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3B Hospital Specialities > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

Definitive management of fractures

A

1) Reduction of deformity
2) Stabilisation
3) Rehabilitation

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2
Q

Techniques for reduction of deformity of a fracture

A

Manipulation
Traction
Open reduction
Closed reduction and fixation

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3
Q

Bones at hip joint and type of joint

A

Pelvic acetabulum + head of femur.

Synovial ball and socket joint.

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4
Q

Bones at knee joint and type of joint

A

Femur, tibia, patellar and fibular.

Hinge type synovial joint.

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5
Q

Bones and type of joint at shoulder

A

Ball and socket synovial joint.

Head of humerus and glenoid fossa of scapula.

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6
Q

Winged scapula pathology

A

Damage to long thoracic nerve innervating serrates anterior.

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7
Q

Bones at and type of joint of elbow

A

Hinge synovial joint.

Humerus, ulna, radius.

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8
Q

Erb’s palsy nerves

A

C5 and C6 branches

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9
Q

Klumpke palsy nerves

A

T1 branches

Claw hand

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10
Q

3 types of NOF #

A

Intracapsular (most common)
Extracapsular intertrochanteric
Extracapsular subtrochanteric

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11
Q

Shenton line on x-ray

A

Line from inferior border of the superior pubic ramus to the inferomedial border of the neck of femur. Interrupted in NOF #

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12
Q

Rotator cuff muscles, function, nerve supply and examination.

A

Supraspinatus = abduct to 15 degrees, suprascapuarlis nerve, ‘empty can test’.
Infraspinatus = laterally rotate arm, suprascapuarlis nerve, external rotation against resistance.
Subscapularis = medially rotate arm, subscapular nerve, ‘lift off test’.
Teres minor = laterally rotate arm, axillary nerve, external rotation against resistance.

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13
Q

‘Dinner fork’ deformity on lateral XR

A

Colles’ fracture of wrist.

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14
Q

S+S of compartment syndrome and pathophysiology

A

Fascia of a muscular compartment has no stretch so any increases in volume from bleed or oedema will significantly increase the pressure. High pressure reduces blood supply = ischaemia and necrosis.
Can lead to rhabdomyolysis and AKI.

Pain, out of proportion to the visible situation, refractive to morphine.
Paraesthesia
Pallor
Paralysis
Perishingly cold
Absent pulses distally.
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15
Q

Ix and Rx of compartment syndrome

A

Pressure >40mmHg, renal function and creatinine kinase (rhabdomyolysis)
Analgesia, NBM as will need surgery, senior help and Prompt fasciotomy for decompression!

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16
Q

Loss of external rotation of shoulder in old diabetic

A

Frozen shoulder

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17
Q

Causes of compartment syndrome

A

Major trauma (RTA)
Lower leg, radial or ulnar fraction
Restriction from casts

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18
Q

Presentation of a neck of femur fracture

A

Hx of a fall in an elderly patient.
Pain - at hip, groin, knee.
Unable to weight bear and reduced mobility.

O/E: depends on whether displaced or not. If it is displaced: Affected leg is SHORTENED, ADBUCTED, EXTERNALLY ROTATED.
Pain on palpation of greater trochanter.
Pain exacerbated by rotating hip.

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19
Q

Ix and Mx for a neck of femur fracture

A

Xray - AP pelvis and lateral Hip.
Pre-op as FY1 = analgesia, IV access, coagulation (elderly on warfarin), FBC, U+E, LFT, bone profile bloods, group+save, NBM. Low molecular weight heparin pre-op.
Surgical Mx = Within 36hrs of admission! Procedure dependent on type of NOF#. PHYSIO REHAB

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20
Q

Management of specific types of NOF#

A

INTRACAPSULAR

  • Undisplaced / Garden type 1+2 = dynamic hip screw or cancellous screws.
  • Displaced / Garden type 3+4 = higher risk of avascular necrosis, hemi-arthroplasty if elderly or total hip replacement if fit and active.

EXTRACAPSULAR
- Intertrochanteric = dynamic hip screw from femur to femoral head.
- Subtrochanteric = inter medullary nail
Less risk of vascular necrosis.

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21
Q

Which patients with a displaced intracapsular NOF# get a total hip replacement rather than hemi-arthroplasty.

A

basically if they will rehab well.

  • Able to walk outdoors, independently prior to injury (nothing more than a stick).
  • No cognitive impairments (will be able to follow physio commands and do at home by themselves).
  • Medically fit for anaesthesia and procedure.
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22
Q

Which NOF# is highest risk for avascular necrosis and Rx

A

Displaced intracapsular.
If fit and independent = total hip replacement.
If elderly and need support = hemi-arthroplasty.

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23
Q

Mx for non-displaced intracapsular

A

Cancellous or dynamic screws.

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24
Q

Mx for intertrochanteric

A

Dynamic hip screw and weight bear ASAP

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25
Q

Mx for subtrochanteric

A

Intramedullarly nail.

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26
Q

Classification for intracapsular NOF#

A

Garden
1 and 2 = undisplaced
3 and 4 = displaced

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27
Q

Difference between total and hemi hip replacement

A 
Total = new ball and socket / femoral head and acetabular cup.
Hemi = just new ball / femoral head
28
Q

Mechanism of shoulder dislocations and how to differentiate between them

A

Complete or partial / subluxation.
Anterior (most common) - pts hold arm in abduction and external rotation. Xray shows humorous closer to ribs. Hill-Sachs and Bankart lesions.
Posterior - pts hold arm closer to body adducted and internal rotated. Xray shows light bulb sign. Seen mostly in seizures, electric shock and trauma.
Inferior - very rare.

29
Q

Fracture of inferior part of glenoid process.

A

Bankart lesion

30
Q

Fracture along the posterior and superior of humeral head

A

Hill-Sachs lesion.

31
Q

How to manage:

  1. Anterior shoulder dislocation
  2. Posterior shoulder dislocation
A
  1. Sling

2. Closed reduction with ortho help

32
Q

Ix for shoulder dislocation

A

Shoulder x ray in 2 different planes - anteroposterior and axillary view.

33
Q

What nerve is at risk in a posterior elbow dislocation

A

Ulnar! test motor with finger adduction/splaying

34
Q

What is at risk in an anterior shoulder displacement

A

Axillary nerve = C5 and C6.
Sensation to lower deltoid = regimental badge area.
Motor to deltoid and teres minor.

(Hornblower’s syndrome = weak term minor).

35
Q

Distal radius fracture with radial tilting upwards

A

Colles’ fracture - dorsal angulation and dorsal displacement.
Elderly fall in outstretched hand.
DO THEY HAVE OSTEOPOROSIS?! (FRAX)
Is a risk factor for hip fractures.
- X-ray = dinner-fork deformity.
Risk of median nerve damage - thumb to little finger
- Mx = Reduction via manipulation with anaesthesia and analgesia.

36
Q

Smith’s fracture

A

Distal radius fracture with volar displacement of fragments.

37
Q

Colles’ fracture

A

Distal radial fracture with dorsal displacement of fragments.

38
Q

Distal radius fracture with volar displacement fragments

A

Smith’s fracture - volar angulation of distal fragment.
Falling backwards common mechanism onto outstretched palm. ‘Garden spade deformity’.
Xray = displacement anteriorly.
Also at risk of median nerve injury - thumb to little finger power.
Mx = Reduction via manipulation with anaesthesia and analgesia.

39
Q

Fracture dislocation of the radiocarpal joint and distal radius…?

A

Barton’s fracture

Mx with surgical reduction via manipulation.

40
Q

Which hand fracture is high risk of avascular necrosis and how would you examine for it?

A

Scaphoid fracture. Seen in young men 👨
Pain in anatomical snuffbox.
Risk fo radial nerve injury - assess wrist and finger extension.
Ix = 4 planes of x-rays

41
Q

What is a distal radius fracture

A 
Fracture within 2.5cm of the wrist.
Includes Bartons (with radio-carpel joint), Smiths and Colles' fractures.
42
Q

How to assess nerves in hands

A

Motor:
Radial = wrist and finger extension
Ulnar = adduct/splay fingers
Median = thumb to little finger ring.

Sense:
Radial = back of hand and thumb
Ulnar = little finger on the front and back
Median = palm towards thumb side. Top of index finger.

43
Q

Person has a big high-energy, fast car RTA what hip fracture are they likely to get

A

Femoral shaft.

44
Q

Name the 2 joints of the ankle

A

Ankle joint where tibia, fibular and talus meet

Syndesmosis joint where tibia and fibula join with ligaments.

45
Q

How to classify ankle fractures

A

Weber classification

46
Q

What is a Pott’s fracture

A

Bimalleolar fracture

47
Q

When do you x ray an ankle ??!?!?!?!!?!?!?!?!

A

The Ottawa Ankle Rules 🇨🇦
Use with ankle/midfoot pain or tenderness.
Ankle XR if there is pain in malleolar zone and either

  • Bone tenderness at the posterior tip of the lateral malleolus.
  • Bone tenderness at the posterior of the medial malleolus.
  • An inability to bear weight.
48
Q

Ix for ?ankle#

A

Anteroposterior, lateral and oblique ankle XR.

49
Q

Mx for ankle #

A

Reduce, stabilise, elevate. Keep assessing neurovascular status.

50
Q

General Mx for an open fracture as an FY1 👩‍⚕️

A 
NBM
IV access
Saline soaked sterile gauze.
IV Abx e.g. co-amoxiclav.
Analgesia (PMC)
IV fluids if going to surgery.

Pre-op bloods = FBC, U+E, clotting, group+save.
Imaging = book xray of bone.

51
Q

Rehabilitation of a fracture

A

Early mobilisation

Physio therapy.

52
Q

Loss of external rotation of the shoulder

A

Frozen shoulder.

53
Q

Risk assessment for fractures

A

FRAX
Age, Sex, BMI
Hx of fracture, FHx of hip fracture, femoral neck BMD (g/cm3).
Smoking, alcohol, steroid use.
Rheumatoid arthritis, secondary osteoporosis (T1DM, osteogenesis imperfecta, hyperthyroidism, premature menopause etc).

54
Q

Epidemiology of bone tumours

A

In adults = mostly secondary from breast, prostate, lung, thyroid and kidney.
In children = mostly primary.

55
Q

Name some malignant bone tumours

A

Osteosarcomas - association with Paget’s disease of bone, commonly around knee or proximal humerus.
Chondrosarcoma - arise from a pre-existing bone lesion e.g. chondroma.
Ewing’s sarcoma - primitive neuroendocrine tumour of 15 year old caucasians.

56
Q

Presentation of a bone tumour

A

Bone pain - worse at night, unremitting - limp
Mass or swelling
Systemic features - Weight loss, fever.
Pathological fracture

57
Q

What bone tumour rapidly mets to lungs

A

Osteosarcoma

58
Q

X-ray of

  1. osteosarcoma
  2. Ewing’s tumour
  3. in both
A
  1. ‘sunburst’ appearance.
  2. overlying onion-skin layers.
  3. Codman triangle, new subperiosteal bone from acute bone lesion.
59
Q

Childhood cancers which commonly met to bone

A

Wilm’s tumour

Neuroblastoma.

60
Q

Ix and Mx for a bone tumour

A

Ix:
Bloods = LFT incl ALP, Calcium, LDH, FBC
Imaging = x-ray, CT/MRI/Radionuclide bone scan.
Biopsy

Mx:
MDT, surgical and chemo

61
Q

Infection of bone marrow and common pathogen

A

Osteomyelitis

S.aureus
IVDU = P.aeurginosa
Sickel cell = Salmonella.

62
Q

Rfx for osteomyelitis

A 
Trauma
Prosthetic joints
DM
IVDU
Immunosuppression
63
Q

Presentation of osteomyelitis

A

Febrile

Painful, immobile joint. Swollen, erythema, tender, hot to touch. Oedema at area.

64
Q

2 types of osteomyelitis

A 
Haematogenous = from a bacteraemia
Contiguous = focal infection.
65
Q

Ix and Mx for osteomyelitis

A

FBC - WCC raised
ESR and CRP
BLOOD CULTURES
X-ray of area = osteopenia within a week. ‘fallen-leaf’ sign as piece of endosteal sequestrum falls into medullary canal.

MX = bone and soft tissue debridement (mc+s of debridement). Stabilise and immobilise bone. ABx e.g. vancomycin or flucloxacillin. Analgesia

3B Hospital Specialities (17 decks)

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