Surgery

Question 1

Name 10 indications external fixation

Answer 1

•severe open fracture for wound management!
• damage control!
• correct deformity or length inequality!
. Severe comminuted and unstable # which can be held out to length while healing
• # associated with major vessel damage
• paediatric fractures
• closed fractures with soft tissue compromise
• periarticular fracture eg pilon!
•Pelvic ring fracture! Esp open book
• burns
• infected fractures!
• malunion/nonunion! Which require bone reconstruction
• arthrodesis
• osteomyelitis. For stabilisation

Question 2

What is a Hemiarthroplasty of the hip and who is it indicated for?

Answer 2

• Only the femoral head is replaced with a prosthesis
• indicated for older patients who are expected to live less than 10 years and not very mobile
. Benefits: early recovery, less traumatic
• disadvantage: will erode patient’s acetabulum therefore not indicated in younger, more mobile patients

Question 3

What is a full arthroplasty of the hip and who is it indicated for?

Answer 3

• Prosthesis inserted for both femoral head and acetabulum
• Young, mobile patients
• last about 15-20 years before need replacement

Question 4

Name 10 indications orif

Answer 4

Absolute RAINS
• unable to obtain adequate reduction
• displaced intra-articular # eg tibial plateauand plafond #, distal radius, radial head, femoral and humerus
• certain types displaced epiphyseal fractures - salter Harris 3 and 4
• major avulsion # where there is loss function of joint or muscle group
• non-unions
• re-implantations of limbs or extremitie.
• NOF # in young
. Galleazzi and monteggia #
• lower limb # elderly
• floating knee or elbow

Relative UPPIR
• delayed unions
• polytrauma
• unable to maintain reduction
• pathological #
• reduce morbidity due to prolonged immobilisation
• for # of which closed methods are known to be ineffective eg neck of femur #

Questionable CON
• fractures with nerve or vessel injury
• open #
• cosmetic and economic considerations

Question 5

Name 4 general indications orif according to algorithm

Answer 5

• Intra-articular, displaced #
• intra-anticular, undisplaced # that probably won’t remain undisplaced until Union
• extra-articular displaced, closed reduction, unstable
• extra-articular, undisplaced but displaces after immobilisation

Question 6

Name general indications immobilization and follow up according to algorithm

Answer 6

Intra-articular, undisplaced, will probably remain undisplaced until Union

Question 7

Name general indications immobilisation according to algorithm

Answer 7

Extra-articular, displaced, stable after closed reduction

Question 8

Name indications closed reduction according to algorithm

Answer 8

Extra-articular displaced

Question 9

Name 8 contraindications to joint replacement

Answer 9

Absolute
• sepsis in joint
• remote source of ongoing infection
• severe vascular disease

Relative
• med conditions that preclude safe anaesthesia and demands of surgery and rehab
• skin conditions within field of surgery eg psoriasis
• past history osteomyelitis around joint
• neuropathic joint
• obesity