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Y3 surgery old > T&O > Flashcards

T&O Flashcards

1
Q

What is the classifcation for Intracapsular NOF fractures?

A

Garden classification:

Garden I: incomplete and undisplaced fracture

Garden II: Complete but undisplaced fracture

Garden III: Complete fracture with partial displacement

Garden IV: Complete fracture with 100% displacement

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2
Q

What is the classification system for open fractures and explain the types

A

Gustilo-Anderson classification

Type 1: <1cm wound and clean

Type 2: 1-10cm wound and clean

Type 3A: >10cm wound and high-energy, but with adequate soft tissue coverage

Type 3B: >10cm wound and high-energy, but with inadequate soft tissue coverage

Type 3C: All injuries with vascular injury

3A can be managed by orthopaedics alone, 3B requires plastics input, and 3C requires vascular input

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3
Q

What are the common sites for open fracture?

A

Tibial

Phalangeal

Forearm

Ankle

Metacarpal

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4
Q

Name the different classifications of fracture based on how they appear

A
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5
Q

What are the 3 most common sites for avascular necorosis?

A

Neck of Femur (intracapsular)

Scaphoid (Carpal bones)

Talus (most superior of tarsal bones)

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6
Q

If a scaphoid fracture of a broken wrist was missed and led to avascular necrosis. What might the patient complain of?

A

Pain

Stiffness

Reduced function

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7
Q

Which 5 organ cancers most commonly metastasies to bones?

A

Breast

Prostate

Kidney

Lungs

Thyroid

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8
Q

Where do injuries to the Talus most often occur / how do they occur?

A

50 % occur in the neck (can occur in head, neck, lateral body)

Neck fractures: high energy fracture causing ++ dorsiflexion. Talus pushed agaisnt Tibia. Blood supply disturbed - avascular necrosis

Body fractures : jumping from height

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9
Q

How do calcaneal fractures often occur?

What type of fracture is common?

What are some long term complications of calcaneus fracture?

A

Occur due to axial loading e.g. falling from a height like a ladder

Comminuted fracture is common. Xray - calcaneus shorter and wider

Can lead to arthritis in sub-talar joint. Inversion and eversion are painful making walking on unever ground painful.

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10
Q

What type of joint is the ankle joint?

What 2 movements does this allow and which is more stable?

A

Hinge joint

Dorsiflexion and Plantarflexion of the foot

Dorsiflexion is more stable as the anterior part of talus is wider and is held in the mortise (In plantarflexion the narrower posterior part is)

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11
Q

At the ankle joint the Tibia and Fibia are held together by ____(1)____

This results in a bracket shaped socket called ____(2)_____ which the _____(3)_____bone fits snugly into

A

(1) Tibiofibular ligaments
(2) Mortise
(3) Talus

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12
Q

60 yr old pt presents with a knee that is swollen, stiff, ++ painful and hot. Says he thinks its happened before but can’t remember when. Pt temp is 38

You get follwing Xray, what is the diagnosis?

A

Calcium pyrophosphate deposition disease - CPPD (Pseudo Gout)

Rhombioid shaped calcium pyrophosphate crystals can be seen on xray in menisci

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13
Q

Distinguish between Gout and Pseudo-Gout

A

Gout: uric acid crystals

Pseudo -Gout: calcium pyrophosphate crystals (rhomboid)

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14
Q

What are some differencials for a patient presenting with an acutely swollen joint?

A

Septic Arthritis (*** exlude! ***especially if 1 joint)

Trauma - Haemarthrosis

Crystal arthropathies - Gout & Pseudo-Gout

Rheumatological - RA

Spondyloarthropathies - Psoriatic Arthritis, ankylosing spondylisits, Reactive Arthritis

Osteoarthritis

MSK injuries (brusitis, ligament / tendon injury)

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15
Q

How does pseudo gout mimic RA and OA over time?

A

Worse in the morning - stiffness / fatigue

knobbly, deformed joint e.g. knee, elbow, wrist etc

Low grade fever

Reduced joint movement

Pain

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16
Q

What investigations would you do to diagnose pseudo gout?

A

Xray - see calcium pyrophosphate crystals and exclude other cause

Aspirate knee - find crystals (exclude gout crystals)

Full blood count - exclude other diseases

17
Q

What are some risk factors for psudeo - gout?

A

Advanced age

Injury or previous joint surgery

Hyperparathyroidism

Hypophosphataemia

Haemochromatosis

Hypomagnesaemia

18
Q

What are some treatments for Pseudo - Gout

A

NSAIDS (- pain / inflammation )

Colchicine if NSAIDs contraindicated

Corticosteroid interarticular injection / short course oral steroids if above contraindicated

Ice / rest etc

19
Q

Open Fracture in A& E descibre immediate stesps

A

1) Look for polytrauma (often found with OF)
2) A- E assessment including Hx / contamination
3) Neurovascular exam

Treatment depends on location of fracture but generally requires immediate IV antibiotics (broad spec) and urgent irrigation and debridement followed by surgical fixation as needed.

20
Q

What complications are associated with open fractures? (Orthobullets)

A

Surgical site infection

Compartment syndrome

Osteomyelitis

Neurovascular injury

21
Q

What 4 ways can the outcome of an open fracture be thought of?

A

Skin - large wound will need plastics input for cover e.g. grafting

Soft Tissue - damage to ligaments /tendons may need reconstructive surgery

Neurovascular - nerves and blood vessesls may be compressed by deformity- arteriospasm, intimal transection or fully transected

Infection - High risk due to systemic compromise (trauma), contamination, reduced vasculaity and insertion of metal work when reducing.

22
Q

What initial (non surgical) and surgical management would you do for a pt with an open fracture?

A

Non surgical

IV broad spectrum AB (immeidate if contaminated e.g. farm)

Tetanus injection if out of date

Photograph (to avoid excessive undressings)

Remove large debris form wound

Resusitation and stablisation- realign and splint with saline covered gauze- assess neurovascular after re-aligning

Surgical

Surgical debridement and theatre saline wash

Definitive reconstruction and fracture fixation

Soft tissue cover (plastics) / neurovascular input (vascular)

23
Q

What investigations for an open fracture ?

A

Xray

Blood test - Group & Save (so transfusion blood is ready)

24
Q

What are the 2 most common injuries for NOF fracture?

A

Low energy trauma - osteoperiotic frail older pt -falls

High energy trauma - road traffic accident, fall from height

25
Q

Which 2 areas can be affected in an extracapsualr NOF fracture?

A

Extracapsular

Inter-trochanteric - between greater and lesser trochanter

Sub-trochanteric - from lesser trochanter to 5 cm distal to this point

26
Q

The Garden classification for NOF fracutres describes both Intra-capsualr and Extra-capsular fractures

TRUE or FALSE?

A

FALSE

Only for Intracapsular fractures !

27
Q

Blood supply to the the NOF is ____________ and is supplied by the ___________ which lies directly on the __________. Fracture to the NOF can lead to___________

A

Blood supply to the the NOF is __retrograde__ and is supplied by the _**Medial Circumflex Artery** which lies directly on the _femoral neck_. Fracture to the NOF can lead to__avascular necrosis_.

28
Q

What are the symptoms / presentation of NOF fracture?

A

Pain- groin, anterior thigh and hip (elderly pt may refer to knee)

Swelling

Inability to weight bear

29
Q

What would you find on examination ?

A

Shortened, externally rotated leg (external rotators: obturator internus, gemelli, piriformis, quadratus femoris)

Test: Pain on pin rolling and axial loading

Neurovascualr : rare to have defecits- but do full exam

investigate injury cause: especially if Hx of injury not clear

30
Q

What are some differencial diagnosis for NOF fracture?

A

Other fractures :

  • Pelvis - esp. pubic ramus
  • Femoral head / diaphysis
  • acetabulum

Pathological Fractures:

Esp. if no significant trauma

31
Q

What is a pathological fracture? What are some examples?

A

A Pathologic fracture is when the force or impact didn’t cause the break to happen. Instead, an underlying disease leaves your bones weak and brittle. You may move wrong or shift your body weight in a way that puts pressure on weak bones.

E.g. Osteoperoisis

Pagets disease

Osteomalacia

Osteogenesis imperfecta

Ostetoitis

Benign bone tumours

Primary malignant bone tumour / secondary malignant bone mets

32
Q

If suspect a pathological fracture what changes would you make to your investigations?

A

Ensure full length femoral Xray - ensure no other fractures

Y3 surgery old (6 decks)

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