Orthopedics Run Flashcards
What is the salter harris classifcation?
-
Straight across (Type I)
- through the growth plate, not involving bone
-
Above (Type II)
- across most of the growth plate and up through the metaphysis
-
Lower (Type III)
- passes some distance along the growth plate and down through the epiphysis
-
Through (Type IV)
- fracture plane passes directly through the metaphysis, growth plate and down through the epiphysis
-
Runied or Rammed (Type V)
- crushing type injury
Label the areas of the bone
What is the most common type of bone related cyst?
Treatment options?
Ganglion cyst: an outpouching of the joint sace, filled with synovial fluid, usually asymptomatic. Transilluminates with light.
- Aspiration and steroids: 50% reoccurence
- Surgical resection: only if neccassary
- Mainly observation!
Allen’s test is for what?
Shows that there is dominant ulnar vascularisation of the hand > radial.
Compress botht he radial and ulnar artery at the level of the wrist, get patient to pump fist > hand will go white. Ulnar artery will reperfuse faster then radial.
Four major signs of Osteoarthritis?
- Diminshed Joint space
- Osteophytes
- Heberdens Nodules @DIP; common
- Bouchards Nodules @PIP; rare
- Subchondral sclerosis
- Subchondral cysts
What is a lisfranc injury
Tarsometatarsal injury between the medial cuniform and 2nd phalange
Symptoms
- severe pain
- inability to bear weight
- Physical examinspection & palpation
- medial plantar bruising
- swelling throughout midfoot
- tenderness over tarsometatarsal joint
Immobilise for upto 8 weeks!
Why do you sometimes see the Trendelenburg gair post hip surgery?
The tredelenburg gait is due to a weakness of the abductor muscles of the hips, causing an abnormal gait as the patient’s contralateral hip will drop to maintain balance.
Compensated trendelenburg will invlve the upper body leaning over the injured hip to stabalise the centre of gravity.
This can occur post surg with rupture of the abductor tendon.
Signs of Rheumatoid arthritis within a hand examination?
- Elbow nodules
- Deformaties of the finger joints (with sparing of the DIP)
- Boutonniere’s
- Swan neck
- Z-deformity of the thumb
- Ulnar deviation at the MCP
- +/- sublaxation
- Joint swelling and erythema
- Joint nodules
- Wasting of the interossei
What do Gouty tophi look like and where would you ffind them
Nodular masses of monosodium urate crystals. They occur ~12 years after first gout attack
- Found on fingers and the helix / anti-helix of the ears
- Contain white pasty looking material
What is the pathophysiology behind Rheumatoid arthritis?
Cell-mediated (T cell-MHC type II) immune response against soft tissues (early), cartilage (later), and bone (later)
-
rheumatoid factor
- an IgM antibody against native IgG antibodies
- immune complex is then deposited in end tissues like the kidney as part of the pathophysiology
-
mononuclear cells
- are the primary cellular mediator of tissue destruction in RA
-
IL-1, TNF-alpha
- are part of cascade that leads to joint damage
- immune response thought be related to
- infectious etiology or
- HLA locus
What lab tests should you do to confirm Rheumatoid arthritis?
- anti-CCP (cyclic citrullinated peptide, most sensitive and specific test)
- anti-MCV (mutated citrullinated vimentin)
- elevated ESR
- elevated CRP
-
positive Rheumatoid factor (most commonly IgM)
- targets the Fc portion of IgG
- elevated in 75-80% of patients with RA
- joint fluid testing
- decreased complement
- may have elevated RF level
When do you see wasting of the thenar eminence?
Carpal tunnel syndrome
What 3 tests do you do on the hadn to check musular innervation is intact?
- Medial: thumb flexion
- Radial: Finger extension
- Ulnar: Finger abduction
What is Raynauds Syndrome?
exaggerated vasocontriction of the digital arteries in response to a variety of stimuli.
- Cold
- Sympathetic stimuli (pain or emotional stress)
What is the difference between Raynauds Phenomenon and Raynauds Disease?
Raynauds Phenomenon: Due to an underlying condition
- Females >40
Raynauds Disease: Ideopathic with no underlying cause
- Premenopausal females <40
What are the underlying conditions associated with Raynauds Phenomenon?
Connective tissue diseases
- Scleroderma (80%)
- SLE (20%)
- Dermatomyositis (30%)
- RA (10%)
- CREST: calcinosis, Raynauds, esophageal dysmotility, sclerodactyly, telangiectasias
What is the Triphasic colour change seen in Raynauds?
- White: vasospasm and stasis of blood flow
- Blue: cyanosis and venous stasi
- Red: repurfusion with rebound hyperemia (rebound redness)
Clinical signs of scleroderma (excessive deposition of collagen in the skin?)
**** What is the newly funded NSAID that doesn’t have as much of an impact on the GI?
What type of inhibitor is it?
Celecoxib
selective COX-2 inhibitor
What nerve is most likely impacted by a shoulder dislocation?
Axillary Nerve Palsy
- Weakness of deltoid
- Cannot flex elbow or lift arm
- Sensory loss below the shoulder
Whats the difference between a buckle and a greenstick fracture?
They are both incomplete/nondisplaced fractures that occur in kids.
- Buckle: buckle upon itself on side, other side of the cortex is intact
- Greenstick: Bone bends and a little bit cracks
Whats is a Charcot Joint?
What are signs that a knee aspirate is due to septic arthritis?
-
White Cell Count >50, 000
- if 25-50 then consider inflammatory disease
- Culture
- Uric acid crystals or CPPD
CPPD is found where?
Calcium pyrophosphate deposition is found in pseudogout
clinically resemble acute attacks of urate gout
Is aspirating a larger volume or smaller volume indicate better prognosis for a query septic arthritis
larger volume as that is more indicative of an inflammatory cause
What is colchicine used for, and why would people avoid using it?
Acute exascerbations of gout. Used with NSAIDs
Causes diarrhoea so people avoid prescribing! if so use oral corticosteroids instead
what is Tronchateric bursitis?
Due to repeated movement of the ITB
Causes pain + tenderness over lateral thigh
Women 50-70
What is a Colles fracture
common extra-articular fractures of the distal radius that occur as the result of a fall onto an outstretched hand.
Fracture of the distal radial metaphysial region with dorsal angulation
What does low Ca2+ phosphate and high ALP indicate
Osteomalacia
- normal bony tissue but decreased mineral content
- If prior to growth plate fusion rickets can occur
Symptoms of osteomalacia?
- Bone pain
- Muscle weakness
- bony tenderness
- Difficulty walking/waddling gait
- fracture
- muscle spasms /cramps
What are the causes of osteomalacia
Treatment?
- vitamin D deficiency e.g. malabsorption, lack of sunlight, diet
- renal failure
- drug induced e.g. anticonvulsants
- vitamin D resistant; inherited
- liver disease, e.g. cirrhosis
calcium + vit D supplements
What are the features of Cauda Equina?
- lower back pain
- urinary incontinence/retention
- Saddle anaesthesia: reduced sensation in the perianal area and external genitalia + upper thighs
- decreased anal tone
- Gait distrubance
- Bilateral sciatica type pain
Causes of Cauda Equina Syndrome
- Slipped disc
- Cancer
- Trauma
- Epidural abscess/haematoma
What nerves are within the Cauda Equine and what do they form?
L1-S4 (L1-5 and S1-4)
Makes up the sacral plexus
What is the most appropriate scan to confirm cauda equina syndrome?
MRI
