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Specialities > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

What are the two main types of postoperative infection?

A

Superficial:

  • skin
  • subcutaneous tissue
  • occurs within 30 days

Deep:

  • to fascia and muscle
  • occurs within 30 days or 90 days if prosthetic
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2
Q

What are the most common organisms to cause postoperative infection in a hip arthroplasty?

A

Coagulase negative Staph

Staph Aureus

Strep - 9%

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3
Q

What are some risk factors for post opp infection in ortho?

A

Patient factors:

  • immunosuppressed
  • diabetic
  • malnourished
  • elderly

Trauma factors:

  • Trauma related injury
  • Open wounds
  • open fracture

Surgical factors:

  • long operating time
  • complicated surgery
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4
Q

How should post operative wound infections be managed?

A

Contact orthopaedic on call

Bloods:
- FBC 
- CRP 
- U&ES 
- G&S
\+/-
- blood cultures
  • Wound swaps
  • only commence antibiotics after wound swab and with senior ortho guidance.
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5
Q

Why is it so important to get swabs of wound or isolation cultures of in the infection prior to antibiotics starting?

A

The infections can be very difficult to treat. Especially in prosthetic joints, and require large amounts of antibiotics. As such getting the right antibiotics first time is helpful.

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6
Q

What is the predominant blood supply to scaphoid bone?

A

Dorsal Carpal Branch of the radial artery

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7
Q

What advice should be given to someone who has had a hip replacement, to avoid dislocation?

A

Don’t flex hips beyond 90 degrees

Avoid deep seats

Don’t sit crossed legged

Sleep on back for 1st 6 weeks

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8
Q

Name some x-ray signs seen with Pagets disease:

A

Skull:

  • Osteoporosis Circumscripta - areas of radiolucency in a circle
  • Cotton wool appearance
  • Tam O’Shanter sign - looks like person is wearing a hat

Pelvis:

  • Cortical thickening
  • Acetabular thickening

Long bones:

  • Blades of grass
  • Candle flame sign

Spine:
- squaring of the vertebrae

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9
Q

What signs on x-ray may be seen in osteomalacia?

A

Looser zones
- pseudofractures

Trefoil Pelvis

  • Lateral indentation of acetabulum
  • causes issues with cephalo-pelvis disproportion

Protrusio acetabuli
- medial indentation of the acetabulum

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10
Q

List some clinical findings seen in Ricket’s:

A

Skull:

  • Delayed fontanelle closure
  • Frontal bossing
  • Craniotabes

Chest:

  • Rachitic rosary/ Beading of the ribs (beads at costochondral joints)
  • Harrison’s grooves

Limbs:

  • Widening of wrists
  • Genu varum/ Valgus
  • Wind Swept look

Spine:
- Kyphosis

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11
Q

In osteoporosis what do you expect the blood results to show:

A

Calcium
- normal

Vitamin D
- normal

PTH
- normal

**this contrasts with osteomalacia in which you expect the opposite and PTH to be high

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12
Q

What is a urinary investigation that can be done into Paget’s disease?

A

Hydroxyproline

- break down of collagen

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13
Q

What is ulnar’s paradox?

A

The more proximal the lesion (i.e on the elbow) he lesser the deformity. Where as the more distal the lesions the worse the deformity

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14
Q

What are some common complications of a hip dislocation?

A

AVN - set in within 4 hours

Sciatic nerve pain

Recurrent dislocations

OA

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15
Q

List some core features of adhesive capsulitis:

A

Typically seen in diabetics.

  • reduction in all planes especially external rotation
  • active and passive movements are painful
  • worse in morning
  • varies between freezing phases and recovery phases
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16
Q

What is the management of cubital tunnel syndrome?

A

Soft Elbow Splints

Decompression surgery

  • cubital tunnel release, ligamental tunnel is removed and scar tissue is removed
  • anterior transposition of ulnar nerve
  • medial epicondylectomy

*steroid injections are not used to due risk of injury to the nerve

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17
Q

List some differentials for a stuck finger:

A

Dupuytren’s contraction

Posterior interosseous nerve palsy (radial nerve)

Locked trigger finger

Subluxed MCPs

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18
Q

List some differentials for radial side wrist pain:

A

De Quervain’s Tenovaginits

Radial fracture

Scaphoid fracture

Thumb CMC joint OA

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19
Q

Which population of people are affected more severely from RA?

A

Black Caribbean

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20
Q

In a joint aspiration in suspected septic arthritis/ swollen joint, what investigations are done on the sample?

A

Visual examination
- cloudy/ colour

Gram staining
Microscopy
Culture

Crystal examination

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21
Q

What drug is used in septic arthritis if allergic to penicillin?

A

Clindamycin

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22
Q

What are some of the co-moralities seen in Psoratic arthritis?

A 
Cardiovascular disease - 30% 
Ischemia - 10% 
Lymphoma 3% 
Obesity - 30% 
Uveitis - 20% 
Osteoporosis
23
Q

What is another name for the straight leg test and when is it positive?

A

Lasegue sign

At 30 degrees if painful = positive sign

24
Q

What x-rays should you order for a Lisfranc injury and what findings would you see on the x-ray?

A

Weight baring foot x-ray
and
Stress foot- graph

Miss-alignment of 1st and 2nd rays.
medial border of the base of the 2nd won’t align with the medial cuneiform

25
Q

Is a infected prosthetic joint drained to dryness like a native?

A

No.

This can be detrimental

26
Q

What is the most important aspect to consider in management of a fracture:

A

Soft tissue injury
- this should be done first to assess for bleeding or nerve damage.

Following this:
- reduction

27
Q

What is the best investigation for assessing a intra-articular fracture?

A

CT Scan

28
Q

What structures pass through the Carpal tunnel?

A

Median Nerve
4 x Flexor Digitorum Superficialis
4 x Flexor Digitorum profundus
Flexor Pollicis Longus

29
Q

What muscles does the median nerve supply and which is the most sensitive for assessing the degree of muscle weakness causes by the damaged to the median nerve?

A

Lateral (2) Lumbricals
Opponens Pollicis
Abductor Pollicis Brevis
Flexor Pollicis Brevis

  • testing Abduction of the thumb is most sensitive
  • abduction is pointing the thumb away from the palmer plane *towards the sky if palms are facing up.
30
Q

What is the management for Carpal tunnel syndrome?

A 
NIght splints 
Steroid Injections (especially during pregnancy)

Carpal tunnel decompression surgery
- divided longitudinally not transversely - prevent damage to structures

31
Q

In cubital tunnel syndrome, what structures does the ulnar nerve pass between?

A

Two heads of the Flexor Carpi Ulnaris
and
Cubital Tunnel Retinaculum

32
Q

What are the symptoms of cubital tunnel syndrome? and what is the management?

A

Reduced power in the nerve distrupution and sensation
*Little finger abduction severely reduced

Clawing of digits
Hypothenar wasting
Interosseous muscle wasting

Treatment:

  • Night splints
  • Decompression surgery

**steroid injections are not warranted due to risk of damaging the nerve

33
Q

Trigger finger is caused by constriction and thickening of what structure? and how is it treated?

A

Thickening of the flexor tendon
or
A1 pulley
- prevents extension of the finger

treated:
- night splints
- Steroid injection - single injection
- surgery on the A1 pulley

34
Q

What disease is also known as Viking’s disease and how does it inherit?

and what is the pathology?

A

Dupuytren’s contracture

  • Autosomal Dominant

Proliferation of myofibroblasts on the palmar fascia producing nodules and cords.

35
Q

What are the therapies available for Dupeytrens contracture?

A

Medical:

  • hand therapy
  • injectable collagenases to dissolve the fibrosis plaques

Surgical:

  • Needle aponeurotomy
  • Fasciectomy
  • Dermofasciectomy
  • finger amputation
36
Q

List some differentials for stuck fingers:

A 
Dupeytrens contraction 
Palsy of the posterior interrouses nerve 
Subluxed MCPJs (often seen with RA)
37
Q

List some differentials for radial sided wrist pain:

A

De Quervain’s stenosing tenovaginitis

Scaphoid fracture

Radial styloid fracture

Thumb OA

Scaphotrapeziotrapezoid arthritis

38
Q

What is the pathology of DE Quervain’s stenosing tenovaginitis? and what is the diagnostic test.

What is the treatment?

A

Stenosis of the 1st dorsal extensor compartment

  • Extensor pollicis brevis
  • Abductor Pollicis longus

Test:
- Finkelstein test - moving hand in an ulnar position to elecit pain

Treatment:

  • Splinting
  • Steroid injection

Surgical:
- decompression of the 1st dorsal extensor compartment

39
Q

What are the treatment options for a ganglion cysts?

A

leave alone
Aspirate
Surgically remove

40
Q

List some differentials for lumps and bumps on the hands:

A

Ganglion cysts

Giant cell tumour

Heberden’s nodes, Bouchard’s nodes

Enchondroma

  • often presents with pathological fracture
  • benign

Skin lesions

Gouty Tophi

41
Q

What are some of the causes of Subacromial impingement syndrome?

A

Intrinsic:

  • muscle weakness
  • overuse of joint
  • degenerative disease

External:

  • Hook shaped acromion (type III)
  • Glenohumoral instability
42
Q

What tests can be done to examine for subacromial impingement syndrome?

A

Painful Arc
- pain 60-120 degrees

Neer’s test

Hawkin’s test

43
Q

What test can be done to assess for damage to the rotator cuff muscle, naming the specific muscles being exmained:

A

Empty cans test
- supraspinatus

External rotation
- infraspinatus

Hornblower sign

  • Tere’s minor
  • affected side will raise significantly higher

Belly press/ lift off
- Subscapularis

44
Q

Name the bones that are typically affected by avascular necrosis:

A

Head and neck of femur

Scaphoid

Talus

45
Q

If an elderly patient has had flu like symptoms for the past month and weight loss, and currently has a painful lower back then what are your differentials?

A

Metastasis

Osteomyelitis/ discitis

Osteoporosis

Mechanical back pain

46
Q

What are some of the long term consequences of a hip replacement?

A

Chronic pain and stiffness

Leg shortening

Joist loosening requiring further surgery

47
Q

What is the diagnostic test of choice for carpel tunnel syndrome?

A

Electromyography

- nerve conduction tests

48
Q

Which clinical test can be done to establish weakness in the ulnar nerve, helping to differentiate between median nerve and ulnar nerve?

A

Froment’s test

- testing strength of pincer grip

49
Q

What are the two x-ray signs seen of osteosarcomas?

A

Codman’s Triangle
- as it pulls up over the periosteum

Sun burst appearance

50
Q

What features on an x-ray generally make a mass suggestive of malignancy?

A

Poor irregular borders

Cortical destruction

Soft tissue involvement

51
Q

What staging criteria is used for bone tumours?

A

Enneking Stage System

52
Q

What are some of the red flag symptoms of bone sarcoma?

A

Non- mechanical bone / joint pain

Bone pain at night

Pathological fracture

Bone swellings

53
Q

Which muscle contracts the DIPJ and which the IPJ of the hand?

A

DIPJ: Flexor Digitorum Profundus

IPJ: Flexor Digitorum Superficialis

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