MSK key points Flashcards Preview

Finals > MSK key points > Flashcards

Flashcards in MSK key points Deck (205)
Loading flashcards...
1

What classifcation system is used to grade open fractures?

Gustilo

2

What is an open fracture?

fracture with direct communication to the external environment

3

What are the features of a type I open fracture

simple fracture
wound <1cm

4

What are the features of a type II open fracture

simple fracture 1-10cm

5

What features automatically make an open fracture grade III

farmyard contamination
neurovascular compromise
periosteal stripping
comminuted fracture
>10cms

6

What are the features of a type IIIa open fracture

comminuted fracture
high energy mechanism
covered from existing tissue on repair

7

What are the features of a type IIIb open fracture

comminuted
needs plastic surgery
periosteal stripping

8

What are the features of a type IIIc open fracture

neurovascular compromise
comminuted

9

What is the immediate management of an open fracture

cannulate - bloods, analgesia, antiemetics, fluids
assess neurovascular status!!!
remove obvious contamination
take photos
cover with saline dressing
realign and splint
recheck neurovascular status!!!
tetanus status
x ray
NBM
call orthopaedic reg, anaesthetist and plastic surgeon
drug chart - antibiotics, analgesia, fluids, antiemetics, thromboprophylaxis
surgery within 24hrs

10

What are the indications for immediate surgery in an open fracture

neurovascular compromise
farmyard contamination
compartment syndrome

11

What does a higher grade of open fracture increase the risk of

infection
amputation
longer healing time

12

Why does periosteal stripping often result in non-union

the bone relies on the periosteum to provide a blood supply for healing

13

How can the risk of infection be decreased in an open fracture

antibiotics!
surgical debridement

14

What is septic arthritis?

acute infection of a joint capsule

15

What can cause septic arthritis

bacteraemia
direct inocculation
contiguous spread from adjacent osteomyelitis

16

What are the risk factors for septic arthritis

>80y
diabetes
HIV
immunosupression
recent joint surgery
IVDU
history of crystal arthropathies

17

Which joints are commonly affected by septic arthritis

knee
hip
shoulder
elbow
ankle

18

Which joint is commonly affected in IVDUs with septic arthritis

sternoclavicular

19

Which organisms are commonly present in septic arthritis

Staphylococcus aureus
Stahpylococcus epidermis
Neisseria gonorrheae

20

What are the signs and symptoms of septic arthritis

pain
effusion
erythema
tenderness
warmth
inability to weight bear
inability to complete full range of passive movements

21

Describe the pathophysiology of septic arthritis and what makes it an emergency

acute irreversible destruction of the cartilage at joints by proteolytic enzymes from inflammatory cells
can be within 8 hours

22

What are the differential diagnoses in septic arthritis

gout
pseudogout
cellulitis

23

What investigations need to be done in suspected septic arthritis

FBC, CRP, ESR
blood cultures
xray joint
joint aspiration

24

What are the findings on xray in septic arthritis

joint space widening
periarticular osteopenia

25

What are the tests you want to do on the joint aspirate in septic arthritis

cell count
gram stain
culture
glucose leve;
crystal analysis

26

What cell count is diagnostic for septic arthritis in joint aspiration?

WCC >50000
>1000 if there is a joint replacement

27

What is the management of septic arthritis

urgent surgical irrigation and debridement
IV abx for 3-4weeks

28

What is a fragility fracture?

fractures that result from mechanical forces that would not ordinarily result in fracture, known as low-level (or 'low energy') trauma

29

Define compartment syndrome

increased pressure within a myofascial compartment that exceeds capillary perfusion pressure, which exceeds the venous pressure and so impairs blood outflow. Lack of oxygenated blood and accumulation of waste products results in muscle ischaemia

30

What are the causes of compartment syndrome

trauma
tight bandages/casts
crush injuries
extravasation of IV fluids
post ischaemic swelling after revascularisation