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Orthopedics Flashcards

1
Q

What is the classification system for growth plate fractures in children?

A

Salter-Harris System
I - fracture through physis only
II - fracture through physis and metaphysis
III - fracture through physis and epiphysis
IV - fracture through physis, metaphysis and epiphysis
V - crush injury involving the physis

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2
Q

What is osteogenesis imperfecta

A

Failure of maturation of collagen in all connective tissues, leads to defective osteoid formation

This can lead to pathological fractures in children

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3
Q

What is the common age of presentation of perthes’ disease?

A

Between 4-10 years

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4
Q

Pathophysiology of perthes disease

A

Rapid growth leads to avascular necrosis of femoral head (femoral epiphysis)
Interruption of blood supply results in necrosis, removal of necrotic tissue and replacement with new bone
During this process of replacement (which can last several years), there is an initial softer bone. It is during this state that the head of the femur is more likely to collapse into a flatter position

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5
Q

Symptoms of Perthes diabetes

A

Hip pain
Limp
Stiffness and reduced range of movement in hip

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6
Q

Management of perthes’ disease

A

Observation - in young children who show few changes in femoral head in initial X-rays (repeat x-rays over term to make sure regrowth is on track)

Casting and bracing - if range of motion becomes limited or if x-rays suggest that a deformity is developing, this may be used to keep the head in the acetabulum while reformation occurs

Conservative - physio, NSAIDs, avoid high impact running/jumping

Surgery - if child is >6 years of age at diagnosis may be considered to realign the joint

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7
Q

What is slipped upper femoral epiphysis (SUFE)

A

Where the is displacement of the femoral neck anterio-laterally and superiorly

Classically seen in obese teenagers

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8
Q

Clinical features of SUFE

A

Hip pain, thigh pain or knee pain

Loss of internal rotation of the leg in flexion

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9
Q

Investigations for SUFE

A

Bilateral hip X-ray - as bilateral slip occurs in 20% of cases

AP and frog-leg views

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10
Q

Management of SUFE

A

Internal fixation of hip - using single cannulated screw in epiphysis

May consider prophylaxis management of other hip

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11
Q

What is compartment syndrome?

A

Complication that may occur following fractures or surgery

Characterised by raised pressure within closed anatomical space - this can lead to decreased tissue perfusion resulting in necrosis

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12
Q

What are the two main fractures compartment syndrome is more common in?

A

Supracondylar humerus fractures

Tibial shaft fractures

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13
Q

Features of Compartment Syndrome

A

Pain - especially on passive movement
Excessive use of breakthrough analgesia
Parasthesisa
Pallor

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14
Q

What Intracompartmental pressure is diagnostic for compartment syndrome?

A

> 40mmHg

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15
Q

Management of compartment syndrome

A

Remove cast (if present)
Prompt fasciotomies
Aggressive IV fluids - as myoglobinuria may occurs following fasciotomy and result in renal failure

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16
Q

What is the most common infection organism in osteomyelitis?

A

Staph aureus

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17
Q

What is the most common infective organism in osteomyelitis in patients with sickle cell disease

A

Salmonella

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18
Q

Patients at risk for osteomyelitis

A

Diabetics
Sickle cell anaemia patients
IVDUs
Immunosuppresed patients

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19
Q

Management of osteomyelitis

A

Flucloxacillin - 6 weeks

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20
Q

Red flags for back pain

A 
<20 years, >50 years
Hx of previous malignancy 
Night pain 
Trauma 
Bowel/bladder incontinence 
Saddle anaesthesia 
Weight loss, fever
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21
Q

When would you offer MRI to patients with back pain

A

If suspecting: malignancy, infection, fracture, cauda enqina or Ankylosing spondylitis

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22
Q

What is the management for simple back pain

A

Encourage activity as limited
NSAIDs 1st line for pain relief
Physio

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23
Q

What is lumbar spinal stenosis?

A

Condition where the central spinal canal is narrowed by degenerative changes

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24
Q

Clinical signs of lumbar spinal stenosis

A 
Gradual onset back pain 
Neuropathic leg pain (with or without back pain)
Neurogenic claudication 
Pain resolves when sitting 
Easier to walk uphill than downhill
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25
Management of suspected lumbar spinal stenosis
Simple analgesia | Referral for consideration of laminectomy if not improving
26
Signs of a prolapsed disc
Leg pain worse than back pain Pain worse when sitting Clear dermatomal distribution dependant on which nerve root is compressed
27
Difference between femoral and sciatic nerve stretch test and what they mean
Femoral (mackiewicz) - patient lies on front, knee passively flexed to thigh, and hip is passively extended. If anterior thigh pain test is positive (this suggests either L3 or L4 root compression) Sciatic (Lazarevics) - straight leg raise test, when raising the leg to 30 to 70 degrees, pain occurs and radiates down the leg to below the knee (suggests either L5 or S1 compression)
28
What is discitis?
Infection of the intervertebral disc space
29
Features of discitis
Back pain Systemically unwell - fever, rigor, sepsis Neurological features - if epidural abscess develops secondary
30
Why would you do an ECHO on a patient presenting with discitis?
To assess for endocarditis - which can be a common cause of discitis
31
What is de Quervain’s tenosynovitis Who is it most common in?
Inflammation of the sheath containing the extensor pollicis brevis and abductor pollicis longus Typically affects females aged 30-50 years old
32
Features of tenosynovitis
Pain on radial side of wrist Tenderness over radial styloid process Abduction of thumb against resistance is painful
33
Test used to diagnose de Quervain’s tenosynovitis
Finkelstein’s test - thumb in closed fist, tilt hand down (ulnar deviation), pain felt over the radius is positive indicator of de Quervain’s
34
When would you have surgery for Dupuytren contracture?
When the metacarpophalyngeal joints cannot be straightened and thus hand cannot be placed flat on a table
35
Features of carpal tunnel syndrome
Pain/paresthesia in thumb, index and middle finger | Patients classically shake hand at night to obtain relief
36
What are the two examination signs associated with carpal tunnel syndrome?
Tinel’s sign - tapping the carpal tunnel causes paresthesia | Phalen’s sign - flexion of the wrist causes symptoms
37
Management of carpal tunnel syndrome
Corticosteroid injection Wrist splints Surgical decompression - division of flexor retinaculum
38
What are the most common fractures associated with a fall onto an outstretched hand?
Scaphoid fracture | Distal radial fractures
39
Blood supply to scaphoid bone
Dorsal carpal branch of radial artery
40
Clinical features of scaphoid fracture
``` Pain along radial aspect of wrist (base of thumb) Tenderness over anatomical snuffbox Loss of grip/pinch strength Pain on ulnar deviation Wrist joint effusion ```
41
Management of scaphoid fractures
Emergency - immobile in future splint or standard below elbow backslab If undisplaced - cast for 6-8 weeks If displaced - surgical fixation
42
What is the main complication of a scaphoid fracture
Avascular necrosis to scaphoid due to retrograde blood supply
43
What is the most common type of shoulder dislocation?
Glenohumeral dislocation (anterior shoulder dislocation - where the dislocated humeral head lies in a sub coracoid position)
44
How does an anterior shoulder dislocation usually present
Externally rotated and abducted
45
What is impingement syndrome?
Subacromial impingement | Painful abduction of shoulder - pain between 90-120 degrees
46
How many degrees would pain be elicited in a rotator cuff tear injury
Pain usually in first 60 degrees of abduction
47
Rotator cuff muscles special tests
Supraspinatus- empty can test Infraspinatus - external rotation against resistance Teres minor - horn blowers test Subscapularis- gerbers lift off test
48
What group of patients is adhesive capsulitis (frozen shoulder) more common?
Diabetics
49
Types of hip dislocation, presentation and which is more common?
Posterior (90%) - shortened, adducted and internally rotated | Anterior - abducted, externally rotated, no leg shortening
50
Management of hip dislocation
Analgesia | Reduction under anaesthetic within 4 hours - to reduce risk of avascular necrosis to the femoral head
51
Features of hip fracture
Shortened Externally rotated Painful
52
What is the difference between Intracapsular and extracapsular hip fractures?
Intracapsular - from edge of femoral head to insertion into acetabulum Extracapsular - can either be Trochanteric (between greater and lesser trochanter) OR sub trochanteric (below lesser trochanter)
53
Classification of hip fractures
``` Garden classification: I - stable II - complete but undisplaced III - displaced, usually rotated and angulated IV - complete boney disruption ```
54
Management of Intracapsular hip fracture
Undisplaced - internal fixation Displaced (<70 years and fit) - reduction and internal fixation surgery Displaced ( >70 but independent and mobile) - total hip replacement Displaced (>70 but not independently mobile) - hemiarthroplasty
55
Management of extracapsular hip fracture
Depends on location: Trochanteric - dynamic hip screw Subtrochanteric - intramedullary nail
56
Difference between a high and low ankle sprain in location and mechanism of injury
Low ankle - involves lateral collateral ligaments - mechanism is usually via inversion High ankle - involves the syndesmosis (fibrous ligament holding tibia and fibula together) - mechanism is usually via external rotation
57
How would you differentiate between a high and low ankle sprain?
Low - able to weight bear usually High - weight bearing painful, pain elicited when tibua and fibular squeezed together at level of mid calf (Hopkins squeeze test)
58
Classification of ankle fractures
Danis Weber classification A - below syndesmosis (low ankle fracture), stable B - may extend to involve syndesmosis C - above syndesmosis
59
Management of ankle fractures
Stable (type A) - CAM boot for 6 weeks | Unstable (type C) - surgical repair
60
How does an Achilles’ tendon rupture usually present?
Audible pop in the ankle while playing sport or running Significant pain in calf or ankle Inability to walk
61
How would a calf squeeze help to diagnose Achilles’ tendon rupture?
Normally the calf would plantar flex on squeezing | In Achilles’ tendon rupture - the foot will stay in neutral position
62
Imaging choice for diagnosis of Achilles’ tendon rupture
USS
63
What is plantar fasciitis and how does it usually present
Heel pain in adults Inflammation of plantar fascia on the bottom of the foot Presents in patients who have recently started doing more walking/running Pain elicited when squeezing medial calcaneal tuberosity (heel)
64
Management of plantar fasciitis
Rest foot | Wear shoes with good arch support and cushioned heels
65
What is Morton’s neuroma
Benign neuroma affecting the plantar nerve - most commonly in the 3rd inter-metatarsophalangeal space
66
How does Morton’s neuroma present
Forefoot pain | Pain worse on walking - patients may feel they have a pebble in shoe
67
Management of Morton’s neuroma
Metatarsal pad
68
What is Charcot joint
Neuropathic joint - commonly in foot Commonly occurs in neuropathy e.g diabetics, alcoholics Presents with neuropathic pain and loss of sensation Foot appears swollen and disfigured
69
Common Reflexes and spinal cord levels they arise from
``` Biceps - C5/C6 Brachioradialis - C5/C6 Triceps - C7/C8 Knee - L3/L4 Ankle - S1/S2 ```
70
Which nerve is most commonly injured during a shoulder dislocation?
Axillary nerve
71
What is the usual mechanism of injury for a meniscal tear
Twisting injury | Typically twisting around a flexed knee
72
Examination finding on anterior and posterior cruciate ligament rupture
Anterior cruciate - positive anterior drawer test | Posterior cruciate - positive posterior drawer test
73
Difference between medial and lateral epicondylitis
Medial (golfers) - tenderness over medial epicondyle and medial wrist pain on resisted wrist pronation Lateral (tennis) - tenderness over lateral epicondyle and elbow pain on resisted wrist extension
74
Difference between the two types of Barton fracture: colles and smiths fracture
Both fractures of radial bone Colles - wrist extended on impact, dorsal displacement and angulation Smiths - wrist flexed on impact, reverse colles
75
What is the line that is lost on an-X-ray of a hip fracture?
Shenten’s line

Year 5 (17 decks)

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