ORTHOPAEDICS Flashcards
1
Q
What class of cell are osteoclasts?
A
Macrophages
2
Q
What type of collagen is in bone?
A
Type 1
3
Q
What are the stages to fracture healing?
A
Haemotoma Inflammation Callus formation Bone union Remodelling
4
Q
In a tension pneumothorax what is the treatment?
A
Cannula insertion into 2nd intercostal space to burst the bubble Chest drain into 5th intercostal space mid axilla
5
Q
What is special about a cast in the first 2 weeks?
A
Not circumferential (allow fracture to swell - reduces risk of compartment syndrome)
6
Q
In a fracture, if a limb can rotate along its long axis what should be done?
A
Plaster cover above and below
7
Q
What are the common organisms in septic arthritis?
A
S. Aureus
S . Gonorrhoea
Salmonella
8
Q
Risk factors for septic arthritis?
A
>80 y/o
Pre-existing joint disease
Diabetes
Chronic renal failure
Joint prosthesis
9
Q
What are the features of septic arthritis?
A
Single swollen joint
Pyrexia
Pain on movement
10
Q
What are some differentials for septic arthritis?
A
Osteoarthritis
Haemarthrosis
RA
11
Q
What are some investigations for septic arthritis?
A
Routine bloods, FBC and CRP
Blood cultures
Joint aspiration (before abx)
Joint fluid analysis
12
Q
What is the management of septic arthritis?
A
Empirical abx treatment
13
Q
What are the main complications of septic arthritis?
A
Osteoarthritis
Osteomyelitis
14
Q
What are some risk factors for osteomyelitis?
A
Diabetes
Immune suppression
Alcohol excess
15
Q
What is the gold standard for diagnosing osteomyelitis?
A
Culture from bone biopsy at debridgement
16
Q
What is the treatment for osteomyelitis?
A
Long term IV antibiotic use
17
Q
What is the pathophysiology of OA?
A
Loss of Articular cartilage
Remodelling of underling bone
18
Q
What are some risk factors for OA?
A
Obesity
Age
Female
Manual labour jobs
19
Q
What are the features of OA?
A
Pain and stiffness in joint worse on activity
20
Q
What are some investigations for OA?
A
Clinical diagnosis usually
XR features:
Loss of joint space
Osteophytes
Subchondral cysts
Subchondral sclerosis
21
Q
What is the management of OA?
A
Strengthening and exercise
Weight loss
Physio
Topical NSAIDs
Intra-Articular steroid injection
Surgery
22
Q
What is an open fracture?
A
Fracture haemotoma is communicating with the outside
23
Q
What can occur as a result of an open fracture?
A
Tissue loss
Neurovascular injury
Infection
24
Q
What is the management in open fractures?
A
Check neurovascular status
Assess evidence of contamination
Need for plastic surgery input should be identified early
25
What classification should be used for open fractures?
Gustilo-Anderson
26
What is the management of open fractures?
Urgent **realignment and splinting** of the limb
Broad spectrum **abx**
**Tetanus** vaccination
**Photograph** wound
27
What are some symptoms of compartment syndrome?
**Pain disproportionate** to the injury
## Footnote
**Parasthesia distally**
28
What is the investigation for Compartment syndrome?
Clinical
Intra-compartmental pressure monitor
29
What is the treatment of compartment syndrome?
Keep limb at **neutral level**
**Fasciotomy**
Monitor renal function closely after to assess potential effects of rhabdomyolysis or reperfusion injury
30
What cancers cause secondary bone cancer?
Renal
Thyroid
Lung
Prostate
Breast
31
What is another term for frozen shoulder?
Adhesive capsulitis
32
What can cause secondary capsulitis?
Subacromial **impingement syndrome**
**Diabetes** mellitus
Previous **surgery**
33
What are the features of adhesive capsulitis?
Generalised **deep and constant pain disturbing sleep**
Causes **stiffness and reduction in function**
Tenderness on palpating with poor localisation of pain
34
Which movement will patients struggle with for adhesive capsulitis?
**External rotation** and **shoulder flexion**
35
What is the differential diagnosis for adhesive capsulitis?
Muscular **tear**
Subacromial **impingement syndrome**
36
How is adhesive capsulitis diagnosed?
Clinically
37
How is adhesive capsulitis managed?
**Education and reassurance**
Management of pain - **paracetamol and NSAIDs**
38
Who typically gets biceps tendonipathy?
Younger patient who are active
39
What are the features of biceps tendonipathy?
**Pain** worse with flexing
**Tenderness** over affected tendon
Disuse **atrophy**
40
What is the management of biceps tendinopathy?
Conservative
Analgesia
Physio
Surgery
41
When do clavicle fractures occur?
Young and female or \>60 (after osteoporosis)
42
How do the medial and lateral clavicle displace after fracture?
Medial = superior - **SCM**
Lateral = inferior - **Weight of arm**
43
How are clavicle fractures management?
Mainly **conservatively** in a sling
44
When do distal biceps tendon rupture?
Sudden **forced extension of a flexed elbow**
45
What are some risk factors for biceps rupture?
Steroid used
Smoking
CKD
46
How is a bicep rupture diagnosed?
**Ultrasound** imaging
47
How are clavicle fractures managed?
Conservatively with **sling**
Early movement of shoulder to **prevent frozen shoulder**
48
What is a complication of a clavicular fracture?
**Non-union**
**Neurovascular injury**
49
What nerve can be damaged in Humeral shaft fractures?
**Radial nerve** (in radial groove)
50
What are some risk factors for Humeral shaft fractures?
**Osteoporosis**
**Older age**
Previous fractures
51
What indicates radial nerve damage in Humeral shaft fracture?
Reduced sensation over 1st dorsal webspace
Weakness in wrist extension
52
What investigations should there be for Humeral shaft fracture?
AP and lateral plain film **radiograph**
53
How is a Humeral fracture managed?
Conservative **re-alignment of the limb**
## Footnote
**Surgery**
54
What are some complications of Humeral shaft fractures?
**Non-union**
**Radial nerve injury**
55
What muscles comprise the rotator cuff muscles?
**Supraspinatus** - abduction
**Infraspinatus** - external rotation
**Teres minor** - external rotation
**Subscapularis** - internal rotation
56
What are the main risk factors for rotator cuff tears?
Age
Trauma
Overuse
Repetitive overhead shoulder motions
57
What are the clinical features of rotator cuff tear?
**Pain** over **lateral aspect of shoulder**
**Inability** to abduct arm **over 90 degrees**
58
What is the investigation for a rotator cuff tear?
Plain film **radiograph** to exclude fracture
**Ultrasound** to assess presence and size of tear
59
What is the management for rotator cuff tear?
**Conservative** (if presenting within 2 weeks)
Surgery
60
What is the main complication of a rotator cuff tear?
Adhesive capsulitis
61
What timeframe classifies an acute rotator cuff tear?
\<3 months
62
What is the most common type of shoulder dislocation?
Anteroinferior
63
When does a posterior shoulder dislocation typically present?
Seizures
64
What nerves can become compromised in a shoulder dislocation?
Axillary nerve
65
Where are bony bankart lesions and hills-sachs defects typically seen?
**Bony-bankart** (fracture of anterior inferior glenoid bone)
**Hill-Sachs defects** (to the Humeral head)
66
What is the management of shoulder dislocations?
**Analgesia**
**Reduction**, immobilisation and rehab
**Physio**
67
What are some complications of Humeral dislocation?
Chronic **pain**, **limited mobility,** **stiffness** and recurrence
68
What can lead to rotator cuff impingement?
Muscular weakness
Shoulder overuse
69
What exaggerates pain in rotator cuff impingement?
**Abduction in shoulder**
70
What is the imaging for rotator cuff impingement?
MRI
71
What is the management of rotator cuff impingement?
**Analgesia**
**NSAIDs**
**Physio**
Surgery
72
How do fractures of the distal femur present?
**Pain in distal thigh**
**Inability to weight bear**
Obvious deformation
Haemarthrosis
73
How are the majority of distal femur fractures treated?
**Surgically**
Non surgically (minimal displacement / very-comorbid)
74
When are femoral shaft fractures seen?
High energy **trauma**
**Fragility** fractures
**Pathological** fractures
75
What blood supply is to the femur?
Penetrating branches of the Profunda femoris artery
76
What is the management for distal femur fracture?
Pain relief (regional blockade?)
Surgery
77
What are some possible complications of femoral shaft fractures?
**Nerve injury**
**Mal union**
**Infection**
Fat embolism
78
What is the **Salter-Harris** classification system used for?
Fractures involving the growth plate
79
What are the types of hip fracture?
**Intracapsular** (above trochanters)
**Extracapsular** (inter-trochanteric/extra-trochanteric - up to cm below the lesser trochanter)
80
What is a risk in displaced Intra-capsular hip fractures?
Avascular necrosis of the hip
81
What is the main blood supply to the hip?
MCFA
82
What are the features of a hip fracture?
Shortened and **externally rotated**
## Footnote
**Pain**
**Inability to weight bear**
83
What are some investigations for hip fractures?
**Radiographs**
Blood tests (FBC, U&Es, coag screen, G&S, CK level)
84
What classification system is used for intracapsular hip fractures?
**Garden system**
85
What is the treatment for UNDISPLACED intracapsular hip fracture ?
Internal fixation or hemiarthroplasty if unfit
86
What is the treatment for displaced intracapsular hip fracture?
Hip **hemiarthroplasty**
87
What is the treatment for extracapsular hip fracture?
**Dynamic hip screw**
88
What are some #NOF complications?
**Prosthetic joint infection**
**Leg length discrepancies**
**Mortality** (30% at 1 year)
89
What are risk factors for hip OA?
**Increasing age**
**Obesity**
**Female** gender
**Vit D** deficiency
Local trauma to hip
90
What are the signs of hip OA?
**Pain in the groin** aggregated by weight bearing
**Stiffness**
Grinding sensation
Antalgic gait
91
What are some differential diagnoses for hip pain?
Trochanteric **bursitis**
## Footnote
**Sciatica**
**Femoral neck fracture**
92
What is the management of hip OA?
**Pain relief**
Advise **weight loss**, regular exercise and smoking cessation
**Physio**therapy
Eventual **hip replacement**
93
What is degenerative disc disease?
**Natural deterioration** of the intervertebral disc structure related to aging
94
What are some signs of degenerative disc disease?
Local **spinal tenderness**
**Contracted** paraspinal **muscles**
**Pain reproduced by raising the extended leg** (Lasegue test)
95
What are some differentials for lower back pain?
Cauda equina syndrome
Degenerative disc disease
Infection
Malignancy
96
What are some red flag symptoms for back pain and cauda equina?
**Faecal incontinence**
Painless **urinary retention**
**Saddle anaesthesia**
97
What are some red flag symptoms for back pain and infection?
**Immunosuppression**
**IV drug user**
**Unexplained fever**
98
What could indicate a fracture is a cause of back pain?
Chronic **steroid use**
## Footnote
**Trauma**
**Osteoporosis**
99
What could indicate that trauma is the cause of back pain?
New onset after 50 years old
100
What are some differentials for lower back pain?
Referred pain (from urinary tract)
Piriformis syndrome
101
What is the management fo radiculopathy?
**Surgery** (unremitting pain, progressive weakness)
**Analgesia**
Amytriptyline (first line neuropathic pain relief)
102
When should imaging for back pain be conducted?
**Red flag symptoms**
**Radiculopathy** with pain for more than 6 weeks
Spinal cord compression
103
What is the gold standard investigation for degenerative disc disease?
**MRI Spine** (mainly clinical diagnosis)
104
What is indicative of degenerative disc disease on MRI?
**Reduction of disc height**
Annular **tears**
105
What is the management of degenerative disc disease?
**Pain relief**
**Encouraging mobility** - physio
106
When is referral to the pain clinic recommended?
**Pain** continuing **after 3 months**
107
What causes the ‘pinched nerve’ in radiculopathy?
Intervertebral **disc prolapse**
Degenerative **disc disease**
**Fracture**
**Malignancy**
**Infection** (osteomyelitis - Potts)
108
What are the features of radiculopathy?
**Paraesthesia**
**Numbness**
Motor **weakness**
109
How does Carpal tunnel syndrome present?
Pain, numbness and paraesthesia in **lateral 3 1/2 digit**
110
What are the risk factors for Carpal tunnel?
**Female**
Increasing **age**
**Pregnancy**
Obesity
111
What conditions is carpal tunnel associated with?
**Diabetes**
**RA**
Hypothyroidism
112
What muscular changes are there in carpal tunnel syndrome?
**Weakness of thumb abduction**
**Wasting of thenar eminence**
113
How is carpal tunnel syndrome managed?
**Wrist splint** work at night preventing flexion
**Physio**
**Corticosteroid injections**
Surgery: decompress carpal tunnel
114
What are some complications of Carpal tunnel surgery?
**Infection**
**Scar formation**
**Nerve damage**
Trigger thumb
115
What occurs in De Quervain’s tenosynovitis?
**Inflammation of tendons in the 1st extensor compartment of the wrist** (extensor pollicis brevis, abductor pollicis longus)
116
What are the risk factors for De Quervain’s tenosynovitis?
30-50
## Footnote
**Female**
**Pregnancy**
117
What are the features of De Quervain’s tenosynovitis?
**Pain near base of thumb**
**Swelling**
Grasping is painful
118
What test can be used to diagnose De Quervain’s tenosynovitis?
**Finkelstein’s test**
119
What is the management of De Quervain’s?
**Avoid repetitive movements**
**Wrist splint**
Steroid injections for pain
Surgical decompression
120
What is a Colles fracture?
**Extra Articular fracture of radius**
Dorsal angulation within 2 cm of joint
(Smiths is the reverse)
121
What are the main risk factors for distal radial fracture?
**Increasing age**
**Female** gender
**Early menopause**
Smoking
122
How to assess the 3 hand nerves after distal radial fracture?
**Median nerve**: abduct thumb & sensory radial side distal 2nd digit
**Ulnar:** adduct thumb & ulnar size distal 5th digit
**Radial**: Extend thumb & touch dorsal surface of 1st webspace
123
How is a radial fracture managed?
**Closed reduction with analgesia**
Physio
124
What are the complications of a distal radial fracture?
**Malunion**
**Median nerve compression**
**OA**
125
What happens in Dupuytren’s contracture?
**Contraction of the longitudinal palmar fascia**
126
What are the risk factors for Dupuytren’s contracture?
**Smoking**
**Alcoholic liver disease**
**Diabetes**
127
What fingers are commonly involved in Dupuytren’s contracture? How is it diagnosed?
**Ring** and **little finger** (clinical diagnosis)
128
What other things should be checked in Dupuytren’s contracture?
**LFTs**
**HbA1c** for associated risk factors
129
What is the management for Dupuytren’s contracture?
**Hand therapy** (keeping it moving)
Surgical: excision of diseased fascia
130
Where do ganglionic cysts arise?
Along **joint** or **tendon**
131
What are the risk factors for ganglionic cysts?
**Female**
**OA**
**Previous joint injury**
132
How does a ganglionic cyst present?
**Smooth spherical painless lump**
**Pressure on nerve** causes localised parasthesia
133
What is the management of ganglionic cysts?
**Monitor for disappearance**
Aspirate / excise
134
What artery supplies the scaphoid?
**Radial artery**
135
What increases the risk of AVN in scaphoid fractures?
As it becomes **more proximal**
136
What are the contents of the anatomical snuffbox?
Radial artery, radial nerve and cephalon vein
137
What are the differentials of wrist pain following trauma?
Distal radial **fracture**
Scaphoid **fracture**
Wrist **sprain**
138
If a scaphoid fracture cant be visualised on a plain X-ray, what should next be tried?
**Repeat XR** in 10-14 days
139
What are some complications of scaphoid fractures?
Avascular necrosis
Non-union
140
What is trigger finger?
**Finger / thumb** clicks or **locks when in flexion** (caused by flexor tenosynovitis)
141
Name 2 risk factors for trigger finger?
Hobby with **prolonged gripping**
## Footnote
**Diabetes**
**Female**
142
What are some differentials for limited finger movement?
**Dupuytren’s contracture**
**Infection**
Ganglion
143
What is the management for trigger finger?
**Splint** to wear at night
Trial **steroid injections**
Surgery: **Percutaneous trigger finger release**
144
What movement does the ACL stabilise?
**Limits anterior translation of the tibia** (relative to the femur)
145
How does an ACL tear present?
Rapid **joint swelling** (ACL is highly vascular)
Significant **pain**
146
Which tests can be used to diagnose an ACL tear?
**Lachman’s Test**
Anterior Drawer Test
147
What is the differential diagnosis for ACL tear?
**Fracture**
**Meniscal tear**
Collateral ligament tear
148
What is the gold standard to assess ACL tear?
**MRI of the knee**
149
What is the management of an ACL tear?
**RICE**
**Physio** to strengthen quads
Surgical repair
150
What is a complication of ACL tear?
Post traumatic **osteoarthritis**
151
What 2 muscles join to form ITT?
**Tensor fasciae latae**
Glut maximus
152
What are risk factors for ITT syndrome?
Repetitive **flexion and extension of the knee**
153
What are the clinical features of ITT syndrome?
**Lateral knee pain exacerbated by exercise**
154
How is ITT syndrome diagnosed?
**Clinically**
MRI to exclude other pathology
155
What is the management of ITT syndrome?
Advise patients to modify exercise (surgery if no improvement)
156
When does a medial meniscal tear occur?
**Trauma** to the **lateral aspect of the knee**
157
What are the features of a medial meniscal tear?
**‘pop’** with immediate pain
Increased joint laxity when testing MCL
158
What is the gold standard investigation for MCL tear?
MRI scanning
159
What are the risk factors for knee OA?
Family history
Increasing **age**
**Obesity**
**Female**
Previous joint injury
160
How is the pain in knee OA?
**Exacerbated by exercise** and relieved by rest
161
What are the differentials for knee pain?
**Meniscal** injury
Referred pain
162
What is the mnemonic for OA XRs?
**LOSS**
**Loss of joint space**
Osteo**phytes**
Subchondral **sclerosis**
Subchondral **cysts**
163
What is the management of knee OA?
**Weight loss**
**Exercise**
**Pain control**
TKR
164
What is the menisci?
**C-shaped fibrocartilage** found in the knee joint
Act as **shock absorbers**
165
How does a meniscal tear present?
**Tearing sensation in knee** with sudden pain
166
How is a meniscal tear diagnosed?
**MRI**
167
Name a complication of meniscal tear?
OA
168
What does the Achilles’ tendon unite?
**Gastrocnemius**
**Soleus**
**Plantaris muscles**
Inserting into the calcaneus
169
What are the risk factors for Achilles tendonitis / rupture?
Unfit individual with **sudden increase in activity**
**Poor footwear** choice
**Male** gender
**Obesity**
Recent **fluroquinolone** use
170
How does Achilles tendonitis present?
**Gradual onset pain** worse on movement
## Footnote
**Tenderness on palpating**
171
How does Achilles’ tendon rupture present?
**Loss of power** on ankle **plantarflexion**
172
How is an Achilles tendonitis investigated?
**Ultrasound**
173
How is Achilles tendonitis managed?
**Stop precipitating exercise**
**Ice** the area
Use **anti-inflammatory medication**
174
How is Achilles rupture managed?
**Analgesia**
**Immobilisation**
Surgery
175
What are the three bones of the ankle?
Tibia
Fibula
Talus
176
What classification is used for ankle fractures?
**Weber** classification
177
How does an ankle fracture present?
**Ankle pain** following trauma
178
What ‘rules’ determine if an ankle fracture should be x-rayed?
**Ottawa** ankle rules
179
What surgery can be used for ankle fractures?
**ORIF** (open reduction and internal fixation)
180
What is the main risk following ankle fracture?
Post traumatic **arthritis**
181
What is the main differential for an ankle fracture?
Ankle sprain
182
What ligaments are commonly injured in an ankle fracture?
**Anterior talofibular ligament**
**Calcaneofibular** ligament (CFL)
Following inversion injury
183
What are the main risk factors for Hallux Valgus?
**Female**
**Connective tissue disorder**
**Hypermobility** syndrome
184
How does Hallux Valgus present?
**Painful medial prominence**
**Lateral deviation** of the **Hallux**
185
What are some differentials for 1st toe pain?
**Gout**
**Septic arthritis**
**OA**
RA
186
What is the imaging of choice for Hallux Valgus?
**XR** (signs of subluxation)
187
What is the management of Hallux Valgus?
**Analgesia**
**Adjust footwear**
Physio
188
What are some complications of Hallux Valgus?
Avascular **necrosis**
## Footnote
**Reduced ROM**
189
What is the most common cause of infracalcaneal pain?
**Plantar fasciitis**
190
Name some risk factors for plantar fasciitis?
**High arches**
Excessive running
**Leg length discrepancy**
Obesity
191
When is the pain of plantar fasciitis worse?
After periods of inactivity
192
What is the management of plantar fasciitis?
**Activity moderation**
Regular analgesics (**NSAIDs**)
**Corticosteroid** injection
193
What muscles are innervated by the median nerve?
Lateral 2 lumbicals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
