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Year 4 > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

Name the three bones that make up the acetabulum

A

Ischium
Ilium
Pubis

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2
Q

Describe the classification of hip fractures, and which type causes risk of AVN

A

Intracapsular (proximal to the trochanters)

Extracapsular (intra-trochanteric or subtrochanteric)

DISPLACED INTRAcapsular fracture = risk of AVN

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3
Q

What are the presenting features of a NOF #

A

Pain - groin, thigh, referred to knee

Leg length shortened and externally rotated

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4
Q

Describe the main blood supply to the head of femur

A

Retrograde

From medial circumflex femoral artery

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5
Q

What is the mortality of hip fractures at 1 year?

A

30%

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6
Q

What investigations should be carried out for a hip #

A 
X-ray (AP and lateral views)
Bloods: FBC, U&E, coag, G&S, CK (if long lie)
Urine dip (cause of fall)
CXR
ECG
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7
Q

Describe the management of NOF#

A 
A-E
Analgesia (opioids, or regional -> fascia-iliaca block)
Definitive management -> surgical:
Total hip arthroplasty
Hemiarthroplasty
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8
Q

Describe the risk factors for osteoporosis (overlap with RFx for hip #!)

A 
S - steroids
H - hyperthyroid, hyperparathyroid
A - age increasing
T - low testosterone
T - thin (less weight-bearing)
E - early menopause
R - renal/liver failure
E - erosive/inflammatory bone disease
D - diet (low vitamin D/Ca)
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9
Q

Describe the bones that make up the pelvic ring

A

Sacrum
+
Ilium, ischium, pubis

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10
Q

What is the polo-mint rule

A

In Pelvic ring fractures, always look for a second fracture site

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11
Q

Describe the management of pelvic #

A

Stabilisation -> prevent blood loss
Pelvic binder initially will hold the pelvis in place until definite stabilisation -> for attempted clot formation
Fractures fixed definitively with plates/bolts

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12
Q

What are the complications of pelvic #

A 
Risk of damage to pelvis structures:
		○ Bowel
		○ Bladder
		○ Genitals
		○ Nerves 
Urological injury
Venous thromboembolism
Long-standing pelvic pain
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13
Q

what is the rule when diagnosing patella tendon rupture?

A

if the patellar tendon is longer than the length of the patella +/- 20%

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14
Q

Describe the function of supraspinatus

A

Helps adduct the first 15 degrees, then deltoid aids

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15
Q

Describe the function of infraspinatus

A

External rotation

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16
Q

Describe the function of subscapularis

A

Internal rotation and adduction

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17
Q

Describe the function of teres minor

A

External rotation at shoulder

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18
Q

Why are knee dislocations emergencies?

A

Risk of damage to popliteal artery

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19
Q

Describe the management of femoral fractures

A

The longest bone in the body therefore can bleed a lot and cause hypovolaemic shock

Reduce and splint
	• Thomas-type splint -> fixed traction
	• Reduces fracture movement
	• Reduces bleeding
	• Reduces risk of damage to nerves/vessels
	• Improves pain
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20
Q

Describe the parts of a long bone

A

Epiphysis
Growth plate
Metaphysis
Diaphysis

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21
Q

Describe Bohler’s angle

A

draw two lines tangent to the calcaneous, should be 20-40o

To assess for normality of the ankle

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22
Q

Describe a stable vs unstable ankle fracture

A

Stable fractures = have damage to only one side of the joint e.g. medial or lateral
○ Therefore no disruption to the ankle joint mortice and the risk of degenerate change in the future is low

Unstable fractures = damage to both medial and lateral sides
○ May be disruption of the ankle joint mortice and risk of degenerative change in the future is high
○ These fractures require to be stabilised, usually with internal fixation

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23
Q

Describe the bones of the hindfoot, midfoot and forefoot

A

Hindfoot = talus + calcaneus

Midfoot = Navicular, cuboid, cuneiforms

Forefoot = metatarsals and phalanges

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24
Q

What is a Lisfranc fracture

A

Dislocation of the midfoot between the tarsal bones (navicular, cuboid and cuneforms) and the base of the metatarsals

Commonly missed!

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25
Q

List the components to describe an x-ray

A

SOC-F-DAP

Patient details, this is an X-ray of SITE and which side
Open or closed
Fragmented?
Direction - transverse/oblique/spiral?
Articular involvement?
Position (displaced/undisplaced)
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26
Q

Describe the radiographic findings of OA

A

LOSS

Loss of joint space
Osteophytes
Subchondral cysts
Subchondral sclerosis

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27
Q

What is a colle’s fracture

A

Transverse distal radius fracture, caused by FOOSH, with dorsal displacement

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28
Q

What is a Smith’s fracture?

A

Transverse distal radius fracture, caused by falling onto flexed hand, with volar displacement (opposite of Colles)

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29
Q

Describe a Galeazzi and Monteggia #

A

GRIMUS!

Galeazzi - (radial inferior) i.e. radial # with displaced dislocated radio-ulnar joint

Monteggia - (ulna superior) i.e. ulnar fracture with dislocated head of radius (at elbow e.g. proximal/superior)

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30
Q

What is the most dangerous infective agent of an open fracture?

A

Clostridium perfringes -> causes gas gangrene/renal failure

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31
Q

Describe the gardner classification of NOF#

A

Grade 1 = incomplete #
Grade 2 = complete # without displacement
Grade 3 = complete # with partial displacement
Grade 4 = complete # with full displacement

32
Q

What examination findings may you get on examination of an OA hip

A 
Pain (buttock, groin, referred to thigh)
Antalgic gait/trendelenberg
Tenderness over hip
reduced ROM (esp. internal rotation)
Positive thomas' test
33
Q

What are the x-ray findings of OA?

A 
LOSS
loss of joint space
osteophytes
subchondral cysts
subchondral sclerosis
34
Q

What are the x-ray findings of RA?

A 
SPADES
Soft tissue swelling
periarticular erosions
absent osteophytes
deformity
erosion
subluxation
35
Q

Describe the management of OA

A

Non-op:
Education, weight loss, walking aids, analgesia, non-weight bearing exercise

Operative:
THR

36
Q

List the risk factors for avascular necrosis

A

Traumatic: Fractures, dislocations, SUFE

Non-traumatic: Alcohol, steroids, bone malignancy, connective tissue disorders

37
Q

What is SUFE

A

Slipped upper femoral epiphysis = fracture through the capital femoral growth plate and the epiphysis slips posteriorly and inferiorly

common in 10-16yr olds during rapid growth

RFX: Male, obesity

38
Q

What are the radiographic features of SUFE?

A

Steel sign = a shadow behind the superior femoral neck

Shenton’s line disrupted

Line of Klein - fails to intersect the superior femoral epiphysis

39
Q

What is DDH?

A

Developmental dysplasia of the hip = abnormal hip development resulting in shallow under-developed acetabulum, and possible subluxation/dislocation

40
Q

What are the RFx for DDH and what are its tests

A

Female, first born, breech position, FHx

Test with Barlow’s and Ortolani tests

41
Q

Describe the principles of fracture management

A

Resuscitation (A-E)
Reduction
Restriction
Rehabilitation

42
Q

Describe the Gardner classification of intracapsular hip fractures

A

Stage I: Incomplete fracture of the neck (so-called abducted or impacted)
Stage II : Complete without displacement
Stage III: Complete with partial displacement. Fragments are still connected by posterior retinacular attachment and there is malalignment of the femoral trabeculae
Stage IV : This is a complete femoral neck fracture with full displacement, the proximal fragment is free and lies correctly in the acetabulum so that the trabeculae appear normally aligned.

43
Q

Describe the benefits and cons of hemiarthroplasty vs THR

A

Hemi benefits:
Shorter operation
Lower risk of post-op dislocation (as the replaced head is larger than the head put in during a THR)

Hemi cons:
Long term pain
Worse mobility

44
Q

Define staging and grading

A

Staging - working out how far a tumour has spread (e.g. pan-CT plus CT/MRI of organs involved)

Grading - usually from a biopsy sample, to assess how well differentiated/the cell types/how aggressive a cancer is. Predicts cancer behaviour and patient prognosis.

45
Q

What cancers commonly metastasise to bone?

A

think of 5 paired organs!!

  • thyroid
  • lung
  • breast
  • renal
  • prostate
46
Q

What boney sites do cancers commonly metastasise to?

A

Vertebrae

Proximal metaphyses

47
Q

Describe the difference between T1 and T2 weighted MRI scans

A

T1 - fat is bright

T2 - fat and water is bright

48
Q

What nerve root is likely to be affected by a L4/5 disc paracentral herniation?

A

The transiting L5 nerve root

49
Q

What nerve root is likely to be affected by a L4/5 disc foraminal (lateral) herniation?

A

The exiting L4 nerve root

50
Q

In layman’s terms describe osteoporosis, Paget’s disease and Rickets/Osteomalacia

A

Osteoporosis = not enough bone (but normal quality)
Paget’s disease = XS bone (but normal quality)
Osteomalacia = normal quantity of bone but defective mineralisation (after skeletal maturity)
Ricket’s = normal quantity of bone but defective mineralisation (before skeletal maturity)

51
Q

What is the role of OGP (osteoprotegerin)

A

OPG is released from OB
Prevents XS bone resorption as it binds to RANK-L (also released from OB) and stops RANK-L converting pre-OC into OC, therefore limiting the formation of mature OC’s

52
Q

What are the most common # in osteoporotic patients?

A

Hip, femur, spine and radial

53
Q

Describe DEXA scans and the T/Z score result

A

DEXA = dual energy x-ray absorptiometry

T-score = The score is made from comparing your result to a ~30yr old young healthy adult (so not age matched!)

Z-score = The score you get is by comparing your result to an age matched healthy control (e.g. if you are 45 then your score is compared to a 45yr old)

54
Q

Describe the standard deviations generated from DEXA scan

A

SD’s use the T-score (not aged matched)

0 to -1.5 = normal
-1.5 to -2.5 = osteopenia
< -2.5 = osteoporosis
< -2.5 with # = ‘defined’ OP

55
Q

Describe the role of calcitonin

A

Opposes the action of PTH

  • Reduces OC activity (less bone resorption and less Ca released into bloodstream)
  • Reduces Ca absorption at the DCT
56
Q

Describe the two main forms of rickets/osteomalacia:

A

Vitamin-D dependent and vit-D independent

Dependent causes:

  • reduced sun exposure
  • reduced dietary intake
  • reduced intestinal absorption (e.g. IBD)

Independent causes:
- kidneys not working (i.e. there is enough vit D in the body but it cannot be absorbed)

57
Q

Define Paget’s, it’s phases and the bony sites commonly affected

A

Bone remodelling due to increased OC activity
3 phases: lytic/mixed/sclerotic
Bones affected: skull, spine, pelvis, femur

58
Q

What are the S/Sx of Paget’s

A

Joint/bone pain
Deformity
Isolated raised ALP
Headaches/deafness (due to entrapment of CN in growing skull)
Loss of visual fields (bony growth at optic chiasm)
Can cause high output cardiac failure

59
Q

What are the typical X-ray features of Paget’s

A

Mixture of lytic and sclerotic disorganised bone
(Due to accelerated OC resorption of bone, followed by disordered and XS formation)
Acetabular protrusion can occur 2o to Paget’s

60
Q

What is the blood supply of the scaphoid?

A

Branch of radial artery (enters distally and travels proximally)

61
Q

Name the 3 anatomical parts of the scaphoid bone

A

Distal pole
Waist
Proximal pole

62
Q

What makes up the borders of the anatomical snuffbox?

A

EPL (ulnar side)

EPB + APL (radial side)

63
Q

What are the important contents of the anatomical snuffbox?

A

Radial artery
Radial nerve
Cephalic vein

64
Q

Describe risk factors for carpal tunnel syndrome

A 
Previous wrist trauma
OCP
Pregnancy
RA
Cardiac failure
Hypothyroidism
65
Q

What is the management for carpal tunnel syndrome

A
  1. Splintage and rest
  2. Steroid injection
  3. Surgical release
66
Q

Describe the management of a hip fracture based on its location

A

The management of the fracture depends on its location.

Intracapsular fractures:

  • Replacement arthroplasty (hemiarthroplasty or total hip replacement) for patients with a displaced intracapsular fracture.
  • Total hip replacements for patients with a displaced intracapsular fracture who:
  • > Are able to walk independently out of doors with no more than the use of a stick; and
  • > Are not cognitively impaired; and
  • > Are medically fit for anaesthesia and the operation.

Extracapsular fractures:

  • Extramedullary implants e.g. a sliding (dynamic) hip screw for trochanteric fractures above and including the lesser trochanter
  • Intramedullary e.g. pin and plate or extramedullary internal fixation for subtrochanteric fractures
67
Q

What is Froment’s sign?

A

Ulnar nerve weakness results in inability to hold paper between thumb and index finger/terminal phalanx has to compensate by flexing to hold on to the paper

68
Q

Damage to which nerve is associated with claw hand?

A

Ulnar

69
Q

What nerve roots make up the ulnar nerve

A

C8 & T1

70
Q

What nerve roots make up the median nerve

A

C5, 6, 7, 8, T1

71
Q

What nerve roots make up the radial nerve

A

C5, 6, 7, 8, T1

72
Q

How is the motor function of the median nerve tested?

A

Thumb abduction

73
Q

How is the motor function of the radial nerve tested?

A

Wrist extension

74
Q

How is the motor function of the ulnar nerve tested?

A

Finger spread and don’t let them be pushed together!

75
Q

What are the 3 principles of # management?

A

Resus
Reduce
Retain

76
Q

Name and describe 3 tests for impingement syndrome

A

1) Painful arc test (painful abduction between 60-120)
2) Neer impingement test (pain on forward flexion >90)
3) Hawkins Kennedy test (pain when forward flex to 90 and then internally rotate)

Year 4 (28 decks)

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