MSK

Question 1

What is the most common type of shoulder dislocation?

Answer 1

Anterior

Question 2

Initial management of shoulder dislocation

Answer 2

Analgesia and support in temporary sling

Question 3

Give the names of 3 shoulder relocation methods

Answer 3

External rotation, kocher, milch

Question 4

What should be done if shoulder has been dislocated for >24 hours?

Answer 4

Reduce under GA

Question 5

What investigations/ management are needed after shoulder reduction?

Answer 5

Recheck pulses and sensation
Xray
Immobilise in collar and cuff
Analgesia and follow-up

Question 6

Which nerve can be damaged in shoulder dislocation?

How may this present?

Answer 6

Axillary nerve

Reduced sesation in ‘regimental badge’ area

Question 7

What can cause posterior shoulder dislocation?

Answer 7

Anterior blow
Fall onto internally rotated arm
Seizure
Electric shock

Question 8

Difference in presentation between anterior and posterior shoulder dislocation

Answer 8

Anterior: arm is externally rotated and abducted

Posterior: arm is internally rotated

Question 9

What is the most common mechanism of ankle sprain?

Answer 9

Inversion injury

Question 10

Which ligament is most commonly damaged in ankle sprain?

Answer 10

Anterior talofibular

Question 11

In suspected ankle sprain, where do you feel for tenderness over? (6)

Answer 11

Proximal fibular
Lat and med malleoli
Navicular
Calcaneum
Achilles
Base of 5th MT

Question 12

Ottawa criteria: what question does this help answer?

Answer 12

Is an xray required for this ankle?

Question 13

Describe the Ottawa criteria

Answer 13

BONY TENDERNESS over 6cm above malleolus/ base of 5th MT

UNABLE TO WEIGHT-BEAR for 4 steps at the time of injury and examination

Question 14

What advice would you give to someone with a sprained ankle?

Answer 14

RICE!

Initial rest: ankle above hip level, intermittent ice for 10 mins

Begin to weight bear asap!!

Gentle exercise

Question 15

Someone with a sprained ankle wants to use an elastic support, what do you need to tell them?

Answer 15

Do not wear it in bed

Question 16

How long should it take for a minor sprain to recover?

Answer 16

Around 4 weeks

Question 17

Give 2 complications of ankle sprain (re peroneal)

Answer 17

Peroneal tendon subluxation: sensation of clicking/ snapping - may require surgery

Peroneal nerve injury

Question 18

In peroneal nerve injury, where is sensation reduced?

Answer 18

Reduced sensation over the dorsum

Question 19

Why is there an increased risk of hip fracture in the elderly?

Answer 19

Osteoporosis
Osteomalacia
Inc falls risk

Question 20

How may the leg appear in #NOF

Answer 20

Leg looks shorter and is EXTERNALLY rotated

Question 21

An elderly patient with dementia presents with sudden inability to WB - should you suspect #NOF?

Answer 21

YES!!! they may not remember the fall itself

Question 22

Where may pain in #NOF radiate?

Considering this, when should you suspect #NOF?

Answer 22

May radiate to the knee

Suspect #NOF if unable to WB and pain in the knee

Question 23

What is the name of the lines you look for in a hip xray?

Answer 23

Shenton’s lines - compare the shape on both sides

Question 24

How many classes of hip # are there?

Answer 24

4 (garden 1234)

Question 25

Describe grades 1 and 4 of #NOF

Answer 25

1: trabecular angulated, no significant displacement

Grade 4: gross, complete displacement of the femoral head

Question 26

What are the principles of #NOF management?

Answer 26

IV access
Fluids if dehydrated/ shock
Analgesia and anti-emetic
Try to determine the cause: CXR, ECG etc
Admit to orthopaedics

Question 27

Colle’s fracture

• location
• mechanism
• appearance

Answer 27

Within 2.5cm of the wrist

FOOSH

‘dinner fork appearance’

Question 28

In Colle’s #, how may the radius appear on xray

Answer 28

Posterior and radial displacement of the distal fragment of the radius

Question 29

What is the management of a simple colle’s #?

Answer 29

Analgesia
Immobilise in backslab POP
Elevate with sling
Follow-up with # clinic

Question 30

When is manipulation under anaesthesia required in distal radius #?

Answer 30

Grossly displaced #

Loss of normal forward radial articular surface tilt on xray

Question 31

What is a Smith’s fracture?

Answer 31

Usually caused by falling onto flexed wrists (RARE)

Distal radius displaced anteriorly