Orthopedics Flashcards
Give 3 early complications of a fracture?
DVT/PE
Compartment syndrome
Infection
Neurovascular damage
What is compartment syndrome?
This results from swelling of a muscle or bleeding within its compartment. The inability of the compartment to expand means that vessels are liable to be occluded and nerves impinged.
Can lead to Volkmanns ischaemic contracture
How do you manage compartment syndrome?
Fasciotomy of the compartments involved
Give 5 late complications of fractures?
Mal-union, Nonunion & Delayed union Infection Growth disturbance Avascular necrosis Myositis ossificans
In a neck of femur fracture, how might the leg look?
Shortened and externally rotated
What sign on examination would you expect on posterior dislocation of the femur?
Shortened and internally rotated
In an intracapsular fracture of the head of the femur, which vessel is in danger and where does it arise?
Medial circumflex artery from the femoral artery
What are the treatment options for a NoF fracture? 3 things
Non displaced = Cannulated screw or Dynamic hip screw
Displaced intracapsular =
Hemiarthroplasty (old, less fit, comorbidities) or THR (mobile, medically fit)
Extracapsular = Intra medullary device or DHS or Arthroplasty
Suggest 4 functions of the meniscus and how would you test integrity
Buffer between joint
Shock absorption
Lubrication
Limits flexion and extension
McMurrays test
In knee ligament tears, what investigations might you consider?
MRI
Arthroscopy
In a knee ligament tear/damage, what is the basic treatment and what advice would you give? 6 things
RICE Knee immobiliser Ice NSAIDs Don't fully weight bear Advice about high intensity activities
Give 2 early and 2 late symptoms of an ACL tear?
Early-Pain and swelling
Late-Arthritis and joint instability
What causes an ACL tear?
Hyper extension and inversion of the knee
In ACL damage, name 3 examinations that might show an abnormality?
Anterior draw test
Lachmans test
Pivot shift test
What is the surgical option for an ACL tear?
ACL reconstruction using graft
Give 3 possible complications of Arthroscopy?
DVT Infection Excessive bleeding Damage to cartilage Paraesthesia over knee
Which 2 types of fractures only occur in children?
Green stick fracture
Salter Harris epiphyseal fractures
Give 4 aspects of the management of a fracture?
Resuscitation - A to E assessment & Skeletal survey for other fractures
Reduction - closed, traction or open
Restriction - maintenance of reduction (slings, plaster, external/internal fixing, functional bracing, continuous traction)
Rehabilation - Mobilise with Physio ASAP
In a child, give 3 features that might suggest non accidental injury?
Fractures in immobile kids Inconsistent story Delayed presentation Repeated injuries Withdrawn child Kid appears scared of guardian
How do you test for painful arc syndrome?
Hawkins test
In painful arc syndrome, where will the patient feel pain during your examination?
70-120 degrees during active abduction
Which classification can you use for an open fracture?
Gustillo-Anderson Classification
What is the Abx therapy in an open fracture?
Co-Amoxiclav and Metronidazole
Name 3 complications of a shoulder dislocation?
Neurovascular damage
Bankart Lesion (glenoid labrum avulsion)
Recurrence (100-age=%)
Give 3 predisposing factors for carpal tunnel syndrome?
Diabetes Obesity Pregnancy Hypothyroidism Heavy manual work
Give 3 symptoms of osteoarthritis?
Pain
Reduced ROM
Morning stiffness <30mins
Deformity
Name the 4 characteristic findings of osteoarthritis on an X-ray?
Joint space narrowing
Osteophytes
Subchondral cysts
Subchondral sclerosis
Give the aspects involved in management of osteoarthritis? 6 things
Conservative: Analgesia, Lifestyle changes (weight loss and exercise), physio, walking aids, steroid injections
Surgical: Arthroplasty, Arthrodesis, Osteotomy
What is a pathological fracture?
A fracture through abnormal bone caused by tumour, infection, osteoporosis etc.
Name the 5 common places where bone metastases come from?
Breast Lung Thyroid Kidney Prostate
State the phases of fracture healing?
Reactive phases-
- fracture and inflammatory phase
- Granulation tissue formation
Reparative phase
- Callus formation
- Lamellar bone deposition
Remodelling
-remodelling to original bone contour
What is the T score in DEXA scanning and what is its significance?
Measure of how bone density compares to normal average young healthy adults’ bone density
0 to -1 = normal
- 1 to -2.5 = osteopenia
- 2.5 or worse = osteoporosis
Which drugs are the best for osteoporosis and how should they be taken?
Bisphosphonate
Weekly
Empty stomach
Remain upright for 30mins after taking them
Give 2 methods of preventing osteoporosis in post menopausal women?
Exercise
Bisphosphonates
Smoking cessation
Calcium/Vit D supplements
Give 5 causes of delayed union of a fracture?
Separation of fragments Soft tissue between fragments Excessive movement at site Poor local blood supply Smoking
Name 4 ways you can manage carpal tunnel syndrome?
Conservative-lifestyle changes (computer keyboard, machine use) Splint Pain relief (NSAIDs) Carpal injection (hydrocortisone) Surgical decompression
What deformity can occur from a supracondylar fracture? 2 things
Volkmanns contracture
Gun stock deformity (cubitus varus)
What is the Salter Harris classification? Describe the different types?
Classification of growth plate injuries
SALTR
Type I - (Same) - fracture of growth plate
Type II - (Above) - fracture above physis
Type III - (Lower) - fracture below physis
Type IV - (Through) - fracture through meta, epi and physis
Type V - (Rammed) - physis is rammed/crushed
Give 4 clinical features seen in Carpal tunnel syndrome?
Hand of benediction
Pain - worse at night
Parasthaesia (numbness/tingling)
Muscle wasting in advanced cases
What is the arterial supply to the head of the femur? 3 things
Retinacular arteries
Nutrient vessels
Artery of the ligament of the head of the femur
What is the Gustillo Anderson classification? Describe the types?
Classification for open fractures
Type 1 - Open fracture with wound 1cm. Soft tissue cover adequate
Type 3a - Open fracture with extensive soft tissue damage. Cove is adequate
Type 3b - Open fracture with bone exposure and periosteal stripping.
Type 3c - Above plus arterial damage
Give 5 factors which affect fracture healing?
Bone affected Position of fragments Blood supply to fragments Age and comorbidities of patient Method of restriction (plaster or surgery)
Give 3 signs you might see in osteoarthritis?
Restricted movement Bouchards nodes (PIPJ) Heberdens nodes (DIPJ)
Give 6 complications of a Total Hip Replacement?
Immediate:
Fat embolism
Fracture of femur
Early:
Infection
Leg length difference
Dislocation
Late:
Periprosthetic fracture
Bone stock loss
Give 4 risk factors for developing osteoporosis?
Biological: Old age, female, FHx
Lifestyle: Anorexic/Slender, smoker
Endocrine: Early menopause, Amenorrhoea
Medication: Steroids
What are the management steps in septic arthritis? 4 things
Analgesia
Joint washout
Empirical ABx - flucloxacillin, benzylpennicilin, gentamicin
Splint then physio
