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Surgery - DONE > ORTHOPAEDICS > Flashcards

ORTHOPAEDICS Flashcards

1
Q

What class of cell are osteoclasts?

A

Macrophages

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2
Q

What type of collagen is in bone?

A

Type 1

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3
Q

What are the stages to fracture healing?

A

Haemotoma Inflammation Callus formation Bone union Remodelling

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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

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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)

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6
Q

In a fracture, if a limb can rotate along its long axis what should be done?

A

Plaster cover above and below

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7
Q

What are the common organisms in septic arthritis?

A

S. Aureus

S . Gonorrhoea

Salmonella

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8
Q

Risk factors for septic arthritis?

A

>80 y/o

Pre-existing joint disease

Diabetes

Chronic renal failure

Joint prosthesis

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9
Q

What are the features of septic arthritis?

A

Single swollen joint

Pyrexia

Pain on movement

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10
Q

What are some differentials for septic arthritis?

A

Osteoarthritis

Haemarthrosis

RA

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11
Q

What are some investigations for septic arthritis?

A

Routine bloods, FBC and CRP

Blood cultures

Joint aspiration (before abx)

Joint fluid analysis

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12
Q

What is the management of septic arthritis?

A

Empirical abx treatment

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13
Q

What are the main complications of septic arthritis?

A

Osteoarthritis

Osteomyelitis

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14
Q

What are some risk factors for osteomyelitis?

A

Diabetes

Immune suppression

Alcohol excess

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15
Q

What is the gold standard for diagnosing osteomyelitis?

A

Culture from bone biopsy at debridgement

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16
Q

What is the treatment for osteomyelitis?

A

Long term IV antibiotic use

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17
Q

What is the pathophysiology of OA?

A

Loss of Articular cartilage

Remodelling of underling bone

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18
Q

What are some risk factors for OA?

A

Obesity

Age

Female

Manual labour jobs

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19
Q

What are the features of OA?

A

Pain and stiffness in joint worse on activity

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20
Q

What are some investigations for OA?

A

Clinical diagnosis usually

XR features:

Loss of joint space

Osteophytes

Subchondral cysts

Subchondral sclerosis

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21
Q

What is the management of OA?

A

Strengthening and exercise

Weight loss

Physio

Topical NSAIDs

Intra-Articular steroid injection

Surgery

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22
Q

What is an open fracture?

A

Fracture haemotoma is communicating with the outside

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23
Q

What can occur as a result of an open fracture?

A

Tissue loss

Neurovascular injury

Infection

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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

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25
Q

What classification should be used for open fractures?

A

Gustilo-Anderson

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26
Q

What is the management of open fractures?

A

Urgent realignment and splinting of the limb

Broad spectrum abx

Tetanus vaccination

Photograph wound

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27
Q

What are some symptoms of compartment syndrome?

A

Pain disproportionate to the injury

Parasthesia distally

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28
Q

What is the investigation for Compartment syndrome?

A

Clinical

Intra-compartmental pressure monitor

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29
Q

What is the treatment of compartment syndrome?

A

Keep limb at neutral level

Fasciotomy

Monitor renal function closely after to assess potential effects of rhabdomyolysis or reperfusion injury

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30
Q

What cancers cause secondary bone cancer?

A

Renal

Thyroid

Lung

Prostate

Breast

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31
Q

What is another term for frozen shoulder?

A

Adhesive capsulitis

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32
Q

What can cause secondary capsulitis?

A

Subacromial impingement syndrome

Diabetes mellitus

Previous surgery

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33
Q

What are the features of adhesive capsulitis?

A

Generalised deep and constant pain disturbing sleep

Causes stiffness and reduction in function

Tenderness on palpating with poor localisation of pain

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34
Q

Which movement will patients struggle with for adhesive capsulitis?

A

External rotation and shoulder flexion

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35
Q

What is the differential diagnosis for adhesive capsulitis?

A

Muscular tear

Subacromial impingement syndrome

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36
Q

How is adhesive capsulitis diagnosed?

A

Clinically

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37
Q

How is adhesive capsulitis managed?

A

Education and reassurance

Management of pain - paracetamol and NSAIDs

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38
Q

Who typically gets biceps tendonipathy?

A

Younger patient who are active

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39
Q

What are the features of biceps tendonipathy?

A

Pain worse with flexing

Tenderness over affected tendon

Disuse atrophy

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40
Q

What is the management of biceps tendinopathy?

A

Conservative

Analgesia

Physio

Surgery

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41
Q

When do clavicle fractures occur?

A

Young and female or >60 (after osteoporosis)

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42
Q

How do the medial and lateral clavicle displace after fracture?

A

Medial = superior - SCM

Lateral = inferior - Weight of arm

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43
Q

How are clavicle fractures management?

A

Mainly conservatively in a sling

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44
Q

When do distal biceps tendon rupture?

A

Sudden forced extension of a flexed elbow

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45
Q

What are some risk factors for biceps rupture?

A

Steroid used

Smoking

CKD

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46
Q

How is a bicep rupture diagnosed?

A

Ultrasound imaging

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47
Q

How are clavicle fractures managed?

A

Conservatively with sling

Early movement of shoulder to prevent frozen shoulder

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48
Q

What is a complication of a clavicular fracture?

A

Non-union

Neurovascular injury

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49
Q

What nerve can be damaged in Humeral shaft fractures?

A

Radial nerve (in radial groove)

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50
Q

What are some risk factors for Humeral shaft fractures?

A

Osteoporosis

Older age

Previous fractures

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51
Q

What indicates radial nerve damage in Humeral shaft fracture?

A

Reduced sensation over 1st dorsal webspace

Weakness in wrist extension

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52
Q

What investigations should there be for Humeral shaft fracture?

A

AP and lateral plain film radiograph

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53
Q

How is a Humeral fracture managed?

A

Conservative re-alignment of the limb

Surgery

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54
Q

What are some complications of Humeral shaft fractures?

A

Non-union

Radial nerve injury

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55
Q

What muscles comprise the rotator cuff muscles?

A

Supraspinatus - abduction

Infraspinatus - external rotation

Teres minor - external rotation

Subscapularis - internal rotation

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56
Q

What are the main risk factors for rotator cuff tears?

A

Age

Trauma

Overuse

Repetitive overhead shoulder motions

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57
Q

What are the clinical features of rotator cuff tear?

A

Pain over lateral aspect of shoulder

Inability to abduct arm over 90 degrees

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58
Q

What is the investigation for a rotator cuff tear?

A

Plain film radiograph to exclude fracture

Ultrasound to assess presence and size of tear

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59
Q

What is the management for rotator cuff tear?

A

Conservative (if presenting within 2 weeks)

Surgery

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60
Q

What is the main complication of a rotator cuff tear?

A

Adhesive capsulitis

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61
Q

What timeframe classifies an acute rotator cuff tear?

A

<3 months

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62
Q

What is the most common type of shoulder dislocation?

A

Anteroinferior

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63
Q

When does a posterior shoulder dislocation typically present?

A

Seizures

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64
Q

What nerves can become compromised in a shoulder dislocation?

A

Axillary nerve

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65
Q

Where are bony bankart lesions and hills-sachs defects typically seen?

A

Bony-bankart (fracture of anterior inferior glenoid bone)

Hill-Sachs defects (to the Humeral head)

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66
Q

What is the management of shoulder dislocations?

A

Analgesia

Reduction, immobilisation and rehab

Physio

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67
Q

What are some complications of Humeral dislocation?

A

Chronic pain, limited mobility, stiffness and recurrence

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68
Q

What can lead to rotator cuff impingement?

A

Muscular weakness

Shoulder overuse

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69
Q

What exaggerates pain in rotator cuff impingement?

A

Abduction in shoulder

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70
Q

What is the imaging for rotator cuff impingement?

A

MRI

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71
Q

What is the management of rotator cuff impingement?

A

Analgesia

NSAIDs

Physio

Surgery

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72
Q

How do fractures of the distal femur present?

A

Pain in distal thigh

Inability to weight bear

Obvious deformation

Haemarthrosis

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73
Q

How are the majority of distal femur fractures treated?

A

Surgically

Non surgically (minimal displacement / very-comorbid)

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74
Q

When are femoral shaft fractures seen?

A

High energy trauma

Fragility fractures

Pathological fractures

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75
Q

What blood supply is to the femur?

A

Penetrating branches of the Profunda femoris artery

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76
Q

What is the management for distal femur fracture?

A

Pain relief (regional blockade?)

Surgery

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77
Q

What are some possible complications of femoral shaft fractures?

A

Nerve injury

Mal union

Infection

Fat embolism

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78
Q

What is the Salter-Harris classification system used for?

A

Fractures involving the growth plate

79
Q

What are the types of hip fracture?

A

Intracapsular (above trochanters)

Extracapsular (inter-trochanteric/extra-trochanteric - up to cm below the lesser trochanter)

80
Q

What is a risk in displaced Intra-capsular hip fractures?

A

Avascular necrosis of the hip

81
Q

What is the main blood supply to the hip?

A

MCFA

82
Q

What are the features of a hip fracture?

A

Shortened and externally rotated

Pain

Inability to weight bear

83
Q

What are some investigations for hip fractures?

A

Radiographs

Blood tests (FBC, U&Es, coag screen, G&S, CK level)

84
Q

What classification system is used for intracapsular hip fractures?

A

Garden system

85
Q

What is the treatment for UNDISPLACED intracapsular hip fracture ?

A

Internal fixation or hemiarthroplasty if unfit

86
Q

What is the treatment for displaced intracapsular hip fracture?

A

Hip hemiarthroplasty

87
Q

What is the treatment for extracapsular hip fracture?

A

Dynamic hip screw

88
Q

What are some #NOF complications?

A

Prosthetic joint infection

Leg length discrepancies

Mortality (30% at 1 year)

89
Q

What are risk factors for hip OA?

A

Increasing age

Obesity

Female gender

Vit D deficiency

Local trauma to hip

90
Q

What are the signs of hip OA?

A

Pain in the groin aggregated by weight bearing

Stiffness

Grinding sensation

Antalgic gait

91
Q

What are some differential diagnoses for hip pain?

A

Trochanteric bursitis

Sciatica

Femoral neck fracture

92
Q

What is the management of hip OA?

A

Pain relief

Advise weight loss, regular exercise and smoking cessation

Physiotherapy

Eventual hip replacement

93
Q

What is degenerative disc disease?

A

Natural deterioration of the intervertebral disc structure related to aging

94
Q

What are some signs of degenerative disc disease?

A

Local spinal tenderness

Contracted paraspinal muscles

Pain reproduced by raising the extended leg (Lasegue test)

95
Q

What are some differentials for lower back pain?

A

Cauda equina syndrome

Degenerative disc disease

Infection

Malignancy

96
Q

What are some red flag symptoms for back pain and cauda equina?

A

Faecal incontinence

Painless urinary retention

Saddle anaesthesia

97
Q

What are some red flag symptoms for back pain and infection?

A

Immunosuppression

IV drug user

Unexplained fever

98
Q

What could indicate a fracture is a cause of back pain?

A

Chronic steroid use

Trauma

Osteoporosis

99
Q

What could indicate that trauma is the cause of back pain?

A

New onset after 50 years old

100
Q

What are some differentials for lower back pain?

A

Referred pain (from urinary tract)

Piriformis syndrome

101
Q

What is the management fo radiculopathy?

A

Surgery (unremitting pain, progressive weakness)

Analgesia

Amytriptyline (first line neuropathic pain relief)

102
Q

When should imaging for back pain be conducted?

A

Red flag symptoms

Radiculopathy with pain for more than 6 weeks

Spinal cord compression

103
Q

What is the gold standard investigation for degenerative disc disease?

A

MRI Spine (mainly clinical diagnosis)

104
Q

What is indicative of degenerative disc disease on MRI?

A

Reduction of disc height

Annular tears

105
Q

What is the management of degenerative disc disease?

A

Pain relief

Encouraging mobility - physio

106
Q

When is referral to the pain clinic recommended?

A

Pain continuing after 3 months

107
Q

What causes the ‘pinched nerve’ in radiculopathy?

A

Intervertebral disc prolapse

Degenerative disc disease

Fracture

Malignancy

Infection (osteomyelitis - Potts)

108
Q

What are the features of radiculopathy?

A

Paraesthesia

Numbness

Motor weakness

109
Q

How does Carpal tunnel syndrome present?

A

Pain, numbness and paraesthesia in lateral 3 1/2 digit

110
Q

What are the risk factors for Carpal tunnel?

A

Female

Increasing age

Pregnancy

Obesity

111
Q

What conditions is carpal tunnel associated with?

A

Diabetes

RA

Hypothyroidism

112
Q

What muscular changes are there in carpal tunnel syndrome?

A

Weakness of thumb abduction

Wasting of thenar eminence

113
Q

How is carpal tunnel syndrome managed?

A

Wrist splint work at night preventing flexion

Physio

Corticosteroid injections

Surgery: decompress carpal tunnel

114
Q

What are some complications of Carpal tunnel surgery?

A

Infection

Scar formation

Nerve damage

Trigger thumb

115
Q

What occurs in De Quervain’s tenosynovitis?

A

Inflammation of tendons in the 1st extensor compartment of the wrist (extensor pollicis brevis, abductor pollicis longus)

116
Q

What are the risk factors for De Quervain’s tenosynovitis?

A

30-50

Female

Pregnancy

117
Q

What are the features of De Quervain’s tenosynovitis?

A

Pain near base of thumb

Swelling

Grasping is painful

118
Q

What test can be used to diagnose De Quervain’s tenosynovitis?

A

Finkelstein’s test

119
Q

What is the management of De Quervain’s?

A

Avoid repetitive movements

Wrist splint

Steroid injections for pain

Surgical decompression

120
Q

What is a Colles fracture?

A

Extra Articular fracture of radius

Dorsal angulation within 2 cm of joint

(Smiths is the reverse)

121
Q

What are the main risk factors for distal radial fracture?

A

Increasing age

Female gender

Early menopause

Smoking

122
Q

How to assess the 3 hand nerves after distal radial fracture?

A

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
Q

How is a radial fracture managed?

A

Closed reduction with analgesia

Physio

124
Q

What are the complications of a distal radial fracture?

A

Malunion

Median nerve compression

OA

125
Q

What happens in Dupuytren’s contracture?

A

Contraction of the longitudinal palmar fascia

126
Q

What are the risk factors for Dupuytren’s contracture?

A

Smoking

Alcoholic liver disease

Diabetes

127
Q

What fingers are commonly involved in Dupuytren’s contracture? How is it diagnosed?

A

Ring and little finger (clinical diagnosis)

128
Q

What other things should be checked in Dupuytren’s contracture?

A

LFTs

HbA1c for associated risk factors

129
Q

What is the management for Dupuytren’s contracture?

A

Hand therapy (keeping it moving)

Surgical: excision of diseased fascia

130
Q

Where do ganglionic cysts arise?

A

Along joint or tendon

131
Q

What are the risk factors for ganglionic cysts?

A

Female

OA

Previous joint injury

132
Q

How does a ganglionic cyst present?

A

Smooth spherical painless lump

Pressure on nerve causes localised parasthesia

133
Q

What is the management of ganglionic cysts?

A

Monitor for disappearance

Aspirate / excise

134
Q

What artery supplies the scaphoid?

A

Radial artery

135
Q

What increases the risk of AVN in scaphoid fractures?

A

As it becomes more proximal

136
Q

What are the contents of the anatomical snuffbox?

A

Radial artery, radial nerve and cephalon vein

137
Q

What are the differentials of wrist pain following trauma?

A

Distal radial fracture

Scaphoid fracture

Wrist sprain

138
Q

If a scaphoid fracture cant be visualised on a plain X-ray, what should next be tried?

A

Repeat XR in 10-14 days

139
Q

What are some complications of scaphoid fractures?

A

Avascular necrosis

Non-union

140
Q

What is trigger finger?

A

Finger / thumb clicks or locks when in flexion (caused by flexor tenosynovitis)

141
Q

Name 2 risk factors for trigger finger?

A

Hobby with prolonged gripping

Diabetes

Female

142
Q

What are some differentials for limited finger movement?

A

Dupuytren’s contracture

Infection

Ganglion

143
Q

What is the management for trigger finger?

A

Splint to wear at night

Trial steroid injections

Surgery: Percutaneous trigger finger release

144
Q

What movement does the ACL stabilise?

A

Limits anterior translation of the tibia (relative to the femur)

145
Q

How does an ACL tear present?

A

Rapid joint swelling (ACL is highly vascular)

Significant pain

146
Q

Which tests can be used to diagnose an ACL tear?

A

Lachman’s Test

Anterior Drawer Test

147
Q

What is the differential diagnosis for ACL tear?

A

Fracture

Meniscal tear

Collateral ligament tear

148
Q

What is the gold standard to assess ACL tear?

A

MRI of the knee

149
Q

What is the management of an ACL tear?

A

RICE

Physio to strengthen quads

Surgical repair

150
Q

What is a complication of ACL tear?

A

Post traumatic osteoarthritis

151
Q

What 2 muscles join to form ITT?

A

Tensor fasciae latae

Glut maximus

152
Q

What are risk factors for ITT syndrome?

A

Repetitive flexion and extension of the knee

153
Q

What are the clinical features of ITT syndrome?

A

Lateral knee pain exacerbated by exercise

154
Q

How is ITT syndrome diagnosed?

A

Clinically

MRI to exclude other pathology

155
Q

What is the management of ITT syndrome?

A

Advise patients to modify exercise (surgery if no improvement)

156
Q

When does a medial meniscal tear occur?

A

Trauma to the lateral aspect of the knee

157
Q

What are the features of a medial meniscal tear?

A

‘pop’ with immediate pain

Increased joint laxity when testing MCL

158
Q

What is the gold standard investigation for MCL tear?

A

MRI scanning

159
Q

What are the risk factors for knee OA?

A

Family history

Increasing age

Obesity

Female

Previous joint injury

160
Q

How is the pain in knee OA?

A

Exacerbated by exercise and relieved by rest

161
Q

What are the differentials for knee pain?

A

Meniscal injury

Referred pain

162
Q

What is the mnemonic for OA XRs?

A

LOSS

Loss of joint space

Osteophytes

Subchondral sclerosis

Subchondral cysts

163
Q

What is the management of knee OA?

A

Weight loss

Exercise

Pain control

TKR

164
Q

What is the menisci?

A

C-shaped fibrocartilage found in the knee joint

Act as shock absorbers

165
Q

How does a meniscal tear present?

A

Tearing sensation in knee with sudden pain

166
Q

How is a meniscal tear diagnosed?

A

MRI

167
Q

Name a complication of meniscal tear?

A

OA

168
Q

What does the Achilles’ tendon unite?

A

Gastrocnemius

Soleus

Plantaris muscles

Inserting into the calcaneus

169
Q

What are the risk factors for Achilles tendonitis / rupture?

A

Unfit individual with sudden increase in activity

Poor footwear choice

Male gender

Obesity

Recent fluroquinolone use

170
Q

How does Achilles tendonitis present?

A

Gradual onset pain worse on movement

Tenderness on palpating

171
Q

How does Achilles’ tendon rupture present?

A

Loss of power on ankle plantarflexion

172
Q

How is an Achilles tendonitis investigated?

A

Ultrasound

173
Q

How is Achilles tendonitis managed?

A

Stop precipitating exercise

Ice the area

Use anti-inflammatory medication

174
Q

How is Achilles rupture managed?

A

Analgesia

Immobilisation

Surgery

175
Q

What are the three bones of the ankle?

A

Tibia

Fibula

Talus

176
Q

What classification is used for ankle fractures?

A

Weber classification

177
Q

How does an ankle fracture present?

A

Ankle pain following trauma

178
Q

What ‘rules’ determine if an ankle fracture should be x-rayed?

A

Ottawa ankle rules

179
Q

What surgery can be used for ankle fractures?

A

ORIF (open reduction and internal fixation)

180
Q

What is the main risk following ankle fracture?

A

Post traumatic arthritis

181
Q

What is the main differential for an ankle fracture?

A

Ankle sprain

182
Q

What ligaments are commonly injured in an ankle fracture?

A

Anterior talofibular ligament

Calcaneofibular ligament (CFL)

Following inversion injury

183
Q

What are the main risk factors for Hallux Valgus?

A

Female

Connective tissue disorder

Hypermobility syndrome

184
Q

How does Hallux Valgus present?

A

Painful medial prominence

Lateral deviation of the Hallux

185
Q

What are some differentials for 1st toe pain?

A

Gout

Septic arthritis

OA

RA

186
Q

What is the imaging of choice for Hallux Valgus?

A

XR (signs of subluxation)

187
Q

What is the management of Hallux Valgus?

A

Analgesia

Adjust footwear

Physio

188
Q

What are some complications of Hallux Valgus?

A

Avascular necrosis

Reduced ROM

189
Q

What is the most common cause of infracalcaneal pain?

A

Plantar fasciitis

190
Q

Name some risk factors for plantar fasciitis?

A

High arches

Excessive running

Leg length discrepancy

Obesity

191
Q

When is the pain of plantar fasciitis worse?

A

After periods of inactivity

192
Q

What is the management of plantar fasciitis?

A

Activity moderation

Regular analgesics (NSAIDs)

Corticosteroid injection

193
Q

What muscles are innervated by the median nerve?

A

Lateral 2 lumbicals

Opponens pollicis

Abductor pollicis brevis

Flexor pollicis brevis

Surgery - DONE (9 decks)

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