Orthopaedics/ MSK Flashcards
Which is The most common site of metatarsal stress fractures?
2nd metatarsal shaft
What is De Quervain’s tenosynovitis
What is the specific test to identify it?
a common condition in which the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed. It typically affects females aged 30 - 50 years old.
Finkelstein’s test: examiner pulls the thumb in ulnar deviation and longitudinal traction. In a patient with tenosynovitis this action causes pain over the radial styloid process and along the length of extensor pollisis brevis and abductor pollicis longus
What shoulder problem has a big assoc. with diabetics?
Adhesive capsulitis (frozen shoulder)
What sign is seen in a scaphoid fracture
Pain on longitudinal compression of the thumb is a sign of a scaphoid fracture
What nerve is damaged to cause foot drop and tracking that nerve up what nerve can be affected in a knee replacement which can cause this presentation?
Tibialis anterior- Dorsiflex nd inversion
It is a branch of the deep peroneal nerve which is a branch of the common peroneal nerve which can be affected in a knee replacement as it runs through the popliteal fossa and wraps round head of fibula
What drug can increase risk of Dupuytrens contracture?
Phenytoin
Initial management of open fractures (10)
C- Catastrophic haemorrhage
- C-spine (patients with neck and head injury have c-spine injury until proven otherwise) + ABCDE assessment
- Haemorrhage control through direct pressure and PACKING! - tourniquet as last resort
- Neurovascular examination
- Analgesia
- Immobilise the wound using a splint, not external fixators
- ABx (e.g. co-amox, cefataxime, clindamycin), anti-tetanus prophylaxis
- Remove gross contaminants from wound
- Wound photography
- Dressing wound - moist saline gauze & adhesive dressing
- X-rays
-Refer to ortho
Weber classification of fracture and the management
A
B
C
2 other reasons for surgery?
- Weber A- Below syndesmosis, intact and stable
patients with minimally displaced, stable fractures may bear weight as tolerated in a CAM boot 6-8 weeks and analgaesia
- Weber B- At level of syndesmosis, can be intact or partially torn
Mx - if stable and no talar shift then conservative CAM boot and analgaesia
Mx- If unstable/ talar shift… ORIF - Weber C- Above syndesmosis, not intact
Mx- ORIF Open reduction and Internal fix
Open fracture needs ORIF
Bi or trimalleolar displacement needs ORIF
What is the diag when typically present with hip/groin pain and a snapping sensation
patient able to weight bear with pain on external rotation
Acetabular labral tears
Difference in ACL and Meniscal tears in presentation (1)
Swelling much quicker in ACL tear causing haemoarthropy, meniscal tear is slower effusion.
Noonan syndrome features (4)
Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis
Malignant Bone tumours
Which is the most common primary bone tumour?
STEMS on xray:
Osteosarcoma
Ewing’s Sarcoma
Chondrosarcoma- No STEM
- Location?
- Who?
Osteosarcoma: Codman triangle (from periosteal elevation) and ‘sunburst’ pattern
Ewing’s Sarcoma: x-ray shows ‘onion skin’ appearance
Chondrosarcoma- No STEM
- Location- axial skeleton its tumour of the cartilage
- Who- middle-age
Malignant bone tumours- Osteosarcoma
- Key fact
- Who/ age?
- Where?
- STEM on xray? (2)
- 3 Key risk factors
Osteosarcoma
- Most common primary
- Children and teens
- metaphyseal region of long bones prior to epiphyseal closure
- STEM- Codman triangle (from periosteal elevation) and ‘sunburst’ pattern
- RF:
1. Retinblastoma gene mutation
2. Padgets disease of bone
3. Radiotherapy
What is the key rule for hemiarthroplasties in hip fractures?
If there is any displacement, partial or full, a hemi-arthroplasty is given. Or full if fit.
STEM for pain in facet joint pain? (2) and there is extra info that don’t need.
- pain over the facets
- pain is typically worse on extension of the back.
Can be acute or chronic, Pain usually worse in the morning and worse on standing
When is a DEXA scan not needed to diagnose osteoperosis?
Following a fragility fracture in women ≥ 75 years, a DEXA scan is not necessary to diagnose osteoporosis and hence commence a bisphosphonate
Flexor sheath tenosynovitis
- Surgical emergency
Cause?
- Kanavel’s signs: 2Fs and 2Ps
Management
1
2
Flexor sheath tenosynovitis
- Surgical emergency
- Caused by human and animal bites (metacarpal strikes a tooth)
- Kanavel’s signs:
F- fusiform swelling
F - tenderness over flexor sheath
P- semiflexed posture
P- pain on passive extension
Management
1. I.V antibiotics with elevation
2. Mx Surgical debridement
Can lead to fibrosis and contractures which can be very dissabling
Differentiating between L3 and L4 root lesion of movement deficits are the same (think derm)
L3- loss over anterior THIGH
L4- loss over anterior KNEE and down to medial malleolous
Golfers and Tennis elbow, how do you differentiate?
Tennis- lateral epicondyle, pain on desired ext. of wrist
Golfers- medial and pain on resisted pronation
Acromioclavicular joint injury, grades and their management
I and II - manage conservatively with rest and sling
III- individual circumstance and debate
IV. V, VI- Surgical intervention
We know what causes a SABER but what causes shortened and INTERNALLY rotated?
Posterior hip dislocations present with a shortened and internally rotated leg
starting what drugs can causes achilles tendon rupture? and also what inherited condition?
Initial imaging?
- quinolone use (e.g. ciprofloxacin) is associated with tendon disorders
- hypercholesterolaemia (predisposes to tendon xanthomata)
USS
Carap Tunnel Syn Associated conditions ARMPIT
Acromegaly
Rheumatoid (most cmmon RF of bilteral)
Myxoedema (hypothyroid)
Pregnancy
Idiopathic
Trauma- lunate fracture
Presentation of fat embolism? triad
+ 1 extra
- Respiratory distress + nothing on CXR
- Neurological
- Petechial rash (tends to occur after the first 2 symptoms)
- RETINAL HAEMORRHAGE on fundoscopy
Carpal Tunnel Investigation + result (1)
Management
Conservative - (2) how long?
Surgery (1)
Electrophysiology
motor + sensory: prolongation of the action potential
Management
6 week trial of conservative
- Splint
- Corticosteroid injection
Surgery if persists (flexor retinaculum division)
Shoulder dislocation
Most common type is
associated with?
Less common but STEM
+ STEM of stem
Common- Anterior
FOOSH
Posterior- assoc with seizure/ electric shock (because all muscles are contracting)
- IT WILL BE LOCKED IN INTERNAL ROTATION
Osteogeness imperfecta
cant produce… therefore…
radiology shows:
cant produce intercellular substances like osteoid, collagen and dentine therefore pathological fractures
- translucent bones
- multiple fractures, particularly of the long bones, - wormian bones (irregular patches of ossification) and a trefoil pelvis.
Initial/ immediate management of ANY closed ankle fracture?
If open? (3)
Closed reduction- translucent bones, multiple fractures, particularly of the long bones, wormian bones (irregular patches of ossification) and a trefoil pelvis.
definitive management then depends on Webers staging
Open
- IV broad-spectrum antibiotic
- surgical debridement
- external fixation or plastic/vascular surgery input
How do you best describe the clinical findings of a clubfoot? (3)
dont need imaging
Talipes equinovarus
Managment?
inverted (inward turning) and plantar flexed foot
not passively correctable
Ponseti method of recasting for 6-10 weeks + night time brace until 4yo
What is the most common reason total hip replacements need to be revised
Aseptic loosening of the implant
What is a buckle fracture in a kid?
Buckle = bulge
incomplete fractures of the shaft of a long bone that is characterised by bulging of the cortex
typically 5-10yo
self-limiting, sometimes splint and immobilise
Salter Haris
SALTER
1 Straight through growth plate (no epi or meta)
2 Above growth plate (metaphysis)
3 Lower (below growth plate, epiphysis)
4 Through all 3 parts
5 ERasure of growth plate = compression
classical ‘painful arc’ associated with
supraspinatus tendonitis
xray shows calcification from prolonged inflam
Osteochondritis dissecans typically presents with (3)
cause
knee pain after exercise, locking and ‘clunking’
Overuse of joints due to sporting activity
Oslers nodes not just assoc with IE can also present in: (4)
SLE, gonorrhoea, typhoid and haemolytic anaemia.
WHat is charcot joint and what do you see on xray?
DM (can be neuropathy due to syphilis) - a joint which has become badly disrupted and damaged secondary to a loss of sensation
extensive bone remodeling / fragmentation involving the midfoot
CHARCOT:
C - Collapse of bones
H - Hyperemia (increased blood flow)
A - Afebrile (no fever)
R - Redness and warmth
C - Crepitation (crackling sound)
O - Osteoporosis (loss of bone density)
T - Trauma (often minor)
STEM for chondromalacia (2)
you will see-
teenage girl with knee pain on walking down the stairs is (anterior knee pain)
following an injury to knee e.g. Dislocation
Tenderness, quadriceps wasting
Management
- initially with rest, stretching and weight loss if overweight
Tennis elbow- exam findings worse when…
Medial epicondylitis is typically aggravated by wrist flexion and pronation
irst-line investigation for a suspected osteoporotic vertebral fracture
X-ray of the spine
Pathogen for Blood and bone infections caused by gram -ve rods, linked to sickle cell and malaria and in kids
non-typhi salmonella (NTS)
IMaging used for spinal stenosis and why?
MRI to confirm nd exclude other causes such as metastatic disease.
Where is most common for comprtment syn? (2 fractures)
What can you get as a result of compartment syndrome and why?
supracondylar and tibial shaft fractures
AKI- myoglobin release/ rhabdomyloysis due to Increased pressure in the fascial compartment may lead to muscle breakdown
Olecranon bursitis- present?
Swelling over the posterior aspect of the elbow.
middle aged men
Monteggia fracture- what?
Galeazzi fracture- what?
Monteggia ulna (Manchester United)
a fracture of the proximal ulna, with an associated dislocation of the proximal radioulnar joint.
Galeazzi radius (Galaxy rangers)
distal radial fracture with an associated dislocation of the distal radioulnar joint.
blood supply interupted in scaphoid fracture
dorsal carpal branch of the radial artery
Greenstick fracture
common in children, a greenstick fracture would only have a unilateral breach of the cortex
