Bones and Joints Flashcards
Acute osteomyelitis MC seen in ___
Chronic osteomyelitis MC seen in ___
MC organism in osteomyelitis
Acute osteomyelitis MC seen in CHILDREN
Chronic osteomyelitis MC seen in ADULTS
Staph. Aureus
Salmonella* osteomyelitis seen in ____
Tx:
Sickle cell disease
Tx: 3rd gen ceph (Cipro) OR Flouroquinolone (Levofloxacin)
- Most sensitive test in early osteomyelitis
2. Gold standard in dx of osteomyelitis
- MRI
2. Bone Aspiration
- Tx of acute osteomyelitis
2. Tx of chronic osteomyelitis
- IV abx for 4-6 weeks; 6-8 weeks overall of abx
2. 4 weeks - 24 months of IV and PO abx
Tx of acute osteomyelitis from puncture wound
MC organism:
Cipro* or Levofloxacin
Pseudomonas
Tx of acute osteomyelitis w/
- Methicillin sensitive
- Methicillin Resistant
- Nafcillin OR Oxacillin;
PCN allergy –> Clindamycin or Vancomycin - Vancomycin
Osteosarcoma MC in ____
Occur in ____ bones
MC metastasize to ___
X ray shows ____
Adolescents (<20 y/o), 2nd peak in 50-60 y/o
Metaphysis of long bones ( MC in femur*, tibia, humerus)
Metastasize to lung
“hair on end”, “sun ray/burst”
Codman’s triangle
Ewing’s Sarcoma MC in ____
Occur in ____ bones
X ray shows ____
Children, Males 5-25 y/o
Diaphysis of long bones, ribs, flat bones (MC in femur, pelvis)
“Onion peel” = lytic lesion w/ layered periosteal reaction
Chondrosarcoma MC in ___
X ray shows ___
Adults (40-75 y/o)
3rd MC primary malignancy of bone
Matrix punctate or ring and arch appearance pattern of calcifation
Osteochondroma MC in ___
Diagnosis:
Tx:
MC benign bone tumor
Males, 10-20 y/o
Pedunculated, grows away from growth plate*, involves medullary tissue
Observation. Resection if painful, located in pelvis
Intracompartmental pressure of _____ is diagnosis of Compartment syndrome
> 30-45 mm Hg
Primary osteoporosis Type I associated with ____ .
____ bone affected.
MC fracture sites (3)
loss of estrogen in postmenopausal women, testosteron deficiency in men
Trabecular bone
Vertebrae, hip, distal radius
Primary osteoporosis Type II associated with ____.
____bone affected.
MC fracture sites (2)
> 75 y/o w/ poor calcium absorption
Trabecular and cortical bone
Hip, pelvis
Screening DEXA scan recommended for:
Postmenopausal women >65 y/o
Postmenopausal women <65 y/o w/ 1 or more additional RF
RF: alcohol, smoking, low body weight, sedentary, low calcium and vit D intake, corticosteroid use, recurrent falls
Advanced age, Caucasian/Asian, female
1st line treatment of osteoporosis
How should it be taken?
Long term use complications
Bisphosphonate
On empty stomach, sit upright for 30-60 min after ingestion
Weakened bones, Jaw necrosis –> monitor closely
MC wrist injury MOI: Diagnosis: Complication: Tx:
Colles Fracture
MOI: FOOSH –> extension fracture –> dorsal displacement of bone fragment
Diagnosis: “dinner fork deformity”
Complication: Extensor pollicus longus tendon rupture
Tx: Sugar tong splint/cast
Smith fracture =
Diagnosis:
Flexion fracture –> volar displacement of bone fragment
Dx: Garden Spade Deformity
Radial nerve injury causes
wrist drop
Colles and Smith fracture may cause injury to ___ nerve, ___ artery
Median nerve, radial artery
Median nerve injury causes
Inability of thumb opposition
Numbness/tingling in thumb and 2nd,3rd and 1/2 4th digit
Study of choice to diagnose occult hip fracture
MRi
IV abx of choice for open fractures
1st and 2nd gen cephalosporins
aminoglycosides
48 hrs after fracture, 48 hrs after surgical procedures
Salter Harris Classification
Straight through epiphyseal plate = Type 1
Above epiphyseal plate, involve metaphyseal fragment = Type 2
Lower/beLow, through epiphysis into articular surface = Type 3
Through distal metaphysis, epiphyseal plate and epiphysis = Type 4
c(E)Rush of epiphyseal plate = Type 5
Lisfranc fracture
dislocation of tarsometatarsal joint complex
Inability to straighten distal finger/flexed @ DIP joint
Mallet (Baseball) Finger = avulsion of extensor tendon
MC MOI of shoulder dislocation
Fall on outstretched arm in abduction and extension
____ shoulder dislocation more common than ____ shoulder dislocation
Anterior more common than posterior
X ray views to determine ant. vs post. shoulder dislocation
Axillary
“Y” view
Anterior shoulder dislocation most likely will injure ___ nerve, manifests as ____.
Axillary nerve
Pinprick over deltoid
Hill-Sachs lesion =
Humeral head deformities
Seen in recurrent anterior shoulder dislocations
Bankart lesion =
Glenoid inferior rim fracture
Seen in anterior shoulder dislocations
MC fracture in children
Clavicle fracture (mid 1/3)
MOI of acromioclavicular joint dislocation:
Xray:
Ligaments involved:
Direct blow to adducted shoulder
AP w/ weights
Acromioclavicular ligament, coracoclavicular ligament
Proximal humerus fracture must r/o ___injury.
Humeral shaft fracture must r/o ____ injury.
Brachial plexus injury. Check deltoid sensation.
Radial nerve –> wrist drop
Anterior fat pad in children indicate ____
In adults indicate ___
Children –> supracondylar fx
Adults –> radial head fx
____ nerve and ____ artery injury causes Volkmann’s ischemic contracture.
Seen in ____
= claw-like deformity from ischemia w/ flexion/contracture of wrist
MEDIAN nerve, BRACHIAL artery
Seen in Supracondylar fractures
Kienbock disease
Osteonecrosis of the lunate
Dupuytren disease
Tx:
- Palmar aponeurosis, ring, little and middle fingers causing painful nodules, pitting and contractures
- Fixed flexion deformity @ MCP joint
Tx: intra-lesional steroid injection, collagenase injection
Carpal tunnel syndrome involves compression of _____.
Symptoms:
Management:
Median nerve
- Parasthesias and pain of palmar 1st 3 and 1/2 of 4th digit ESPECIALLY AT NIGHT
- Thenar muscle wasting
- Weakness in thumb
Volar splint, NSAIDs
Boxer’s fracture
Tx:
Metacarpal neck of 4th and 5th finger
Tx; 25-30 degrees of angulation –> reduced, ULNAR splint, f/u 1-2 weeks
Eikenella corrodens
organism specific to human mouth
Gamekeeper’s thumb
Tx:
Sprain or tear of ulnar collateral ligament of thumb –> instability of MCP joint, weakness of pinch
Gamekeeper's = chronic Skier's = acute
Tx: Thumb spica
Lateral epicondylitis (a.k.a. ____) = inflammation of tendon insertion of ____ d/t repetitive (pronation/supination) of forearm and excessive wrist (flexion/extension).
“Tennis elbow”
Extensor carpi radialis brevis
Pronation of forearm
Extension of wrist
Medial epicondylitis (a.k.a. ____) = inflammation of tendon insertion of ____ worse with ___ activities.
“golfer’s elbow” or “baseball elbow”
Pronator teres-flexor carpi radialis
Pulling activities
Monteggia Fracture =
____ nerve injury in 17%
Management:
Proximal ULNAR shaft fx w/ anterior radial head dislocation
Radial nerve –> wrist drop
ORIF
Galeazzi Fracture =
Management:
Mid-distal RADIAL shaft fracture w/ dislocation of distal radio-ulnar joint
Unstable! —> ORIF
Scaphoid gets blood supply from ___, runs ___ to ___.
Radial artery, distal to proximal
Proximal pole scaphoid has poor blood supply –> avascular necrosis
Scaphoid fx management
Long-arm thumb spica cast –> referral to ortho
Displacement of >1 mm –> ORIF
De Quervain’s Tenosynovitis = stenosing tenosynovitis of ____ and ___.
Clinical manifestation:
Management:
abductor pollicus longus (APL)
Extensor pollicus brevus (EPB)
Pain along radial aspect of wrist, radiating to forearm
Thumb spica splint x 3 weeks, NSAIDs x 10-14 days, steroid injections (no more than 3), PT
Finkelstein Test
pain w/ ulnar deviation or thumb extension
Dx of De Quervain’s Tenosynovitis
Most common level of scoliosis
- Right thoracic curves @ T7 and T8 (left thoracic curves are rare)
- Double major: right thoracic, left lumbar
Most sensitive test of Scoliosis
Tx:
Adams forward bending test
10-15 degrees: 6-12 month f/u
15-20 degrees: serial AP radiographic f/u Q 3-4 months (large curves) or 6-8 months (smaller curves)
20-40 degrees: bracing
>40 degrees: surgery
Scheuermann disease =
Juvenile kyphosis = idiopathic osteochondrosis of thoracic spine
Pott disease =
Progressive kyphosis caused by TB of spine
Kyphosis =
Tx:
Increased convex curvature of thoracic spine (hump back)
45-60 degrees: observe Q 3-4 months
>60 degrees: Milwaukee brace
Legg-Calve_Perthes Disease =
Presentation:
Avascular osteonecrosis of femoral head in CHILDREN d/t ischemia of CAPITAL FEMORAL EPIPHYSIS
PAINLESS limping x weeks, worsen w/ continued activity
Loss of ABDUCTION and INTERNAL rotation
Tests to evaluate meniscal tears
McMurray’s sign = pop/click while tibia is externally and internally rotated
Apley test
Most sensitive test for dx of ACL tear
Lachman test
Thompson test
Achilles tendon rupture
Morton’s Neuroma
Complication of surgical resection
Degeneration/proliferation of plantar digital nerve –> painful mass near tarsal heads
Permanent numbness of affected toes
Fleck sign
Fracture @ base of 2nd metatarsal
Pathognomonic for disruption of tarsometatarsal ligament (Lisfranc injury)
Jones Fracture = Transverse fx through ____ of ____
diaphysis of 5th metatarsal
Pseudojones Fracture = Transverse avulsion fx ____ of ____ d/t ____ w/ ____
Transverse avulsion fx @ BASE of 5th METATARSAL d/t PLANTAR FLEXION w/ INVERSION.
Maisonneuve Fracture = Proximal _____ fx d/t rupture of talofibular syndesmosis and interosseus membrane as a result of _____.
Proximal SPIRAL FIBULAR fx d/t rupture of talofibular syndesmosis and interosseus membrane as a result of DISTAL MEDIAL MALEOLAR FX and/or DELTOID LIGAMENT RUPTURE.
Ober Test
Pain or resistance to adduction
Dx of Iliotibial Band Syndrome
Class of abx that increases risk of tendon rupture
Fluoroquinolones
Apophysitis =
inflammation of growth plate
