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Acute Care > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

Which blood vessels are at risk of damage in intracapsular hip #

A

Retinacular arteries from the femoral artery

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2
Q

Name the main hip abductors

A

Gluteus minimums and maximis

Tensor fasciae lattea

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3
Q

What is the main action of gluteus maximums?

A

Extension and external rotation

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4
Q

Describe the appearance of a -ve Trendelenberg test. What is the clinical significance?

A

Normal = pelvis falls on the side of the stance leg

Abnormal = pelvis rises on the side of the stance leg —> abductor muscle paralysis

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5
Q

Name the main hip flexors

A

Psoas major and iliacus

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6
Q

Quad muscles innervated by the femoral nerve. What muscles make up the quad group?

A

Rectum femoris

Vastus lateralis, medialis and intermedious

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7
Q

Hamstrings are supplied by sciatic nerve. What muscles make up hamstrings?

A

Biceps femoris
Semimembranosus
Semitendinosis

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8
Q

The adductors are supplied by the obturator nerve. Name the adductor muscles

A

Adductor longus
Adductor brevis
Adductor Magnus
Gracious

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9
Q

Which meniscus is most likely to be torn? Why?

A

Medical meniscus is most likely to be torn as it is fixed. The lateral meniscus is mobile so tears are less likely

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10
Q

Role of medial meniscus?

A

To resist virus stress

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11
Q

Role of PCL?

A

To resist posterior subluxation of the tibia e.g. going down stairs - can also think of resisting anterior subluxation of femur

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12
Q

Role of lateral meniscus

A

To resist varus stress and external rotation of the knee

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13
Q

What is our average anatomical axis of the hip and knee?

A

6 degrees valgus —> knee and ankle aligned perfectly

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14
Q

Which nerve supplies the anterior compartment of the lower leg?

A

Deep peroneal (or fibular) nerve

E.g. tibialis anterior and extensor digitorum

Act to dorsiflex and invert the foot

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15
Q

Which nerve supplies the lateral compartment of the leg?

A 
Superficial perineal (fibular)
Act to evert the foot 
E.g. fibularus longus and brevis
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16
Q

Which nerve supplies the posterior compartment of the leg?

A

Tibial nerve
Acts to plantarflex the foot
E.g. gastrocnemius, soles, tibialis posterior etc

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17
Q

Which 2 structures contribute to the medial arch of the foot?

A

Posterior tibial and plantar fascia

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18
Q

Difference between hammer and claw toe?

A

Claw = flexion at proximal and distal interphalangeal joint

Hammer = flexion at PIP but extension and DIP

Both due to an imbalance between flexors and extenders

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19
Q

Cartilage is made of water, collagen, proteoglycans and chondorcytes. What do chondrocytes do?

A

Make collagen

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20
Q

What is osteochondritis dissecans?

A

Subchondral bone becomes avascular —> cartilage +/- bone fragmenting
Usually medial epicondyle of femur in adolescence
Typically pain with swelling and locking after exercise
Treat conservatively, with pinning or removal of fragment

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21
Q

Good surgical option for builder with valgus alignment and early medical compartment OA?

A

Osteotomy

surgical cutting of bone to alllow realignment

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22
Q

In a well selected patient, how long does a TKR last?

A

15-20 years

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23
Q

Don’t forget that 50% of ACL tears often have a meniscal tear too

A

Medial meniscus 10x more common that lateral

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24
Q

Why do radial meniscal tears not heal?

A

They involve the central surface of the meniscus - only the peripheral 1/3 has a blood supply

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25
Q

Most likely diagnosis in a patient with an acute locked knee

A

Bucket handle meniscal tear

Requires urgent surgery

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26
Q

MCL tear usually heals well. Brace, early motion and physio

A

ACL tear is more worrying. Repair does not work - needs reconstruction from graft e.g. patellar tendon or Achilles

1/3 compensate well
1/3 can avoid instability by avoiding actively
1/3 cannot compensate and get instability

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27
Q

What structures are relatively likely to be damaged in a knee dislocation?

A

1) Common peroneal nerve
2) Popliteal artery
—> potential for compartment syndrome

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28
Q

Patient can’t do a straight leg raise and there is a palpable gap on examination. Diagnosis and management?

A

Extensor mechanism rupture

Needs surgical repairs

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29
Q

Most likely knee injury after hitting dashboard in RTA?

A

PCL tear

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30
Q

Most likely knee injury from getting up from squat?

A

Meniscal

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31
Q

Diagnosis in footballer who twisted and heard a pop. Generalised pain and rotator instability?

A

ACL rupture

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32
Q

Recurrent catching and locking after sudden pain which occurred when getting up from squatting?

A

Meniscal tear

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33
Q

What 3 examination tests are done if suspected ACL tear?

A

1) Lachman (knee at 20 degree flexion)
2) Anterior drawer (knee at 90 degree flexion)
3) Pivot shift (knee externally rotated)

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34
Q

LOSS on x-ray

A

Loss of joint space
Osteophytes
Subchondrol sclerosis
Subarticualr cysts

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35
Q

+ve McMurray test. Likely diagnosis?

A

Probably a meniscal problem

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36
Q

Position of a leg with an intracapsular hip fracture?

A

Shortened, externally rotated and adducted

Need to do AP and lateral view

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37
Q

Intracapsular # occur within the joint capsule and as there is poor blood supply - malunion is common

A

Extracapsular fracture occur outwith the joint capsule so malunion is less likely

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38
Q

Management of intracapsular hip #

A

Undisplaced —> internal fixation and dynamic hip screw

Discplaced —> hemiarthroplasty (exicse head and insert prosthesis)

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39
Q

Management of extra-capsular #

A

Usually a dynamic hip screw

femoral shaft # requires stabilisation and then insertion of intra-medullary nail

40
Q

What does loss of Shenton’s line suggest?

A

Hip #

It is formed by the inferior edge of the superior pubic ramis and medial edge of femoral neck

41
Q

What are the 5 types of hip # ?

A

Intra-capsular:

  • subcapital
  • transcervical
  • basicervical

Extra-capsular:

  • intertrochanteric
  • sub-trochanteric
42
Q

What is Garden’s classification?

A

Tool for assessing the severity of hip #

1 - incomplete or impacted
2 - complete
3 - partially displaced
4 - completely displaced

43
Q

Remember a hip # is EXTRA bad so the leg is EXTERnally rotated

A

Hip dislocations are not too bad so the leg is internally rotated

44
Q

Key things to mention when discussing a #

A

Site - e.g. shaft of femur
Direction of # e.g. transverse/ oblique/ spiral
Displacement - always describe in relation to distal bone fragment e.g. lateral displacement eith shortening and valgus angulation
Soft tissue - open/ closed, NVB? Compartment syndrome?

45
Q

What does comminuted # mean?

A

> 2 bone fragment s

46
Q

In every patient with back pain you must ask about causes equina and any history of malignant

A

In every patient with back pain you must ask about causes equina and any history of malignant

47
Q

Knee pain worse on walking up or down stairs?

A

Classically patellofemoral pain

48
Q

Always look at medication list in a patient with gout. They may have just started a thiazide diuretic which often precipitates attacks

A

Always look at medication list in a patient with gout. They may have just started a thiazide diuretic which often precipitates attacks

49
Q

Differential diagnosis of neck pain?

A
  • mechanical
  • trauma
  • cervical spondylosis, prolapse or discitis
  • OA
  • bony mets
50
Q

Features of complex regional pain syndrome?

A

Pain, hypersensitivity and autonomic dysfunction e.g. excess sweating
Often following trauma
Distal forearm and hand usually involved

51
Q

Carpal tunnel = radial 3.5 fingers affected

A

Cubical tunnel = ulnar 1.5 fingers affected

52
Q

Differential for widespread musculoskeletal pain

A 
PMR
Polymyositis
Fibromyalgia
RA
Psoriatic arthritis
Ank spon 
SLE
Metabolic bone disease
53
Q

Differential for ‘acute hot swollen joint’

A 
Septic arthritis
Gout 
RA
Transient synovitis 
Haemarthrosis - common in patients on warfarin or with a bleeding disorder (if haemarthrosis is suspected, a clotting screen should be done and INR should be checked)
54
Q

Differential for an unwell child with joint pain?

A

Septic arthritis

Idiopathic juvenile arthritis

55
Q

How will a child with a SUFE typically stand?

A

With the affected leg in external rotation

56
Q

What does Thomas’s test test for?

A

A fixed flexion disorder (the contralateral leg comes off the bed)

57
Q

If you suspect a SUFE, which x-ray should you order?

A

Frog leg lateral x-ray

58
Q

What are the hand manifestations of RA?

A

Swan neck deformity
Boutonnière deformity
Ulnar drift

59
Q

In any skin lump/ swelling, consider it sinister if >5cm in diameter

A

In any skin lump/ swelling, consider it sinister if >5cm in diameter

60
Q

List some causes of a secondary arthritis

A 
Perthes
SUFE
AVN 
Trauma
Previous infection
RA
61
Q

HLA DR4 is very important in the development of RA

A

HLA DR4 is very important in the development of RA

62
Q

Rheumatoid factor is in serum of 80% of patients with RA

A

High levels —> severe disease and extra-articulate features

63
Q

Which joints are typically affected by rheumatoid arthritis?

A

Small and medium sized joints in a symmetrical

64
Q

Synovitis is the cardinal feature of RA. It usually affects the small joints of the wrist and hand except…

A

DIPJ -almost always spared

65
Q

Extra-articular of RA

A 
Rheumatoid nodules
Teno synovitis/ bursitis
Carpal tunnel - due to synovitis
Lung nodules/ pulmonary fibrosis 
Eye - keratoconjunctivitis sicca, episcleritis, scleritis
66
Q

What are the 2 serological tests associated with RA.

A

Rh factor

Anti- CCP

67
Q

Name some biological therapies

A

Anti-TNF —> infliximab, adalimumab and etanercept (monoclonal antibodies)
Other biologics —> ritixumab and abatacept

68
Q

People with RA should be on a DMARD asap

A

Steroids are often given to relieve symptoms short term while the DMARD takes effect

69
Q

What is the major side effect of ciclosporin, other than bone marrow suppression?

A

Renal disease —»HT

70
Q

In any fracture, what must you consider other than the actual bone?

A

1) Overlying skin
2) Distal blood supply - pulses?
3) Nerve involvement - weakness/ sensation

71
Q

Describe the salter Harris classification of growth plate #

A 
1 = through growth plate only
2 = mainly epiphysis but part of metaphysis is also involved
3 = growth plate and epiphysis e.g. intra-articular
4 = though epiphysis, growth plate and metaphysis —> most severe
5 = crush injury —> unusual and only detected when bone growth stops later
72
Q

Most common type of salter-Harris fracture

A

Type 2

Through growth plate and epiphysis

73
Q

Operative treatment i.e open reduction is always required for open fractures and displaced intra-articulate fracture

A

Operative treatment i.e open reduction is always required for open fractures and displaced intra-articulate fracture

74
Q

Patient develops hypoxia and sudden onset SOB 2 days after femoral #. Differential?

A

PE

Fat embolus - never forget!

75
Q

First step in management of an open #

A 
ABCDE
Cover in an iodine soaked swab
Splint
Start ABx prophylaxis e.g. IV co-amoxiclav (amoxicillin and clavulanic acid) 
Tetanus prophylaxis 
De-bride in theatre ASAP.
76
Q

What must be considered if there is blood at the urethral meatus/ blood or boggy prostate on PR?

A

Pelvic fracture

77
Q

Scaphoid # are notoriously tricky. You need to get a lateral (scaphoid) view. What are the complications?

A 
Non-union
Malunion
AVN
Reduced grip strength
Increased risk o OA
78
Q

Patient with FOOSH and pain in anatomical snuffbox. Suspected scaphoid # but x-ray normal. What to do?

A

Immobilise wrist and re-do x-ray in 2 weeks

If still normal but tenderness remains then do an MRI

79
Q

Cole’s #

A

Fracture of the distal radius with dorsal displacement (dinner fork appearance)

Most common in old ladies who fall and have osteoporosis

80
Q

Names of bone ends and growth plates

A 
Epiphysis = bone end e.g. beyond growth plate
Physis = growth plate
Metaphysis = between physis and diaphysis
Diaphysis = bone shaft
81
Q

Most likely mechanism for a posterior shoulder dislocation?

A

Epileptic shoulder

82
Q

Views for shoulder dislocation?

A

AP and axillary

83
Q

Which rotator cuff muscles insert into greater tuberosity?

A

Supraspinatous (Jobe’s -thumb down)

Infraspinatous and Teres minor (external rotation)

84
Q

Which rotator cuff muscle inserts onto lesser tuberosity?

A

Subscapularis

Internal rotation - push against hand

85
Q

Popeye sign

A

Ruptured biceps tendon

86
Q

What are the 3 recognised stages of adhesive capsulitis?

A

Painful - often at night
Frozen - reduced ROM, especially external rotation
Thawing - progressive improvement in ROM

87
Q

Galeazzia = radial shaft # with dislocation of DRUJ

A

Monteggia = proximal ulnar # with dislocation of radial head

remember its the ulnar head which forms the elbow joint

88
Q

Bennet’s = intra-articulation # of the base of the thumb

A

Boxers # = 5th metacarpal neck fracture (little finger)

Always volar angulation

89
Q

Remember trascervical is an intracapsular fracture

A

Basicervical is an extracapsular fracture

90
Q

Positive anterior draw and Lachman’s test?

A

ACL rupture

91
Q

The Danis-Weber classification is used for ankle fractures. Describe it

A 
A = below syndesmosis
B = at level of syndesmosis
C = above syndesmosis

Ankle # need reduced in A&E
Any degree of talar shift needs operative fixing

92
Q

Commonest cause of Baker’s cyst?

A

OA

93
Q

Bone bone which resolves with aspirin?

A

Osteoid osteoma

benign

94
Q

Soap bubble appearance of bone tumour?

A

Giant cell tumour

95
Q

Onion skin appearance of bone tumour?

A

Ewing sarcoma

t(11;22) translocation

96
Q

Popcorn appearance of bone tumour?

A

Chondrosarcoma

Acute Care (4 decks)

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