UGTM Orthopaedics Flashcards
Common final year OSCE’s
- Hip
- Knee
- Hand
- Spine
Approach - say what you see (but don’t make up pathology)
What is the approach to orthopaedic examination in OSCE?
- Look
- Feel
- Move
- Special test
- Examinine neurovascular status
- Joint above, joint below
- Summarise and present findings
- Explain structure
What is the initial approach to the OSCE for orthopaedics?
- Wash hands!
- Introduce self to patients and examiner
- Is it ok if I examine you today
- If possible avoid causing discomfort - are you in any pain
- Look around the room
- Commentary - tell them what you are looking for
- If you forget something - go back to it or mention it
What should be included in the ‘look’ part of the orthopaedic examination?
- Lower limb/spine
- Expose appropriately
- Observe gait
- Look for:
- Deformity
- Swelling
- Scars, beware of subtle
- Sinuses
- 360 - ask if they would kindly move, with clear instructions
What should be included in the ‘feel’ part of the orthopaedic examination?
- Know the anatomy
- Know what is normal
- Do not be afraid to touch the patient
- If in doubt ask if it is sore, palpate away from the painful areas first
- Watch the patient’s face, not your hand
- Be systematic
- Bone
- Joint line
- Soft tissue
What should be included in the ‘move’ part of the orthopaedic examination?
- Active
- Passive
- Adapt to the joint
- Flexion/extension
- Adduction/abduction
- External/internal rotation
- Radial/ulnar deviation
- Don’t forget the ligaments
What are the special tests for the hip?
- Thomas’ test
- Trendelenburg test - weakness of the hip
- Leg length, true and apparent
What are the special test for the shoulder?
- Empty can test
- Impingement
- Don’t forget the rotator cuff
What are the special tests for the hand?
- Phalen’s
* Tinnels
What are the special tests for the spine?
- Schrober’s test - assesses the amount of lumbar flexion
What is the approach to examination of compartment syndrome?
- Look
- Feel - muscle compartments
- Move - passive, pain on passive stretch
- Demonstrate 5 P’s (late sign)
What is the approach to C-spine injuries in trauma?
- Cervical collar
- Log roll
- Keep flat
- Imaging
What is the approach to open fractures in trauma?
- IV antibiotics ASAP + tetanus (if required)
- Remove gross contamination
- Photo
What is the approach to pelvic fractures in trauma?
- Pelvic binder applied at level of greater trochanters
What is the approach to femoral fractures in trauma?
- Thomas splint - applies traction to the limb, leading to tamponade which reduces bleeding to the limb
