Surgical Specialties - T&o

Front 1

How does direct fracture healing occur?

Back 1

Relies on Haversian remodelling with osteons crossing the # (gap <1mm)

Front 2

What are the 5 stages of indirect/secondary fracture healing and when do they take place?

Back 2

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

Front 3

How can you classify fractures?

Back 3

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

Front 4

What are the major principles of fracture management?

Back 4

ATLS resus, then:

Reduce #

Hold # until it’s healed

Rehabilitate

Front 5

Where does the clavicle most commonly fracture?

Back 5

Middle 1/3

Front 6

What is a Bankharts lesion?

Back 6

Capsule torn from glenoid anteriorly due to anterior dislocation

Front 7

Which patients are more likely to have a posterior shoulder dislocation?

Back 7

Epilepsy, electric shock, elderly

Front 8

What is at risk of injury in a surgical neck of humerus fracture?

Back 8

Axillary nerve or circumflex humeral artery injury

Front 9

Which nerve is at risk of damage in a humeral shaft fracture?

Back 9

Radial (runs in spiral groove)

Front 10

What is a Monteggia fracture and how should it be treated?

Back 10

Proximal ulna #, dislocation of radial head

Management: ORIF

Front 11

What is a Galeazzi fracture and how should it be treated?

Back 11

Radial shaft #, dislocation of distal ulna

Management: ORIF

Front 12

Complications of supracondylar elbow fractures

Back 12

Damage to brachial artery - leading to Volkmann ischaemic contracture

Also ulnar nerve at risk (and media and radial)

Front 13

Describe a Colles fracture

Back 13

Distal radius #, dorsal & radial displacement of distal fragment

Front 14

Where is aspiration of the elbow conducted?

Back 14

Triangle between lateral epicondyle, radius & ulna

Elbow flexed at 90, hand pronated

Front 15

How would you manage a scaphoid fracture?

Back 15

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

Front 16

What is a Bennetts fracture?

Back 16

Fracture dislocation of the thumb

Front 17

What is the normal neck/shaft angle of the femur?

Back 17

130 degrees

Front 18

What is the blood supply to the femoral head?

Back 18

Major contributor is medial femoral circumflex

Some from: lateral femoral circumflex, inferior gluteal artery, artery of ligamentum teres

Front 19

What are is the Gardens classification of NOF#?

Back 19

1. Impacted

2. Complete # but undisplaced

3. Partially displaced

4. Completely displaced

Front 20

What systemic factors need to be weighed up when deciding timing of femoral shaft # repair?

Back 20

Too late: risk of delay causing fat embolus

Too soon: exacerbating SIRS response

Front 21

Management of tib/fib # with soft tissue trauma

Back 21

Ex fix then delayed ORIF +/- soft tissue recon

Front 22

Weber classification of ankle fractures

Back 22

A - below syndesmosis

B - at syndesmosis

C - above syndesmosis

Front 23

Entry point for aspiration of the knee

Back 23

Knee extended to 15/20 degrees

Needle entry point medial aspect of superior ⅓ of patellar, posterior to patellar

Front 24

Which type of pelvic fracture has the highest risk of massive haemorrhage?

Back 24

AP compression # (open book)

Front 25

Aetiology of vertebral fractures

Back 25

++ Osteoporosis

May also be metastatic disease, fall from height or RTA

Front 26

How do you clear the C spine clinically?

Back 26

Pt alert, neurologically normal, no neck pain, midline tenderness or distracting injury who is able to voluntarily move head from side to side

Front 27

What is a hangman's fracture?

Back 27

C2 on C3 traumatic spondylolysthesis

Front 28

Describe the Salter Harris classification of fractures. Which require fixation?

Back 28

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

Front 29

Which injuries are caused by valgus and varus stress to the knee?

Back 29

Valgus: MCL

Varus: LCL

Front 30

What is compartment syndrome?

Back 30

Osseofascial compartment pressure rises to a level that decreases perfusion

Front 31

Aetiology of compartment syndrome

Back 31

Trauma: ++ fractures or arterial injury

Tight casts, dressings, or external wrapping

Extravasation of IV infusion

Burns

Postischemic swelling

Bleeding disorders

Front 32

What are the early signs of compartment syndrome?

Back 32

Pain (out of proportion)

Pain with passive stretch

Front 33

Pathophysiology of osteoarthritis

Back 33

+++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

Front 34

Describe the difference in pain and stiffness between RA and OA

Back 34

RA - pain eases with use, stiffness is prolonged

OA - pain worsens with uses, stiffness short lived

Front 35

Describe the difference in joint distribution between RA and OA

Back 35

RA: small joints hands and feet, hot & red

OA: knees, Thumb, DIPJ, not inflamed

Front 36

Classic X-ray findings in OA

Back 36

Loss of joint space

Subchondral sclerosis

Osteophytes

Subchondral cysts

Front 37

Management of OA

Back 37

Conservative: analgesia, physio, weight loss, modify activity, hand splintage

Surgery: realign (osteotomy), fuse or replace (excise or excise & replace)

Front 38

Where are Heberdens and Bouchards nodes found?

Back 38

Heberdens: DIPJ

Bouchards: PIPJ

Front 39

Describe the pathophysiology of Rheumatoid arthritis

Back 39

Symmetrical, inflammatory polyarthropathy with systemic manifestations

Pannus formation (inflamed synovium) leads to destruction (autoimmune reaction) of cartilage then bony erosion at the joint margin

Front 40

What are swan neck and Boutonierres deformities and what causes them?

Back 40

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

Front 41

What are the mainstay of treatment for RA?

Back 41

Anti-inflammatories, DMARDs, steroids

Front 42

Describe the usual presenting features of Gout

Back 42

Classically great toe, painful urate crystallisation with asymptomatic intervals

Front 43

How can you differentiate between Gout & pseudogout?

Back 43

Gout: negatively bifringent needle urate crystals

Pseudogout: positively bifringent rhomboid calcium crystals

Front 44

Where might Osteomyelitis arise from?

Back 44

Haematogenous

Post traumatic (open wound)

Contiguous (from local soft tissue infection)

Front 45

What is the commonest causative organism of osteomyelitis? What might pt's with sickle cell get?

Back 45

S.aureus

Sickle: Salmonella

Front 46

Management of osteomyelitis

Back 46

Long course of Abx: 6 weeks (2 weeks IV initially), may also require aspiration of resection

Front 47

Management of septic arthritis

Back 47

Surgical washout

Abx, long course

Front 48

What organism might cause a "cold" joint abscess, where is the most common site?

Back 48

TB

++Spine

Front 49

What are the red flags for back pain?

Back 49

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

Front 50

Which cancers commonly spread to the spine?

Back 50

Bronchus, Breast, Prostate, Thyroid, Kidney

Front 51

Which abdominal organs may have pathology that is felt as back pain?

Back 51

Pancreas, duodenum (perf), kidneys (eg pyelonephritis), Aorta

Front 52

What is the most common primary bone tumour, what is it and how does it appear on XR?

Back 52

Myeloma, Monoclonal proliferation of B cells. “Punched out” lytic lesions on XR

Front 53

What is the 2nd most common primary bone tumour and who does it affect?

Back 53

Osteosarcoma - aggressive, bimodal (aged 10-25 then elderly with Pagets)

Front 54

5 indications for amputation

Back 54

Trauma

Infection

Tumor

Vascular disease

Congenital anomalies

Front 55

What is a pathological fracture?

Back 55

A fracture through a previously abnormal bone

Front 56

5 Metabolic bone diseases that might cause pathological fracture

Back 56

Rickets

Osteomalacia

Renal bone disease

“Brown tumour” of hyperparathyroidism

Steroid treatment

Front 57

6 other conditions that cause pathological fractures

Back 57

Osteoporosis

Metastatic cancer

Primary cancer

Pagets

Radiotherapy causing bone necrosis

Congenital eg osteogenesis imperfecta