T&O Flashcards
How is the medial collateral ligament most often damaged?
When force is applied to the lateral knee e.g. during a football tackle
What is damaged in “the unhappy triad”?
Anterior crucial ligament
Medial collateral ligament
Medial meniscus
Which nerves can be damaged in a proximal humerus #, mid shaft humerus # and supracondylar humerus #?
Proximal humerus: axillary nerve
Mid shaft: radial nerve (sits in radial groove)
Supracondylar: ulnar nerve
What is a Colle’s #?
Distal radius #
Dorsal displacement and dorsal angulation
Most commonly caused by FOOSH
How would you test a patients median nerve function?
Lay their hand flat on the table and ask them to ABduct their thumb
Test sensation by touching radial aspect of index finger
How would you test a patients radial nerve function?
Test their wrist and finger extension against resistance
Test sensation by touching dorsal aspect of thumb web space
How would you test a patients lunar nerve function?
Ask to ABduct fingers
Test sensation by touching ulnar aspect of little finger
What tests can be carried out on a px with ?carpal tunnel?
Tinel’s test
Phalen’s manoeuvre
Nerve conduction studies
What are some red flags for back pain?
Age <20 or >50 Hx of malignancy Night pain Hx of trauma Systemically unwell eg weight loss, fever
Leg pain worse on walking which resolves when sitting, crouching and leaning forwards is typical of what?
Spinal stenosis
What is the common causative organism in osteomyelitis?
Staph aureus (Except in sickle cell where Salmonella predominates)
What predisposing factors can increase the likelihood of osteomyelitis?
Diabetes Sickle cell IVDU Immunosuppression Excess alcohol
What is the imaging of choice in suspected osteomyelitis?
MRI
What Abx oiled you use for osteomyelitis?
Flucloxacillin for 6 weeks
How long prior to surgery should HRT or oestrogen containing oral contraception be stopped?
4 weeks prior to surgery
How long before surgery should warfarin be stopped?
5 days
Cover with LMWH
What is the most common cause of heel pain in adults?
Plantar fasciitis
Why is lidocaine available pre-mixed with adrenaline?
It increases the duration of action of adrenaline and reduces blood loss by vasoconstriction
Never use near extremities due to risk of ischaemia
Why must lidocaine mixed with adrenaline not be used near extremities?
As it is a vasoconstrictor so there is a risk of ischaemia
Which blood group is the universal donor?
O negative
What radiographically signs indicate osteoarthritis?
LOSS = Loss of joint space Osteophytes Sunarticular sclerosis Subchondral cysts
How does osteoarthritis typically present?
Joint stiffness after rest up to 30mins Joint instability Pain on movement Worse at end of day Heberdens node Bouchard nodes
How should osteoarthritis be managed?
Conservative: exercise, weight loss if overweight
Medical: paracetamol + topical NSAIDs (if ineffective, codeine + NSAID + PPI), intra-articularsteroid injection
Surgery: joint replacement
What are some risk factors for osteoporosis?
Family Hx RA Alcohol Smoking Post menopause Low BMI Steroids Hyperthyroidism, hyperparathyroidism, hypercalciuria
What will bloods for osteoporosis show?
Ca, Alkaline phos, Phosphate all in normal range
What test is used to assess bone density?
DEXA scan
What T scores indicate osteopenia and osteoporosis?
T -1 to -2.5 is osteopenia (just give lifestyle advice)
T -2.5 or worse indicates osteoporosis (lifestyle advice + tx)
What is the FRAX tool?
Risk assessment tool to estimate 10 year risk of osteoporotic # in untreated patients
What test can diagnose osteoporosis?
DEXA scan
Generates a T score (strandard deviations of mean young adult of same sex)
And Z score (SDs of same age adult of same sex, if this is abnormal it may be a secondary cause and not just age)
How should osteoporosis be managed?
Conservative: quit smoking, reduce alcohol, OT exercises, calcium rich diet
Medical:
- bisphosphonates: prevent resorption of bone so reduce bone turnover
E.g. alendronic acid is taken P.O. once a week with glass of water and must not lie down or eat for 30mins
-calcium and vitamin D
- strontium ranelate: inhibits breakdown (like BPs) but also promotes new formation, good if intolerant to BPs
How must bisphosphonates be taken?
Once a week
Orally
With plenty of water
Cannot lie down or eat for 30 minutes after taking
What is Paget’s disease of the bone?
Increases bone turnover due to increased osteoblasts, causing bone remodelling and weakness
Hw will Paget’s Disease show on bloods?
Normal Ca and phosphate
Alkaline phos very Raised
What is osteomalacia?
Adult version of Ricketts
Normal amount of bone but with low mineral content
What would blood results show for osteomalacia?
Low Ca
Low phosphate
Raised alkaline phos (due to bone stimulation to replace low Ca)
Raised PTH
How is osteomalacia treated?
Ca and vit D replacement
Tx underlying cause
What is the most common joint affected in septic arthritis?
Knee
What investigation must be done in a joint possibly affected by septic arthritis?
Urgent joint aspiration for synovial fluids microscopy
What would synovial fluid show for a septic arthritic joint?
Yellow ish colour
Raised WCC
Organism cultured
What are some risk factors for septic arthritis?
Pre existing joint disease Diabetes Age Joint replacement Immunosuppression IVDU Recent joint surgery CKD
How is septic arthritis managed?
IV Abx
1st line fluxocacillin (clindamycin if penicillin allergic)
Analgesia
Maybe arthroscopic lavage
How will a prolapsed disc causing radiculopathy at L5-S1 differ to one at L4-L5?
Both will have a positive sciatic stretch test
L5-S1 prolapse will affect the S1 nerve. This will show sensory disturbance on the sole and back of calf and motor disturbance due to weakened ankle plantarflexion
L4-L5 prolapse will affect the L5 nerve. This will show sensory disturbance by sensory loss at the medial side of the big toe, and motor disturbance by weakened ankle dorsiflexion
(An L3-L4 prolapse would show sensation loss on the medial side of the calf and weakened knee extension)
Locking of the knee is more common with injuries to which part of the knee?
Meniscus
What are the principles of # management?
- anatomical reduction
- stable fixation (cast, sling, external fix, internal fix)
- preservation of blood supply
- rehabilitation and mobilisation (involve PT, OT)
How should open #’s be managed?
Photograph Debridement of any foreign material Cover in warm saline gauze Reduce and splint if possible Pressure on circulation Tetanus booster IV Abx ASAP (co-amoxiclav or metro if pen allergy)
How does tetanus work?
Blocks neurotransmitter release from the spinal cord
What is a comminuted #?
Multiple fragments
When describing displacement of a #, do we describe the movement of the proximal or distal fragment?
Distal fragment
What is the effect of smoking on bone healing?
Smoking inhibits osteoblasts activity
Nicotine also causes vasospasms to reduce the blood supply to healing bone
Which joints are Herbeden’s nodes and Bouchard’s nodes at in osteoarthritis?
Bouchards: PIPJ
Herbedens: DIPJ
What are common causative organisms of septic arthritis?
Staph aureus
Salmonella if sickle cell disease
Neisseria gonorrhoea in young, sexually active people
How is septic arthritis managed?
Abx (initially IV, UHL is flucoxacillin)
Irrigation and drainage of the joint in theatre
How would you test for median nerve function?
Sensory: tip of index finger finger
Motor: hand flat on table and test thumb abduction against resistance
How would you test for radial nerve function?
Sensory: dorsal aspect of webspace between thumb and index finger
Motor: test wrist and finger extension against resistance
How would you test for ulnar nerve function?
Sensory: ulnar aspect of tip of little finger
Motor: hold paper between thumb and index finger, or oppose thumb to little finger against resistance
Where will common fibulae nerve injury cause sensory loss?
Over the dorsum of the foot
Where will sciatic nerve palsy cause sensory loss?
On the lateral side of the affect leg below the knee
What are the nerve roots of the sciatic nerve?
L4 to S3
What is a Monteggia #?
of the proximal ulnar with dislocation of the radial head
What is a galeazzi #?
Distal radial # with dislocation of the distal radioulnar joint
to which bone will cause tenderness in the anatomical snuffbox?
Scaphoid #
What is the risk of a scaphoid #?
Avascular necrosis of the proximal fragment due to its distal to proximal blood supply
What is Dupuytrens contracture?
Bands of palmar fascia develop into thick cords and can tether one or more fingers into a fixed flexed position
Ring and middle finger most commonly affected
How is dupuytrens contracture managed?
Steroids injections can help with pain
Fasciectomy to remove the fascia once the contracture impedes the patients ADLs
What nerve can be damaged with a humeral shaft #?
Radial nerve
What are risks of a should dislocation?
High likelihood of recurrence
Future early arthritic changes likely
Risk to damage of axillary nerve
How will the position of the leg be with a fractured femur?
Shortened and externally rotated
Which artery supplies most of the blood supply to the femoral head?
Medial circumflex artery
What does Gardner’s classification classify?
Intracapsular NOF #
1: incomplete #
2: complete # But undisplaced
3: complete and partially displaced
4: complete and fully displaced
Describe a # that is classed as a a Gardner 3.
Intracapsular NOF # that is complete and partially displaced
How are NOF #’s managed if they are a) intracapsular undisplaced, b) intracapsular displaced and c) extracapsular?
A) if comorbidities, hemiarthroplasty. If none, cannulated screws
B) if comorbidities then hemiarthroplasty, if none then total hip replacement (unless <70 try dynamic hip screws as THR won’t last rest of their life)
C) dynamic hip screws
Also rehabilitate with OT/PT and social care
Positive Lachmans test is seen in which injury?
Anterior crucible ligament tear
What are some differentials for knee swelling?
Septic arthritis Reactive arthritis Bursitis Gout Pseudogout ligament tear
What is Weber’s classification used for?
Classify fibula fractures
What is Weber’s classification?
Type A below the syndesmosis (generally stable)
Type B at the level of the syndesmosis (likely to be unstable)
Type C above the syndesmosis (always unstable)
When a fractured bone is reduced, what checks should be made afterwards?
Repeat x Ray
Repeat neurovascular exam
Check for any signs of compartment syndrome
What are some immediate and some delayed complications of fractures?
Immediate: neurovascular compromise, compartment syndrome
Delayed: malunion, wound dehiscence, infection, joint stiffness
What is hallux valgus?
Bunion deformity of the 1st metatarsal
Under what circumstances should an acutely swollen joint not be aspirated?
If cellulitis is Also present as this could lead to sepsis
