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phase 3b > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

How would you manage an extracapsular proximal femoral fracture?

A

1) reduce
2) immobilise: Dynamic hip screw
3) rehab

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2
Q

Which nerve is most likely to be damaged during a knee arthroplasty? and what signs would the pt have?

A

Common peroneal nerve

difficultly dorsiflexing foot when walking (foot drop)

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3
Q

what is compartment syndrome?

A

complication following fracture where there is raised pressure in a closed anatomical space

-pain, parasthesiae, pallor, reduced pulse

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4
Q

what fractures is compartmental syndrome associated with?

A

supracondylar and tibial shaft fractures

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5
Q

Which movement is classically impaired in adhensive capsulitis?

A

External rotation (shoulder)

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6
Q

How would left posterior hip dislocation typically present?

A

Left leg shortened adducted and internally rotated

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7
Q

how would a left leg anterior hip dislocation typically present?

A

left leg abducted and externally rotated

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8
Q

how does slipped upper femoral epiphysis typically present?

A

overweight teen boy (puberty) with knee/hip problems

could have been minor trauma

progressive hip pain, limp, stiffness and reduced ROM

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9
Q

Locking and giving way are common symptoms of

A

Meniscal injury

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10
Q

Risk factors for hip fracture

A

previous hip fracture

osteoporosis

frequent falls

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11
Q

Types of hip fracture

A

1) intracapsular

  • transcervical: through NOF
  • subcapital: above NOF

2) extracapsular

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12
Q

What is the difference between intra/extracapsular fractures

A

Risk of necrosis in intracap because severes blood supply

in extracap the blood supply is intact

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13
Q

How does a hip fracutre present?

A

Shortened leg: reduced angle between neck and shaft of femur

external rotation

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14
Q

How do you describe a fracture?

A

1) position: displaced or not
2) completeness: complete or not
3) orientation: linear, transverse
4) skin penetration: compound (penetrates) simple (doesnt)

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15
Q

What are the stages of fracture healing?

A

1) haematoma and inflam
2) fibrocartilaginous callus formation (soft callus) - days
3) bony callus formation - weeks
4) bone remodelling - months

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16
Q

what happens in the first stage of healing

A

-haematoma and inflam

accumulation of blood causing death of bone cells, swelling and pain

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17
Q

what happens in the second stage of fracture healing?

A

-fibrocartilaginous callus formation

new blood vessels forming, meshwork from granulated tissue by chondrocyres secreting collagen and proteoglycans -> callus which rejoin the fracture

external callus also forming

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18
Q

What happens in the 3rd stage of fracture healing?

A

-bony callus formation

endochondral ossification turns soft callus into hard callus

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19
Q

what happens in the final stage of fracture healing?

A

-Bone remodelling

bony callus-> fine bone which is organised and strong. Compact bone laid down bc increased osteoblast activity

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20
Q

What is osteoporosis

A

low bone mass and deterioration of bone tissue which increases facture risk

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21
Q

what tool is used to assess femoral neck fractures?

A

Garden classification

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22
Q

what is garden 1 fracture

A

incomplete and minimally displaced

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23
Q

what is a garden 2 fracture

A

complete, non-displaced

24
Q

what is a garden 3 fracture?

A

complete fracture and partially displaced

25
Q

what is a garden 4 fracture?

A

completely displaced- no engagement of 2 fragements

26
Q

Where do fragility fractures occur?

A

Distal forearm: Colles

hip: NOF

vertebrae

27
Q

what factors increase pt risk of hip fracture and how would would determine risk?

A

FRAX

  • female
  • age
  • personal Hx and FHx

Meds: corticosteroids

Secondary: RA, CKD, IBD, hyper/hypothyroid

28
Q

How does a vertebral fracture present?

A

back pain

decreased height

29
Q

How do you diagnose a patient with suspected osteoporosis?

A

DEXA scan - produces T score

if T score >-2.5 =osteoporosis

if T Score >-2.5 + fracture = severe OP

T score 1-2.5 = osteopenia

30
Q

How do you manage osteoporosis?

A

Lifestyle

meds

  • Vit D/calcium supplements
  • bisphosphonates (alendronate)
  • Monoclonal Antibodies (denosumab)
  • Forsteo
31
Q

What is pagets?

A

increased osteoclast activiy -> increased osteoblast activity = disordered and weaker bone

32
Q

How does pagets present?

A

affects axial skeleton, normally asx

Bone pain

33
Q

How would you investigate a pt with ?pagets?

A

Bone specifc alkaline phosphatase levels increased

Isotope scans - affected bones in black

X-ray

34
Q

What X-ray findings would you expect to find on ?Pagets

A
  • blade of grass lesions between healthy and diseases long bone
  • cotton wool pattern in the skull
35
Q

how would you manage a pt with Pagets?

A

NSAIDS

IV/PO bisphos (zoledronate)

surgery

36
Q

What are the potential complications of pagets?

A

Triad: pain, deformity, fractures

Deafness: if skull affected

Myelopathy

osteosarcoma: life long monitoring required

37
Q

How does Osteomalacia present?

A

Bone: pain, tenderness, bilat symmetrical fractures

Prox muscle weakness

Lethargy

change in gait

38
Q

Which groups are at risk of Vit D deficiency?

A
  • dark skin
  • clothes covering skin
  • housebound
  • alcoholics
  • poverty
39
Q

What are the causes of Vit d def?

A

insufficient exposure

malabsorption

anti-c

renal failure

40
Q

How do you manage osteomalacia?

A

Increase exposure

vit D supplements: colecalciferol or calcitriol (CKD pt)

41
Q

Why do CKD patietns have to receive calcitriol instead of colecalciferol

A

calcitriol is the active form, needed because dont have enzyme to convert cholecalciferol -> calcitriol

*25(oh)D3-1-alpha-hydroxylase*

42
Q

Typical presentation of hypercalcaemia?

A

Polyuria and polydipsia

Dyspepsia

Depression

cog impairment

43
Q

How does very hight (>3.5mmol/L) hypercalcaemia present?

A

vomiting and abdo pain

dehydration

lethargy

arrhythmias

44
Q

How does middle high hypercalcaemia present (<3.5)

A

muscle weakness

anorexia and nausea

constipation

fatigue

45
Q

blood results and likely cause of hypercalcaemia?

A

high PTH: primary hyperparathryoidism

high albumin and urea: dehydration

high alk phos: boney mets

high plasma protein: sarcoidosis, lymphoma, thyrotoxicosis

46
Q

Most common primary hyperparathyroid cause?

A

adenoma

47
Q

4 year old child developed pain yesterday in L hip when walking. Had chest infection last week, otherwise well

Diagnosis and management

A

Transient synovitis of the hip

Mx: rest and physio, resolves in 2 weeks

48
Q

Classic presentation of Transient synovitis of the hip?

A

acute onset post infection

unilateral

no pain at rest

3-10 years

49
Q

Obese 7 year old boy presents with several week history of increasing pain in R hip, started limping, struggling with sports at school

investigations and diagnosis

A

X-ray: widening joint space and remodelling deformities

-Perthes

50
Q

Classic presentation of Perthes?

A

insidious limp +hip/knee pain

decreased ROM

5-10 year old boys

51
Q

How would you manage Perthes?

A

If <50% fem head affected: bed rest and NSAIds

if >50% affected: plaster cast and surgery

52
Q

what is perthes?

A

Bone remodelling following avascular necrosis of the femoral head causes epiphysis distorsion

53
Q

Overweight 14 year old limping and complaining of pain after being tackled in football yesterday

what is your suspected diagnosis and management plan?

A

Slipped capital femoral epiphysis

X-ray: displacement

Mx: surgical fixation

54
Q

Red flags for paeds limp and condition indicated

A

temp>38.5

WCC>12

CRP>20

not weight bearing

If 3+ of above then BC ± aspiration for ?septic arthritis

55
Q

When would you suspect osteomyelitis and what would your management plan be?

A

acute febrile, pain, swollen, red tender over bone

+ve BC and increased WCC

IV then PO Abx

56
Q

How would you manage Lyme disease?

A

doxy or amox

phase 3b (15 decks)

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