Orthopeadics Flashcards
What are the 6 characteristic deformities of a Colles #
Its is a distal # of the radius in elderly women, caused by a fall onto an outstretched hand.
- anterior displacement of the distal fragment
- dorsal displacement of the distal fragment
- impaction
- lateral displacement of the distal fragment
- ulnar angulation
- rotational or torsional deformity
What is an intra articular # of distal radius called?
Bartons #
Its can be displaced dorsally or palmar
What is a # where the distal radius is angled and displaced forward and palmar?
Smiths #, a reverse Colles.
More often needs to be fixed as the fragments migrate palmarly.
What is a # where the distal radius is angled and displaced forward and palmar?
Smiths #, a reverse Colles.
More often needs to be fixed as the fragments migrate palmarly.
What are the radiological signs of osteoarthritis?
Reduction of joint space
Osteophytes
Subchondrial cysts
Periarticular sclerosis
What are the causes of osteoarthritis?
Primary OA - degeneration of the articular cartilage with no predisposing factors.
Secondary OA - underlying precipitant factor, post traumatic, post operative, post infective malposition, mechanical instability, osteochondritis dissecans
What is the treatment for osteoarthritis of the knee?
MDT approach:
Strengthening exercises and walking aids from physio.
Occupational therapy making adjustments in the home
Medical non invasive - simple analgesics, NSAIDS
Invasive medical - steroid injections (long term benefits unclear), hyaluronan injections (gives lubrication to the synovium, better evidence than steroids)
Surgical - arthroscopy, osteotomies (is malalignment) or keen replacement
What are the indications for a knee replacement?
Pain at rest or disturbing sleep or making housebound
Pain correlates very poorly with radiological signs.
What are the indications for a knee replacement?
Pain at rest or disturbing sleep or making housebound
Pain correlates very poorly with radiological signs.
What clinical test can be used to elicit signs of an Achilles tendon rupture?
Simmonds Test - kneeling on a chair, plantar flexion is not induced by squeezing the calf on affected side.
What restriction of movement suggests damage to the patella?
Limitation of extension
If the patella mechanism interrupted wont be able to do straight leg raise.
What restriction of movement suggests damage to the patella?
Limitation of extension
If the patella mechanism interrupted wont be able to do straight leg raise.
What are the 3 different types of shoulder dislocation and how do they occur?
- Anterior - most common.
Overly external rotation from a fall.
Capsule tear and greater tuberosity # are not uncommon (Bankarts lesion) - Posterior - electrocuted or epileptic fit.
Overly internal rotation. or direct blow to front of humerus. - Luxatio errecta
Inferior dislocation due to hyper abduction.
What are the 3 different types of shoulder dislocation and how do they occur?
- Anterior - most common.
Overly external rotation from a fall.
Capsule tear and greater tuberosity # are not uncommon (Bankarts lesion) - Posterior - electrocuted or epileptic fit.
Overly internal rotation. or direct blow to front of humerus. - Luxatio errecta
Inferior dislocation due to hyper abduction.
Which nerve is at risk when a shoulder is dislocated and how do you test for it?
Axillary
Regimental patch on the forearm.
Which nerve is at risk when a shoulder is dislocated and how do you test for it?
Axillary
Regimental patch on the forearm.
Leg is shortened, adducted and externally rotated?
NOF
Leg is flexed, internally rotated, adducted and shortened?
Posterior Hip dislocation
How do you treat the various different hip #?
Non displaced intracapsular = screw fixation
Displaced intracapsular = THR
Intratrochanteric and extra capsular = DHS
What is Garden Classification?
How hip # are classified from the AP film.
I: incomplete undisplaced # with inferior cortex intact
II: Complete undisplaced # through neck
III: complete neck # with displacement,
IV; fully displaced # with proximal fragment in neutral position.
What is Garden Classification?
How hip # are classified from the AP film.
I: incomplete undisplaced # with inferior cortex intact
II: Complete undisplaced # through neck
III: complete neck # with displacement,
IV; fully displaced # with proximal fragment in neutral position.
What does trendelenburg’s test test and what causes a +ve result?
The function of the hip abductors.
A +ve test is when one side of the pelvis sags when standing on one leg (the sound side sags as the abductors of the leg being stood on are not strong enough to keep the pelvis horizontal)
Caused by abductor muscle paralysis.
Upward displacement of the greater trochanter (coxa vara or dislocated hip).
Absence of a stable fulcrum (ununited NOF #)
What are the complications of a hip replacement?
Early:
VTE, dislocation, deep infection, #, nerve palsy, limb length discrepancy, death.
Long term: loosening, infection, central migration of the prosthesis via perforation of the medial acetabular well ( bladder and internal iliac injury RARE)
What are the complications of a hip replacement?
Early:
VTE, dislocation, deep infection, #, nerve palsy, limb length discrepancy, death.
Long term: loosening, infection, central migration of the prosthesis via perforation of the medial acetabular well ( bladder and internal iliac injury RARE)
How do you classify ankle #?
Webers classification:
A - distal to syndesmosis
B- Involves syndesmosis
C- proximal to syndesmosis (unstable and needs fixation)
How do you classify ankle #?
Webers classification:
A - distal to syndesmosis
B- Involves syndesmosis
C- proximal to syndesmosis (unstable and needs fixation)
What are the causes of carpel tunnel syndrome?
Idiopathic RA Wrist # Hypothryoidism Pregnancy Alcoholism Renal failure
What causes compartment syndrome?
Pressure –> vascular occlusion –> hypoxia –> necrosis –> increasing pressure.
What causes compartment syndrome?
Pressure –> vascular occlusion –> hypoxia –> necrosis –> increasing pressure.
What are some systemic causes of osteonecrosis?
Sickle cell SLE Scleroderma Infective endocarditis Alcoholism Extensive burns Radiation DM Steriods Cushings disease Gaucher's disease (accumulation of fatty substances in tissues)
What are some systemic causes of osteonecrosis?
Sickle cell SLE Scleroderma Infective endocarditis Alcoholism Extensive burns Radiation DM Steriods Cushings disease Gaucher's disease (accumulation of fatty substances in tissues)
What would causes immediate pain and swelling in the knee?
Haemarthrosis: ACL/ PCL tear Patella dislocation Osteocondral Medial meniscal tear Hoffa's syndrome (fat pad impingement) Bleeding diathesis
What is the unhappy triad?
When the medial meniscus, medial collateral and ACL tear due to a blow to the lateral side of the knee whilst knee in fixed on the floor. Putting the leg into valgus.
When the knee is locked after an injury what does this suggest?
Meniscal tear - usually bucket handle (whole thickness longitudinal tear)
What associated injuries needs to be rulled out when the lateral collateral ligament is injured?
Biceps femoris and fascia lata and fibula.
Avulsion # needs to be ruled out.
What associated injuries needs to be rulled out when the lateral collateral ligament is injured?
Biceps femoris and fascia lata and fibula.
Avulsion # needs to be ruled out.
What are the two different routes of infection for oestomyelitis?
Acute haematogenous
Secondary to contiguous local infection
What are the chronic changes seen in oestomyelitis?
Sequestra - devascularlised portion of bone surrounded by necrosis and reabsorption
Involution - a thick sheath of new periosteal bone, surrounding the sequestra
What are the chronic changes seen in oestomyelitis?
Sequestra - devascularlised portion of bone surrounded by necrosis and reabsorption
Involution - a thick sheath of new periosteal bone, surrounding the sequestra
Sinus tracts
Marjolins ulcers (aggressive ulcerating SCCs)
What are some risk factors for osteomyleitis?
Diabetes Vascular disease Impaired immunity Sickle cell Surgical prostheses Open # Impaired immunity
How do you test for damage to C5-T1?
C5: shoulder abduction C6: elbow flexion C7: elbow extension C8: finger flexion (grip) T1: finger abduction
In minor injuries what are the criteria that if present will results in a C spine radiograph?
Neuro exam reveals focal deficit Spine exam reveals tenderness (posterior midline) Alteration in consciousness Intoxication Distracting injury
In minor injuries what are the criteria that if present will results in a C spine radiograph?
Neuro exam reveals focal deficit Spine exam reveals tenderness (posterior midline) Alteration in consciousness Intoxication Distracting injury
What are the causes of a limping child?
Septic arthritis:
MUST RULE OUT! wont be able to weight bare, often systemically unwell.
Perthes's disease: Osteochondritis of the femoral head, All movements limited, especially internal rotation and abduction. Increased risk of arthritis More common in boys
Slipped upper femoral epiphysis:
Increased risk in boys, obese
Flexion, abduction, and medial rotation is limited.
Needs to be treated by stablising the physis.
Transient synovitis of the hip:
Diagnosis of exclusion!!
What is dupuytrens contracture?
A progressive painless fibrotic thickening of the palmar fascia, with skin puckering and tethering.
Assoicated with genetic, smoking, diabetes, antiepileptics, peyronies disease.
How do you manage fractures?
Resuscitate - ABCD
Reduce - manipulation, traction or open reduction
Restrict - collar and cuff, braces, POP, percutaneous wires, internal fixation, external fixation
Rehabilitate - MDT
How do you manage fractures?
Resuscitate - ABCD
Reduce - manipulation, traction or open reduction
Restrict - collar and cuff, braces, POP, percutaneous wires, internal fixation, external fixation
Rehabilitate - MDT
How are open # managed?
ABCD
Assess neurovascular status, the soft tissue injuries, and photograph wound
Analgesia
Antiseptic - take swabs and irrigate with copious saline.
Anti tetnus
Antibiotics
Xray
Ask for help
Theatre - for wound debridement and fixation
How do you describe #?
Clinically: limb/ bone/ clinical deformity/ open or closed
Radiologically:
Bone (L or R)
Location in bone
Pattern (transverse, obliques, spiral)
Displacement/ translation - describe in terms of distal fragment, describe % of boney surface in contact
Angulation - “ distal fragment tilted laterally”
Axial rotation - one fragment rotating on its long axis compared to another one
Any shortening
Intra or extra artciular
Divide long bones into 1/3s
If no deformity “ in anatomical position
What are the complications of fractures?
IMMEDIATE:
Neurovascular injury
Soft tissue injury
What are the complications of fractures?
IMMEDIATE:
Neurovascular injury
Soft tissue injury
EARLY: Compartment syndrome Fracture blisters Infection Embolus
LATE: delayed/ mal / non union Avascular necrosis Post traumatic OA Complex regional pain disorder Growth arrest Deformity Stiffness
Why are scaphoid fractures susceptible to avascular necrosis?
Because the proximal pole relies on interosseous supply from the distal part
What does the Salter Harris classification classify and describe it.
Classification of epiphyseal injury:
I: # through the physis
II: # through the physis and metaphysis (above the growth plate)
III: # through the physis and the epiphysi (below the growth plate)
IV: # through the physis, and the meta and epiphysis, (through all tree)
V: crush injury to the growth plate (often diagnosed retrospectively)
What does the Salter Harris classification classify and describe it.
Classification of epiphyseal injury:
I: # through the physis
II: # through the physis and metaphysis (above the growth plate)
III: # through the physis and the epiphysi (below the growth plate)
IV: # through the physis, and the meta and epiphysis, (through all tree)
V: crush injury to the growth plate (often diagnosed retrospectively)
What are the indications for open reduction internal fixation?
Failed conservative treatment 2 # in the one limb bilateral identical # Intra articular # Open #
What are the indications for external fixation?
Burns Loss of skin and bone Open # Open book pelvic # Poly trauma
What complications need to be assess after a supracondylar #?
neurovascular status ++ because the brachial artery, the median, radial or ulnar nerve may be affected.
What complications need to be assess after a supracondylar #?
neurovascular status ++ because the brachial artery, the median, radial or ulnar nerve may be affected.
Describe what happens in Charcot Marie tooth syndrome?
It starts in puberty with weakness in legs and foot drop, with variable loss in sensation and reflexes.
It is an autosomal dominant disorder.
Peroneal muscles waste to result in the upside down champagne bottle sign.
Describe what happens in Charcot Marie tooth syndrome?
It starts in puberty with weakness in legs and foot drop, with variable loss in sensation and reflexes.
It is an autosomal dominant disorder.
Peroneal muscles waste to result in the upside down champagne bottle sign.
What is the pathology behind Paget’s disease?
Increased bone turn over associated with increased numbers of osteoblasts and osteoclasts with resultant remodelling, bone enlargement, deformity and weakness
What clinical chemistry does pagets produce?
Ca Po4 normal
ALP raised
Which muscles make up the rotator cuff?
Supraspinatus
Infraspinatus
Teres minor
Sub scapularis
What are the four signs of suppurative flexor tenosynovitis?
Flexed posture
Swelling
Pain on passive extension
Flexor sheath tenderness
What are the four signs of suppurative flexor tenosynovitis?
Flexed posture
Swelling
Pain on passive extension
Flexor sheath tenderness
What injury usually results from hyperextension of the cervical spine on a background of spinal canal stenosis?
Central cord syndrome - greater loss of the motor power in the upper extremities compared to the lower.
What does the foramen magnum transmit?
Medulla Meninges Vertebral arteries Anterior and posterior spinal nerves Spinal accessory nerves Sympathetic plexus
What does the foramen magnum transmit?
Medulla Meninges Vertebral arteries Anterior and posterior spinal nerves Spinal accessory nerves Sympathetic plexus
What is different about the presentations of Osteosarcoma, Ewings sarcoma, Giant cell tumour and chondrosarcoma?
OSTEOSARCOMA: Most common malignant primary bone tumour In metaphyses of long bones (espec KNEE) May arise post pagets On xray has sunray spiculation
EWINGS SARCOMA: Found in diaphysis Onion ring sign on xray Soft tissue mass Common in femur, pelvis, tibia and humerus
GIANT CELL TUMOUR aka osteoclastoma rare Epiphyses Osteolytic tumour can cause pathological #
CHONDROSARCOMA:
Pain or a lump in the axial skeleton
Pop corn calcification
Injury at what levels would cause these problems? Not able to stand from squatting Not being able to walk on heels Not being able to walk on tip toe Reduced knee jerk Reduced ankle jerk
Not being able to stand from squatting = L4 defect
Not being able to walk on heels = L5 defect
Not being able to walk on tip toes = S1 problem
Reduced knee jerk = L3/L4 problem
Reduced ankle jerk = L5/S1 problem
