Surgery: Ortho Flashcards
The general principles of T&O
Trauma: Resus, Reduce, Restrict, Rehabilitate
Ortho: Look, Feel, Move, Special Tests
What are the clinical signs of a fracture?
Pain, swelling, crepitus, deformity, adjacent structural injury
How would you describe a fracture?
Location, pieces, pattern, displacement, plane
Outline translation and angulation
Coronal Plane:
- Medial/Lateral
- Varus/Valgus
Sagittal Plane:
- Anterior/Posterior
- Dorsal/Volar
Axial Plane:
- Proximal/Distal
- Internal/External
When is external fixation most commonly used?
Large amount of soft tissue damage inc risk of infection and also as a quick fix to save life
Where is Shenton’s line?
Imaginary curved line drawn along the inf border of the superior pubic ramus and inferomedial border of NOF
What is the % risk of AVN in a displaced intracapsular #?
25-30%
Hemi vs THR
If young, fit, mobile -> THR
If older and less fit -> hemiarthroplasty
Why don’t you give everyone a THR?
Lower mobility, multiple comorbidities, risk of dislocation, requires specialist hip surgeons
Important points in an OA hx
Pain (exertional, rest, night)
Disability (walking distance, stairs, giving way)
Deformity
Prev hx of trauma or infection
Tx given physio, injections, ops
Other joints affected
What is the angle of flexion if the leg is straight?
0°
The mx of OA
Conservative: analgesics, physio, walking aids, avoidance of exacerbating activity, infections
Operative: replace, realign, excise, fuse, synovectomy, denervate
RA vs OA
RA - inflammatory - worse in the morning
OA - degenerative - worse w activity
Look
Scars
Swellings
Deformities
Redness
Feel
PET: pain, effusion, temp
Move
Active -> Passive
Active ❌ Passive ✅
Think muscle, tendon, neuro
Active ❌ Passive ❌
Think mechanical block
Why do osteophytes form?
They’re outgrowths of bone to try spread the SA and dec friction
What are the special tests?
Knee - C’s - collaterals, cruciates, cartilages
Hip - T’s - Trendelenburg’s and Thomas’s
Shoulder - I SITS - impingement, supraspinatus, infraspinatus, teres minor, subscapularis
What should you always ask for before performing Thomas’s test?
If they have a hip replacement
How does a frozen shoulder present?
Extremely painful, global dec ROM, normal xray
Bone growth in width and length?
Width - intramembranous ossification
Length - endochondral ossification
What are the two types of bone healing?
Primary/Direct - by direct union and cutting cone where haematoma has been disturbed - slow
Secondary/Indirect - by callus formation where haematoma has NOT been disturbed - fast
Which type of bone healing can the union be evaluated by xray?
Secondary
Which type of bone healing is fastest?
Secondary