Yr 3 Surgery > Othopaedics > Flashcards

Othopaedics Flashcards

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1
Q

What’s the appearance of the leg in a hip fracture?

A

Shortened
Externally rotated

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2
Q

What can be used to classify NOF fractures?

A

Garden system

Type I: Stable fracture with impaction in valgus
Type II: Complete fracture but undisplaced
Type III: Displaced fracture, usually rotated and angulated, but still has boney contact
Type IV: Complete boney disruption

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3
Q

What treatment is recommended for undisplaced intracapular hip fracture?

A

internal fixation, or hemiarthroplasty if unfit

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4
Q

What is the recommended treatment for displaced intracapsular hip fractures?

A

replacement arthroplasty (total hip replacement or hemiarthroplasty) to all patients with a displaced intracapsular hip fracture

total hip replacement is favoured to hemiarthroplasty if patients:
-were able to walk independently out of doors with no more than the use of a stick and
-are not cognitively impaired and
-are medically fit for anaesthesia and the procedure.

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5
Q

What is the management for extracapsular hip fractures?

A

stable intertrochanteric fractures: dynamic hip screw

if reverse oblique, transverse or subtrochanteric fractures: intramedullary device

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6
Q

What are some causes of avascular necrosis of the hip?

A

long-term steroid use
chemotherapy
alcohol excess
trauma

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7
Q

What is found on examination on carpal tunnel syndrome?

A

weakness of thumb abduction (abductor pollicis brevis)

wasting of thenar eminence (NOT hypothenar)

Tinel’s sign: tapping causes paraesthesia

Phalen’s sign: flexion of wrist causes symptoms

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8
Q

What are the treatment options for carpal tunnel syndrome?

A

a 6-week trial of conservative treatments if the symptoms are mild-moderate:
- corticosteroid injection
- wrist splints at night: particularly useful if transient factors present e.g. pregnancy

severe symptoms or symptoms persist with conservative management:
- surgical decompression (flexor retinaculum division)

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9
Q

What are the features of OA in the hand?

A

Usually bilateral

CMCs, DIPJs > PIPJs

Episodic joint pain: An intermittent ache. Provoked by movement and relieved by resting the joint

Stiffness worse after periods on inactivity, lasts few mins in morning

Painless nodes (bony swellings)
-Heberden’s nodes at the DIP joints
-Bouchard’s Nodes at the PIP joints

Squaring of thumb - fixed adduction

May have reduced grip strength

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10
Q

How does the leg appear in posterior hip dislocation?

A

Shortened
Internally rotated
Adducted

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11
Q

What ligament is most commonly sprained on excessive inversion of the ankle?

A

Anterior talofibular ligament

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12
Q

What are the features of compartment syndrome?

A

Pain, especially on movement (even passive)

Pallor

Parasthesia

Arterial pulsation may still be felt as the necrosis occurs as a result of microvascular compromise

Paralysis of the muscle group may occur

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13
Q

What’s the treatment for compartment syndrome?

A

prompt and extensive fasciotomies

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14
Q

What are some features of spinal stenosis?

A

Usually gradual onset

Unilateral or bilateral leg pain (with or without back pain), numbness, and weakness which is worse on walking. Resolves when sits down.

Pain may be described as ‘aching’, ‘crawling’.

Relieved by sitting down, leaning forwards and crouching down

Clinical examination is often normal

Requires MRI to confirm diagnosis

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15
Q

What are the red flags for lower back pain?

A

age < 20 years or > 50 years

history of previous malignancy

night pain

history of trauma

systemically unwell e.g. weight loss, fever

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16
Q

What are some complications of scaphoid fracture?

A

non-union → pain and early osteoarthritis

avascular necrosis

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17
Q

What is Bennet’s fracture?

A

Intra-articular fracture of the first carpometacarpal joint

Impact on flexed metacarpal, caused by fist fights

X-ray: triangular fragment at ulnar base of metacarpal

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18
Q

What is the management of scaphoid fractures?

A

1)immobilisation with a Futuro splint or standard below-elbow backslab
2)referral to orthopaedics
3) further imaging should be arranged for7-10 days later

Ortho management:

Undisplaced:
-cast for 6-8 weeks
-union is achieved in > 95%
-certain groups e.g. professional sports people may benefit from early surgical intervention

displaced scaphoid waist fractures:
-requires surgical fixation

proximal scaphoid pole fractures:
-require surgical fixation

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19
Q

What system is used to grade open fractures?

A

the Gustilo and Anderson system

1 Low energy wound <1cm

2 Greater than 1cm wound with moderate soft tissue damage

3 High energy wound > 1cm with extensive soft tissue damage

3 A (sub group of 3) Adequate soft tissue coverage

3 B (sub group of 3) Inadequate soft tissue coverage

3 C (sub group of 3) Associated arterial injury

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20
Q

What is monteggia’s fracture?

A

Dislocation of the proximal radioulnar joint in association with an ulna fracture

Fall on outstretched hand with forced pronation

Needs prompt diagnosis to avoid disability

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21
Q

What is Galeazzi fracture?

A

Radial shaft fracture with associated dislocation of the distal radioulnar joint

Direct blow

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22
Q

What is Pott’s fracture?

A

Bimalleolar ankle fracture

Forced foot eversion

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23
Q

How is osteomyelitis managed?

A

flucloxacillin for 6 weeks
clindamycin if penicillin-allergic

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24
Q

What investigations are done in suspected osteomyelitis?

A

MRI

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25
What’s the most common causative organism of osteomyelitis?
Staphylococcus aureus Sickle-cell anaemia pts - Salmonella species
26
What are some key features of adhesive capsulitis?
Common in middle-age and diabetics Characterised by painful, stiff movement Limited movement in all directions, with loss of external rotation and abduction in about 50% of patients
27
What are some key features of supraspinatus tendonitis?
Rotator cuff injury Painful arc of abduction between 60 and 120 degrees Tenderness over anterior acromion
28
What are the x-ray findings in OA?
L – Loss of joint space O – Osteophytes (bone spurs) S – Subarticular sclerosis (increased density of the bone along the joint line) S – Subchondral cysts (fluid-filled holes in the bone)
29
How is OA diagnosed?
diagnosis can be made without any investigations if the patient is over 45, has typical pain associated with activity and has no morning stiffness (or stiffness lasting under 30 minutes).
30
How is OA managed?
Exercise, weight loss, OT Topical NSAIDs 1st line Oral NSAID + PPI 2nd line Intra-articular steroid injections may temporarily improve symptoms (NICE say up to 10 weeks) Joint replacement may be used in severe cases
31
What are some adverse affects of nsaids?
Gastrointestinal side effects, such as gastritis and peptic ulcers (leading to upper gastrointestinal bleeding) Renal side effects, such as acute kidney injury (e.g., acute tubular necrosis) and chronic kidney disease Cardiovascular side effects, such as hypertension, heart failure, myocardial infarction and stroke Exacerbating asthma
32
What is the VTE prophylaxis for hip and knee replacements?
LMWH: 28 days post elective hip replacement 14 days post elective knee replacement Other options: Aspirin DOACs (e.g., rivaroxaban) Anti-embolism stockings
33
What are some generic risks of joint replacement surgery?
Risks of the anaesthetic Pain Bleeding Infection – infection of the prosthesis can be highly problematic Damage to nearby structures (e.g., nerves or arteries) Stiffness or restricted range of motion in the joint Joint dislocation Loosening Fracture during the procedure Venous thromboembolism (DVT or PE)
34
What is the most common causative organism of prosthetic joint infections?
Staphylococcus aureus
35
What are some risk factors for developing prosthetic joint infection?
Prolonged operative time Obesity Diabetes
36
What are some symptoms of prosthetic joint infection?
Fever Pain Swelling Erythema Increasing warmth
37
How is prosthetic joint infection diagnosed?
clinical findings, x-rays, blood tests (raised inflammatory markers), cultures (e.g., blood or synovial fluid) and findings during further operations
38
How is prosthetic joint infection managed?
Repeat surgery - joint irrigation, debridement or complete replacement Prolonged Abx
39
How can fractures of the lateral malleolus be classified?
Type A – below the ankle joint – will leave the syndesmosis intact Type B – at the level of the ankle joint – the syndesmosis will be intact or partially torn Type C – above the ankle joint – the syndesmosis will be disrupted
40
What are some early complications of fractures?
Damage to local structures (e.g., tendons, muscles, arteries, nerves, skin and lung) Haemorrhage leading to shock and potentially death Compartment syndrome Fat embolism Venous thromboembolism (DVTs and PEs) due to immobility
41
What are some long term complications of fractures?
Delayed union (slow healing) Malunion (misaligned healing) Non-union (failure to heal) Avascular necrosis (death of the bone) Infection (osteomyelitis) Joint instability Joint stiffness Contractures (tightening of the soft tissues) Arthritis Chronic pain Complex regional pain syndrome
42
What can be drawn on x-ray to help identify fractures neck of femur?
Shenton’s line is one continuous curving line formed by the medial border of the femoral neck and continues to the inferior border of the superior pubic ramus
43
What are some risk factors for developing osteomyelitis?
Open fractures Orthopaedic operations - esp prosthetic joints Diabetes - diabetic foot ulcers Peripheral arterial disease IV drug use Immunosuppression
44
What are some causes of spinal stenosis?
Congenital Degenerative changes Herniated discs Thickening ligamenta Flava or posterior longitudinal ligament Spinal fractures Spondylolisthesis Tumours
45
What is greater trochanteric pain syndrome?
Tronchanteric bursitis Bursa over greater trochanter - outer hip
46
What is the presentation and management of plantar fasciitis?
Gradual onset of pain on plantar aspect of heel, worse with pressure, tenderness on palpitation Management: - rest - ice - analgesia - physiotherapy - steroid injection - surgery very rare
47
What is a bunion?
Hallux valgus bony lump created by a deformity at the metatarsophalangeal joint (MTP) at the base of the big toe first metatarsal becomes angled medially, the big toe (hallux) become angled laterally (towards the other toes), and the MTP joint becomes inflamed and enlarged
48
What are the phases of adhesive capsulitis?
Painful phase – shoulder pain is often the first symptom and may be worse at night Stiff phase – shoulder stiffness develops and affects both active and passive movement (external rotation is the most affected) – the pain settles during this phase Thawing phase – there is a gradual improvement in stiffness and a return to normal
49
What is tennis elbow?
Lateral epicondylitis Pain in lateral epicondyle that radiates down forearm Can lead to reduced grip strength
50
What is Golfers elbow?
Medial epicondylitis Pain and tenderness in medial epicondyle that radiates down forearm Can reduce grip strength
51
How is epicondylitis managed?
Rest Adapting activities Analgesia (e.g., NSAIDs) Physiotherapy Orthotics, such as elbow braces or straps Steroid injections Platelet-rich plasma (PRP) injections Extracorporeal shockwave therapy
52
What is De Quervain’s tenosynovitis?
Swelling and inflammation of tendon sheaths in wrist: -Abductor pollicis longus (APL) tendon -Extensor pollicis brevis (EPB) tendon Repetitive strain injury Pain on radial side of wrist
53
What is typical presentation of De Quervain’s tenosynovitis?
symptoms at the radial aspect of the wrist near the base of the thumb Pain - radiate to forearm Aching Burning Weakness Numbness Tenderness
54
What special test is available for De Quervain’s tenosynovitis?
Finkelsteins test patient making a fist with their thumb inside their fingers. Then, the wrist is adducted (ulnar deviation), causing strain on the APL and EPB tendons. If this movement causes pain at the radial aspect of the wrist, the test is positive
55
What is the management for De Quervain’s tenosynovitis?
Rest and adapting activities Using splints to restrict movements Analgesia (e.g., NSAIDs) Physiotherapy Steroid injections Rarely, surgery may be required to release (cut) the extensor retinaculum
56
What is trigger finger?
condition causing pain and difficulty moving a finger. It is also known as stenosing tenosynovitis
57
What is the pathophysiology of trigger finger?
thickening of the tendon or tightening of the sheath prevents the tendon from smoothly moving through the sheath when the finger is flexed and extended, causing pain, stiffness, or catching symptoms most commonly affected part of the sheath is the first annular pulley (A1) at the metacarpophalangeal (MCP) joint may be a nodule on the tendon. When the finger is flexed, the nodule is outside the A1 pulley. As the finger is extended from a flexed position, the tendon nodule can get stuck at the entrance to the A1 pulley. This causes the finger to lock or get stuck in the bent position. It may release suddenly with a painful pop or click
58
What are some risk factors for developing trigger finger?
In 40s or 50s Women Diabetes
59
What is the typical presentation of trigger finger?
Is painful and tender (usually around the MCP joint on the palm-side of the hand) Does not move smoothly Makes a popping or clicking sound Gets stuck in a flexed position Symptoms typically worse in morning
60
What is the management for tigger finger?
Rest and analgesia (a small number resolve spontaneously) Splinting Steroid injections Surgery to release the A1 pulley
61
What is Dupuytrens contracture?
condition where the fascia of the hand becomes thickened and tight, leading to finger contractures contracture is a shortening of the soft tissues that leads to restricted movement in a joint Dupuytren’s contracture, the finger is tightened into a flexed position and cannot fully extend
62
What are some risk factors for Dupuytrens contracture?
Age Family history (autosomal dominant pattern) Male Manual labour, particularly with vibrating tools Diabetes (more with type 1, but also type 2) Epilepsy Smoking and alcohol
63
What is the management for Dupuytrens contracture?
Needle fasciotomy (also known as needle aponeurotomy) involves inserting a needle through the skin to divide and loosen the cord that is causing the contracture. Limited fasciectomy involves removing the abnormal fascia and cord to release the contracture. Dermofasciectomy involves removing the abnormal fascia and cord, as well as the associated skin. A skin graft is used to replace the removed skin.
64
What is the presentation of Dupuytrens contracture?
development of hard nodules on the palm. There may be skin thickening and pitting Slowly, the fascia becomes thicker, and the finger is pulled into flexion. It becomes impossible to extend the affected finger fully thick, nodular cord can be palpated from the palm into the affected finger ring finger is most often affected. The index finger is least likely to be affected.
65
What structure joins the tibia and fibula?
Syndesmosis
66
What makes up the ankle?
Talus bone articulating with mortise Mortise - tibial plafond, medial malleolus and lateral malleolus
67
What are some types of ankle fractures?
isolated lateral malleolar fractures isolated medial malleolar fractures bimalleolar fractures ( = medial + lateral malleolar fracture) trimalleolar fractures ( = medial + lateral + posterior malleolar fracture)
68
What classification is used for lateral fractures?
Weber classification: Type A = below the syndesmosis Type B = at the level of the syndesmosis Type C = above the level of the syndesmosis
69
What ankle fractures are managed conservatively and how?
Weber A Weber B without Talar shift Non-displaced medial malleolus fractures Immediate fracture reduction Cast or boot Weight baring
70
What ankle fractures require surgical fixation?
Displaced bi or trimalleolar fractures Weber C Weber B with talar shift Open fractures ORIF using plates and screws
71
What are some complications of ankle fractures?
Post-traumatic arthritis Surgery: DVT or PE Infection Neurovascular injury Non-union
72
What rules are used to determine if pt needs ankle X-ray?
Ottawa ankle rules Bone tenderness at the posterior edge or tip of the lateral malleolus, OR Bone tenderness at the posterior edge or tip of the medial malleolus, OR An inability to bear weight both immediately and in the emergency department for four steps
73
What investigations are done in suspected ankle fractures?
Ankle x-ray AP and lateral with mortise view
Yr 3 Surgery
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