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Finals - Surgery > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

Signs of a Fracture

A
  • Bony Pain
  • Inability to weight bear
  • Decreased ROM
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2
Q

What are the 4 principles of fracture management

A
  1. Resuscitate - pain, bleeding + neurovascular damage
  2. Reduce - restoring anatomical alignment
  3. Restrict - immobilising the fracture
  4. Rehabilitate - PT/OT
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3
Q

What are the stages of bone healing

A
  1. Haematoma
  2. Soft callous
  3. Hard callou
  4. Remodelled to cortical bone
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4
Q

What are the X-ray classifications for bone (SOD)

A
  1. Site
  2. Oliquity
  3. Displacement
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5
Q

Fracture X-ray: what to comment on about site

A
  • Which bone
  • Intra or Extra-articular
  • Which third of the bone (proximal, middle, distal)
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6
Q

Fracture X-ray: what to comment on about obliquity

A
  • Completeness of fracture
  • Direction: spiral, transverse (straight), oblique (at an angle)
  • Skin penetration: open or closed
  • Condition of bone
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7
Q

Fracture X-ray: what are the different conditions the bone can be in?

A
  • Comminuted: 2+ detached pieces
  • Segmented: 2 complete fractures in same bone
  • Multiple: several fracture lines
  • Impacted: compression of ends at break
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8
Q

Fracture X-ray: what to comment on about displacement

A

Describe distal end in relation to proximal

  • Translation: anterior/posterior or medial/lateral
  • Angulation
  • Rotation
  • Length distraction/shortening
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9
Q

Open fracture - Definition

A

Fracture with direct communication between skin + fracture site

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10
Q

Open fracture - Types

A

In-to-out: sharp bone penetrates out through skin

Out-to-in: high energy injury penetrates skin + bone

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11
Q

Open fracture - Common sites

A
  • Tibial
  • Phalangeal
  • Forearm
  • Ankle
  • Metacarpal
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12
Q

Open fracture - What are the aspects to consider

A
  1. Skin: wound size
  2. Soft tissue: degree of muscle/tendon/ligament damage
  3. Neurovascular injury: compression/transection
  4. Infection: high risk
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13
Q

Open Fracture - Initial Management

A

The 6 As

  1. Analgesia
  2. Assess NV status
  3. Antiseptics - swabs, irrigation, dressing)
  4. Alignment
  5. Anti-tetanus - check status
  6. Antibiotics - flucloxacillin + benzylpenicillin
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14
Q

Open Fracture - Definitive Management

A

Debridement + fixation in theatre

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15
Q

Fracture Complications - Immediate

A
  • Neurovascular damage

- Haemodynamic instability

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16
Q

Fracture Complications - Short term

A
  • Compartment syndrome
  • Infection
  • Fat embolism (esp. long bone fracture)
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17
Q

Fracture Complications - Long term

A
  • Delayed union
  • Mal-union
  • Non-union: hypertrophic = wrong direction, atrophic = no growth
  • AVN
  • Growth + articular disturbances
  • Complex regional pain syndromes
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18
Q

Neck of Femur fracture: Cause

A
  • Low-impact (older people): fall

- High-impact: fall from height + road traffic accident

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19
Q

What is the blood supply to the neck of femur

A
  • Retrograde supply

- Medial circumflex femoral artery

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20
Q

Neck of femur fracture: Garden classification

A

I: Non-displaced, incomplete fracture
II: Non-displaced, complete fracture
III: Partially displaced, complete fracture
IV: Fully displaced, complete fracture

21
Q

Neck of femur fracture: Clinical features

A

Hx of trauma –> followed by pain
- can be referred to groin + knee

Inability to weight bear

Shortened, externally rotated leg
Pain on pin-rolling + axial loading

22
Q

Neck of femur fracture: Investigations

A

X-ray in orthogonal views
CK: if long lie
Full femur X-ray: if pathological fracture suspected
Investigate underlying cause of fall

23
Q

Neck of femur fracture: Management

A

ABCDE approach
Analgesia

Surgery

  • Intra-capsular: hip replacement
  • Extra-capsular: dynamic hip screw
  • Sub-trochanteric: intramedullary nail
24
Q

What is a colle’s fracture

A

Extra-articular distal radial fracture

  • Caused by falling on outstretched hand
  • Dorsal: dorsal displacement + dorsal angulation
  • Avulsion (splitting) of ulnar styloid
  • ‘Dinner fork’ sign
25
Q

What is a smith’s fracture

A

Extra-articular distal radial fracture

  • “opposite of colle’s”
  • Caused by falling on dorsiflexed hand
  • Volar: volar angulation +/- volar displacement
26
Q

What is Weber’s classification

A

For lateral malleolus fractures

  • Type A: below level of syndesmosis
  • Type B: at level of syndesmosis
  • Type C: above level of syndesmosis

Higher up more unstable
(i.e. Type C always needs surgery)

27
Q

What is the syndosmosis

A

Ligament that connects the tibia + fibula

28
Q

Osteomyelitis - Definition

A

Infection of the bone

29
Q

Osteomyelitis - Cause

A

Most commonly staph. aureus

30
Q

Osteomyelitis - Risk factors

A

DM
Immunosuppression
Alcohol excess
IVDU (more likely to get P. aeruginosa)

31
Q

Osteomyelitis - Clinical features

A
  • Severe pain in region
  • Low grade fever
  • Immobility of affected area
32
Q

Osteomyelitis - Investigations

A
  • MRI: definitive (imaging) diagnosis

- Bone biopsy: gold standard diagnosis

33
Q

Osteomyelitis - Management

A

Long-term antibiotics - IV flucloxacillin

Curettage of area - if continues to deteriorate

34
Q

Septic Arthritis - Cause

A

Most commonly Staph. aureus

35
Q

Septic Arthritis - Risk Factors

A 
>80yrs
Pre-existing joint disease/joint prosthesis
DM/immunosuppression
Chronic renal failure
IVDU
36
Q

Septic Arthritis - Clinical Features

A

Single, red, warm, swollen joint
Pain on active + passive movement
Pyrexia

37
Q

Septic Arthritis - Investigation

A

Joint aspiration - Gold standard

Inflammatory markers

38
Q

Septic Arthritis - Management

A

Medical: IV abx 2wks + PO abx 4-6wks
Surgical: Irrigation + debridement
Prosthetic joint: washout + revision surgery

39
Q

Compartment syndrome - Definition

A

Critical pressure increase within a confined compartmental space

40
Q

Compartment syndrome - Pathophysiology

A

Typically following: high-energy trauma, crush, fracture

Fluid deposited in fixed fascial compartments causes increase in pressure

41
Q

Compartment syndrome - Common areas

A 
Leg
Thigh
Forearm
Foot + Hand
Buttock
42
Q

Compartment syndrome - Clinical features

A

Severe pain disproportional to injury
Parasthesis of distal compartment
Affected compartment may feel tense

43
Q

Compartment syndrome - Investigation

A

Clinical diagnosis
Intra-compartmental pressure monitor
CK: elevated/trending upwards

44
Q

Compartment syndrome - Management

A

Immediate surgical treatment - urgent fasciotomy

Pre-op: keep limb neutral, remove all dressings, high flow O2

Post-op: skin incisions left open for 24 hours

45
Q

Osteoporosis - Pathophysiology

A

Characterised by:

  • Reduced bone mass
  • Michroarchitectural deterioration

Three mechanisms

  • Failure to achieve adequate peak bone mass
  • Increase in bone resorption
  • Reduction in bone formation
46
Q

Osteoporosis - Causes

A 
Post-menopause
Long-term steroid use
Hyperthyroidism
Malabsorption
Osteomalacia
Anorexia
47
Q

Osteoporosis - Clinical features

A

Asymptomatic

Fragility fractures: low-impact fractures or loss of height
Thoracic kyphosis development

48
Q

Osteoporosis - Investigations

A

DEXA scan - gold standard
Bone turnover markers
Bone profile
Renal, Thyroid, Liver functions - underlying cause

49
Q

Osteoporosis - Management

A

Conservative

  • reduce incidence of fractures: education + support
  • Vitamin C + D supplements
  • Exercise + weight loss

Medical
- Bisphosphonates sometimes used

Finals - Surgery (5 decks)

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