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Orthopaedics > Orthopaedics Part 2 > Flashcards

Orthopaedics Part 2 Flashcards

1
Q

What is De Quervain’s tenosynovitis?

A
  • sheath containing extensor pollicis brevis and abductor pollicis longs tendons inflamed
  • females 30-50yo
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2
Q

Features of De Quervain’s tenosynovitis:

A
  • pain on radial side of wrist
  • tenderness over radial styloid process
  • abduction of thumb against resistance painful
  • Finkelstein’s test
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3
Q

What is Finkelstein’ test?

A
  • pull thumb in ulnar deviation and longitudinal traction

- pain over radial styloid process along length of extensor pollicis brevis and abductor pollicis longus

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4
Q

Management De Quervain’s tenosynovitis:

A
  • analgesia
  • steroid injection
  • immobilisation with thumb splint
  • surgical treatment sometimes
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5
Q

What is discitis and what are the features?

A
  • infection in intervertebral disc space
  • can lead to serious complications such as sepsis or epidural abscess
  • back pain, pyrexia, riggers, sepsis
  • neurological features: e.g. changing lower limb neurology, if epidural abscess develops
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6
Q

Causes of discitis:

A
  • bacterial: staph aureus most common
  • viral
  • TB
  • aseptic
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7
Q

Diagnosis and Treatment of discitis:

A
  • MRI has highest sensitivity
  • CT guided biopsy may be required
  • 6-8 weeks IV Abx
  • identify organism with positive culture with bloods or CT guided
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8
Q

Further investigation required when someone has discitis:

A

assess for endocarditis e.g. with trans thoracic echo or transesophageal echo

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9
Q

In whom is dupuytren’s contracture most common?

A

older male patients with 60-70% positive family history

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10
Q

Specific causes of dupuytren’s contracture:

A
  • manual labour
  • phenytoin treatment
  • alcoholic liver disease
  • diabetes mellitus
  • trauma to hand
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11
Q

Management of Dupuytren’s contracture:

A

consider surgical treatment when metacarpophalangeal joints cannot be straightened and thus the hand cannot be placed flat on the table (fasciectomy)
can recur and risks neuromuscular damage

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12
Q

Features of lateral epicondylitis (tennis elbow):

A
  • pain localised to lateral epicondyle
  • worse on resisted wrist extension with albow extended or supination of forearm with elbow extended
  • episodes 6 months - 2 years
  • acute pain 6-12 weeks
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13
Q

Features of medial epicondylitis (golfer’s elbow):

A
  • pain and tenderness localised to medial epicondyle
  • aggravated by writs flexion and pronation
  • numbness/tingling in 4th and 5th finger due to ulnar nerve involvement
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14
Q

What is radial tunnel syndrome and what are the features?

A
  • compression of posterior interosseous branch of radial nerve
  • result of overuse
  • symptoms similar to lateral epicondylitis
  • pain 4-5cm distal to lateral epicondyle
  • worsened by extending elbow and pronating forearm
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15
Q

What is cubital tunnel syndrome and what are the features?

A
  • compression of ulnar nerve
  • initially intermittent tingling in 4th and 5th finger
  • worse when elbow on firm surface for extended periods
  • later numbness in 4th and 5th finger with weakness
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16
Q

What is olecranon bursitis?

A

swelling over posterior aspect of elbow - pain, warmth, erythema (middle aged males)

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17
Q

What is a Smith’s fracture?

A
  • reverse Colles
  • volar angulation of distal radius fragment (garden spade deformity)
  • by falling backwards onto palm of outstretched hand or falling with wrists flexed
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18
Q

What is a Bennett’s fracture?

A
  • intra-articular fracture of first carpometacarpal joint
  • impact on flexed metacarpal, caused by fist fights
  • x-ray: triangular fragment at ulnar base of metacarpal
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19
Q

What is a Monteggia’s fracture?

A
  • dislocation of proximal radioulnar joint in association with an ulna fracture
  • fall on outstretched hand with forced pronation
  • needs prompt diagnosis to avoid disability
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20
Q

What is Galeazzi fracture?

A
  • radial shaft fracture with associated dislocation of distal radioulnar joint
  • direct blow
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21
Q

What is a Pott’s fracture?

A
  • bimalleolar ankle fracture

- forced foot eversion

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22
Q

What is a Barton’s fracture?

A
  • distal radius fracture (Colles/Smith) with associated radoiocarpal dislocation
  • fall onto extended and pronated wrist
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23
Q

Fat embolism in respiratory system features:

A
  • early persistent tachy
  • tachypnoea, dyspnoea, hypoxia 72 hours post injury
  • pyrexia
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24
Q

Fat embolism in dermatological system features:

A
  • red/brown impalpable petechial rash

- subconjunctival and oral haemorrhage/petechiae

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25
Q

Fat embolism in CNS features:

A
  • confusion and agitation

- retinal haemorrhages and intra-arterial fat globules on fundoscopy

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26
Q

Treatment fat embolus:

A
  • prompt fixation of long bone fractures
  • DVT prophylaxis
  • general supportive care
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27
Q

Fracture types:

A
  • oblique
  • comminuted
  • segmental
  • transverse
  • spiral
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28
Q

Gustilo and Anderson classification system:

A

1: low energy wound <1cm
2: greater than 1cm wound with moderate soft tissue damage
3: high energy wound >1 cm with extensive soft tissue damage
3A: adequate soft tissue coverage
3B: inadequate soft tissue coverage
3C: arterial injury

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29
Q

Management of fractures:

A
  • immbolise including proximal and distal joints
  • monitor neuromuscular status
  • tetanus prophylaxis
  • IV broad spec antibiotics for open injuries
  • debride thoroughly if open
  • open fractures constitute an emergency and should be lavage within 6 hours
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30
Q

What is a ganglion?

A
  • cyst arising from joint or tendon sheath
  • most commonly around back of wrist and 3 times more common in women
  • often disappear spontaneously after several months
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31
Q

What is greater trochanteric pain syndrome?

A
  • trochanteric bursitis
  • repeated movement of fibroelastic iliotibial band
  • most common 50-70yo
  • pain over lateral hip/thigh
  • tenderness on palpation of greater trochanter
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32
Q

What is Dupuytren’s contracture?

A
  • fixed flexion of hand
  • underlying ontractures of palmar aponeurosis
  • progresses slowly ad painlessly
33
Q

What is the aim of carpal tunnel syndrome surgery?

A
  • decompression

- division of flexor retinaculum

34
Q

What are Osler’s nodes?

A
  • painful, red, raised lesion on hands and feet

- deposition of immune complexes

35
Q

What are Bouchard’s nodes?

A
  • hard, bony outgrowths or gelatinous cysts
  • proximal interphalangeal joints
  • osteoarthritis
  • formation of calcific spurs of articular cartilage
36
Q

What are Heberden’s nodes?

A
  • middle age
  • chronic swelling of affected joints or sudden painful onset of redness, numbness and loss of dexterity
  • symptoms usually subside
  • permanent bony outgrowth
37
Q

Types of hip dislocations:

A
  • posterior: 90%, affected leg is shortened, adducted and internally rotated
  • anterior: affected leg abducted and externally rotated, no leg shortening
  • central dislocation
38
Q

Management of hip dislocation:

A
  • ABCDE
  • analgesia
  • reduction under general anaesthetic within 4 hours to reduce the risk of avascular necrosis
  • long term management: physiotherapy to strengthen muscles
39
Q

Complications of hip dislocations:

A
  • sciatic or femoral nerve injury
  • avascular necrosis
  • osteoarthritis
  • recurrent dislocation: due to damage of supporting ligaments
40
Q

Prognosis of hip dislocation:

A
  • 2-3 months for hip to heal after traumatic dislocation

- prognosis best when hip is reduced less than 12 hours post injury

41
Q

Features of hip fracture:

A
  • pain
  • shortened and externally leg
  • non-displaced or incomplete neck of femur fractures may be able to weight bear
42
Q

What is an intracapsular hip fracture:

A

from edge of femoral head to insertion of capsule of hip joint

43
Q

What is an extra capsular hip fracture:

A

trochanteric or subtrochanteric

44
Q

Garden system of hip fracture classification:

A
  • type I: stable fracture with impaction in valgus
  • type II: complete fracture but undisplaced
  • type III: displaced fracture, usually rotated and angulated but still has boney contact
  • type IV: complete boney disruption
45
Q

In which hip fractures is blood supply disruption most common?

A

types III and IV

46
Q

Management of undisplaced intracapsular hip fracture:

A

internal fixation or hemiarthroplasty if unfit

47
Q

Management of displaced intracapsular hip fracture:

A
  • arthroplasty (total hip replacement or hemiarthroplasty)
  • total is favoured if patients were able to walk independently, are not cognitively impaired and are medically fit for anaesthesia
48
Q

Management of extra capsular hip fracture:

A
  • dynamic hip screw

- if reverse oblique, transverse or subtrochanteric: intramedullary device

49
Q

What is development dysplasia of the hip?

A
  • often picked up on newborn examination
  • Barlow’s test, Ortolani’s test positive
  • unequal skin folds/leg length
50
Q

What is transient synovitis (irritable hip):

A
  • typical age group: 2-10 years
  • acute hip pain associated with viral infection
  • commonest cause of hip pain in children
51
Q

What is Perthes disease:

A
  • degenerative condition affecting hip joints of children (4-8yo)
  • avascular necrosis of femoral head
  • 5 times more common boys
  • 10% bilateral
  • limp, stiffness, reduced range of movement
52
Q

X ray findings of Perthes disease:

A
  • early changes including widening of joint space

- later changes include decreased femoral head size/flattening

53
Q

How does a slipped upper femoral epiphysis present?

A
  • 10-15yo
  • more common in obese and boys
  • displacement of femoral head epiphysis postern-inferiorly
  • bilateral in 20%
  • may present following trauma or more commonly chronic
  • knee or distal thigh pain
  • loss of internal rotation of leg in flexion
54
Q

What is juvenile idiopathic arthritis:

A
  • arthritis occurring in someone who is less than 16yo for more than 3 months
  • pauciarticular JIA refers to cases where 4 or less joints are affected
  • 60% of JIA
55
Q

Features of JIA:

A
  • joint pain and swelling (knees, ankles, elbows)
  • limp
  • ANA may be positive - associated with anterior uveitis
56
Q

What is an iliopsoas abscess?

A

collection of pus in iliopsoas compartment

57
Q

Primary causes iliopsoas abscess:

A
  • haematogenous spread of bacteria

- staphylococcus aureus most common

58
Q

Secondary causes of iliopsoas abscess:

A
  • Crohn’s
  • Diverticulitis, CRC
  • UTI, GU cancers
  • vertebral osteomyelitis
  • femoral catheter, lithotripsy
  • endocarditis
  • IV drug use
59
Q

Mortality rates of iliopsoas abscess:

A
  • primary: 2-4%

- secondary: 19-29%

60
Q

Features iliopsoas abscess:

A
  • fever
  • back/flank pain
  • limp
  • weight loss
61
Q

Clinical examination iliopsoas abscess:

A
  • supine with knee flexed and hip mildly externally rotated
  • place hand proximal to patient’s ipsilateral knee and ask patient to lift thigh against your hand - pain due to contraction of poses muscle
  • lie patient on normal side and hyperextend the affected hip - pain as muscle is stretched
62
Q

Investigation and management of iliopsoas abscess:

A
  • CT abdomen
  • Abx
  • percutaneous drainage
  • surgery if failure to drain or presence of another intra-abdominal pathology which requires surgery
63
Q

What is iliotibial band syndrome?

A
  • common cause of lateral knee pain in runners
  • 1 in 10 runners
  • tenderness 2-3cm above the lateral joint line
64
Q

Management of iliotibial band syndrome:

A
  • activity modification and iliotibial band stretches

- if not improving - physiotherapy

65
Q

What is the unhappy triad?

A

commonly seen following lateral blow to knee:

  • anterior cruciate ligament
  • medial collateral ligament
  • meniscus
66
Q

How is the ACL commonly damaged and what tests are positive?

A
  • from twisting injuries (sports)
  • anterior drawer test: knee at 90 degrees
  • Lachman test: knee at 30 degrees
67
Q

What damage commonly results in PCL injury and tests?

A
  • following dashboard injuries
  • hyperextension
  • tibia lies on back of femur
  • paradoxical anterior draw test
68
Q

What damage commonly results in MCL injury and what test?

A
  • skiing and following valgus stress
  • causes abnormal passive abduction of knee
  • leg forced into valgus via force outside leg
69
Q

How common is lateral collateral ligament injury?

A

isolated injury uncommon

70
Q

How can the menisci be damaged and symptoms?

A
  • twisting injuries
  • locking and giving way
  • rotation sporting injuries
  • delayed knee swelling
  • recurrent pain and effusions common (often following minor trauma)
71
Q

Presentation of ruptured ACL:

A
  • loud crack
  • pain and rapid joint swelling (haemoarthrosis)
  • poor healing
72
Q

Chondromalacia patellae:

A
  • teenage girls following injury to knee e.g. dislocation patella
  • typical history of pain going downstairs or at rest
  • tenderness, quadriceps wasting
73
Q

How does dislocation of patella come about?

A
  • most commonly due to trauma or severe contraction of quadriceps with knee stretched in valgus and external rotation
  • genu valium, tibial torsion and high riding patella risk factors
  • skyline x-ray views of patella required
  • osteochondral fracture in 5%
  • 20% recurrence rate
74
Q

2 types of fracture of patella:

A
  • direct blow to patella causing undisplaced fragments

- avulsion fracture

75
Q

Tibial plateau fracture:

A
  • elderly
  • knee forced into valgus or virus, but knee fractures before ligaments rupture
  • varus affects medial plateau and if valgus, lateral plateau depressed fracture
  • classified using Schatzker system
76
Q

Test for meniscal tear:

A

Thessaly’s test: weight bearing at 20 degrees at knee flexion, patient supported, positive if pain on twisting knee

77
Q

What is infra patellar bursitis associated with?

A
  • also Clergyman’s knee

- kneeling

78
Q

What is prepatellar bursitis associated with?

A
  • housemaid’s knee

- upright kneeling

Orthopaedics (4 decks)

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