1. Which patient we put POP, which
patient we put backslab? Apa beza?
• Full cast POP usually we do after CMR to
keep
stabilize fracture that we already reduced,
kalau letak backslab no pointlah kita
reduce
bersungguh2, nanti ia akan tertarik balik
la kan?
Radius/ ulnar fracture yang no need
operation
biasanya kita letak full POP, for
conservative mx,
then pt boleh balik.
• Back slab we use for temporary immobilize
je,
contohnya letak kat ED, sementara nak menunggu
turn op beberapa hari tu kita boleh guna
backslab.
• Above Elbow backslab/Above Knee/Below
Knee/
Boot slab
• U Slab/Volar slab/Sugar Tong.
Itulah contoh jenis-jenis slab
2. DFU bagi antibiotic apa?
• IV Unasyn to cover polymicrobial usually
kita
bagi, tapi tengoklah juga result tissue CnS
atau
Pus CnS yang kita dapat masa pt underwent
wound debridement dalam OT tu organism apa,
then kita change antibiotic base on
sensitivity.
3. Necrotizing Fascitis? Bagi antibiotic
apa?
• Empirically - penicillin, Clindamycin,
Metronidazole
• Kalau strep atau clostridium - Penicillin
‘
• Polymicrobial - Meropenam
(Depend on sensitivity)
4. Cloxacillin cover apa? Gentamicin?
Unasyn? Cefuroxime? Rifampicin?
• IV Cloxacillin 1g QID - more on gram
positive
(cellulitis biasa bagi ni)
• Iv Cefuroxime 750mg TDS/ Tab Cefuroxime
250
BD - more on gram positive, patient
prophylaxtic
nak masuk OT kita bgi ni, post op plating
pun kita
bagi, mungkin sampai seminggu?
• IV unasyn Diabetic Foot Ulcer
• Tab Rifampicin 300mg BD - good for bone
penatrating- boleh bagi utk Pt
Osteomyelitis, but
need to monitor RFT weekly, ask orange
color
urine to know compliance.
5. Why irrigate with a lot normal saline in
open fracture?
• Bagi stat dose antibiotic as soon as
possible,
then irrigate to Reduce Bacterial Load.
6. Sciatic nerve branch? Post op nak
check apa? Foot drop disebabkan
nerve mana yang affected?
• Sciatic Nerve ada dua branch
» Common Peroneal Nerve (Give branch to
Deep Peroneal Nerve (supply ms anterior
compartment leg n sensory 1st web spacs)
and Superficial Peroneal Nerve- supply
lateral
compartment leg and dorsum foot exept 1st
web space)
» Tibial Nerve
• Foot drop - injury to common peroneal
nerve
7. Calceneum pin insertion medial ke
lateral? Nak avoid nerve apa? High
tibial pin?
• Calceneum pin must inserted from medial
to
lateral - 1/4 posterior from tip med
malleolus tu
calceneum. To avoid neurovascular bundle
over
medial side. Ada tibial nerve, tibial
artery.
• High tibial pin - insert from lateral, to
avoid
common peroneal nerve near head fibula
8. Skin traction? Berapa maxima berat
untuk letak pemberat? Nak balut
sampai mana? Apa yang kena monitor?
Kawasan masa yang mudah nak kena
pressure sore?
• Skin traction - not more than 5% body weight
Bandage up to distal part of fracture.
• Usually some hosp prefer non adhesive
type
because can irritate patient skin, skin
excoriation
can occur.
• Put some orthoban to prevent pressure
sore.
Post application must monitor distal
circulation
chart( crt, dpa pta palpable or not, able
to move
ankle and toes)
Most importantly pressure sore- if pt pun
on backslab, check
at bony prominence - medial/ lateral
malleolus, calceneum and
head of fibula (deep peroneal nerve kat
situ)
9. Skeletal traction? How much weight?
• Not more than 10% body weight
10.Fat embolism syndrome nak check
macam mana?
Pt can have SOB, tachycardia, drowsiness,
Fever suddenly.
Check petichae over armpit, conjunctiva and
chest.
GURD Criteria
11.Median, radial and ulnar nerve nak
check di point mana?
• Median - medial to distal phalanx index
finger
Radial - anatomical snuff box
Ulnar - tepi little finger
12.OK sign nak test hand untuk nerve
apa?
• Can do O (index and thumb) - Median Nerve
opponen pollicis
Able to extend wrist - Radial Nerve
Able to extend medial 3 finger - Ulnar
Nerve
13.Open fracture management?
• ABCD
• Secure bleeding
• Large bore branulla - iv fluid
• Analgesic
• V cefuroxime (+IV Gentamicin, + IV
Flagyl) -
depend on severity and dirty
• ATT injection
• Irrigate with a lot NS/ water for
irrigation
• Immobilize - backslab/skin traction/
splinting/ to
reduce pain
• External Fixator first until wound
closure
• Dressing
• Once open fracture become close fracture,
can
do internal fixation
14.Neck of femur fracture? Apa beza total
hip athroplasty, bipolar and unipolar?
In which patient and which operation?
Premorbidly? Age factor?
• Old age >6yo usually can do
orthosynthesis,
if young patient <65yo can try screw
first, to
give time, if anything happen, can proceed
with
orthosynthesis later.
• Must ask premobidly able to ambulate or
socially
active or not because can affect mx
15.LRINEC Score NF?
• L (leucocyte) / R (RBS) / I infective
parameter
(CRP)/ E Anemia (HB) /C : (Creatinine)
» Total White Cell
» Glucose
» Na
» Creatinine
» Hb
16.NF vs Cellulitis?
• NF - Not well demarcated margin,
purplish, bullae,
aggresive worsen, crepitus
17.DFU -
examination/history/classification/
pharmaco/ non pharmaco/ surgical tx
18.Plating/ internal fixation?
• Plating yang biasa saya tengok - plating
fibula,
tibia plateau fracture, radius/ ulnar
butress
plating.
• Internal fixation more on lower limb
• Midashaft tibia fracture, femur fracture
19. Interlocking nail, plating, butress
plate,
cerclage, tension band wiring.
• Tension Band Wiring - Patella fracture,
malleolus
fracture
• Screw - small fracture, malleoulus, head
fibula
fracture
• K Wire - Small bone fracture MCB, MTB.
• Spring plate - Acetabulum fracture
20.Clavicle fracture can be mx
consevatively?
• Can be manage conservatively usually by
just use
armsling, but in certain condition can do
plating
(hook)- eg pt also had lower limb fracture,
need
to use crutches to ambulate, so need to
operate
clavice for early mobilization. Pernah juga
tengok
patient had bilateral clavicle fracture
also need to
operate.
21.Septic arthritis?
• Kocher criteria?
• X- ray changes? ROM?
• One of orthopedic emergency
22.KOCHER criteria
» Pt will have fever
» Increase Total White Cell
» ESR/CRP increase
» Unable to weightbear
» Limited ROM join
» X Ray - Increase in join space
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