Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Year 3 Surgery > T&O (Lower) > Flashcards

T&O (Lower) Flashcards

1
Q

Describe the three stages of Degenerative Disc Disease

A

Dysfunction - outer annular tears, cartilage destruction
Instabiity - Sublaxation & Spondylolisthesis
Restabilisation - Osteophytes and canal stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

State the three types of intracapsular fracture

A

Subcapital
Transcervical
Basocervical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

State the two types of extracapsular fracture

A

Intertrochanteric

Subtrochanteric

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Describe the blood supply of the Neck of Femur

A

Retrograde flow primarily through medial circumflex
branch of femoral artery
Very minor supply through ligamentum arteriosum (running through ligamentum teres in head of femur)
Minor supply through intramedullary vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe the Garden Classification of Intracapsular #NOF

A

I - Incomplete Fracture
II - Complete Fracture
III - Partial Displacement
IV - Complete Displacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Give 3 clinical features of #NOF

A

Pain
Inability to weight bear
Shortened and Externally Rotated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What X-Ray planes are needed for suspected #NOF?

A

AP and Lateral of Hip

AP of Pelvis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How would you surgically manage a non displaced intracapsular #NOF

A

IE Garden Classification I or II

Dynamic Hip Screw

Very dependent on blood supply interruption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How would you surgically manage a displaced intracapsular #NOF

A

Low Activity level pre fracture - HemiArthroplasty (ideally cemented)

Active Individual - Total Hip Replacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How would you surgically manage an extracapsular #NOF

A

Intertrochanteric - Dynamic Hip Screw

Subtrochanteric - IM Femoral Nail

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe how OA of the Hip would present on examination

A
  • Passive movement is painful
  • If severe ROM is reduced
  • At end stage the patient may have a fixed flxeion deformity and may walk with a Trendelenberg Gait
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is OA of the Hip classified?

A

WOMAC classification (based on pain stiffness and function)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

The definitive management for OA of the Hip is a hip replacement. Describe the three approaches.

A
  • Posterior Approach (most common, quick recovery as abductors intact, may damage sciatic nerve)
  • Anterolateral Approach (Abductor mechanisms are detached, allowing excess abduction and exposure of acetablum, risk of superior gluteal nerve damage)
  • Anterior Approach
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe the blood supply of the femur

A

Highly vascularised due to it’s role in Haemopoiesis

Supplied by penetrating branches of profunda femoris

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How might a Femoral Shaft fracture present

A

Pain and Inability to weight bear

May have obvious deformity (proximal segment flexed and externally rotated)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Give three risk factors for Femoral Shaft Fractures

A

Bisphosphonate
Metastatic Deposits
High Energy Trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How are Femoral Shaft Fractures classified?

A

Winquist and Hansen Classification (0-4 with increasing communition)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What two managements would you carry out for an OPen Fracture

A

Antibiotic Prophylaxis

Tetanus Injection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How would you immobolise a Femoral Shaft Fracture?

A

Potentially traction splinting is required if it is an isolated fracture due to strong force of the quads

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Describe the surgical management of a Femoral Shaft Fracture

A 
IM Nail (usually anterograde although if other lower limb fractures may use retrograde)
Ex-Fix (if open fracture or polytrauma)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Describe the aetiology of an ACL tear

A

Aims to prevent anterior movement of tibia on fibula

Caused by sudden twisting on weight bearing knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Give three presenting features of an ACL tear

A

Rapid Joint Swelling (as ligament is highly vascular)
Significant Pain
Leg may feel like it’s giving way

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Give 3 investigations of a suspected ACL tear

A

MRI
X-Ray (rule out bony injuries)
Lachmans Test (pulling tibia forward when leg is bent at a 30 degree angle)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Describe the management of an ACL tear

A

RICE
Rehab and Strength training
Surgical (uses tendon as a graft)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Describe two mechanisms of PCL tear
- Direct blow to proximal tibia | - Fall with hyperflexion of the knee and plantar flexed foot
26
How does a PCL tear present?
Immediate pain and joint instability
27
MCL tears are the most commonly injured ligament of the knee. What is its normal role?
Acts as a valgus stabiliser of the knee
28
How is the MCL normally torn?
When external force is applied to the lateral knee
29
How does an MCL tear present clinically?
Pain at joint line following trauma to lateral knee Swelling may occur a few hours later May be able to weight bear Can be graded I-III
30
Give two investigations for MCL tear
MRI | Valgus Stress Test (Grade II - lax in 30 degree flexion but not in extension, Grade III - Lax in flexion and extension)
31
How would you manage MCL tears?
Grade I - RICE and Strength Training Grade II - Knee Brace and Strength Training Grade III - Knee brace and consider of surgical repair
32
The Menisci of the Knee are two C shaped fibrocartilages resting on the tibial plateau. State two of their roles
- Shock absorbers | - Increasing articular surface area
33
Meniscal Tears are often caused by twisting on a weight bearing knee. State the four types of tear.
- Bucket Handle (longitudinal where medial becomes separated from lateral) - Vertical (longitudinal with no separation) - Transverse (Parrot Beak) - Degenerative
34
Give three clinical features of Meniscal Tears
- Tearing sensation associated with sudden pain - Swelling over 6-12 hrs - Part of it may be trapped in the joint giving the feature of knee locking
35
Surgery is generally only required for Meniscal Tears greater than 1cm. Describe the two arthroscopic managements
If outer 1/3 - rich vascular supply allows for healing via sutures If inner 1/3 - trimmed
36
Give three risks of Arthroscopic Meniscal Repairs
DVT Saphenous Nerve/Vein Damage Peroneal Nerve Damage
37
What region of the Tibial Plateau is more damaged in a Tibial Plateau fracture?
Normally the lateral Tibial Plateau resulting in a varus deformity
38
What would an X-Ray of a Tibial Plateau fracture show?
Lipohaemarthroses
39
How are Tibial Plaeau Fractures classified?
Schatzker Classification (from I-VI)
40
How are Tibial Plateau Fractures managed?
Conservative - Hinged knee brace, minimal weight bearing, physio Surgical - ORIF or Ex-Fix
41
What is the IT band?
Longitudinal fibres from shared aponeuroses of TFL and Gluteus Maximus Iliac Tubercle to the Anterolateral Tibial Tubercle
42
What is IT Band Syndrome?
The most common cause of lateral knee pain in athletes Inflammation from repeated flexion and extension of the knee causing impringement against lateral femoral condyle
43
Give three risk factors for IT Band Syndrome
Athletic Genu Varum/Bow Legged Weak Abductors
44
How does IT Band Syndrome Present?
Lateral knee pain (worse downhill or on a camber)
45
IT Band Syndrome is a clinical diagnosis, explain a clinical test.
Nobles Test - Patient lays supine, palpate lateral femoral condyle as patient bends leg. Pain should be felt at 30 degrees as the IT band slides over condyle.
46
How would you manage IT Band Syndrome?
``` Modify Activity Simple Analgesia Steroid Injections Physio Surgery - release of IT band at its insertion ```
47
What forms the ankle joint?
Talus and Mortise (formed of lateral malleolus/medial malleolus/tibial plafond)
48
Describe the Syndesmosis bonding the tibia and fibula together
Interosseous Membrane Anteroinferior Tibiofibular Ligament Posteroinferior Tibiofibular Ligament
49
What is an ankle fracture?
Any fracture to the malleoli (medial, lateral or posterior) with or without syndesmosis disruption
50
Name four anatomical classifications of Ankle Fractures
Isolated Medial Malleolus Fracture Isolated Lateral Malleolus Fracture Bimalleolar Trimalleolar
51
Describe the Weber Classification of Ankle Fractures (for lateral malleoli)
A - Below level of syndesmosis B - At level of Syndesmosis C- Above level of Syndesmosis
52
How would you investigate Ankle Fractures?
XRay - AP and Lateral
53
What are the Ottawa Rules?
The concept that if the diagnosis is unclear, pain/tenderness over one of the malleoli and inability to weight bear for >4 steps indicates an Ankle Fracture
54
How would you manage an Ankle Fracture?
Reduce Below knee back slab Surgery - If displaced B, or class C, or Open, requires ORIF
55
How can you classify Ankle Sprains?
High Ankle - Injuries to Syndesmosis | Low Ankle - Injuries to Anterior Talofibular/Calcaneofibular
56
What mechanism is likely to cause an Ankle Sprain?
Inversion on a plantarflexed ankle
57
What is the Achilles Tendon?
Unites the tendons of Gastrocnemius, Soleus and Plantaris and inserts into Calcaneous
58
Describe the pathophysiology of Achilles Tendonitis
Repetitive action causes microtears and subsequently inflammation Over time the tendon becomes thickened/fibrotic/loses its elasticity
59
Give three risk factors for Achilles Tendonitis
Poor Footwear Choice Unfit Individual with sudden increase in exercise Fluoroquinolone use
60
How would Achilles Tendonitis present?
Gradual onset of pain and stiffness in posterior ankle (often worsened by movement and improved by heat) Tenderness over palpation
61
How would Achilles Rupture present?
Sudden onset severe pain following audible popping sound | Loss of power of plantar flexion
62
How would you diagnose an Achilles Rupture?
Simmons Test - squeeze patients calf while they are knelt, normally the reaction should be plantarflexion USS
63
How would you manage Achilles Tendonitis?
RICE NSAIDs May require physio
64
How would you manage Achilles Rupture?
- Immobilisation (Full equinus for two weeks, semi equinus for four weeks, then neutral for four weeks) - If you give the patient a moonboot over the plaster they can weight bear - Any delayed presentation will require surgical repair
65
What is a Talar Fracture?
Typically occurs in high energy trauma where ankle is forced into dorsiflexion 50% through Talar Neck
66
Why is the Talus at risk of avascular necrosis in a fracture?
The talus relies on extra-osseous blood supply which is likely to be interuppted
67
How would a Talar Fracture present?
Immediate pain and swelling | Unable to dorsiflex/plantarflex
68
Describe the Hawkins Classification of Talar Neck Fractures
I - Undisplaced II - Subtalar Dislocation III - Subtalar and Tibiotalar Dislocation IV - Subtalar, Tibiotalar and Talonavicular Dislocation Increasing risk of AVN
69
How should you image a suspected Talar Fracture?
X-Ray (AP and Lateral) Taken in dorsiflexion as plantarflexion reduces any sublaxation
70
How would you manage a Talar Fracture?
I - Conservatively in plaster for 3 months, non weight bearing II-IV - Closed reduction and temporary cast, definitive surgical fixation
71
What is Hallux Valgus (AKA Bunion)
Deformity of the first metatarsalphalangeal joint Medial deviation of first metatarsal and lateral deviation of hallux Once the metatarsal head escapes intrinsic control, tendons become a deforming force
72
Give three risk factors for Hallux Valgus
Female High Heel use Hypermobility disorders
73
How does Hallux Valgus present?
Painful Medial Prominence (aggravated by walking/weight bearing)
74
What investigation could you use to diagnose Hallux Valgus?
X-Ray - looking at the angle between the first metatarsal and the proximal phalanx (diagnosed if greater than 30 degrees
75
Describe two surgical managements of Hallux Valgus
Chevron Procedure - V Shaped Osteotomy of distal metatarsal | Lapidus Procedure - fuses first metatarsal and medial cuneiform
76
Plantar Fasciitis accounts for 80% of heel pain complaints. Describe the pathophysiology
Thick fibrous tissue from calcaneal tuberosity to proximal phalanx Microtears cause a chronic breakdown
77
Give 3 risk factors for Plantar Fasciitis
Obesity Prolonged Standing Pes Cavus
78
How does Plantar Fasciitis present?
Sharp heel pain worse in the morning, before easing off after the first few steps
79
How would you manage Plantar Fasciitis?
Activity Modification NSAIDs Steroid Injections Plantar Fasciotomy
80
What is a complication of Plantar Fasciotomy?
Medial Foot Instability
81
Give 5 medical managements of Hip Fractures
- Establish cause of fall - Analgesia (Nerve Block)/Antiemetics/Laxatives - Discuss rescucitation - Prevent AKI - Bone protection assessment
82
What X-Ray feature are you looking for on lateral view of Hip Fracture?
'Head off the back'
83
Describe three possible X-Ray features of a #Hip
Obvious fracture More proximal lesser trochanter (Also may be more prominent due to external rotation) Disruption of Shenton's Line Increased density due to overlapping bone
84
Why do total hip replacements last well?
The femoral head is replaced with metal, whereas the acetabulum is replaced with plastic. This wears well
85
Describe a Dynamic Hip Screw
One screw into femoral shaft, and four more to keep that in place Screw can shorten and lengthen with weight bearing (compression is good for healing)
86
What is a Cephalomedullary Nail and when is it used?
One nail from femoral head to knee, kept in place by two more Used if reverse oblique displacement as they are generally more unstable and not appropriate for DHS fixation
87
How does a Bisphosphonate Fracture present?
Normally after 8-10 years of taking Bisphosphonates Generally subtrochanteric stress fracture Pre fracture changes include cortical expansion and black line developing on XRAY
88
What is SCFE?
Slipped Capital Femoral Epiphyses Perichondrial ring that normally resists shearing forces pre ossification becomes weak, allowing the femoral neck to slide from the head/epiphyses
89
Name two risk factors of SCFE
Hyperthyroidism, Obesity
90
How does SCFE present?
Groin or Thigh Pain | Limp
91
How is SCFE imaged?
Frog leg XRay
92
How is SCFE managed?
Surgical screw connecting diaphysis through the femoral neck and epiphyses to femoral head May do prophylactic screwing of contralateral leg
93
When should you weight bear after IM nail?
Immediately
94
How would you manage an undisplaced patella fracture?
Aspirate any Haemarthroses | 4-6 weeks leg immobilised in extension
95
How would you manage a displaced patella fracture?
ORIF with tension banding
96
How do tension bands work?
Convert tensile to compressive forces by shifting the centre of rotation
97
How does a Patella Dislocation normally occur?
Sudden severe contraction of the Quads, normally in external rotation
98
How is a patella dislocation managed?
Back slab with knee in extension
99
How does a Knee Dislocation occur and what are the associated injuries?
Occurs in high velocity trauma | Cruciate ligaments and at least one collateral ligaments are torn
100
How are Knee Dislocations managed?
Backslab for one week at 15 degree flexion (to allow swelling reduction) 12 week cast (with Quad exercises and weight bearing as soon as they can lift the leg)
101
Name the three main ligaments of the lateral ankle
Anterior Talofibular, Posterior Talofibular, Calcaneofibular
102
What ligament is commonly damaged in ankle fractures?
Deltoid

Year 3 Surgery (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions