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3B General Care > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

Cervical Spondylosis

A

Degenerative changes of the cervical spin (e.g. annulus fibrosis and bony spurs)
narrow the spinal canal and intervertebral foramina
- usually asymptomatic but can cause neck and arm pain with parasthesiae
5-10% symptomatic patients develop cevical myelopathy

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2
Q

Cervical spondylolisthesis

A

Displacement of one vertebra onto the one below

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3
Q

Causes of cervical spondylolisthesis

A
  1. congenital failure of fusion of the odontiod process in the axis or fracture of the odontoid process (skull, atlas and odontoid slip forward on the axis)
  2. inflammation softens the transverse ligament of the atlas e.g. RA or complicating throat infection
  3. Instability after injury
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4
Q

Treatment of cervical spondylolisthesis

A

traction
immobilisation in plaster jacket
spinal fusion

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5
Q

Prolapsed cervical disc

A

Central protrusions give symptoms of spinal cord compression
posterolateral protrusions may cause a stiff neck, pain radiating to the arm, weakness of muscles affected by the nerve root and depressed reflexes

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6
Q

Investigating prolapsed discs

A

MRI

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7
Q

Treating prolapsed disc

A

NSAIDs
Collar (if cervical)
Physio to restore mobility
surgery if indicated by MRI findings

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8
Q

Rotator cuff tears

A

tears in supraspinatus, subscapularis and infraspinatus
- insidious & degeneration in the elderly, after trauma in the young
- night pain
-USS and MRI are helpful
Surgery

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9
Q

Shoulder impingement syndrome

causes

A
  1. Supraspinatus tendinopathy
  2. Calcifying tendinopathy - acute calcific arthropathy. Physio, NSAIDs, steroid injection
  3. Acromioclavicular joint osteoarthritis- common in young weight lifters. Rest, NSAIDs, steroids.
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10
Q

Rupture of long head of biceps

A

discomfort- something has gone wehn lifting or pulling

ball appears in the muscle on elbow flexion (popeye)

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11
Q

Long head of biceps tendinopathy

A

pain in anterior shoulder
characteristically on forced contraction of biceps
Pain relief, corticosteroid injection

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12
Q

Lateral epicondylitis

tennis elbow

A

inflammation where common extensor tendon arises from lateral epicondyle of humerus

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13
Q

Lateral epicondylitis

presentation

A

clear history of repetitive strain

pain felt at the from of lateral condyle exacerbated when tendon is stretched

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14
Q

Treatment

lateral epicondyitis

A

rest
6-24 months
physio

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15
Q

Medical epicondylitis

golfers elbow

A

inflammation of the forearm flexor muscles at their origin on the medial epicondyle
pain exacerbated by pronation and forearm flexion

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16
Q

Olecranon bursitis

students elbow

A

traumatic bursitis from pressure on elbows
pain and swelling behind the olecranon
may develop into septic bursitis if overlying cellulitis

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17
Q

ulnar neuritis

cubital tunnel syndrome

A

osteoarthritis or rheumatoid narrowing of the ulnar groove and constriction of the ulnar nerve as it passes behind the medial epicondyle
- decreased sensation over little finger and medial half of ring finger
Surgical decompression

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18
Q

Dupuytren’s contracture

A

progressive, painless fibrotic thickening of palmar fascia with skin puckering and tethering

  • ring and little fingers- bilateral and symmetrical
  • may have MCP join flexion
  • if interphalangeal joints are affected hand may be quite disabled
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19
Q

Treatment of Dupuytren’s contracture

A

Early - injection of clostridium histolyticum or percutaneous needle fasciotomy
Later- fasciectomy

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20
Q

Ganglia

A

smooth, multiocular swellings with cysts containing jelly like fluid
communicate with joint capsules or tendon sheaths
treatment not needed unless causing pain or pressure

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21
Q

Trigger finger

tendon nodules

A

caused by swelling of flexor tendon or tightening of the sheath
ring and middle fingers most commonly affected

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22
Q

Kyphosis

A

excessive curvature of the spine in the sagittal planne

  • typically thoracocervical spine
  • less common than scoloiosis but potentially more dangerous with dislocations–> cord compression
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23
Q

Scoliosis

A

lateral spinal curvature
secondary spinal vertebral rotation
- idiopathic (infantile, juvenile, adolescent or adult onset)
- neuromuscular (neuropathic or myopathic)
- syndromic (e.g. Marfan’s, neurofibromatosis)
- other- tumour, osteoporosis, infection

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24
Q

lumbar disc prolapse

A

severe pain brought on by coughing, sneezing or twisting a few days after back sprain
signs- forward flexion and extension limited ± lateral flexion
- calf pain, weak foot plantar flexion, reduced pinprick sensation = S1

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25
Q

Treatment of disc prolapse

A

brief rest and early mobilisation + pain relief ± physiotherapy
Discectomy is needed in cauda equina syndrome, progressive muscular weakness or continuing pain

26
Q

Degenerative disc disease

A

multifactorial
may lead to herniation
surgical options include prosthetic disc replacement

27
Q

Spondylolisthesis

A

Displacement (usually forward) of one lumbar vertebra on one below (usually L5/S1)
causes- spondylosis, spondyloloysis, congenital malformation of the articular process, OA of posterior fact joints
- onset of pain ± sciatica in adolescence ± hamstring tightness causing qaddling gait
curative treatmetn- spinal fusion

28
Q

Lumbar spinal stenois

A

generalised narrowing of lumbar spinal canal or lateral recesses –> nerve ischaemia
typically caused by facet joint OA and osteophytes
- pain worse on walking, aching and heaviness in one or both legs = spinal claudication
- pain on extension
- negative straight leg raise
- prefers to walk up hill, lean over trollies or cycling

Treatment = decompressive laminectomy, NSAIDs, epidural steroids and corsets

29
Q

Pott’s disease

spinal TB

A

Frequent form of extra-pulmonary TB, especially with HIV co-infection
Systemic symptoms, gradual onset localised back pain and stiffness of all back movements

30
Q

Cauda Equina Syndrome

A

compresssion to cauda equina
- poor anal tone, severe back pain, saddle anaethesia, incontinence or retention of faeces/urine, paralysis ± sensory loss

31
Q

Transient synovitis of the hip

irribitable hip

A

chief cause of hip pain in children- diagnosis of exclusion

  • acute onset and self limiting with rest ± analgesia
  • viral illness preceeded by viral URTI or autoimmune
32
Q

Perthe’s disease

A

Avascular necrosis of the femoral head occurs (ischaemia is self healing), bone remodelling distorts the epiphysis and generates abnormal ossification

  • presents with pain in hip or knee
  • causes a limp
  • all hip movements are limited esp. internal rotation
33
Q

Slipped upper femoral epiphysis

SUFE

A

10-16yrs
combination of hormonal and biomechanical factors (50% obese)
displacement through the growth plate- epiphysis slips down and back
- usually presents after a minor injury with limping and pain in groin, anterior thigh or knee

34
Q

Osteomalacia

A

problem with bone modelling or formation due to a lack of Vit D–> reduced intake of GI calcium and phosphate –> reduced mineralisation of bone

  • bony pain, muscle weakness, pathological fractures, waddling gait (proximal myopathy)
  • low serum Ca2+, PO43-, raised ALP
35
Q

Paget’s disease of the bone

A

increased bone turnover associated with increased numbers of osteoblasts and osteoclasts with resultant remodelling, bone enlargement, deformity and weakness

36
Q

Clinical features of Paget’s disease of the bone

A

asymptomatic
deep, boring pain and bony deformity and enlargement
- typically pelvis, lumbar spine, skull, femur and tibia

37
Q

Complications of Pagets

A 
pathological fractures
osteoarthritis
raised calcium 
nerve compression due to bone overgrowth e.g. deagess, root compression)
high output CCF
osteosarcoma
38
Q

Treatment of Pagets

A

analgesia

alendronate may be tried to reduce bone pain and reduce deformity

39
Q

Osteoporosis

A

reduced bone mass
primary - age related or secondary to condition/drugs
- trabecular bone affected = crush fractures of vertebrae
- cortical bone affected = long bone fractures

40
Q

risk factors for osteoporosis

A

parental history
alcohol >4 units a day
rheumatoid arthritis
BMI<22

S- steroid use
H- hyperthyroidism, hyperparathyroidism, hypercalcuria 
A- alcohol/tabacco use 
T- thin 
T- testosterone low 
E- early menopause
R - renal/ liver failure
E- erosive/ inflammatory bone disease
D- dietary Ca2+ low, malabsorption, T1DM
41
Q

Investigations of osteoporosis

A

x-ray
DEXA scan
Bloods- Ca2+, phosphate and alk phos normal

42
Q

Management of osteoporosis

Lifestyle

A
  • quit smoking, reduce alcohol
  • weight bearing exercise
  • balance exercises such as tai chi to reduce falls
  • calcium and vit d rich diet
  • home based falls prevention programme
43
Q

Management of osteoprosis

Pharmacological

A
  • bisphosphonates
  • calcium and vit D supplements
  • strontium ranelate reduces fractures in those intolerant to bisphosphonates
  • HRT
  • raloxifene - selective oestrogen receptor modulator similar to HRT but with lower breast ca risk
  • recombinant PTH
  • calcitonin may reduce pain after vertebral fracture
  • testosterone in hypogonadal men
    denosumab decreases reabsorption
44
Q

Osteogenesis imperfecta

A

inherited disorder for type 1 collagen that results in joint laxity and fragile, low density bine
-immature unorganised bone with abnormal cortex

45
Q

Achondroplasia

A

most common cause of disproportionate short stature

  • reduced growth of cartilaginous bone
  • short proximal long bones and wide epiphyses
46
Q

Osgood-Schlatter disease

A

tibial tuberosity apophysitis
children 10-15
- repeated traction causes inflammation and chronic avulsion of the secondary ossification centre –> inflammation
- associated with physical overuse
- pain below the knee is worse on strenuous activity and quadriceps contraction

Treatment- limitation of activity, ice, oral anti-inflammatories, knee padding and physio

47
Q

Steps of fracture healing

A

haematoma

  • -> vascular granulation tissue
  • ->subperiosteal osteoblast stimulation
  • ->bone matrix
  • ->endochonral ossification
  • ->deformable woven bone (callus)
  • ->lamellar bone
  • ->facture union
48
Q

risk factors for poor fracture healing

A 
older age
co-morbidities (esp. DM)
recent trauma
smoker 
osteoporosis
corticosteroids 
NSAIDs
local complications to fractures
49
Q

management of fractures

4 steps

A
  1. Anatomic reduction - realignment of fracture fragments
  2. Stabilisation of fragments to enable normal activity
  3. maintaining neurovascular supply
  4. encouraging early rehabilitation
50
Q

Methods of traction

A
  • skin traction - adhesive strapping to attach load to skin
  • skeletal traction - pin through bone
  • –> fixed traction e.g. Thomas’ spin,
  • -> balanced traction - weight of limb balanced against load
  • -> Gallows traction
51
Q

Managemet of severe open lower limb fractures

A
  1. IV Abx - coamoxiclav
  2. continuous assessment of neurovascular status
  3. Immediate surgery - vascular impairment/ compartment syndrome
  4. Debridement
  5. Cover wound- saline soaked gauze to prevent desiccation
  6. Splint the limb
  7. Vacuum foam dressing/ abx bead pouch until definitive surgery
  8. definitive skeletal stabilisation and wound cover
52
Q

Indications for ORIF

A 
failed conservative treatment 
2 fractures in 1 limb
bilateral identical fractures 
intra-articular fractures 
open fractures 
displaced unstable fractures
53
Q

Plates in ORIF

A

provide strength and stabilse fractures including articular surfaces
specifically designed types exist to counteract various doces in different joints
may heal slower as have to remove periosteum to attach

54
Q

Screws in ORIF

A

combined with other devices

55
Q

Intermedullary nails in ORIF

A

placed in the medullary cavity of long bones

typically used in femoral and tibial shaft fixation

56
Q

Kirschner wires (K-wires) in ORIF

A

often used for closed reduction and percutaneous or internal fixation of fractures
less rigid than plates or screws
easily removed after use

57
Q

ORIF

A

open reduction, internal fixation

  • fractures involving joint articulations
  • stable internal fixation in oder to facilitate healing and reduce serious complications
58
Q

External fixation

A

useful in burns/ loss of skin or bone/ open fractures

  • less disruption of fracture site and associated soft tissue
  • stability of fixation depends on number and site of pins, larger pins, moving rods closer to bone, different planes of pins
59
Q

Complications of fractures

immediate

A 
internal bleeding 
external bleeding 
organ injury 
nerve or skin injury 
vessel injury
60
Q

complications of fractures

local later

A

skin necrosis/ gangrene
pressure sores
infection
non or delayed union

61
Q

complications of fractures

later general

A

venous/ fat embolism
pulmonary embolism
pneumonia
arthritis

62
Q

Compartment syndrome

A

occurs when swelling of tissues in an anatomical compartment occludes the vascular supply –> hypoxia and necrosis
rhabdomyolysis can cause renal failure
- correct hypovolaemia
- monitor urine output and plasma potassium
swelling, redness, mottling and pain on passive muscle stretching
pain is disproportionate to injury

3B General Care (8 decks)

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