Orthopaedics Flashcards
How do you manage an open fracture?
Take photo Saline soaked gauze IV Co-amox Tetanus booster Analgesia IVI/tranfusion XR CTA/Doppler if arterial injury suspected Pre-op bloods Specialist- reduce and splint , debride, Gustilo and Anderson classification
Bloods to prep for theatre
U&E Group & save FBC Clotting ECG/CXR Cannula Fluids O/N Consented by reg Neurovascular status
Shoulder fracture- which nerve affected and how do you test for it?
Axillary
Sensation on top of arm
How do you test ulnar nerve?
Hand sensation
Finger spread for motor
How do you damage the ulnar?
Elbow injury
What is colles?
Wrist fracture with dorsal angulation
How do you test motor radial?
Thumbs up
How do you test motor of median nerve
form a fist
and cross fingers over (interosseus)
What are criteria for a THR?
displaced, intracapsular NOF fracture and old, but
-able to mobilise with 1 stick or less outside, not cognitively impaired and medically well
What are criteria for hemiarthorplasty?
intracapsular and old
How to manage an intertrochanteric NOF?
Dynamic hip screw
MOST COMMON
How to manage a extracapsular NOF?
IM nail
Where do you press for ottawa ankle rules?
Midfoot zone, lateral and medial malleolus and 5th metatacal head
What criteria are used in deciding on cast and ops for ankles?
Webber criteria
Based on ligament placement- if below then stable so no cast (A), if aboce then C, least stable so pin
What investigations do you need to do in myeloma?
IgG RBC with film U&E with calcium Urinary bence jones Xray any painful bones Refer to radiology for myeloma screen
What fractures does osteomalacia present with?
Pseudo
Luscent lines on xray
Painful but not fracture as not displaced
What is osteomalacia?
impaired bone mineralisation resulting in softening which deforms.
How is osteomalacia manages?
Ca++ and vit D and monitor response with serium Ca++ and alkaline phos
OR PUT THEM OUTSIDE!
What is Pagets?
Disregulation of osteoclasts and blasts forming large, new, weak bone quickly.
Focal disease of remodelling- mosaic of woven and lamellar bone
How does Pagets present?
Bone pain in elderly
FH history
Isolated raised ALK PHOS, all other LFTs, GGT, calcium etc normal
How is Pagets assessed?
Isotope bone scan to identify all affected
Radiographs for diagnosis
Serum alk phos for monitoring
How is pagets Managed?
Bisphosphonates (zolendronate (IV)/ alendronate/ risedronate)
Give Ca and vit D too
What are Pagets complications?
Deafness
Cord compression
nerve compression
Long bone weakness
What cells are present in Pagets?
Giant multinucleate osteoclasts
How do you diffentiate between mets and pagets lesions?
Mets- small areas on axial skeleton and tend to be symetrical
PAgets- unilateral lesions on mono/poly joints
What are 3 signs of on xray?
white sclerotic patches
increased bone size
loss of trabecular acrhitecture
What are red flags for back pain?
Under 16 or over 65 new onset Neurology Night pain pain at rest/unrelenting Immunocompromised Long term steroid use Malignancy history Weight loss concurrent illness
What are symptoms of cauda equina?
Asymmetrical Flaccid Decreased reflexes Bladder and bowel present late LMN (PR needed)
What are symptoms of spinal cord compression?
Symmetrical
UMN
Perianal numbness
Urinary retention, foecal incontinence
What is the criteria to decide between NOF treatments called?
Garden criteria
What nerve is affected in humerus breaks?
Radial
What nerve is affected in wrist fractures?
Median
What nerve is affected in proximal fibular fractures?
Common peroneal
