Orthopaedics Flashcards
Types of Fracture:
What is a comminuted fracture?
This is a fracture that is made up of lots of splinters.
Defined as more than 2 pieces
Ax normally trauma
Fractures:
What is a delayed union fracture?
This is when a fracture is taking longer than expected to heal.
Fracture:
What is a green stick fracture?
Mostly seen in paediatrics as occurs in those with soft bones.
Sudden force only breaks the outer side of the bone.
What is a malunion fracture?
Healing of a fracture at an incorrect anatomical alignment.
Fracture:
What is a non union fracture?
Absence of healing in a fracture
Fractures:
What is an oblique fracture?
Bone broken at an angle
Fracture:
What is a spiral fracture?
This is when you have a fracture that is caused by a twisting force around an oblique fracture.
Fractures:
What is a transverse fracture?
Fracture in the horizontal plane.
Fractures:
What is a union fracture?
Healing of fracture fragments.
What is the 4 step management plan for any fracture?
Analgesia
Reduce
Immobilise
Rehab
What is a good study to look at for fracture information?
Trauma Audit Research Network (TARN)
What are 4 causes of cauda equina?
Trauma
Infection
Tumours
Herniation of a lumbar disc
Describe the pathophysiology behind compartment syndrome?
- You get muscle swelling.
- The pressure is higher in the muscle than the artery. This means that the muscle no longer gets as much blood supply and becomes ischaemic.
- This can cause muscle and nerve death alongside absent pulses
What are 4 causes of compartment syndrome?
- Trauma
- Tight bandages or tourniquets
- Continued pressure on a limb i.e old person who fell and is now lieing on the floor (rhabdomyosis)
- Chronic in athletes due to frequent rhabdomyosis
What are the clinical features of a patient with compartment syndrome?
- Pain out of proportion with appearance.
- Pain on passive flexion of the toes and feet
- Pain not managed by analgesia
- Pain not relieved by immobilisation
What does the pressure have to be in compartment syndrome?
The pressure needs to be more than 30 mmHg
What is the gold standard investigation for compartment syndrome?
Compartment pressure measurement test.
> 30 mmHg
What is the management for compartment syndrome?
IV analgesia , IV fluids and Catheter
Fasciotomy
Keep the leg above the head
What med + vaccine do you need to give to someone after presenting with an open fracture?
- Antibiotics
2. Tetanus
How would you manage the following open fractures?
A. Ready for permanent fixation
B. Not ready for permanent fixation
A. Internal screws
B. External screws
What are 4 complications of an open fracture?
Compartment syndrome
Amputation
Non union of the bone
Infection
Give 3 reasons why someone wouldn’t need C spine support?
No pain in neck
No neuro signs or symptoms
Full 360 movement in neck
What is the largest tendon in the body?
The Achilles’ tendon
What is the normal cause of Achilles’ tendon rupture?
Rapid acceleration or deceleration
What two muscles does the Achilles’ tendon attach to the calcaneus ?
- Gastrocnemius
2. Soleus
What is the presentation of Achilles’ tendon rupture?
Pain
Limp
Unable to stand on tip types
Localise swelling
What triad is Achilles’ tendon rupture associated with?
Simmond’s Triad:
- Localised swelling
- Calve squeeze doesn’t cause plantar flexion
- Foot will dangle dorsiflexed
What is the investigation of choice for Achilles’ tendon rupture and what is the management?
US
Management = rest or surgery
What drug combination is associated with an Achilles’ tendon rupture ?
Ciprofloxacin and Steroid
Who is De Quervain’s Tenosynovitis common in?
Tennis, golf players and any one who does repetitive movement
Is De Quervain’s Tenosynovitis Finklestein Manoeuvre positive or negative?
POSITIVE
What area of the arm does de Quervain’s tenosynovitis effect?
It affects the extensors
Describe how De Quervain’s Tenosynovitis would present?
Gradual onset
Pain exacerbated by pinching or grabbing
What are the 3 stages of managing De Quervain’s Tenosynovitis?
- Rest + Splint + NSAIDs + Physio
- Not settled after 4-6 weeks give a steroid injection
- Surgery in very resistant cases.
What is dupuytren’s contracture?
Deformity of the 4th finger.
Due to contraction and fibrosis of the aponeurosis
What will be felt on the palm of a patient with dupuytren’s contracture?
Tender nodule on the palm
What test will someone with dupuytren’s contracture be positive with?
Hueston Table Test positive. Unable to put hand down flat
How do you treat dupuytren’s contracture>?
Collagenase Injections
Radiotherapy
Surgery
What scale is used to measure hip fractures?
Garden scale
What is the management of a patient with an intrascapular NOF with no displacement?
Internal fixation
What is the management of a patient with an intrascapular NOF with displacement?
Total hip replacement
What is the management of a patient with an extrascapular NOF ?
Internal fixation
What is intersection syndrome ? Who is it associated with?
This is a flexor disorder . Hard to distinguish from de Quervain’s.
Seen commonly in rowers and weight lifters.
What will the finklestein test be in intersection syndrome?
Negative
What is the management of intersection syndrome ?
- Rest and splint
- Steroid injection
- Surgery
When is plantar fascia pain worse?
On a morning
Post exercise
What are 3 investigations you would like to do in suspected plantar fasciitis ?
Inflammatory Markers:
X- Ray
US
What is trigger finger?
It’s a type of flexor Tenosynovitis
Affects the thumb, 3rd and 4th fingers
Tender node
Can only straighten the finger manually.
How do you manage trigger finger?
Splinting
NSAIDs
Steroid injections and Surgery
What classification do you use to judge the severity of Pelvic Injuries?
Young Burgess Classification
Why is a pelvic fracture so life threatening?
The pelvis involves many key structures: including the reproductive organs, nerves and blood vessels
What are the 3 causes of pelvic fractures ?
- RTA accident
- Secondary to avulsion fractures: muscle contractions in runners
- Osteoporosis
How will a pelvic fracture present?
- Tenderness, bruising and swelling
- Haematomas
- Rectal Bleeding or haematuria
- Neurovascular complications
- instability of the hip adductors
What are 3 signs of an unstable pelvic fracture?
Pain and Shock
Pelvic instability
Under the Young Burgess Classification.
What does it stay are the definitions of Type A, Type B and Type C fractures?
Type A: avulsion and stable fractures
Type B: rotationally or vertically unstable. Or a compression fracture
Type C: rotationally and vertically unstable. Disruption at 2 or more places. Associated with an increased blood loss and increased mortality
How do you manage young- burgess classification
Type A
Type B
Type C
Type A: bed rest , analgesia, physio and possibly LMWH
Type B and C: do life support avoid rolling and instead perform a straight lift.
Fluid Resus + bloods and fluids
Reduce pelvic volume with binders and external fixation
Needs surgery
What are 3 complications of pelvic fractures?
Uro gynae damage Compartment syndrome Haemorrhage DVT Sexual dysfunction Chronic Pain
What is a ~Monteggia fracture
Monteggia fracture (3): a fracture of the proximal ulna in association with a dislocation of the proximal head of the radius. It is most commonly seen in children aged between 4 and 10 years.
What is a galeazzi fracture
A Galeazzi (4) fracture is a fracture of the distal radius with an associated dislocation of the distal radioulnar joint.
A method to remember the difference between the two of these is by combining the name of the fracture with the bone that is broken:
Monteggia ulna (Manchester United), Galeazzi radius (Galaxy rangers)
What is a Bennett fracture
A Bennett’s fracture (2) is a fracture of the base of the first metacarpal, that extends into the carpometacarpal joint.
