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57 Cards in this Set
- Front
- Back
How does direct fracture healing occur? |
Relies on Haversian remodelling with osteons crossing the # (gap <1mm) |
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What are the 5 stages of indirect/secondary fracture healing and when do they take place? |
1. Haematoma (0-48hr) - fibrin mesh 2. Inflammatory (2-7 days) - inflammatory cells 3. Soft callus (1-3 weeks) - fibrin to collagen 4. Hard callus (3-12 weeks) - Endochondral ossification 5. Remodelling (>3 months) - woven bone to lamellar |
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How can you classify fractures? |
Site Position eg distal/proximal/midshaft Simple/Comminuted Orientation: transverse, oblique, spiral Intra/extra-articular Displacement: undisplaced, minimally displaced, off ended Angulation - eg dorsally/ventrally |
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What are the major principles of fracture management? |
ATLS resus, then: Reduce # Hold # until it’s healed Rehabilitate |
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Where does the clavicle most commonly fracture? |
Middle 1/3 |
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What is a Bankharts lesion? |
Capsule torn from glenoid anteriorly due to anterior dislocation |
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Which patients are more likely to have a posterior shoulder dislocation? |
Epilepsy, electric shock, elderly |
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What is at risk of injury in a surgical neck of humerus fracture? |
Axillary nerve or circumflex humeral artery injury |
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Which nerve is at risk of damage in a humeral shaft fracture? |
Radial (runs in spiral groove) |
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What is a Monteggia fracture and how should it be treated? |
Proximal ulna #, dislocation of radial head Management: ORIF |
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What is a Galeazzi fracture and how should it be treated? |
Radial shaft #, dislocation of distal ulna Management: ORIF |
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Complications of supracondylar elbow fractures |
Damage to brachial artery - leading to Volkmann ischaemic contracture Also ulnar nerve at risk (and media and radial) |
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Describe a Colles fracture |
Distal radius #, dorsal & radial displacement of distal fragment |
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Where is aspiration of the elbow conducted? |
Triangle between lateral epicondyle, radius & ulna Elbow flexed at 90, hand pronated |
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How would you manage a scaphoid fracture? |
If no # on XR but clinical suspicion: immobilise in tumb spica for 2 weeks then repeat XR Undisplaced #: Plaster immobilisation: wrist pronated, radially deviated, from MCPs to forearm. For at least 6-8 weeks Displaced #: ORIF |
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What is a Bennetts fracture? |
Fracture dislocation of the thumb |
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What is the normal neck/shaft angle of the femur? |
130 degrees |
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What is the blood supply to the femoral head? |
Major contributor is medial femoral circumflex Some from: lateral femoral circumflex, inferior gluteal artery, artery of ligamentum teres |
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What are is the Gardens classification of NOF#? |
1. Impacted 2. Complete # but undisplaced 3. Partially displaced 4. Completely displaced |
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What systemic factors need to be weighed up when deciding timing of femoral shaft # repair? |
Too late: risk of delay causing fat embolus Too soon: exacerbating SIRS response |
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Management of tib/fib # with soft tissue trauma |
Ex fix then delayed ORIF +/- soft tissue recon |
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Weber classification of ankle fractures |
A - below syndesmosis B - at syndesmosis C - above syndesmosis |
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Entry point for aspiration of the knee |
Knee extended to 15/20 degrees Needle entry point medial aspect of superior ⅓ of patellar, posterior to patellar |
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Which type of pelvic fracture has the highest risk of massive haemorrhage? |
AP compression # (open book) |
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Aetiology of vertebral fractures |
++ Osteoporosis May also be metastatic disease, fall from height or RTA |
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How do you clear the C spine clinically? |
Pt alert, neurologically normal, no neck pain, midline tenderness or distracting injury who is able to voluntarily move head from side to side |
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What is a hangman's fracture? |
C2 on C3 traumatic spondylolysthesis |
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Describe the Salter Harris classification of fractures. Which require fixation? |
1. Straight across growth plate 2. Growth plate & Metaphyseal fragment 3. Growth plate & epiphysis # 4. Through growth plate, epiphysis & metaphysis 5. Crush injury of growth plate 3 & 4 require fixation because they are intra-articular |
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Which injuries are caused by valgus and varus stress to the knee? |
Valgus: MCL Varus: LCL |
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What is compartment syndrome? |
Osseofascial compartment pressure rises to a level that decreases perfusion |
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Aetiology of compartment syndrome |
Trauma: ++ fractures or arterial injury Tight casts, dressings, or external wrapping Extravasation of IV infusion Burns Postischemic swelling Bleeding disorders |
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What are the early signs of compartment syndrome? |
Pain (out of proportion) Pain with passive stretch |
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Pathophysiology of osteoarthritis |
+++Secondary OA, caused by abnormal mechanical forces (e.g. occupational, obesity) or by a previous joint insult (e.g. trauma, RA) Damage to hyaline cartilage leads to inflammation, repair attempts may lead to new cartilage that ossifies (osteophytes) Pain is due to, inflamed synovium, muscle spasm, irregular exposed joint surfaces |
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Describe the difference in pain and stiffness between RA and OA |
RA - pain eases with use, stiffness is prolonged OA - pain worsens with uses, stiffness short lived |
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Describe the difference in joint distribution between RA and OA |
RA: small joints hands and feet, hot & red OA: knees, Thumb, DIPJ, not inflamed |
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Classic X-ray findings in OA |
Loss of joint space Subchondral sclerosis Osteophytes Subchondral cysts |
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Management of OA |
Conservative: analgesia, physio, weight loss, modify activity, hand splintage Surgery: realign (osteotomy), fuse or replace (excise or excise & replace) |
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Where are Heberdens and Bouchards nodes found? |
Heberdens: DIPJ Bouchards: PIPJ |
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Describe the pathophysiology of Rheumatoid arthritis |
Symmetrical, inflammatory polyarthropathy with systemic manifestations Pannus formation (inflamed synovium) leads to destruction (autoimmune reaction) of cartilage then bony erosion at the joint margin |
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What are swan neck and Boutonierres deformities and what causes them? |
Swan neck deformity: DIP flexion with PIP hyperextension Boutonierres deformity: PIP flexion with DIP hyperextension Cause: destruction of the extensor mechanism & unbalanced action of intrinsic muscles |
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What are the mainstay of treatment for RA? |
Anti-inflammatories, DMARDs, steroids |
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Describe the usual presenting features of Gout |
Classically great toe, painful urate crystallisation with asymptomatic intervals |
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How can you differentiate between Gout & pseudogout? |
Gout: negatively bifringent needle urate crystals Pseudogout: positively bifringent rhomboid calcium crystals |
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Where might Osteomyelitis arise from? |
Haematogenous Post traumatic (open wound) Contiguous (from local soft tissue infection) |
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What is the commonest causative organism of osteomyelitis? What might pt's with sickle cell get? |
S.aureus Sickle: Salmonella |
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Management of osteomyelitis |
Long course of Abx: 6 weeks (2 weeks IV initially), may also require aspiration of resection |
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Management of septic arthritis |
Surgical washout Abx, long course |
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What organism might cause a "cold" joint abscess, where is the most common site? |
TB ++Spine |
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What are the red flags for back pain? |
Recent violent trauma Minor trauma in osteoporosis Age at onset <20 or >50 years Hx of: Cancer, IVDU, HIV, Immunosuppression, Constitutional symptoms Severe pain at nighttime Accompanied by saddle anaesthesia or recent onset of difficulty with bladder or bowels |
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Which cancers commonly spread to the spine? |
Bronchus, Breast, Prostate, Thyroid, Kidney |
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Which abdominal organs may have pathology that is felt as back pain? |
Pancreas, duodenum (perf), kidneys (eg pyelonephritis), Aorta |
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What is the most common primary bone tumour, what is it and how does it appear on XR? |
Myeloma, Monoclonal proliferation of B cells. “Punched out” lytic lesions on XR |
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What is the 2nd most common primary bone tumour and who does it affect? |
Osteosarcoma - aggressive, bimodal (aged 10-25 then elderly with Pagets) |
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5 indications for amputation |
Trauma Infection Tumor Vascular disease Congenital anomalies |
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What is a pathological fracture? |
A fracture through a previously abnormal bone |
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5 Metabolic bone diseases that might cause pathological fracture |
Rickets Osteomalacia Renal bone disease “Brown tumour” of hyperparathyroidism Steroid treatment |
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6 other conditions that cause pathological fractures |
Osteoporosis Metastatic cancer Primary cancer Pagets Radiotherapy causing bone necrosis Congenital eg osteogenesis imperfecta |