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MSK > Trauma ortho 2 > Flashcards

Trauma ortho 2 Flashcards

1
Q

Hip fractures

X-ray - what would you see [2]

A

Disruption of Shenton’s line

Intracapsular or extracapsular

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2
Q

Hip fractures Mx

Immediate management [6]

A 
ABCDE
Analgesia: IV morphine
Fluid resus
Imaging
DVT prophylaxis
Prepare for theatre
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3
Q

Hip fractures Mx
Why would a conservative approach be rare? [2]
Who would this be applicable to? [1]

What is involved in prep for theatre? [6]

A

Why? Takes weeks to heal, leaves patient bedridden for extended periods of time
Those unfit for surgery

Prep for theatre:

  • FBC
  • Clotting, crossmatch 2 units
  • U&E
  • CXR
  • ECG
  • Gain consent
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4
Q

Hip fractures Mx
Surgical management
Intracapsular vs extracapsular

A

Intracapsular - REPLACE

Extracapsular - FIX

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5
Q

Hip fractures Mx

Surgical management of intracapsular # [3]

A

Disrupted blood supply so risk of AVN
Hemiarthroplasty
OR THR

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6
Q

Types of extracapsular fractures [2]

A

Trochanteric

Subtrochanteric

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7
Q

Mx of intracapsular hip fractures: Undisplaced [2]

A
  • internal fixation or

- hemiarthroplasty if unfit.

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8
Q

Mx of intracapsular hip fractures: displaced [2]

A
  • young and fit: reduction and internal fixation

- old and reduced mobility: hemiarthroplasty or THR

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9
Q

Mx of extra capsular hip fractures

Post-operative management of hip fractures in general [3]

A

Dynamic hip screw

SAME DAY MOBILISATION, anti-coagulation, good nutrition

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10
Q

Displaced intracapsular hip fracture: THR between hemiarthroplasty

A

THR: >70 with no co-morbidities
Hemiarthroplasty: >70 with major co-morbidities or immobile

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11
Q

Mx of extra capsular fractures

A

Dynamic hip screw

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12
Q

When would you use an intramedullary device for extra capsular fracture? [3]

A

Reverse oblique
Transverse
Subtrochanteric

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13
Q

Hip OA
RF [3]
Mx

A
  • post-avascular necrosis of the hip
  • paediatric hip disease
  • BUT NOT increased BMI (unlike knee OA)
    Mx: THR
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14
Q

Hip OA symptoms [4]

A

Poorly localized groin, thigh or buttock pain
Referred pain to knee
Worse on weight bearing
Stiffness on hip flexion eg tying shoelaces

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15
Q

Hip OA signs [3]

A 
Antalgic gait
Positive Trendelenburg sign
Reduced ROM (esp internal rotation)
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16
Q

Types of THR for Hip OA [2]

A

Conventional (replacement of femoral head and neck)

Simple resurfacing of femoral head (young with preserved femoral neck)

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17
Q

Early complications of THR [6]

A 
VTE
Dislocation
Deep infection
Pathological fracture
Nerve palsy
Limb length discrepancy
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18
Q

Causes of hip replacement failure [4]

A

Prostethic loosening*
Dislocation
Periprosthetic fracture
Infection

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19
Q

Hip pain in adults differentials [8]

A 
Osteoarthritis
Inflammatory arthritis
Referred lumbar spine pain
Greater trochanteric pain syndrome
Meralgia parenthetic
Avascular necrosis
Pubic symphysis dysfunction
Transient idiopathic osteoporosis
20
Q 
Greater trochanteric pain syndrome
AKA
Cause
Ep
Symptoms
A

AKA Trochanteric bursitis
Due to repeated movement of the fibroelastic iliotibial band
Ep: women, 50-70 years
Pain and tenderness over the lateral side of thigh

21
Q

Avascular necrosis definition
Causes [4]
Investigation [3]

A 
Def: death of bone tissue secondary to loss of blood supply
Causes:
- long term steroid use
- chemotherapy
- alcohol excess
- trauma
Ix:
- x-ray normal initially
- crescent sign means collapse of articular surface
- MRI*
22
Q

Pubic symphysis dysfunction:
Causes
Symptom [2]
Sign

A

Common in pregnancy due to ligament laxity
Pain over the pubic symphysis with radiation to the groins and the medial aspects of the thighs.
A waddling gait may be seen

23
Q

Transient idiopathic osteoporosis
Ep
Clinical features [4]

A 
Third trimester
Groin pain 
Associated with limited ROM at hip
NWB
Elevated ESR
24
Q

Femoral shaft fracture

Management [4]

A
  • stabilisation in ED with traction AND
  • Thomas splint
  • followed by locked intramedullary nail introduced proximally with a guide wire
  • to allow early immobilisation
25
Q

What must you always assess for in femoral shaft fractures? [2]

A

Sciatic nerve injury

Femoral artery injury, blood loss

26
Q

Posterior hip dislocation
Most common mechanism of injury
Presentation [2]
Complications [3]

A

Ax: front seat passenger when knee strikes dashboard
Sy/Si:
- femoral head palpable in buttock
- leg is flexed, INTERNALLY rotated, adducted and shortened

Complications:

  • sciatic nerve injury
  • Equinus deformity
  • AVN
27
Q

Posterior hip dislocation
Investigation [2]
Mx [2]

A

Ix:
- AP and lateral XR
- MRI to assess for sciatic nerve injury
Mx:
- closed reduction under GA within 4h reduces risk of AVN
- followed by traction for 3w to promote joint capsule healing

28
Q

Scaphoid fracture
Ax
Symptoms [3]
Investigations [2]

A

Ax: FOOSH
Sy/Si:
- tenderness over anatomical snuff box and scaphoid tubercle
- pain on axial compression of the thumb
- pain on ulnar deviation of a pronated wrist or supination against resistance
Ix:
- scaphoid series of XR
- MRI or repeat XR in 2w if -ve but highly suspicious of #

29
Q

Scaphoid fracture mx [2]

Complication

A

Mx:
- immobilisation in neutral cast (or Futura splint) or
- percutaneous cannulated screw fixation
Cx: avascular necrosis (proximal pole relies on interosseous supply from distal part)

30
Q

Ankle ligament strain
Classification [3]
Symptoms [3]

A

Inversion injury to anterior tibiofibular part of lateral ligament
Eversion injury: medial deltoid ligament
Syndesmosis injury

Symptoms:

  • stifness
  • tenderness over lateral ligament
  • pain on inversion
31
Q

Management of simple sprains

POLICE

A 
Protection from further injury
Optimal Loading
Ice
Compression
Elevation  + analgesia 
Aim: allow WB ASAP
32
Q

What is a severe sprain?
How do we manage severe sprains?
Safety net [3]

A 
Ligament completely ruptured, NWB
Below knee immobilization for 10d
Advise to return if:
- any NV compromise 
- pain hindering WB after 24h
- Not fully WB by 4d
33
Q

ANKLE FRACTURES
Management of minimally displaced or stable fractures [3]

Management of high velocity or proximal injuries

Management of elderly patients

A

Weight bear
Immobilisation
the Controlled Ankle Motion boot does both these things

Surgical repair: compression plate

Elderly: conservative mx as thin bone doesn’t hold metalwork well

34
Q

Neck of talus fracture
Mechanism
Mx

A

Ax: forced dorsiflexion
Mx: ORIF if displaced

35
Q

Calcaneous fracture
Mechanism
Presentation [3]
Mx

A

Ax: serious manual worker fall e.g. ladder or scaffolding

Sy/Si:

  • often bilateral
  • swelling, bruising, inability to weight bear
  • look for associated spinal injury*

Mx: immobilisation or surgery (cx higher with surgery)

36
Q

Stress/March fracture
Ep
Ax
Mx

A

Ep: soldiers
Ax: excessive walking causes shaft # of 2nd or 3rd metatarsal
Sy/Si: pain and excessive walking
Ix: XR may be normal or show subtle periosteal changes
Mx: rest and analgesia +/- plaster cast

37
Q

Lisfranc fracture
Ax
Which bones are involved

A

Ax: polytrauma or awkwardly stepping off kerb
Px:
- fracture dislocation of a tarsometatarsal joint causes
- dislocation of the second metatarsal joint (Lisfranc joint)

38
Q

Lisfranc fracture
Presentation [2]
Mx [2]

A

Sy/Si:

  • pain, tenderness and swelling
  • causes COMPARTMENT SYNDROME OF MEDIAL FOOT

Mx:

  • ORIF (precise anatomic reduction
  • with screw fixation across second metatarsal joint (Lisfranc joint))
39
Q

Ankle fractures
Ottawa Rules
Uses [2]

A

Can help to clinically ddx between likely sprain and likely fracture
Can guide indication for imaging in ED

40
Q

Ankle fractures

Classification [4]

A

Medial malleolar
Lateral malleolar
Bimalleolar
Trimalleolar (third is the posterior part of tibia)

41
Q

Ankle fractures
Weber AO system refers to level of fibular #
Describe what a Weber A # is and their likely management [2]

A

Transverse fractures

below the syndesmosis [1] generally stable fractures (can often be managed non- operatively) [1]

42
Q

Ankle fractures
Weber AO system
Describe what a Weber B # is and their likely management [3]

A

at the level of the syndesmosis [1], extending proximally – spiral or short oblique fracture pattern [1]; may be stable or unstable fractures (more likely to require surgical fixation) [1]

43
Q

Ankle fractures
Weber AO system
Describe what a Weber C # is and their likely management [3]

A

fracture above the tibial plafond [1], likely to involve a syndesmotic injury [1]; unstable fractures (should always be considered for surgical fixation) [1]

44
Q

Ankle fractures

General mx approach [4]

A

Assess
Reduce
Immobilise in backslab
Plan definitive mx

45
Q

Ankle fractures

Conservative management is best for which group of patients [2]

A

Stable, undisplaced fractures [1] with minimal disruption to articular surface [1]

46
Q

Ankle fractures

Conservative management for displaced fractures - descrbe [3]

A

Manipulation under anaesthesia
Moulded casting to hold in place
Requires close follow up - X-ray at week 1 then week 2 as re-displacement is common

47
Q

Ankle fractures

Surgical management indications [2]

A

Unstable # with taller shift or displacement and fragmentation of articular surface
Where conservative has failed

MSK (28 decks)

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