orthopedics Flashcards
golfers vs tennis elbow
golfers (medial epicondyle)
tennis (lateral epicondyle)
Fever/back pain with pain on extension of the hip
iliopsoas abscess
what is the FRAX score?
FRAX estimates the 10-year risk of fragility fracture for 40-90year olds based on various risk factors such as age, sex, weight etc and bone mineral density measurements
FRAX score >10% needs a DEXA scan
scores for fracture risk
FRAX or QFracture
knee pain and swelling after exercise, locking and ‘clunking’
Osteochondritis dissicans
shortened and externally rotated leg
hip fracture
open fracture management
After primary wound debridement of an open fracture with or without temporary fixation (e.g. external fixation), a secondary inspection and debridement after 24-48 hours is warranted before definitive surgical fixation.
causes of fracture
trauma (Excessive force applied to healthy bone)
stress (repetitive low velocity injury)
pathological (minimal force to abnormal bone)
open fractures classification
Gustilo and Anderson classification
falls on outstretched hands cause fractures where?
scaphoid colles fracture (distal radius)
risk factors for Baker’s cysts
arthritis or gout and following a minor trauma to the knee
what is Foucher’s sign?
the increase in tension of the Baker’s cyst on extension of the knee. the cyst becomes hard as the pressure changes
Mx non-specific lower back pain
- NSAIDS eg Ibuprofen (paracetamol is ineffective!)
- proton pump inhibitors should be co-prescribed for patients over the age of 45 years who are given NSAIDs!!!
- physio, rest etc
Pencil in cup appearance X ray
psoriatic arthritis
X ray changes osteoarthritis
Loss of joint space (narrowing),
osteophytes,
Subchondrol sclerosis
Subchondrol cysts
DIPs, base of thumb, glenohumeral shoulder
X ray changes RA
soft tissue swelling
joint effusions
bony erosions
secondary osteoarthritis
light bulb sign x ray
posterior shoulder dislocation
nerve roots affected most commonly affected areas for cauda equina syndrome
L4, L5, S1
what is the most common cause is septic emboli/ septicaemia from Staphylococcus aureus?
endocarditis
investigations for discitis
MRI - gold standard diagnosis
CT guided biopsy - to target treatment
echocardiogram - look for source (endocarditis)
Mx scaphoid fracture
undisplaced fractures of the scaphoid waist
cast for 6-8 weeks — union is achieved in > 95%
displaced scaphoid waist fractures: requires surgical fixation
proximal scaphoid pole fractures: require surgical fixation
what is charcot joint?
aka. neuropathic joint
weight bearing joint which has become badly disrupted and damaged (midfoot remodelling) secondary to a loss of sensation (repeated damage to foot)
causes: ***diabetes, alcohol, syphillis, leprosy, spinal cord injury
signs: months of swollen, red, warm joint (not as painful to patient because of sensory damage)
complications of discitis
sepsis, epidural abscess
definitive management of compartment syndrome
fasciotomy.
Twisting sporting injuries followed by delayed onset of knee swelling. diagnosis?
meniscal tear
high twisting force is applied to a flexed knee. Rapid joint swelling
Anterior cruciate ligament rupture
classification of tibial plateau fractures? how many levels are there?
Schatzker
6
azathioprine + allopurinol interaction
bone marrow suppression
azathioprine is metabolised into mercaptopurine which inhibits purine synthesis
allopurinol inhibits xanthine oxidase which normally inactivates mercaptopurine
so with allopurinol, higher levels of mercaptopurine which incorporates into DNA and causes pancytopenia
before starting azathioprine
thiopurine methyltransferase (TPMT) for individuals prone to azathioprine toxicity