occur?

What physical signs would you expect?

A

Common in young adults, usually by FOOSH

  • Local tenderness over the head of the radius
  • Impaired movements at the elbow
  • Sharp pain on lateral side of the elbow at extremes of pronation and supination
37
Q

What is talipes equinovarus?

What % are bilateral?

A

Club foot.
Inverted and plantar flexed foot. Not passively correctable.
50% are bilateral.

38
Q

What are the features of lateral epicondylitis (tennis elbow)?

A

Pain and tenderness localised to the lateral epicondyle
Pain worse on:
- resisted wrist extension with elbow extended
- supination of the forearm with elbow extended

39
Q

What are the features of medial epicondylitis (golfer’s elbow)?

A

Pain and tenderness localised to medial epicondyle
Pain worse on wrist flexion and pronation
May be accompanied by numbness/tingling in the 4th and 5th finger due to ulnar nerve involvement

40
Q

Back pain relieved by sitting down, leaning forwards and crouching down would be typical of what?

A

Spinal stenosis

41
Q

How is a diagnosis of spinal stenosis confirmed?

A

MRI

42
Q

What is syringomyelia? Which tracts does it affect?

A

Cystic cavity forms within the spinal cord.

Selectively affects the spinothalamic tracts, bilaterally. (pain and temperature)

43
Q

What is a Morton’s neuroma?

A

A benign neuroma affecting the intermetatarsal plantar nerve, most commonly in the third inter-metatarsophalangeal space.
4x more common in females

44
Q

What are the features of a Morton’s neuroma?

A

Forefoot pain, most commonly in third inter-metatarsophalengeal space
Pain worse on walking - may feel like a pebble in shoe

45
Q

What is a Baker’s cyst?

A

A fluctuant swelling in the popliteal space = synovial fluid herniating between the two heads of the gastrocnemius.
Becomes tense on knee extension = Foucher’s sign.
More likely in patients with gout or arthritis, following a minor knee trauma.

46
Q

What fracture fixation most commonly leads to compartment syndrome?

A

Tibial fractures, following fixation with intra-meduallary devices

47
Q

What are the symptoms and signs of compartment syndrome?

A
  • Pain, especially on movement (even passive)
  • Parasthesiae
  • Pallor
  • Arterial pulsation may still be felt as the necrosis occurs as a result of microvascular compromise
  • Paralysis of the muscle group
48
Q

How is compartment syndrome diagnosed?

A

Intracompartmental pressure measurements. Pressures in excess of 20mmHg are abnormal and >40mmHg is diagnostic.

49
Q

What is the treatment of compartment syndrome?

A

Prompt, extensive fasciotomy

50
Q

What is a complication of fasciotomy for compartment syndrome?

A

Myoglobinuria -> Renal failure.

Give aggressive IV fluids.

51
Q

What clinical prediction tools can be used to assess a patients 10 year fracture risk?

A
  • FRAX

- QFracture

52
Q

What is the treatment of clubfoot?

A

Ponseti method.
= Manipulation and progressive casting which starts soon after birth. The deformity is usually corrected after 6-10 weeks. An Achilles tenotomy is required in around 85% of cases but this can usually be done under local anaesthetic.
Night-time braces should be applied until the child is 4.

53
Q

How do you treat a undisplaced intracapsular hip fracture?

  • No comorbidities
  • With comorbidities
A

If no co-morbidities: Internal fixation (especially if young)

If major illness or advanced specific organ disease: Hemiarthroplasty

54
Q

How do you treat a displaced intracapsular hip fracture?

  • <70
  • > 70
  • Major comorb/illness
A

<70: Internal fixation
>70: Total hip arthroplasty
Major comorbidities/immobile: Hemiarthroplasty

55
Q

How do you treat an extracapsular hip fracture (non-special type)?

A

Dynamic hip screw

56
Q

How do you treat an extracapsular hip fracture (reverse oblique, transverse or sub-trochanteric)?

A

Intramedullary device

57
Q

What is the Garden classification system?
I?
II?
III?
IV:
When is blood supply typically disrupted?

A

Type I: Stable fracture with impaction in valgus.
Type II: Complete fracture but undisplaced.
Type III: Displaced fracture, usually rotated and angulated, but still has bony contact.
Type IV: Complete bony disruption.

Blood supply disruption is most common following Types III and IV.

58
Q

What is a Hill-Sachs lesion?

A

When the cartilage surface of the humerus is in contact with the rim of the glenoid. Occurs in about 50% of anterior glenohumeral dislocations.

59
Q

What is a buckle fracture?

A

Incomplete fracture of a long bone, characterised by bulging of the cortex. Typically in children 5-10 years old.

60
Q

What is Freiberg’s disease?

What are the x-ray findings?

A

Anterior metatarsalgia affecting the head of the second metarsal, typically occurring in the pubertal growth spurt.

On x-ray:

  • Joint space widening
  • Formation of bony spurs
  • Sclerosis and flattening of the metatarsal head
61
Q

What is cubital tunnel syndrome? What are its features?

A

Compression of the ulnar nerve near the medial epicondyle.

Features:

  • 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
62
Q

What is osteopetrosis?

A

A rare autosomal recessive condition, commonest in young adults. = marble bone disease, Albers-Schönberg disease.
Bones become more dense and brittle, with a lack of differentiation between the cortex and the medulla.
May also present with features of anaemia or thrombocytopenia due to decreased marrow space.

63
Q

What is the commonest reason for revision of a total hip replacements?

A

Aseptic loosening of the implant.

Less common: pain, dislocation, infection

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