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Surgery- T&O Flashcards

Emergencies ✔ Ankle X Hip - Foot and ankle - Hand - Wrist - Arm X Spine X

1
Q

How is plantar fasciitis initially managed?

A

Rest
Stretching
Weight loss

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2
Q

How is plantar fasciitis managed if conservative measures fail?

A

NSAIDs
Orthotics 6 week referral

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3
Q

How is a Weber C fracture managed?

A

Surgical fixation

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4
Q

How are ankle fractures classified?

A

Weber classification is used if there is both a fibula and tibia #. Also look for talar shift.
In regards to fibula fracture:
A- below level of syndesmosis
B- at the level of the syndesmosis
C- above the syndesmosis

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5
Q

What are the Ottawa ankle rules?

A

Xray if there is malleolar pain and:
Inability to weight bear for 4 steps
Tenderness over distal tibia
Bone tenderness over the distal fibula

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6
Q

What examination findings support a diagnosis of NOF#

A

Leg shortened and externally rotated

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7
Q

What is the Garden classification?

A

Classification of NOF:
1- Non displaced and incomplete #
2- Non displaced and complete #
3- Partially displaced
4- Fully displaced

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8
Q

How are the different types of extracapsular #NOF managed?

A

Intertrochanteric- dynamic hip screw
Subtrochanteric- intramedullary nails

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9
Q

What are the different types of intracapsular NOF#?

A

Subcapital
Transcervical
Basicervical

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10
Q

How are displaced intracapsular #NOF managed?

A

ORIF if <70 years old
Total hip arthroplasty if 70 or older

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11
Q

How are undisplaced intracapsular #NOF managed?

A

Internal fixation

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12
Q

How are intracapsular #NOF managed, in an unfit pt?

A

Hemiarthroplasty

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13
Q

What is the initial management of a suspected scaphoid #?

A

Immobilisation with a futuro splint or below elbow backslab
Referral to orthopaedics

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13
Q

When is surgical fixation required in scaphoid #?

A

Certain groups with undisplaced e.g. professional sports people
Displaced scaphoid #
Proximal scaphoid pole #

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13
Q

What is the orthopaedic management of an undisplaced scaphoid #?

A

Cast for 6-8 weeks

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13
Q

If initial imaging in suspected scaphoid # are inconclusive, what should be done?

A

Clinical review with imaging 7-10 days later
If still inconclusive, MRI can be done

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14
Q

What are the complications of scaphoid #?

A

Non union leading to pain and early OA
Avascular necrosis- more likely the more proximal the #

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15
Q

What is the most common causative organism of osteomyelitis?

A

Staph aureus

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16
Q

Via what routes can osteomyelitis be spread?

A

Haematogenous
Direct inoculation of micro organisms e.g. open #
Direct spread from local infection e.g. adjacent SA

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17
Q

What causative organism is more common in osteomyelitis in IVDU than non IVDU pts?

A

P aeruginosa

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18
Q

What can happen in chronic osteomyelitis cases?

A

Devascularisation of the affected bone, leading to necrosis and resorption of surrounding bone. Leads to ‘floating’ bone called sequestrum
This can be encased by new bone and form an involucrum

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19
Q

What are the risk factors for osteomyelitis?

A

DM
Immunosuppression
Alcohol excess
IVDU

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20
Q

What is the gold standard for diagnosis of osteomyelitis?

A

Culture via bone biopsy and debridement

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21
Q

How is osteomyelitis initially imaged? When are these investigations done and what will they show?

A

X ray- initially but poor accuracy. Show osteopenia, focal cortical bone loss etc 7-10 days post infection.
MRI imaging- shows bone marrow oedema 1-2 days post infection

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22
How is osteomyelitis managed?
Long term IV abx, for more than 4 weeks Surgical management may be needed to debride the infected bone. +/-reconstruction
23
What are the differentials of an acutely swollen joint?
Always need to exclude septic arthritis first -Gout or pseudo gout -Rheumatoid: RA, spondyloarthropathies -Trauma: haemarthrosis
24
How are open # initially managed?
Realignment and splinting of the limb. Broad spec abx Tetanus vaccination Photograph wound Remove any gross debris Dress with a saline soaked gauze
25
What is the definitive management of an open #?
Surgical debridement of the wound and # site. Remove all devitalised tissue. -do immediately if contaminated with marine/agricultural/sewage -do within 12-24 hours otherwise Wash out with saline Skeletal stabilisation
26
What are the causes of compartment syndrome?
High energy trauma, crush injuries or # with vascular trauma most commonly Tight casts or splints DVT Post reperfusion swelling
27
What is the pathophysiology of compartment syndrome?
Fascial compartments are closed and cannot expand. Any fluid in this area will cause an increase in intra-compartmental pressure. Veins will be compressed. This increases the hydrostatic pressure causing fluid to shift out of the veins, and further increase pressure. Traversing nerves are compressed. Arterial flow is then compromised, as pressure matches diastolic bp.
28
What are the 5 P's of compartment syndrome?
Pain- out of proportion and not responding to analgesia Pallor- or non blanching mottled Perishing cold Paralysis Pulseless
29
What investigations can aid in diagnosis of compartment syndrome?
(mainly clinical dx) CK level Intra compartmental monitor
30
How is compartment syndrome managed?
Immediate fasciotomy- definitive. Skin incisions are left open and reassessed 24-48 hrs later Keep limb at neutral level High flow O2 Inc bp with IV fluids Remove all dressings Opioid analgesia
31
What should be monitored for complications post compartment syndrome?
Renal function -rhabdomyolysis -reperfusion injury
32
At what age do growth plates close?
F: 13-15 yrs M: 15-17 yrs
33
What is the physiology of growth plates?
Epiphysis, physis and metaphysis. The physis is the hyaline cartilage plate, where endochondral ossification occurs. This is where chondrocytes replace cartilage with bone, resulting in growth of long bones.
34
What are the complications of growth plate #?
Disruption or early closure of growth plate: Impaired function Growth arrest Limb deformity
35
What is Dupuytren's contracture?
Contraction of the longitudinal palmar fascia
36
What is the pathophysiology of Dupuytren's contracture?
Fibroplastic hyperplasia causes thickening and contraction of the palmar fascia 1- pitting and thickening 2- nodule forms 3- cord develops and contracts over months/years 4- contraction pulls on MCP and PIP causing flexion deformity
37
What are the risk factors for dupuytren's?
Male Smoking Alcoholic liver cirrhosis DM Occupational e.g. manual work or vibrational tools
38
What are the conservative and medical management options for Dupuytren's?
Hand therapy Injectable collagenase clostridum histolyticum
39
What is the surgical management for Dupuytren's disease?
Fasciectomy
40
What is De Quervain’s tenosynovitis?
Inflammation of the tendons within the first extensor compartment of the wrist
41
How does De Quervain’s tenosynovitis present?
Pain near the base of the thumb Swelling Pain on grasping or pinching Positive Finkelstein's test
42
What are the management options for De Quervain’s tenosynovitis?
Avoiding repetitive actions Wrist splinting Steroid injections Surgical decompression of the extensor compartment
43
What movements are the nerve roots C5-T1 responsible for?
C5 – Shoulder abduction C6 – Elbow flexion C7 – Elbow extension C8 – Finger flexion T1 – Finger abduction
44
What movements are the nerve roots L2-S1 responsible for?
L2 – Hip flexion L3 – Knee extension L4 – Ankle dorsiflexion L5 – Great toe extension S1 – Ankle plantarflexion
45
When assessing power, what do the different grades (0-5) mean?
0-paralysis 1-contraction 2-full active ROM with gravity eliminated 3-full active ROM against gravity 4-full active ROM against gravity, moderate resistance 5-full active ROM against gravity, full resistance
46
What are the long term complications of NOF repair?
Joint dislocation Aseptic loosening Peri prosthetic fracture Deep infection
47
What is a ganglionic cyst and where are they found?
Soft tissue limps along any joint or tendon, due to degeneration within the joint capsule or tendon sheath. They become filled with synovial fluid. Usually around the hands or feet
48
What are the risk factors for developing a ganglionic cyst?
Female Osteoarthritis Previous joint or tendon injury
49
What does a ganglionic cyst look like o/e?
Soft spherical painless lump. Transilluminates.
50
How are ganglionic cysts managed?
Most disappear spontaneously If symptomatic e.g. impinges nerve: Aspiration Cyst excision
51
What is trigger finger?
AKA stenosing flexor tenosynovitis: Finger or thumb click or lock when in flexion
52
What is the pathophysiology of trigger finger?
Flexor tendons with local tenosynovitis at the metacarpal head, develop localised nodal formation on the tendon distal to the pulley. Fingers are flexed and node moves proximal to pulley. When the pt attempts extension the node is unable to pass back under the pulley, locking the finger
53
What are the management options for trigger finger?
Avoid certain movements Small splint to stay in extension at night Steroids injections Percutaneous release via a needle Surgical decompression
54
What muscles are affected in De Quervain's tenosynovitis
Extensor pollicis brevis -EPB Abductor pollicis longus -APL
55
What are the primary causes of avascular necrosis?
Trauma Intravascular coagulation Fat emboli Steroid therapy
56
What is carpal tunnel syndrome?
Compression of the median nerve within the carpal tunnel of the wrist, due to a raised pressure within this compartment
57
What are the risk factors for carpal tunnel syndrome?
Female Increasing age Pregnancy Obesity Previous injury to the wrist Occupation or hobby involving repetitive hand or wrist movements DM/hypoT/RA
58
Why is the palm spared in carpal tunnel syndrome?
Palmar cutaneous branch of median nerve branches proximal to the carpal tunnel
59
What are the special tests for carpal tunnel?
Tinel's test Phalen's test
60
What can be seen in the late stages of carpal tunnel syndrome?
Weakness of thumb abduction or wasting of the thenar eminence
61
What are the management options for carpal tunnel syndrome?
Wrist splint Steroid injections Carpal tunnel release surgery
62
What is the olecranon?
Proximal ulna: from the tip to the coronoid process
63
What causes a visible and functional defect in an olecranon #?
Triceps insert onto the olecranon, thus the fractred bone is pulled in line with the pull of the triceps. It also results in an inability to extend at the elbow, against gravity.
64
At what angle is the elbow immobilised at, in non operative management of an olecranon #?
Elbow flexion 60-90 degrees
65
How are olecranon # usually managed?
Operative management as the olecranon is commonly displaced
66
What is the most common mechanism of injury in a radial head #?
Axial loading Most commonly with arm in extension and pronation
67
What is the most common mechanism of injury of olecranon #?
FOOSH
68
What is a 'sail sign'?
Effusion seen on lateral projection, causing elevation of the anterior fat pad Suggestive of an underlying #
69
What population is supracondylar humeral # most commonly seen in?
Paediatrics
70
What are the 3 types of elbow # to know?
Supracondylar Olecranon Radial head
71
What cast is used in conservative management of a supracondylar #?
Above elbow cast in 90 degrees flexion
72
What are the two most common nerve palsies resulting from supracondylar #?
Anterior interosseous nerve Ulnar nerve is most at risk during insertion of the medial k wire
73
What is the first line surgical management for supracondylar ?
Closed reduction and k wire fixation
74
How is a definitive diagnosis of olecranon bursitis made?
Aspiration of fluid and sending for MC&S
75
What are the other names for lateral and medial epicondylitis?
Tennis and Golfer's elbow, respectively
76
What is the terrible triad?
Elbow dislocation (posterolateral) with: Lateral collateral ligament injury Radial head # Coronoid #
77
What is the mechanism of injury, resulting in the terrible triad?
FOOSH onto extended arm with rotation
78
What are the 3 measurements on xray that can help with the diagnosis of a distal radius fracture?
Radial height <11 mm Radial inclination <20 degrees Volar tilt >11 degrees
79
What nerve can be damaged in shoulder #, and how can this be checked?
Axillary nerve Regimental badge area sensation and power of the deltoid muscle
80
What vessels can be damaged in shoulder #?
Circumflex vessels
81
What is the most common type of shoulder dislocation, and what can cause the least common type?
Anteroinferior Posterior can occur in seizure or electrocution
82
What nerve may be injured in humeral shaft #. and how might this be checked?
Radial nerve (in radial groove) Reduced sensation of dorsal 1st web-space, weakness in wrist extension
83
What are the features of OA on xray?
Subchondral cysts Osteosclerosis Osteophytes Joint space narrowing
84
What is the effect of smoking on healing #?
Nicotine constricts vascular smooth muscle impairing healing Higher rate of non union #
85
What are the implications on operating on a fracture that has lots of soft tissue swelling?
Increased risk of infection Poor wound healing Increases risk of wound dehiscence ?Compartment syndrome
86
Is ACL or PCL tear more commoon, and what is the mechanism of injury?
ACL more common Usually non traumatic, from twisting the knee whilst weight bearing
87
What are the tests o/e for cruciate ligament tears?
Anterior and posterior drawer test Lachman's
88
What is the most common mechanism of injury of the medial collateral ligament of the knee?
Trauma to the lateral aspect of the knee, causes valgus stress direction
89
What are the most common causes of meniscal tears of the knee?
Trauma Degenerative diseases
90
What is cubital tunnel syndrome?
Compression of the ulnar nerve within the ulnar tunnel

Finals (8 decks)

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