Orthopaedics Flashcards
What is cervical spondylosis?
Degenerative changes of the cervical spine - annular fibrosis and bony spurs
Narrows spinal canal and intervertebral foramina
Neck and arm pain, paraesthesia
What is whiplash?
Sudden neck extension with rebound flexion
Protective muscle spasm causes pain and stiffness
What are some causes of impingement syndrome?
Supraspinatus tendinopathy
Calcifying tendinopathy
ACJ-osteoarthritis
What are the features of rupture of long head of biceps?
Discomfort occurs after lifting or pulling
‘Ball’ appears in the muscle on elbow flexion
What are the phases of adhesive capsulitis?
- Painful phase - less than a year
- Frozen phase 6-12 months
- Thawing phase - 1-3 years
What is olecranon bursitis?
Traumatic bursitis following elbow pressure
Pain and swelling behind olecranon
Check for skin cellulitis
What are the features of subluxation of the radial head?
Typically 1-4 year old lifted by the arm
Radial head slips out of anular ligament
Arm is held slightly flexed and twisted inwards
What are the features of Dupuytren’s contracture?
Progressive painless fibrotic thickening of the palmar fascia
Skin puckering and MCP joint flexion
Consider fasciectomy
What are some causes of Dupuytren’s contracture?
Genetic
Smoking
Diabetes
AEDs
What is De Quervian’s disease?
Stenosing tenosynovitis of 1st extensor compartment, APL and EPB as the cross the radial styloid
What is scoliosis and what are the symptoms?
Lateral spinal curvature with secondary vertebral rotation
Pain, cosmesis issues, poor lung function
What are some features of discitis?
Fever, night pain, specific tenderness
Raised ESR
50% staphylococcal
What is Pott’s disease?
Spinal TB
Focal tenderness, kyphosis and stiffness
Do CXR to check for pulmonary TB
What are some symptoms of transient synovitis?
Viral prodrome
Child systemically well
Acute onset limp and reduced movements
What is Perthes disease?
Avascular necrosis of the femoral head
Gradual onset limp and pain
Can cause early onset OA
What are some features of SUFE?
Boys over 10
Increased risk in obesity and hypothyroidism
Do frog leg lateral hip x-rays
What are some signs of developmental dysplasia of the hip?
Asymmetrical leg length
Asymmetrical skin folds
Buttock flattening
What is Osgood-Schlatter disease?
Tibial tuberosity apophysitis
10-15 year olds
Physical overuse
What are hammer toes?
Extended MTPJ
Hyperflexed at PIPJ
Extended at DIPJ
Toes look curled
What are claw toes?
Extended MTPJ
Hyperflexed at PIPJ
Flexed at DIPJ
What are some features of osteosarcoma?
Can be primary (metaphases of long bone) or secondary e.g. Paget’s, radiation
Bone destruction and new bone formation on imaging
HRCT chest to look for metastases
What is Ewing’s sarcoma?
Malignant round cell tumour of long bones
Affects adolescents
What are some red flags for bone tumours?
Non-mechanical bone or joint pain
Nocturnal pain
Bony swellings
Pathological fractures
What is osteochondroma?
Benign painful mass associated with trauma
XR - bony spur arising from cortex
What is osteogenesis imperfecta?
Inherited disorder of type 1 collagen
Joint laxity, fragile low-density bones
What are the different types of osteogenesis imperfecta?
- Mildest, commonest, AD, blue sclera, hearing loss
- Lethal perinatal form, recessive, dwarfism
- Severe form, recessive, fractures and birth, spinal and limb deformity
- Moderate, AD
What are the complications of joint replacements?
VTE Dislocation Infection Limb length discrepancy Nerve palsy
When should a c-spine x-ray be performed?
Neuro exam shows focal deficit Spine tenderness Alteration in consciousness Intoxication Distracting injury
What are some risk factors for poor fracture healing?
DM Recent trauma Smoking Osteoporosis Steroids
What are the four stages of fracture management?
Reduction
Stabilisation
Maintain NV supply
Rehabilitation
What should be done for an open fracture?
- IV antibiotics
- NV status assessment - impaired do urgent surgery
- Debridement within 24 hours
- Photograph
- Cover wound in saline soaked gauze
- Splint the limb
- Definitive stabilisation and wound cover within 72 hours
What are some immediate fracture complications?
Bleeding
Organ injury
Nerve/skin/vessel injury
What are some local later fracture complications?
Skin necrosis
Pressure sores
Infection
Delayed or non-union
What are some general later fracture complications?
Fat embolism
PE
Pneumonia
Arthritis
What is the immediate management of compartment syndrome?
Remove any constrictive dressings
Elevate to level of heart
Analgesia and fluids
Fasciotomy
What is the order of structures in the antecubital fossa from lateral to medical?
Radial nerve
Biceps brachii
Brachial artery
Median nerve
What are some features of supracondylar fractures?
Happen in paeds
Pain, swelling and inability to move elbow
Can damage median nerve
Heal in around 4 weeks
What are some features of schaphoid fractures?
Often result from fall onto outstretched hand
Tenderness over anatomical snuff box
What are the signs of NOF?
External rotation, adduction and shortening of affected leg
