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Finals > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

What is meant by a pathological fracture

A

Fracture through an abnormal bone e.g. osteoporosis, tumour/mets, osetemalacia, Pagets disease

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2
Q

How many points are allocated to each aspect of GCS

A

Eyes 4
Voice 5
Motor 6

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3
Q

Describe GCS assessment of eyes

A

1 - wont open
2 - open to pain
3 - open to voice
4 - spontaneously open

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4
Q

Describe the GCS assessment of voice

A 
1 - no voice
2 - incomprehensible
3 - inappropriate
4 - confused
5 - orientated
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5
Q

Describe the GCS assessment of motor

A 
1 - none
2- abnormal extension (decerebrate)
3 - abnormal flexion (decorticate)
4 - flexion to withdraw from pain
5 - moves to localise pain
6 - obeys commands
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6
Q

Early complications of a fracture

A 
DVT/PE
Avascular necrosis
Wound infection
Osteomyelitis
Compartment syndrome
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7
Q

Late complications of a fracture

A 
Mal-union, Non-union
Delayed union
Infection
Stiffness
Instability
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8
Q

Delayed union of a fracture is classed as non-union how long after the injury?

A

6 months

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9
Q

Risk factors for incomplete bone healing

A 
Joint instability
Infection
Segmental fracture
Areas of low blood supply - scaphoid, distal tibia, 5th MTP
DM
Smoker
HIV
Steroids
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10
Q

What are the 6 Ps of critical limb ischaemia

A 
Pain
Pallor
Pulseless
Paralysis
Paraesthesia
Perishingly cold
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11
Q

Signs/symptoms of a fracture

A 
Pain, swelling, tenderness
Mobile at fracture site
Loss of limb function
Neurovascular compromise distally
Crepitus
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12
Q

What are the 3 types of nerve injury from fractures

A

Neuropraxia
Axonotmesis
Neurotmesis

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13
Q

Management of a fracture

A

Wound care and analgesia

  1. Reduction (closed/open)
  2. Stabilisation/fixation (internal/external)
  3. Rehabilitation
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14
Q

What are the 2 broad types of hip fracture

A

Intracapsular

Extracapsular

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15
Q

Describe the Garden classification of intracapsular hip fractures

A

1 - undisplaced + incomplete
2 - undisplaced + complete
3 - partly/incompletely displaced
4 - completely displaced

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16
Q

Management of Garden hip fractures type 1 and 2

A

Dynamic hip screw (internal fixation)

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17
Q

Management of Garden hip fractures type 3 and 4

A

Hemi/total arthoplasty

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18
Q

When describing fractures what are the 3 main questions you need to think about

A

Which bone
Which bit of that bone
How is it broken

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19
Q

When describing how a bone is broken what descriptive categories can you use

A 
Complete/incomplete
Transverse/spiral/oblique
Non-displaced/angulated/displaced
Distracted/impacted
Simple/segmental/comminuted
Open/closed
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20
Q

OA affects mostly which joints

A

Hip, knee, hand, spine, shoulder

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21
Q

Secondary causes of OA

A

Metabolic: gout/pseudogout, haemochromatosis, Wilsons
Neuropathic: DM, syphilis
Anatomical: slipped epiphysis, Perthes disease
Traumatic: injury, fracture, surgery
Inflammatory arthritis

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22
Q

Clinical features/symptoms of OA

A

Pain and stiffness that gets worse with activity
Sometimes swelling
Giving way/locking
Decreased ROM
Bony deformities - heberdens nodes, bouchards nodes, squaring of the thumb base
Crepitus
Joint line tenderness

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23
Q

Heberdens nodes affect which joint

A

DIP

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24
Q

Bouchards nodes affect which joint

A

PIP

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25
Q

X-ray findings of OA

A

Loss of joint space
Subchondral sclerosis
Subchondral cysts
Osteophytes

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26
Q

Management of OA

A 
Conservative: weight loss, exercise, physio
Analgesia - NSAIDs + paracetamol + PPI
Intra-articular steroid injections
Orthoses
Surgery
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27
Q

Bone density T score for osteopenia

A

-1 to -2.5

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28
Q

Normal bone density T score

A

Over -1

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29
Q

Osteoporosis bone density T score

A

Less than -2.5

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30
Q

Risk factors for osteoporosis

A 
Female
Low BMI
Maternal FH
Steroid use
Aromatase inhibitors
Smoking
Alcohol
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31
Q

Diseases that can cause osteoporosis

A

Hyperthyroidism
Hyperparathyroidism
Cushings
Vitamin D deficiency

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32
Q

Management of osteoporosis

A

Falls prevention
Bisphosphonates (Alendronic acid)
Ca/Vit D replacement

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33
Q

Differentials of childhood leg pain

A 
Transient synovitis of the hip
Perthes disease
Slipped upper femoral epiphysis
Developmental dysplasia of the hip
Juvenile idiopathic arthritis
Tumour
Referred pain - malignancy, testicular, appendix
NAI
Joint sepsis/osteomyelitis
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34
Q

Classic findings of a fractured neck of femur

A

Classically the affected leg is shortened, ABducted and externally rotated
Exacerbation of pain on palpation of the greater trochanter
Pain is exacerbated by rotation of the hip

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35
Q

Typical presentation and management of transient synovitis of the hip

A

Boy aged around 5
Acute mild/moderate hip pain and limp following recent URTI or gastroenteritis
Limited movement, positive leg roll, sometimes abducted and externally rotated

Usually resolves after 7-10 days, management is supportive with analgesia and activity restriction

36
Q

What is Perthes disease

A

Decreased blood supply to femoral epiphysis –> avascular necrosis, remodelling, deformity, secondary OA

37
Q

Typical presentation of Perthes disease

A

Boys aged around 5

Painless limp, usually unilateral, decreased ROM, short stature, pain worse with activity, asymmetrical limb length

38
Q

Typical presentation of slipped upper femoral epiphysis

A

Adolescent/puberty
Associated obesity, hypothyroidism or metabolic disorder
Pain, limp, external rotation upon flexion of the hip
Restricted range of movement

39
Q

Typical presentation of developmental dysplasia of the hip

A

Newborn girls
Hip subluxation/dislocation
Asymmetrical leg folds, asymmetrical hip abduction, delayed crawling

40
Q

Back pain differentials

A 
Mechanical
Disc herniation
Spinal stenosis
Fracture
Discitis/osteomyelitis/spinal abscess
Malignancy
Inflammatory arthropathy
Cauda equina syndrome
Referred: peptic ulcer, AAA, pyelonephritis
41
Q

At what level does the spinal cord end and cauda equina start

A

T12/L1

42
Q

Sciatic nerve root levels

A

L4 + L5

S1,2,3

43
Q

Back pain red flags

A 
Thoracic pain
Leg weakness
Incontinence
Fever
Saddle anaesthesia
History of cancer
44
Q

Typical presentation of spinal stenosis

A

Neurogenic claudication - Leg/back pain, weakness, numbness bought on by walking

45
Q

Differential diagnosis of shoulder pain

A 
Subachromial impingement
Bursitis
Referred pain from neck
Rotator cuff tear
RA
OA
Frozen shoulder
46
Q

Typical symptom complaint of shoulder impingement

A

Pain and weakness with overhead movements

47
Q

Risk factors for bursitis

A 
Occupation with repetitive mechanical stress
Nearby joint infection
OA
RA
Gout/pseudogout
48
Q

Typical symptom complaint of bursitis

A

Localised pain, worse with movement, over months and has flare ups

49
Q

Risk factors for frozen shoulder

A 
Female
Shoulder injury or surgery
DM
Thyroid disease
Previous frozen shoulder
50
Q

Describe the 4 typical stages of frozen shoulder (adhesive capsulitis)

A

1 - lateral shoulder pain, worse at night, only slight reduction to range of movement
2 - pain and ROM get worse
3 - pain only on extremes of movement but loss of ROM really bad
4 - negligible pain but profound loss of ROM

51
Q

How long does frozen shoulder typically take to resolve

A

18-24 months

52
Q

How long after intra-articular steroid injections do you have to wait before you could have implant/prosthesis surgery

A

3 months

53
Q

What are the muscles of the rotator cuff

A

Supraspinatus
Infraspinatus
Subscapularis
Teres minor

54
Q

What action does the supraspinatus muscle facilitate

A

Abduction of the shoulder

55
Q

What action does the subscapularis muscle facilitate

A

Internal rotation of the shoulder

56
Q

The infraspinatus muscle and teres minor facilitate which movement

A

External rotation of the shoulder

57
Q

Which nerve supplies the supraspinatus muscle

A

Suprascapular nerve

58
Q

Which nerve supplies the subscapularis muscle

A

Upper and lower subscapular nerves

59
Q

Which nerve supplies the infraspinatus muscle

A

Subscapular nerve

60
Q

Which nerve supplies teres minor

A

Axillary nerve

61
Q

What does pain upon the Hawkins-Kennedy test suggest

A

Supraspinatus impingement

62
Q

What are the two tests for shoulder impingement

A

Hawkins-Kennedy

Scarf test

63
Q

What are the three tests for the rotator cuff

A

Empty can test
External rotation against resistance
Gerber’s lift-off test

64
Q

Which muscle does Gerbers lift off test assess

A

Subscapularis

65
Q

Which muscles does external rotation of the shoulder against resistance assess

A

Infraspinatus and teres minor

66
Q

Which muscle does the empty can test assess

A

Supraspinatus

67
Q

Low arc pain on abduction of the shoulder suggests what

A

Supraspinatus impingement

68
Q

High arc pain on abduction of the shoulder suggests what

A

ACJ injury/pathology

69
Q

Loss of shoulder external rotation is common in which disease process

A

Frozen shoulder

70
Q

Winging of the scapula suggests damage to which nerve

A

Long thoracic nerve

71
Q

Typical clinical features of meniscal tears

A 
Knee pain worse on weight bearing or activity
Joint line tenderness
Restricted knee extension
Locked knee
Clicking/popping/locking of knee joint
Intermittent joint effusion
72
Q

What special test in examination can assess for knee meniscal tears

A

McMurray’s test

73
Q

What aspects of the history can be used to differentiate meniscus tear from knee ligament injuries

A

Meniscal tears - axial loading and rotation with fixed foot or degenerative changes are mechanism of injury. You get delayed slow onset effusion. There is palpable popping/clicking/locking of the knee with maneuvers

Knee ligaments - varus or valgus stress is mechanism of injury. Rapid onset effusion. Absent popping sensation.

74
Q

Features of L3 nerve root compression

A

Sensory loss over anterior thigh
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test

75
Q

Features of L4 nerve root compression

A

Sensory loss anterior aspect of knee
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test

76
Q

Features of L5 nerve root compression

A

Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test

77
Q

Features of S1 nerve root compression

A

Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test

78
Q

Describe the femoral stretch test

A

This is a test for irritation of higher nerve roots - L4 and above.

The patient is positioned lying face downwards, and with the knee flexed, the hip is lifted into extension. Lumbar root irritation tension may cause pain to be felt in the front of the thigh and the back.

79
Q

An elderly man with bone pain, raised ALP but normal Ca and PO4 is typical of which diagnosis

A

Pagets disease

80
Q

If a FRAX score shows intermediate risk what should you do

A

Arrange a bone mineral density scan

81
Q

Describe a Colle’s fracture

A

Fall onto extended outstretched hand
Classical Colles’ fractures have the following 3 features:

  1. Transverse fracture of the radius
  2. 1 inch proximal to the radio-carpal joint
  3. Dorsal displacement and angulation of distal fragment
82
Q

Describe a Smiths fracture

A

Palmar angulation of distal radius fragment (Garden spade deformity)
Caused by falling backwards onto the palm of an outstretched hand or falling with wrists flexed

83
Q

Describe Bennetts fracture

A

Intra-articular fracture of the first carpometacarpal joint
Impact on flexed metacarpal, caused by fist fights
X-ray: triangular fragment at ulnar base of metacarpal

84
Q

Describe Monteggia’s fracture

A

Dislocation of the proximal radioulnar joint in association with an ulna fracture
Fall on outstretched hand with forced pronation
Needs prompt diagnosis to avoid disability

85
Q

Describe Galeazzi fracture

A

Radial shaft fracture with associated dislocation of the distal radioulnar joint
Direct blow

86
Q

Describe Pott’s fracture

A

Bimalleolar ankle fracture

Forced foot eversion

87
Q

Describe Barton’s fracture

A

Distal radius fracture (Colles’/Smith’s) with associated radiocarpal dislocation
Fall onto extended and pronated wrist

Finals (32 decks)

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