Lists that come up in the FRACS Orthopaedic Examination. Pick a list on the left and the answer appears on the right. Turn on Test me to hide each answer until you have recalled it, or use Random to quiz yourself.
Adverse Effects of Radiation
- Skin, erythema, desquamation, fibrosis and poor wound healing
- Bone, osteonecrosis, growth arrest in children and insufficiency fractures
- Radiation induced sarcoma (latent period over 3 years, often osteosarcoma or UPS)
- Delayed union and nonunion of fractures in the field
- Soft tissue contracture, lymphoedema and joint stiffness
- Neuropathy, brachial or lumbosacral plexopathy
- Higher wound complication rate after preoperative radiotherapy (O'Sullivan 2002)
- Higher fibrosis and joint stiffness after postoperative radiotherapy
- Myelosuppression and secondary leukaemia
AO Classification of Fractures
- Alphanumeric code, bone, segment, type, group, subgroup
- Bones numbered 1 humerus, 2 radius and ulna, 3 femur, 4 tibia and fibula, 5 spine, 6 pelvis, 7 hand, 8 foot
- Segments 1 proximal, 2 diaphysis, 3 distal, 4 malleolar (tibia only)
- Diaphysis types A simple, B wedge, C multifragmentary
- End segment types A extra-articular, B partial articular, C complete articular
- Example 31A2 is a pertrochanteric multifragmentary fracture
Blocks to reduction of MCP thumb dislocation
- Volar plate interposed in the joint
- Flexor pollicis longus tendon wrapped around the metacarpal head
- Sesamoid bones trapped in the joint
- Metacarpal head buttonholed through the capsule
- Adductor pollicis or flexor pollicis brevis interposition
- Avoid longitudinal traction, which converts a simple to a complex dislocation
- Reduce with flexion of the wrist and pressure on the base of the phalanx
Causes lytic lesions with sclerotic rim
- Non-ossifying fibroma
- Fibrous dysplasia
- Simple bone cyst
- Brodie abscess
- Chondromyxoid fibroma
- Osteoid osteoma (nidus)
- Intraosseous ganglion
- Eosinophilic granuloma (healing)
- Geographic margin with sclerosis implies slow growth
Causes of Benign Lytic Bone Lesions
- Mnemonic FEGNOMASHIC
- Fibrous dysplasia
- Eosinophilic granuloma
- Giant cell tumour
- Non-ossifying fibroma
- Osteoblastoma
- Metastasis and myeloma
- Aneurysmal bone cyst
- Simple bone cyst
- Hyperparathyroidism (brown tumour)
- Infection
- Chondroblastoma and chondromyxoid fibroma
Causes of bone necrosis
- Trauma, femoral neck fracture, hip dislocation, scaphoid and talar fractures
- Corticosteroids
- Alcohol
- Sickle cell disease and haemoglobinopathies
- Caisson disease (dysbaric osteonecrosis)
- Gaucher disease
- SLE and antiphospholipid syndrome
- Radiation
- Chemotherapy and HIV treatment
- Pancreatitis
- Pregnancy
- Idiopathic (Perthes, Kienböck, Freiberg)
Causes of Chondrocalcinosis
- Calcium pyrophosphate deposition, idiopathic and age related
- Hyperparathyroidism
- Haemochromatosis
- Hypomagnesaemia
- Hypophosphatasia
- Wilson disease
- Ochronosis
- Gout
- Acromegaly
- Osteoarthritis
Causes of eccentric & expansile Bone Lesions
- Aneurysmal bone cyst
- Giant cell tumour
- Non-ossifying fibroma
- Chondromyxoid fibroma
- Fibrous dysplasia
- Brown tumour
- Renal and thyroid metastases (blow out)
- Plasmacytoma
Causes of localised Sub-periosteal New Bone
- Fracture healing
- Stress fracture
- Osteomyelitis
- Primary bone tumour (osteosarcoma, Ewing)
- Metastasis
- Osteoid osteoma
- Langerhans cell histiocytosis
- Subperiosteal haematoma
- Myositis ossificans
Causes of lucent Lesions with no sclerotic rim
- Metastasis
- Myeloma
- Giant cell tumour
- Brown tumour of hyperparathyroidism
- Infection
- Langerhans cell histiocytosis (active)
- Lymphoma
- Ill defined margin implies aggressive growth
Causes of Neuropathic Arthritis
- Diabetes mellitus (foot and ankle)
- Syringomyelia (shoulder and elbow)
- Tabes dorsalis (knee and hip)
- Leprosy
- Spinal cord injury
- Spina bifida and myelomeningocele
- Congenital insensitivity to pain
- Alcoholic neuropathy
- Peripheral nerve injury
- Charcot-Marie-Tooth disease
Causes of Protrusio Acetabuli
- Primary (Otto pelvis), women, bilateral
- Rheumatoid arthritis
- Ankylosing spondylitis
- Paget disease
- Osteomalacia
- Osteogenesis imperfecta
- Marfan syndrome
- Trauma (acetabular fracture)
- Infection
- Radiation
- Migration of a hemiarthroplasty or THA cup
Causes of Sub-periosteal New Bone
- Trauma and fracture healing
- Infection
- Tumours (osteosarcoma, Ewing)
- Hypertrophic pulmonary osteoarthropathy
- Venous stasis
- Hypervitaminosis A
- Caffey disease
- Thyroid acropachy
- Scurvy
- Non-accidental injury
Causes of symmetrical Sub-periosteal New Bone
- Hypertrophic pulmonary osteoarthropathy
- Venous stasis and varicose veins
- Thyroid acropachy
- Hypervitaminosis A
- Caffey disease (infantile cortical hyperostosis)
- Physiological in neonates
- Prostaglandin therapy
- Scurvy
- Pachydermoperiostosis
Causes of Ulnar Drift in Rheumatoid Arthritis
- Synovitis stretches the radial sagittal bands
- Extensor tendons sublux into the ulnar gutters
- Radial deviation of the wrist (zigzag deformity)
- Ulnar pull of the flexor tendons
- Intrinsic muscle tightness
- Volar subluxation of the proximal phalanx
- Gravity and pinch forces push the fingers ulnarwards
Causes sclerotic secondary deposits
- Prostate
- Breast (can be mixed)
- Carcinoid
- Small cell lung cancer
- Lymphoma (Hodgkin)
- Medulloblastoma
- Bladder
- Mucinous adenocarcinoma of the gut
Classification of Haemophilic arthropathy
| Arnold-Hilgartner stage | Features |
|---|---|
| I | Soft tissue swelling, no bony change |
| II | Osteopenia and epiphyseal overgrowth |
| III | Subchondral cysts, squared patella, widened intercondylar notch |
| IV | Joint space narrowing |
| V | Fibrous ankylosis and joint destruction |
Classification of Boutonniere Deformity
| Burton stage | Features |
|---|---|
| I | Supple, passively correctable |
| II | Fixed contracture, lateral bands contracted |
| III | Fixed contracture with PIP joint arthritis |
- Central slip failure with volar subluxation of the lateral bands
- PIP flexion with DIP hyperextension
Classification of Aneurysmal Bone Cysts ABC
| Capanna type | Features |
|---|---|
| I | Central, well contained, little expansion |
| II | Whole segment of bone, marked expansion |
| III | Eccentric metaphyseal |
| IV | Subperiosteal |
| V | Periosteal, extends into soft tissue |
- Primary in about 70%, secondary to GCT, chondroblastoma or osteoblastoma in about 30%
- USP6 gene rearrangement in primary ABC
Classification of Avascular Necrosis of the Hip (AVN)
| Ficat stage | Features |
|---|---|
| I | Normal radiograph, MRI changes |
| II | Sclerosis and cysts, no collapse |
| III | Crescent sign, subchondral collapse |
| IV | Joint space narrowing and arthritis |
- Steinberg adds size of lesion
- ARCO is the current international system
Classification of Avascular Necrosis of the Lunate (AVN)
| Lichtman stage | Features |
|---|---|
| I | Normal radiograph, MRI changes |
| II | Lunate sclerosis, no collapse |
| IIIA | Lunate collapse, carpal alignment maintained |
| IIIB | Collapse with fixed scaphoid flexion (radioscaphoid angle over 60 degrees) |
| IV | Pancarpal arthritis |
- Negative ulnar variance is a risk factor
Classification of Developmental Dysplasia of the Hip (DDH)
| Graf type | Alpha angle |
|---|---|
| I | 60 degrees or more, mature |
| IIa | 50 to 59 degrees, under 3 months, physiological immaturity |
| IIb | 50 to 59 degrees, over 3 months |
| IIc | 43 to 49 degrees, critical |
| D | 43 to 49 degrees, decentring |
| III | Under 43 degrees, dislocated, cartilage roof displaced upwards |
| IV | Under 43 degrees, dislocated, labrum inverted |
- Tönnis and IHDI radiographic classifications for older children
- Crowe classification for adult DDH
Classification of Cerebral Palsy
- Physiological, spastic (most common), dyskinetic (athetoid, dystonic), ataxic, mixed
- Topographical, hemiplegia, diplegia, quadriplegia (total body involvement)
| GMFCS level | Function |
|---|---|
| I | Walks without limitation |
| II | Walks with limitations |
| III | Walks with hand held aid |
| IV | Limited self mobility, powered mobility |
| V | Transported in a manual wheelchair |
Classification of Compound Fractures
| Gustilo-Anderson type | Features |
|---|---|
| I | Wound under 1 cm, clean, low energy |
| II | Wound 1 to 10 cm, moderate soft tissue damage |
| IIIA | Extensive soft tissue damage, adequate bone cover |
| IIIB | Periosteal stripping, needs flap cover |
| IIIC | Arterial injury needing repair |
- Final grade is assigned after debridement
- BOAST 4 guides timing of antibiotics, debridement and cover
Classification of Fractures around THR stem
| Vancouver type | Features and treatment |
|---|---|
| A (AG, AL) | Greater or lesser trochanter, usually non-operative |
| B1 | Around or just below the stem, stem well fixed, ORIF |
| B2 | Stem loose, good bone stock, revision stem |
| B3 | Stem loose, poor bone stock, revision with grafting or proximal femoral replacement |
| C | Well below the stem, ORIF |
Classification of Giant Cell Tumours of Bone
| Campanacci grade | Radiology |
|---|---|
| I | Well defined margin, intact cortex |
| II | Thin, expanded cortex, no breach |
| III | Cortical breach with soft tissue extension |
- Enneking stages 1 latent, 2 active, 3 aggressive
- Lung metastases in about 2 to 3%
- Denosumab targets RANKL
Classification of Growth Plate Fractures
| Salter-Harris type | Fracture line |
|---|---|
| I | Through the physis |
| II | Physis and metaphysis (Thurstan Holland fragment), most common |
| III | Physis and epiphysis, intra-articular |
| IV | Metaphysis, physis and epiphysis |
| V | Crush of the physis |
- Rang added type VI, perichondral ring injury
- Peterson type I is a metaphyseal fracture extending to the physis
Classification of Heterotopic Calcification
| Brooker class | Features |
|---|---|
| I | Islands of bone in the soft tissue |
| II | Spurs with over 1 cm between opposing surfaces |
| III | Spurs with under 1 cm between surfaces |
| IV | Bony ankylosis |
- Prophylaxis with indomethacin or single dose radiotherapy (7 to 8 Gy)
Classification of Juvenile Chronic Arthritis
- ILAR classification of juvenile idiopathic arthritis, onset under 16, over 6 weeks
- Oligoarthritis (4 or fewer joints), most common, risk of uveitis
- Polyarthritis rheumatoid factor negative
- Polyarthritis rheumatoid factor positive
- Systemic onset (Still disease), fever, rash, organomegaly
- Psoriatic arthritis
- Enthesitis related arthritis (HLA B27)
- Undifferentiated
- Slit lamp screening for uveitis, especially ANA positive oligoarthritis
Classification of Nonunions
- Weber and Cech
| Type | Features |
|---|---|
| Hypertrophic (elephant foot, horse hoof) | Viable, good biology, poor stability, needs rigid fixation |
| Oligotrophic | Viable, little callus |
| Atrophic | Non viable, poor biology, needs biology and stability |
| Infected | Debridement, stabilisation and antibiotics |
| Synovial pseudarthrosis | Fluid filled cavity, excision and fixation |
Classification of Osteogenesis Imperfecta
| Sillence type | Features |
|---|---|
| I | Mild, blue sclerae, hearing loss, dominant |
| II | Lethal perinatal |
| III | Severe progressive deformity, short stature, white sclerae |
| IV | Moderate, normal sclerae, dominant |
- Types V and above added later (V hyperplastic callus, interosseous membrane ossification)
- COL1A1 and COL1A2 mutations in most
- Bisphosphonates and rodding (Fassier-Duval)
Classification of Osteomyelitis
- Cierny-Mader anatomical types 1 medullary, 2 superficial, 3 localised, 4 diffuse
- Host A normal, B compromised (local, systemic or both), C treatment worse than the disease
- Waldvogel classification by mechanism, haematogenous, contiguous spread, vascular insufficiency
- Acute versus chronic (sequestrum and involucrum)
Classification of Perthes Disease
| Herring lateral pillar | Features |
|---|---|
| A | Lateral pillar height preserved |
| B | Over 50% height maintained |
| B/C border | About 50%, narrow pillar |
| C | Under 50% height maintained |
- Catterall groups 1 to 4 by extent of head involvement
- Head at risk signs (Gage sign, lateral calcification, lateral subluxation, horizontal physis, metaphyseal cysts)
- Waldenström stages, initial, fragmentation, reossification, healed
- Stulberg classification of outcome at maturity
Classification of Proximal Focal Femoral Deficiency
| Aitken class | Features |
|---|---|
| A | Femoral head present, short femur, subtrochanteric pseudarthrosis that ossifies |
| B | Head present, no bony connection between head and shaft |
| C | Head absent, acetabulum dysplastic |
| D | Head and acetabulum absent, very short femur |
- Paley classification guides reconstruction
Classification of RSD
- Now called complex regional pain syndrome (CRPS)
- Type 1 without nerve injury (formerly RSD)
- Type 2 with a definable nerve injury (formerly causalgia)
- Budapest diagnostic criteria
- Classic stages, acute (warm), dystrophic (cold), atrophic
- Vitamin C after wrist fracture may reduce risk
Classification of Soft Tissue Damage (Tscherne & Gotz)
| Grade | Closed fracture soft tissue injury |
|---|---|
| C0 | Minimal damage, indirect injury |
| C1 | Superficial abrasion or contusion |
| C2 | Deep contaminated abrasion, muscle contusion, impending compartment syndrome |
| C3 | Extensive crush, degloving, compartment syndrome, vascular injury |
- Open fractures graded O1 to O4
Classification of SUFE
- Loder, stable (can walk) or unstable (cannot walk, AVN risk about 47%)
- Temporal, acute (under 3 weeks), chronic, acute on chronic
| Southwick slip angle | Severity |
|---|---|
| Under 30 degrees | Mild |
| 30 to 50 degrees | Moderate |
| Over 50 degrees | Severe |
- Klein line on AP fails to intersect the epiphysis
Classification of Tibial Pseudarthrosis
- Boyd classification types I to VI
- Crawford types I to IV by bowing, sclerosis, cysts and fracture
- Anterolateral bowing, half associated with neurofibromatosis type 1
- Posteromedial bowing is a different, benign condition
Classification of Tibial Plateau Fractures (Schatzker)
| Type | Description |
|---|---|
| I | Lateral split |
| II | Lateral split depression |
| III | Pure lateral depression |
| IV | Medial plateau |
| V | Bicondylar |
| VI | Metaphyseal diaphyseal dissociation |
- Three column concept (Luo) uses CT
Classification of Spondylolisthesis
| Wiltse type | Cause |
|---|---|
| I | Dysplastic |
| II | Isthmic (lytic, elongated pars, acute fracture) |
| III | Degenerative |
| IV | Traumatic |
| V | Pathological |
| VI | Post surgical (iatrogenic) |
| Meyerding grade | Slip |
|---|---|
| 1 | Under 25% |
| 2 | 25 to 50% |
| 3 | 50 to 75% |
| 4 | 75 to 100% |
| 5 | Spondyloptosis |
Classification Swan Neck Deformity
| Nalebuff type | Features |
|---|---|
| I | Flexible PIP joint in all positions |
| II | PIP flexion limited with MCP extended (intrinsic tightness) |
| III | PIP flexion limited in all positions, joint preserved |
| IV | Stiff PIP joint with joint destruction |
- PIP hyperextension with DIP flexion
Classification of Thumb Deformities
- Nalebuff classification of rheumatoid thumb
| Type | Deformity |
|---|---|
| I | Boutonnière, MCP flexion, IP hyperextension, most common |
| II | Boutonnière with CMC subluxation, rare |
| III | Swan neck, CMC subluxation, MCP hyperextension, IP flexion |
| IV | Gamekeeper, MCP ulnar collateral laxity |
| V | Swan neck with volar plate laxity, primary MCP hyperextension |
| VI | Arthritis mutilans |
Complications of Pagets Disease
- Bone pain and deformity (bowing, sabre tibia)
- Pathological and fissure fractures
- Secondary osteoarthritis
- Sarcomatous change (osteosarcoma) in about 1%
- Deafness and cranial nerve compression
- Spinal stenosis
- High output cardiac failure
- Hypercalcaemia when immobilised
- Basilar invagination
- Excess bleeding and malunion at arthroplasty
Conditions associated with Slipped Upper Femoral Epiphysis
- Obesity
- Hypothyroidism (most common endocrine cause)
- Growth hormone treatment and deficiency
- Hypogonadism
- Panhypopituitarism
- Renal osteodystrophy
- Radiotherapy to the pelvis
- Down syndrome
- Atypical cases (under 10, under 50th centile weight) need endocrine workup
Contraindications to DVT Prophylaxis
- Active bleeding
- Bleeding disorders (haemophilia, platelets under 50)
- Recent intracranial haemorrhage
- Severe uncontrolled hypertension
- Heparin induced thrombocytopenia (for heparins)
- Severe liver disease
- Severe renal impairment (adjust or avoid LMWH and DOACs)
- Epidural catheter timing (relative)
- Mechanical methods contraindicated in peripheral vascular disease and leg ulcers
Enneking classification tumours
| Benign stage | Features |
|---|---|
| 1 latent | Inactive, well marginated |
| 2 active | Growing, bone remodelling |
| 3 aggressive | Breaches cortex |
| Malignant stage | Features |
|---|---|
| IA | Low grade, intracompartmental |
| IB | Low grade, extracompartmental |
| IIA | High grade, intracompartmental |
| IIB | High grade, extracompartmental |
| III | Metastases |
- Surgical margins, intralesional, marginal, wide, radical
Factors affecting Fracture Healing
- Patient, age, smoking, diabetes, malnutrition, vitamin D deficiency, NSAIDs, steroids
- Injury, energy, open fracture, soft tissue stripping, bone loss, infection
- Bone, blood supply (scaphoid, talus, femoral head), cortical versus cancellous
- Treatment, stability (strain theory), gap, distraction, surgical stripping
- Diamond concept, osteogenic cells, osteoconductive scaffold, growth factors, mechanical stability
Factors Affecting Wound Healing
- Local, infection, ischaemia, tension, foreign body, haematoma, radiation, oedema
- Systemic, diabetes, smoking, malnutrition (albumin under 35), obesity, age
- Drugs, corticosteroids, chemotherapy, biologic DMARDs
- Peripheral vascular disease and venous insufficiency
- Immunosuppression and HIV
- Vitamin C and zinc deficiency
Conditions with Giant cells
- Giant cell tumour of bone
- Aneurysmal bone cyst
- Brown tumour of hyperparathyroidism
- Chondroblastoma
- Non-ossifying fibroma
- Giant cell tumour of tendon sheath and PVNS
- Osteosarcoma (giant cell rich)
- Langerhans cell histiocytosis
- Tuberculosis and sarcoid granulomas
- Giant cell reparative granuloma
- Paget disease
Grades of Muscle Function
| MRC grade | Function |
|---|---|
| 0 | No contraction |
| 1 | Flicker of contraction |
| 2 | Movement with gravity eliminated |
| 3 | Movement against gravity |
| 4 | Movement against some resistance |
| 5 | Normal power |
Classification of Spine secondary deposits
- Tokuhashi score predicts survival (general condition, extraspinal and vertebral metastases, organ metastases, primary, neurology)
- Tomita score, primary growth rate, visceral metastases, bone metastases
- SINS score for stability (0 to 6 stable, 7 to 12 indeterminate, 13 to 18 unstable)
- Bilsky grade of epidural compression (0 to 3)
- NOMS framework, neurological, oncological, mechanical, systemic
- Patchell (2005), surgery plus radiotherapy better than radiotherapy alone for MSCC
Indications for ORIF of Metastatic Lesions
- Pathological fracture in a patient expected to live over 6 weeks
- Impending fracture, Mirels score 9 or more
- Lytic lesion over 2.5 cm or over 50% cortical destruction
- Lesser trochanter avulsion
- Persistent pain after radiotherapy
- Spinal instability or cord compression
- Fix the whole bone, aim for immediate weight bearing, follow with radiotherapy
Indicators of Spinal Instability
- Denis three column theory, two or more columns injured is unstable
- Over 50% loss of vertebral body height
- Kyphosis over 20 to 30 degrees
- Canal compromise over 50%
- Neurological deficit
- Translation or facet dislocation
- Posterior ligamentous complex injury (TLICS)
- White and Panjabi checklist for the cervical spine (translation over 3.5 mm, angulation over 11 degrees)
Methods of Sterilisation
- Steam under pressure (autoclave), 121 degrees for 15 minutes or 134 degrees for 3 minutes
- Dry heat
- Ethylene oxide for heat sensitive items
- Gamma irradiation (implants, polyethylene, allograft)
- Hydrogen peroxide gas plasma
- Low temperature formaldehyde steam
- Prions need extended autoclave cycles or incineration
Neurofibromatosis Diagnostic Criteria
- NF1 needs two or more of the following features (NIH, revised 2021)
- Six or more café au lait spots (over 5 mm before puberty, over 15 mm after)
- Two or more neurofibromas or one plexiform neurofibroma
- Axillary or inguinal freckling
- Optic glioma
- Two or more Lisch nodules or choroidal abnormalities
- Distinctive bony lesion (sphenoid dysplasia, anterolateral tibial bowing or pseudarthrosis)
- Heterozygous NF1 variant
- First degree relative with NF1
Pathological Fractures
- Local causes, primary benign tumour (simple bone cyst, NOF, enchondroma), primary malignant tumour, metastasis, infection, radiation
- Generalised causes, osteoporosis, osteomalacia, Paget disease, hyperparathyroidism, osteogenesis imperfecta, renal osteodystrophy, myeloma
- Atypical femoral fractures from bisphosphonates
- Workup before fixation, never assume a metastasis without a diagnosis
Principles of Tendon Transfer
- Supple joints with full passive range
- Healed soft tissue bed
- Expendable donor
- Adequate donor power (loses one MRC grade after transfer)
- Similar excursion and amplitude
- Straight line of pull
- One tendon, one function
- Synergistic transfers preferred
- Sensate, stable skin
- Motivated patient able to rehabilitate
Principles of Tumour Biopsy
- Biopsy at the treating sarcoma centre after staging
- Longitudinal incision in line with the definitive resection
- Through one compartment, avoid neurovascular structures and joints
- Sample the soft tissue component or lesion edge
- Core needle biopsy is preferred, open if non diagnostic
- Tight haemostasis, drain through or near the wound
- Send for histology, microbiology and frozen section to confirm lesional tissue
- Mankin (1982), biopsy errors altered treatment in 18%
Rheumatoid Arthritis Radiological Classification
| Larsen grade | Features |
|---|---|
| 0 | Normal |
| 1 | Slight abnormality, soft tissue swelling, osteopenia |
| 2 | Definite early erosion |
| 3 | Marked erosion |
| 4 | Severe abnormality, original articular surface partly preserved |
| 5 | Mutilating change, articular surface lost |
- Steinbrocker stages I to IV
- Sharp score used in trials
Rheumatoid Diagnostic Criteria
- 2010 ACR and EULAR criteria, score 6 or more of 10 in a patient with synovitis
- Joint involvement 0 to 5 (large and small joints)
- Serology 0 to 3 (RF and anti-CCP)
- Acute phase reactants 0 to 1 (CRP, ESR)
- Duration 6 weeks or more scores 1
- 1987 ACR criteria needed 4 of 7 for 6 weeks
Rheumatoid Extensor Tendon Rupture Differential
- Extensor tendon rupture (Vaughan-Jackson)
- Extensor tendon subluxation into the ulnar gutter at the MCP joint
- PIN palsy from elbow synovitis (tenodesis effect preserved)
- MCP joint dislocation or subluxation
- Trigger finger locking
- Tenodesis test separates rupture from palsy
Rheumatoid Extra-Articular Manifestations
- Rheumatoid nodules
- Vasculitis and skin ulcers
- Pleural effusion, pulmonary fibrosis, nodules (Caplan)
- Pericarditis
- Episcleritis, scleritis and Sjögren syndrome
- Felty syndrome (splenomegaly, neutropenia)
- Anaemia of chronic disease
- Peripheral neuropathy and entrapment
- Amyloidosis
- Osteoporosis
Risk Factors for DVT & PE
- Virchow triad, stasis, endothelial injury, hypercoagulability
- Previous VTE
- Hip and knee arthroplasty, hip fracture and pelvic surgery
- Immobility and long travel
- Malignancy
- Obesity
- Age over 60
- Oestrogen therapy and pregnancy
- Thrombophilia (factor V Leiden, prothrombin mutation, protein C and S deficiency)
- Smoking and varicose veins
Scoliosis Aetiology
- Idiopathic, infantile, juvenile, adolescent
- Congenital, failure of formation (hemivertebra) or segmentation (bar)
- Neuromuscular, neuropathic (CP, spina bifida, syringomyelia) or myopathic (DMD)
- Syndromic, Marfan, NF1, Ehlers-Danlos
- Degenerative (adult de novo)
- Postural and leg length difference
- Painful scoliosis from osteoid osteoma or infection
Surgical Sieve
- Congenital
- Acquired
- Traumatic
- Infective
- Inflammatory
- Neoplastic (benign, malignant, primary, secondary)
- Metabolic and endocrine
- Degenerative
- Vascular
- Iatrogenic
- Idiopathic
Tumours more common in Females
- Giant cell tumour of bone
- Parosteal osteosarcoma
- Fibrous dysplasia (McCune-Albright)
- Breast and thyroid metastases
- Desmoid tumour
- Giant cell tumour of tendon sheath
Zones of Growth Plate
| Zone | Features |
|---|---|
| Reserve (resting) | Stores lipids and matrix, low oxygen, Gaucher and diastrophic dwarfism |
| Proliferative | Column formation, longitudinal growth, achondroplasia (FGFR3) |
| Hypertrophic | Cells enlarge and calcify matrix, weakest zone, SUFE and most physeal fractures, rickets widens this zone |
| Primary spongiosa | Vascular invasion, mineralisation, osteomyelitis seeds here |
| Secondary spongiosa | Woven bone replaced by lamellar bone, scurvy |
- Groove of Ranvier and perichondral ring of LaCroix surround the physis
Use the up and down arrow keys to move through the lists. In Test me mode, press space to show the answer.
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.