1
Q
What is compartment syndrome? What is it a complication of and what is a key risk?
A
- complication occurring following fractures or ischaemia reperfusion injury
- raised pressure in a closed anatomical space
- compromises tissue perfusion > necrosis
2
Q
Of which two main fractures is compartment syndrome a complication?
A
- supracondylar fractures
- tibial shaft
3
Q
What are the characteristics of pain in compartment syndrome?
A
- pain especially on movement
- occurs on passive movement
- excess use of breakthrough analgesia
4
Q
What features other than pain are present in compartment syndrome?
A
- parasthesia
- pallor
- arterial pulsation
- paralysis of muscle group
5
Q
How is compartment syndrome diagnosed? Give the values
A
- intracompartmental pressure measurements
- > 20mmHg is abnormal
- > 40mmHg is diagnostic
6
Q
How is compartment syndrome treated?
A
- fasciotomies
- aggressive IV fluids to prevent myoglobinuria
- if necrotic: debridement and potential amputation
7
Q
What are the 2 subcategories of osteomyelitis? Which is more common in children and which in adults?
A
- haematogenous: children
- non-haematogenous: adults
8
Q
Which bacteria most commonly causes osteomyelitis, and which bacteria in sickle cell anaemia patients?
A
- Staph aureus
- sickle cell: Salmonella
9
Q
Which investigations are done for osteomyelitis?
A
- MRI
10
Q
How is osteomyelitis managed?
A
- IV flucloxacillin for 6 weeks
- IV clindamycin if penicillin allergic
- IV vancomycin if MRSA
11
Q
Where is osteomyelitis most commonly found in adults? Is it mono or polymicrobial?
A
- monomicrobial
- vertebral is MC in adults
12
Q
What are risk factors for haematogenous osteomyelitis?
A
- sickle cell anaemia
- IVDU
- immunosuppressed
13
Q
What are risk factors for non-haematogenous osteomyelitis?
A
- diabetic foot ulcers
- pressure sores
- peripheral arterial disease
14
Q
What is the mechanism of non-haematogenous osteomyelitis?
A
- contiguous spread from adjacent soft tissue
- or direct injury to bone
- polymicrobial
15
Q
What are the pathophysiological features of acute osteomyelitis?
A
- neutrophil rich infiltrates
- bone oedema
- vascular congestion
- small vessel thrombosis
16
Q
What are the pathophysiology features of chronic osteomyelitis?
A
- large necrotic regions
- sequestrum (dead bone)
- granulation tissue
- overlay of new bone
17
Q
What are the 4 stages of osteomyelitis?
A
- 1: medullary
- 2: superficial
- 3: localised
- 4: diffuse
18
Q
What are the common sites of osteomyelitis?
A
- spine
- fingers and toes
- long bones
- adjacent to metalwork
- pelvis
19
Q
How does osteomyelitis present?
A
- low grade fever
- swelling
- non specific pain
- inability to weight bear
20
Q
What are features of a hip fracture?
A
- pain in hip/groin, radiates to knee
- if displaced/complete NOF - inability to weight bear
21
Q
What are the key features on examination of a hip fracture?
A
- shortened
- abducted
- externally rotated
22
Q
What are the two classifications of hip fracture?
A
- intracapsular
- extracapsular
- the capsule is a fibrous structure that surrounds the head and neck of the femur
23
Q
What is an intracapsular fracture?
A
- proximal to intertrochanteric line
- femoral head or neck fractures
- damage capsule and disrupt blood supply
24
Q
What is the significant risk of an intracapsular fracture and why?
A
- avascular necrosis
- the only blood supply to the femoral head is via the circumflex femoral arteries which join proximal to the intertrochanteric line
- blood supply easily damaged > avascular necrosis/osteonecrosis
25
How are intracapsular fractures managed if the femoral head is undisplaced? (i.e. blood supply undisrupted)
- dynamic hip screw
- cannulated screws
26
How are intracapsular fractures managed in displaced hip fractures?
- total or hemiarthroplasty
- uses cement to hold head in place
- replaces femoral head with prosthetic
- total hip replacement
27
Which patients are offered a total hip replacement?
- fit for surgery
- can walk independently
- not cognitively impaired
28
Where are extracapsular fractures found?
- intertrochanteric
- subtrochanteric
- do not damage blood supply
29
What is the Garden classification for intracapsular NOF fractures?
- I: incomplete fracture, non-displaced
- II: complete, non-displaced
- III: partial displacement (trabeculae at angle) still bony contact
- IV: full displacement (trabeculae parallel)
30
Where do intertrochanteric fractures occur and how are they treated?
- between the greater and lesser trochanter
- dynamic hip screw to heal via controlled compression
31
Where do subtrochanteric fractures occur and how are they treated?
- distal to the lesser trochanter
- intramedullary nail inserted into shaft of femur
32
How are hip fractures investigated?
- X-ray: AP and lateral
- Shenton's line may be disrupted > fractured NOF
- MRI/CT if negative XR
33
How quickly should a hip fracture be operated upon?
- within 48h
34
What is trochanteric bursitis?
- greater trochanteric pain syndrome
- repeated movement of fibroelastic iliotibeal band
35
What is the presentation of trochanteric bursitis?
- women aged 50-70
- pain over lateral side of hip/thigh
- tenderness on palpation of greater trochanter
36
What is olecranon bursitis and what is the epidemiology?
- fluid filled bursa overlying the olecranon process at proximal ulna
- men aged 30-60
37
What are the causes of olecranon bursitis?
- repeated trauma: students, miners, plumbers
- direct trauma
- infection: Staph aureus
- gout, RA
38
What is the presentation of olecranon bursitis? Including septic vs non-septic
- swelling over olecranon process
- non-septic: variable tenderness, mild erythema
- septic: more painful, fever, pronounced erythema
- elbow movement preserved
- extreme flexion painful
39
What are examination signs of olecranon bursitis?
- Fluctuant, well-circumscribed swelling at posterior elbow (golf ball)
- tenderness, warmth over bursa
- Fever and overlying skin changes = infection
- Tophi/joint effusions if gout/RA
40
What investigations should be done in olecranon bursitis if sepsis is suspected?
- aspirate for gram stain, crystals, culture
- straw coloured fluid: non-infective
- purulent fluid: infection
- FBC, CRP, imaging
41
How is olecranon bursitis managed?
- non-septic: conservative - ice, compression, NSAIDs
- septic: aspirate, oral flucloxacillin
- surgical drainage if needed
42
What is a Colles' fracture?
- fall onto outstretched hand
- distal radius fracture with dorsal displacement of fragments
- described as a dinner fork deformity
43
What are the 3 features of a classic Colles' fracture?
- transverse radius fracture
- 1in proximal to radio-carpal joint
- dorsal displacement and angulation
44
What are early complications of a Colles' fracture?
- median nerve injury: weakness/loss of thumb or index finger flexion
- compartment syndrome
- vascular compromise
45
What are the 3 bones that make up the ankle joint?
- tibia
- fibula
- talus
46
Which bones make up the medial, posterior and lateral malleoli in the ankle?
- medial and posterior: tibia
- lateral: fibula
47
What is the presentation of an ankle fracture?
- pain on palpation
- unable to weight bear
- reduced ROM
- swelling
- bruising/discolouration
48
What symptoms indicate neurovascular injury in an ankle fracture?
- cold, pale, pulseless
- sensory disturbance
49
When is an ankle X-Ray indicated by Ottawa rules in suspected ankle fracture? Give the 3 rules
1. Inability to weight bear for 4 steps
2. Tenderness over the distal tibia/medial malleolus
3. Bone tenderness over the distal fibula/lateral malleolus
50
When is a closed reduction used in ankle fracture?
- stable fracture (non displaced medial malleolus)
- unfit for surgery
- soft tissue conditions
51
When is an open reduction internal fixation indicated in ankle fracture? give 4
- open fracture
- bi/trimalleolar fractures
- unimalleolar with talar shift
- maisonneuve fracture
52
What is a sprain?
- partial or complete tear of a ligament
53
Describe a low ankle sprain:
- ligament
- mechanism
- symptoms
- anterior talofibular ligament (ATFL)
- inversion injury
- pain, swelling, tenderness
- common
54
How are sprains managed?
- RICE
- rest, ice, compression, elevation
55
Describe a high ankle sprain:
- ligament
- mechanism
- symptoms
- syndesmosis
- external rotation, talus pushes fibula laterally
- weight bearing painful
56
What is the Hopkin's squeeze test in high ankle sprain?
- pain when tibia and fibula squeezed together at level of mid calf
57
What is the management of high ankle sprain based on diastasis vs non-diastasis?
- diastasis: orthosis or cast
- non-diastasis: operative fixation
58
What is the most common type of 5th metatarsal fracture?
Where does it occur?
What type of ankle sprain is it associated with and what is the mechanism?
- proximal avulsion (pseudo-Jones)
- occurs at proximal tuberosity
- associated with lateral ankle sprain
- follows inversion injury to ankle
59
What is a Jones fracture?
- transverse fracture at metaphseal-diaphyseal joint
60
Where is the most common site of metatarsal stress fracture?
- 2nd metatarsal shaft
61
What are the features of metatarsal fracture?
- pain and bony tenderness
- swelling
- antalgic gait
62
How are metatarsal fractures investigated?
- X-ray can distinguish displaced vs non-displaced
- MRI can diagnose stress fractures
63
What are risk factors for Achilles tendon disorders?
- quinolone use (ciprofloxacin)
- hypercholesterolaemia
64
What are the features of Achilles tendinopathy?
- gradual onset of posterior heel pain
- worse following activity
- morning pain and stiffness
65
What is the management of Achilles tendinopathy?
- analgesia
- reduction in activities
- calf muscle exercises
66
What features suggest Achilles tendon rupture?
- an audible pop in the ankle whilst running or playing sport
- followed by inability to walk or continue the sport
67
What is the Simmond's triad for Achilles tendon rupture?
- patient lies prone with feet over edge of bed
- greater dorsiflexion in injured foot
- gap in tendon
- foot remains neural when calf squeezed
68
How is Achilles tendon rupture investigated and managed?
- USS
- refer to orthopaedics
69
In what group does iliotibial band syndrome occur and what is a symptom?
- lateral knee pain in runners
- tenderness 2-3cm above lateral joint line
70
What is the presentation of plantar fasciitis?
- heel pain
- worse around medial calcaneal tuberosity (middle of heel)
71
What are the general features of prolapsed lumbar disc?
- dermatomal leg pain
- neuro deficits
- leg pain > back pain
- pain worse on sitting
72
What are symptoms of L3 root compression?
- sensory loss over anterior thigh
- weak hip flexion, knee extension, hip adduction
- reduced knee reflex
- positive femoral stretch test
73
What are symptoms of L4 root compression?
- Sensory loss on anterior aspect of knee and medial malleolus
- Weak knee extension and hip adduction
- Reduced knee reflex
- Positive femoral stretch test
74
What are symptoms of L5 root compression?
- Sensory loss dorsum of foot
- Weakness in foot and big toe dorsiflexion
- Reflexes intact
- Positive sciatic nerve stretch test
75
What are symptoms of S1 root compression?
-Sensory loss posterolateral aspect of leg and lateral aspect of foot
- Weakness in plantar flexion of foot
- Reduced ankle reflex
- Positive sciatic nerve stretch test
76
How is a prolapsed lumbar disc managed?
- NSAIDs ± PPI
- if symptoms persist 4-6 weeks: refer for MRI
77
What are the features of meniscal tear of the knee?
- pain worse on straightening knee
- knee may give way
- knee locking
- tenderness along joint line
78
What is Thessaly's test for meniscal tear of the knee?
- weight bearing at 20 degrees of flexion
- support the patient
- positive if pain on twisting knee
79
What are the features of anterior cruciate ligament injury?
- sudden 'popping' sound
- knee swelling
- instability, feeling the knee will give way
80
What two knee tests test the ACL?
- anterior draw test
- Lachman's
81
What causes medial collateral ligament injuries and what movement is abnormal on exam?
- skiing and valgus stress
- abnormal passive abduction
82
What is a boxer fracture?
- break in neck of 4th/5th metacarpal
- occurs with closed fist/hitting hard object
83
What are the features of a boxer fracture?
- pain and swelling over 4th and 5th metacarpals
- discomfort making a fist
- visible deformity of hand
84
What is the cause of a scaphoid fracture and in what position will the wrist present?
- FOOSH
- hyperextended wrist, radially deviated
85
Give 5 examination signs of scaphoid fracture
1. maximal tenderness over anatomical snuffbox
2. wrist joint effusion
3. pain elicited by telescoping of thumb
4. tenderness of scaphoid tubercle
5. pain on ulnar deviation
86
What are the 2 presenting complains of a scaphoid fracture?
1. pain along radial aspect of wrist at base of thumb
2. loss of grip/pinch strength
87
How is scaphoid fracture investigated?
- X-ray
- MRI is definitive
88
What is the initial management of scaphoid fracture?
- immobilisation with splint
- refer to orthopaedics
89
How does the management of undisplaced vs displaced or proximal scaphoid fractures differ?
- cast for undisplaced
- surgical fixation for others
90
What artery may be affected in scaphoid fracture and what is the risk?
- dorsal carpal branch
- avascular necrosis
MLA
flashcards
Decks in class (28)
# Cards
-
Renal148
-
Respiratory161
-
CV264
-
Derm109
-
Endocrinology271
-
Oncology72
-
Rheumatology226
-
3a Neuro228
-
3a Obstetrics247
-
GI303
-
Ophthalmology250
-
ENT102
-
Gynaecology286
-
Paeds resp117
-
Paeds GI130
-
Sexual Health105
-
Paeds endo26
-
Paeds cardio59
-
Haematology158
-
Ortho90
-
Anaesthesia + surgery4
-
Paeds neuro52
-
Paeds derm41
-
Paeds infectious68
-
Psychiatry269
-
Paeds MSK69
-
Paeds renal5
-
Paeds Genetics38
