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ITE '23 > Ch. 4 Ortho > Flashcards

Ch. 4 Ortho Flashcards

1
Q

Which antibiotic is preferred in open fractures?

A

first generation cephalosporin

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2
Q

What antibiotic should be given in addition to ancef if it is a crush injury, contaminated, or wound >5 cm?

A

aminoglycoside

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3
Q

Which two nerves/vessels are commonly injured with anterior shoulder dislocations?

A

Axillary N.
Axillary A.

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4
Q

Which nerves/vessels are commonly injured with humeral shaft injuries?

A

Radial N.

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5
Q

Which nerves/vessels are commonly injured with medial epicondylar fractures?

A

Ulnar N.

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6
Q

Which nerves/vessels are commonly injured with Supracondylar fractures and/or elbow dislocations?

A

Brachial A.
Radial, ulnar, and median N.

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7
Q

Which nerves/vessels are commonly injured with hip dislocations?

A

Femoral N.

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8
Q

Which nerves/vessels are commonly injured with knee dislocations?

A

Popliteal A.
Peroneal (fibular) and Tibial N.

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9
Q

Which two nerves/vessels are commonly injured with lateral tibial plateau fractures?

A

Peroneal (Fibular) N.

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10
Q

If axillary N. was injured, what would you find on exam?

A

Deltoid muscle paralysis—check by asking patient to abduct shoulder against resistance

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11
Q

If Radial N. was injured, what would you find on exam?

A

Loss of wrist extension, inability to give “thumb’s up”
Numbness of dorsal web space

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12
Q

If Ulnar N. was injured, what would you find on exam?

A

Inability to spread fingers against resistance
Numbness over dorsal and palmar surfaces of fourth/fifth digits

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13
Q

If Median N. was injured, what would you find on exam?

A

Inability to make “ok sign”
Numbness over palmar aspect of index finger

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14
Q

If Femoral N. was injured, what would you find on exam?

A

Weakened extension at knee
Numbness over anterior/medial thigh, medial shin, arch of foot

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15
Q

If Peroneal N. was injured, what would you find on exam?

A

Weakened dorsiflexion at ankle (“foot drop”)
Numbness over anterior shin, dorsal foot

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16
Q

If Tibial N. was injured, what would you find on exam?

A

Weakened plantarflexion, dorsiflexion, and eversion of foot at ankle
Numbness over lateral aspect of calf and foot

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17
Q

Which 4 bones are most commonly implicated in avascular necrosis?

A

femoral head, proximal scaphoid, capitate, and talus fractures

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18
Q

Where is compartment syndrome most commonly seen?

A

tibia fractures; in anterior compartment

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19
Q

In compartment syndrome, when is fasciotomy indicated?

A

Surgical fasciotomy indicated for compartment pressure > 30 or within 30 mm Hg of mean arterial pressure (MAP)

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20
Q

How is compartment syndrome diagnosed?

A

Clinical diagnosis: Excessive or increasing pain, pain on passive stretch, paresthesias, tender/tight compartment

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21
Q

When does Fat Embolism Syndrome most commonly occur?

A

Most common 1-2 days after LONG bone and PELVIC fractures or surgical repair

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22
Q

What is the triad of Fat Embolism Syndrome?

A
  1. Respiratory distress/hypoxemia
  2. Petechiae
  3. Altered mental status
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23
Q

What is the treatment for Fat Embolism Syndrome?

A

supportive

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24
Q

What is a Volkman ischemic contracture?

A

Flexion contracture of hand/wrist due to untreated forearm compartment syndrome or brachial artery injury and resultant muscle ischemia

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25
Q

Where does an anterior shoulder dislocation most commonly occur?

A

Subcoracoid

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26
Q

What is the mechanism of injury that causes anterior shoulder dislocation?

A

Blow to abducted, externally rotated arm, or less commonly fall on the outstretched hand (FOOSH)

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27
Q

What imaging view is most helpful for looking at anterior shoulder dislocations?

A

Y view; anterior dislocation: humeral head will appear anterior to the glenoid

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28
Q

What is a sign of axillary nerve injury as a complication of anterior shoulder dislocation?

A

loss of sensation at “badge” area of shoulder, weak abduction due to deltoid paralysis

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29
Q

What is a Bankart lesion?

A

an avulsion of the anteroinferior glenoid labrum (often diagnosed on MRI); If present, high incidence of instability and may require SURGERY

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30
Q

What is a Hill-Sachs deformity

A

an impaction fracture of the posterolateral aspect of the humeral head
(generally not clinically significant enough unless large enough to cause instability)

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31
Q

What is the mechanism of injury that causes a posterior shoulder dislocation?

A

significant direct force to the anterior shoulder classically from a seizure, electrocution, or high speed injury – fall from height or grabbing dashboard during MVC

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32
Q

How does posterior shoulder dislocation appear clinically?

A

arm is adducted and slightly internally rotated (patient cannot externally rotate the arm); coracoid process in prominent anteriorly

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32
Q

How does posterior shoulder dislocation appear clinically?

A

arm is adducted and slightly internally rotated (patient cannot externally rotate the arm); coracoid process in prominent anteriorly

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33
Q

What is another name for inferior shoulder dislocation?

A

Luxatio Erecta

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34
Q

What mechanism of injury causes inferior shoulder dislocations?

A

hyperabduction of the shoulder

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35
Q

How does inferior shoulder dislocation appear clinically

A

Arm is held in fixed position up over head 180 degrees

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36
Q

What is the treatment for inferior shoulder dislocation?

A

procedural sedation and closed reduction via traction-countertraction

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37
Q

What accompanies inferior shoulder dislocations?

A

rotator cuff disruption and tear though inferior capsule ; often associated with fractures of proximal humerus; also has high incidence of neurovascular compromise, including axillary nerve, brachial plexus, and axillary artery injuries

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38
Q

What examination test is positive in rotator cuff tears?

A

Drop arm test - patient abducts to 90 degrees, then lowers slowly to side; positive if unable to lower slowly

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39
Q

What is the treatment for AC joint separation?

A

Depends on degree of separation

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40
Q

When is immediate orthopedic consultation necessary for clavicular fractures?

A

open fractures, skin tenting, or neurovascular injury; or severely comminuted (>20 mm of shortening or 100% displacement)

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41
Q

What is the most common location of clavicular fractures?

A

middle third (80% of clavicle fractures)

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42
Q

Why are 3rd degree posterior sternoclavicular injuries so bad?

A

25% chance of life-threatening injuries, including esophageal rupture, carotid artery injury, and injury to great vessels

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43
Q

What are complications of scapular injury?

A

Rib fractures, pneumothorax, hemothorax, pulmonary contusion, clavicular
fractures, shoulder dislocation with associated rotator cuff tears, neurovascular
injuries, and vertebral compression fractures.

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44
Q

What are the four parts of the proximal humerus?

A

humeral head
greater tuberosity
lesser tuberosity
humeral shaft

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45
Q

What is the treatment for a nondisplaced humeral shaft fracture?

A

stabilization with coaptation splint with sling or hanging cast

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46
Q

What is the most common complication of humeral shaft fractures?

A

radial nerve injuries; neuropraxia that resolves after weeks to months;

radial nerve injury causes weakness of the extensors of the wrist and digits and numbness of the dorsoradial aspect of the hand

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47
Q

How are supracondylar fractures classified?

A

Gartland classification

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48
Q

What is the Gartland classification system for supracondylar elbow fractures?

A

Type I (nondisplaced) may be immobilized in posterior splint with orthopedic follow-up in 48 hours.
Type II (some displacement but intact posterior cortex) and Type III (completely displaced, no cortical contact) require urgent operative management.

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49
Q

What is the treatment for NONdisplaced condylar fractures?

A

Posterior splint and early orthopedic follow-up; displaced comminuted or otherwise complicated fractures require immediate ortho consultation

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50
Q

Medial epicondylar fractures are more common in children; 50% are associated with an associated _____ injury

A

ulnar nerve

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51
Q

How are elbow dislocations classified?

A

according to position of ulna relative to humerus

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52
Q

What is the mechanism of injury that causes posterior elbow dislocations?

A

FOOSH with elbow hyperextended

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53
Q

What is the mechanism of injury that causes anterior elbow dislocations?

A

Direct posterior blow to flexed elbow

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54
Q

How will a posterior elbow dislocation appear clinically?

A

Posterior prominence of the olecranon with swelling, shortened forearm held in 45° flexion

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55
Q

How will an anterior elbow dislocation appear clinically?

A

Elongated forearm, arm held in full extension

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56
Q

What is the most serious complication that can occur with elbow dislocations?

A

Brachial artery injury

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57
Q

How do you treat a NONdisplaced olecranon fracture?

A

posterior splint

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58
Q

How do you treat an olecranon fracture with >2mm displacement

A

Ortho consult for possible ORIF

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59
Q

What is a complication that can occur with olecranon fracture?

A

ulnar nerve injury; loss of triceps flexion

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60
Q

What is the treatment for NONdisplaced radial head fracture?

A

Sling and early ROM; more complicated fractures require operative intervention

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61
Q

What do you call a distal radius fracture with dorsal displacement?

A

Colles fracture

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62
Q

What do you call a distal radius fracture with volar displacement?

A

Smith fracture

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63
Q

What do you call a distal radius rim fracture with intra-articular involvement?

A

Barton fracture

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64
Q

What do you call a radial head fracture and dislocation of the distal radioulnar joint?

A

Essex-Lopreseti fracture

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65
Q

What do you call a radial shaft fracture with dislocation of distal radioulnar joint?

A

Galeazzi fracture

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66
Q

What do you call a midshaft ulnar fracture?

A

Nightstick fracture

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67
Q

What do you call an ulnar shaft fracture with radial head dislocation

A

Monteggia fracture

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68
Q

What is the treatment for a Colles fracture?

A

reduction,
sugar tong splint,
orthopedic follow-up

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69
Q

What are the goals of reduction for Colles fractures?

A

Neutral volar tilt, <5 degrees loss of volar inclination, <2-3 mm loss of length, step off <2mm

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70
Q

What is the treatment for Smith fractures?

A

closed reduction,
long arm or sugar tong splint
ortho follow up

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71
Q

What is the treatment for Barton fractures?

A

ORIF for joint stabilization

Barton fracture – Dorsal or volar rim fracture of the distal radius, intra-articular, disrupts
radiocarpal joint

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72
Q

What is the difference between Essex-Lopreseti and Galeazzi fractures?

A

Essex-Lopreseti –
A radial head fracture with dislocation of the distal radioulnar joint and disruption of the interosseous membrane (similar to Galeazzi, but radial head is fractured instead of shaft).

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73
Q

What is the treatment for Essex-Lopreseti fractures?

A

sugar tong splint & ortho referral

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74
Q

What is the treatment for Galeazzi fractures?

A

Sugar tong splint and referral to ortho for ORIF;
this is an UNSTABLE fracture

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75
Q

What is the treatment for Monteggia fracture?

A

reduction, long arm splint, ORIF

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76
Q

What is a frequent complication of Monteggia fractures?

A

Radial Nerve injury

77
Q

What is the treatment for simple nightstick fractures?

A

Long arm splint

78
Q

What is the most common carpal fracture?

A

Scaphoid fracture

79
Q

What mechanism of injury causes scaphoid fractures?

A

FOOSH

80
Q

What is the treatment for scaphoid fractures?

A

thumb spica and ortho follow up in 7-10 days

81
Q

What is the second most common carpal fracture?

A

Triquetral fracture

82
Q

What is the treatment for triquetral fracture?

A

Volar splint

83
Q

What is a boxer’s fracture?

A

a fracture of the fifth metacarpal neck

84
Q

What degree of angulation of a fifth metacarpal fracture is unacceptable and warrants reduction?

A

> 40 degrees of volar angulation is unacceptable

85
Q

What is a Bennett fracture?

A

Intra-articular fracture of thumb at the base of the metacarpal with associated subluxation or dislocation at the carpometacarpal joint

86
Q

What is a Rolando’s fracture?

A

Comminuted intra-articular fracture of the thumb at the base of the metacarpal.

87
Q

How are fractures of first metacarpal treated?

A

thumb spica, ortho consult

88
Q

How do you treat fractures of digits that are stable and nondisplcaed?

A

buddy taping

89
Q

What is gamekeepers thumb?

A

Rupture of the ulnar collateral ligament (UCL), also known as skier’s thumb.

90
Q

What is the mechanism of injury for gamekeepers thumb?

A

Hyperabduction of the thumb (eg, fall on the hand while holding a ski pole) leads to a tear of this ligament or avulsion from its insertion site on the base of the proximal phalanx.

91
Q

Where does the Flexor Digitorum Superficialis insert?

A

FDS divides into two slips that insert on
either side of the middle phalanx

92
Q

Where does the Flexor Digitorum Profundus insert?

A

passes through these slips to insert on the base of the distal phalanx

93
Q

What is the treatment for injuries to Flexor Digitorum Profundus and/or Superficialis?

A

Surgical repair

94
Q

What is Mallet finger?

A

extensor tendon rupture at its insertion site on the base of distal phalanx

95
Q

What is a Boutonniere deformity?

A

Disruption of the extensor tendon at the central slip over the PIP

96
Q

What is the gold standard for diagnosing femoral neck fractures?

A

MRI (CT has an unacceptably high misdiagnosis rate)

97
Q

What is a complication of femoral trochanteric and shaft fractures?

A

Hypovolemia – can have up to 3L blood loss into fracture site and thigh compartment

98
Q

What is the treatment for nondisplaced patella fractures?

A

immobilization in full extension
with weight bearing as tolerated and orthopedic referral

99
Q

What is the treatment for patella fractures with >3 mm displacement or loss of extensor function?

A

Ortho referral for surgical intervention

100
Q

What is the treatment for Patella dislocation?

A

Reduction by placing knee in full extension, hip in some flexion and pushing on patella medially up and over lateral condyle;
Once reduced, immobilize in full extension for Ortho follow-up

101
Q

What is the most common fracture of the knee?

A

tibial plateau fracture (usually lateral plateau)

102
Q

How are tibial plateau fractures treated?

A

Nondisplaced fractures can be treated with knee-immobilizer and non–weight bearing. Displaced fractures require ORIF.

103
Q

What is the most common knee ligamentous injury?

A

ACL injury

104
Q

What is the “terrible triad” of knee injuries?

A

ACL, MCL, medial meniscus injury

105
Q

What is the most sensitive physical exam test for ACL tear?

A

Lachman test – Instability with anterior stress in 15°-30° of flexion (anterior drawer test is in 90 degrees of flexion)

106
Q

What is the McMurray test?

A

Pain as the knee is brought from full flexion to 90° flexion while the leg is externally rotated with compression over the medial joint
line and/or when the leg is internally rotated with compression over the lateral joint line;

Medial joint line pain = medial meniscus injury

107
Q

What is the Apley test?

A

In prone position with knee flexed 90º, pain as knee is internally/externally rotated with downward pressure to heel;

Indicated Meniscal injury

108
Q

What is the Ege test?

A

In squatting position, pain, and/or click on maximum rotation of knee;

External rotation = medial meniscus tear
Internal rotation = lateral meniscus tear

109
Q

Describe a Grade I (first degree) sprain.

A

Ligamentous stretching without tear or rupture.
No joint instability.
Able to bear weight.

110
Q

Describe a Grade II (second-degree) sprain.

A

More significant ligament damage (partially torn), but no joint instability.
Limp with walking.

111
Q

Describe a Grade III (third-degree) sprain.

A

Torn ligament with joint instability. Unable to bear weight, severe swelling.

112
Q

What is the treatment for ankle sprain?

A

■ If ankle is unstable, consider posterior splint and urgent orthopedic referral.
■ If ankle is stable but patient is unable to bear weight, rest, ice, compression, elevation, crutches, apply ankle brace, and follow-up in one week with orthopedics.

113
Q

What is the most commonly injured ligament in the ankle?

A

ATL – anterior talofibular ligament

114
Q

What is the mechanism of injury for the ATL?

A

Inversion with internal rotation of a plantar-flexed foot

115
Q

What is the mechanism of injury for the medial deltoid ligament?

A

Eversion and external rotation of foot

116
Q

What is it called when a medial deltoid ligament injury is associated with proximal fibula fracture?

A

Maisonneuve fracture

117
Q

What test can be used to evaluate for syndesmosis sprains?

A

positive Squeeze test – examiner firmly grasps the patient’s lower leg and “squeezes” the distal tibia and fibula together, causing pain if the injury is present

118
Q

What exam finding would be present in peroneal / fibular tendon subluxation/dislocation/injury?

A
  • swelling posteriorly/inferiorly to lateral malleolus in abscess of tenderness over anterior ATL
  • when held in dorsiflexion, unable to evert the foot
119
Q

What is the treatment for peroneal tendon injury?

A

Splint in midplantar flexion; ortho referral for possible surgical repair

120
Q

What are 4 risk factors for achilles tendon rupture?

A
  1. older age
  2. rheumatoid arthritis
  3. Lupus
  4. Recent fluoroquinolone use
121
Q

What is the typical mechanism of injury for achilles tendon rupture?

A

forceful plantar flexion against resistance

122
Q

How is achilles tendon rupture diagnosed on physical exam?

A

Abnormal Thompson test – position patient prone with knee bent to 90 degrees. Squeeze the calf. If tendon is intact, the foot should plantarflex.

123
Q

What is the treatment for achilles tendon rupture?

A

Posterior splint in plantar flexion
aka “Equinus splint”; Ortho consult – early surgical repair leads to better outcomes.

124
Q

What are 4 types of ankle fractures that require ortho consult in ED?

A
  1. Any unstable joint, including bimalleolar fractures
  2. Intra-articular fractures
  3. Open fractures
  4. Fracture dislocation
125
Q

What is a Maisonneuve Fractures?

A

Ankle-eversion injury with forces transmitted along interosseous membrane
causing proximal fibula fracture.

May also be associated with avulsion fracture of the medial malleolus, rupture of the deltoid ligament, or distal tibiofibular syndesmosis.

126
Q

What is the treatment for Maisonneuve fracture?

A

Often requires ORIF to stabilize the tibiofibular syndesmosis

127
Q

What is the most commonly fractured tarsal bone?

A

Calcaneus

128
Q

What is Bohler’s angle and what is it used for?

A

angle between a line formed from the posterior tuberosity of the calcaneus and the apex of the posterior facet and a line between the apex of the posterior facet and anterior process of the calcaneus

Used to detect calcaneus compression fracture

129
Q

What is a normal Bohlers angle? What is abnormal?

A

Bohler’s angle of 20°-40° is normal

<20° is abnormal –> compression fracture

130
Q

What is the treatment for calcaneal fractures?

A

Bulky Jones dressing, posterior splint, non–weight bearing; orthopedic consult.
■■ Surgical repair (when needed) is delayed up to three weeks until swelling is improved.

131
Q

What is a complication that can occur in comminuted calcaneal fractures?

A

Comminuted fractures have a high rate of compartment syndrome.

132
Q

What is the treatment for minor talar avulsion fractures?

A

posterior splint and crutches

133
Q

What is the treatment for major fractures of the neck and body of talus?

A

Ortho consult, often requires ORIF

134
Q

What is a common complication of talus fracture?

A

High rates of AVN

135
Q

What do you call a tarsometatarsal fracture?

A

Lisfranc fracture

136
Q

What is the Lisfranc joint?

A

the tarsometatarsal complex made up of the 5 metatarsals and their adjoining tarsal bones (3 medial cuneiforms and 2 lateral cuboids).

Lisfranc injuries are Ortho emergencies

137
Q

When should you suspect a Lisfranc fracture?

A

if there is gap > 1 mm between the base of the first and second or second and third metatarsals or any fractures around the Lisfranc joint.

138
Q

What is Fleck sign and what does it represent?

A

an avulsion fracture of the base of the SECOND metatarsal on the medial side
it is pathognomonic of a Lisfranc fracture

139
Q

Lisfranc injuries are commonly associated with injury to which vessel?

A

Dorsalis Pedis artery

140
Q

What is a Jones fracture?

A

a transverse fracture through the metaphyseal-diaphyseal junction of the FIFTH metatarsal;

the fracture will be at least 1.5 cm distal to the base of the 5th metatarsal

141
Q

What is the treatment for a Jones fracture?

A

splint, NWB, ortho referral for possible ORIF

142
Q

What is a Pseudo-Jones Fracture?

A

Avulsion of the base of the fifth metatarsal
(more common than Jones frcatures)

143
Q

What is the treatment for a Pseudo-Jones fracture?

A

Ankle stirrup splint, hard post-op shoe, or rocker walker.

144
Q

What type of spread most commonly causes osteomyelitis in adults? in children?

A

adults – contiguous spread
children – hematogenous spread

145
Q

What organism most commonly causes osteomyelitis?

A

Staph aureus

146
Q

Which antibiotics should be used to treat Osteomyelitis caused by injection drug use?

A

PRP (nafcillin, dicloxacillin) + antipseudomonal aminoglycoside (tobramycin, amikacin, gentamycin)

147
Q

Which antibiotics should be used to treat Osteomyelitis caused by chronic infection or diabetic foot infection?

A

PRP (nafcillin, dicloxacillin) + fluoroquinolone + flagyl

148
Q

What indicates a positive straight leg raise?

A

Positive when back pain is elicited, radiating past the knee, at an elevation <60 degrees

149
Q

What does a positive contralateral straight leg raise indicate?

A

highly specific for sciatica

150
Q

Which systemic rheumatic diseases cause symmetric joint involvement?

A
  1. rheumatic arthritis
  2. SLE
  3. viral
  4. IBD
  5. Spondylitis
151
Q

Which systemic rheumatic diseases cause asymmetric joint involvement?

A
  1. psoriatic arthritis
  2. reactive arthritis
152
Q

What organism is most commonly found in septic joints?

A

staph aureus

153
Q

What medication should not be used in acute gout attacks?

A

Allopurinol

154
Q

Which medications CAN be used in acute gout attacks?

A

NSAIDs, steroid injection, colchicine

155
Q

What viruses most commonly cause a polyarthritis?

A
  1. Parvovirus
  2. Hepatitis A, B, and C

parvovirus will also have “slapped cheek” and lacey rash

156
Q

What is the triad of Reiter syndrome?

A

conjunctivitis
urethritis
polyarthritis

seen in males 15-30 years old

157
Q

What is the treatment for Reiter syndrome?

A

NSAIDs; antibiotics are NOT helpful

158
Q

What gene is commonly associated with Reiter syndrome?

A

HLA-B27 (80-90%)

159
Q

What joints are most commonly affected by septic arthritis?

A

Large joints of lower extremity (hip and knee)

160
Q

What is the only way to definitively diagnose a septic joint?

A

Joint fluid cultures is the only definitive test

161
Q

If endemic to the area, Lyme should be considered in a monoarticular arthritis. How do you test for this?

A

Serum antibody titers

162
Q

What are risk factors for bursitis?

A

diabetes, ETOH use, overlying skin disease, trauma (most common), and steroid use

163
Q

What cell counts for aspirate suggest infection in suspected bursitis?

A

WBC counts >5000/uL

164
Q

What is the treatment for septic bursitis?

A

oral antistaph abx (eg oxacillin)

165
Q

What is the most common electrolyte abnormality seen in rhabdomyolysis?

A

hypocalcemia
(however, hyperkalemia is the most lethal)

166
Q

How is rhabdo diagnosed?

A

CK >5x normal limit (about ~1000U/L)

167
Q

Why must platelets and coags (PT/PTT) be monitored in rhabdo?

A

rhabdo can cause DIC

168
Q

What urine output should you target is IV hydration for patient’s with rhabdo?

A

3ml/kg/hr

169
Q

What is carpal tunnel syndrome?

A

A compressive neuropathy of the median nerve (at the level of the carpal tunnel in the volar aspect of the wrist)

170
Q

What is a positive Durkin Compression test?

A

Reproduction of symptoms with compression of carpal tunnel for 30 seconds.
for carpal tunnel syndrome

171
Q

What is a positive Phalen sign?

A

Reproduction of symptoms with hyperflexion of wrists at 90° for 1 minute.
for carpal tunnel syndrome

172
Q

What is a positive Tinel sign?

A

Pins-and-needles sensation in the median nerve distribution with tapping on the carpal tunnel.
for carpal tunnel syndrome

173
Q

What is a positive Flick sign?

A

Shaking or “flicking” the hands provides relief of symptoms during episodes.
for carpal tunnel syndrome

174
Q

What do you call synovitis of the tendons in the first dorsal wrist compartment?

A

De Quervain Tenosynovitis

175
Q

What causes de quervain tenosynovitis?

A

thickening of the extensor retinaculum of the wrist from repetitive trauma or wrist movement

176
Q

What symptoms/exam is present in De Quervain Tenosynovitis?

A

pain over radial styloid that radiated proximally or down thumb

177
Q

What physical exam test can be used to test for De Quervain tenosynovitis?

A

Finkelstein test - pain near radial styloid upon ulnar deviation of wrist with hand in fist position

178
Q

What is the treatment for de quervain tenosynovitis?

A

rest, ice, NSAIDs, thumb spica splint

179
Q

What is the treatment for plantar fasciitis?

A

conservative management with rest, orthotics, stretches; surgery is rarely needed

180
Q

What is felon?

A

infection of the fingertip pulp

181
Q

What bacteria most commonly causes felon?

A

s. aureus

182
Q

What is the treatment for felon?

A

early –> warm soaks and antibiotics
otherwise I&D may be necessary in addition to abx

183
Q

What is paronychia?

A

soft tissue infection along the border of the fingernail or paronychium that results from the breakdown of skin (trauma, nail biting) and entry of bacteria or fungi into the nail fold

184
Q

What bacteria most commonly causes acute paronychia?

A

s. aureus

185
Q

What commonly causes chronic paronychia?

A

candida albicans

186
Q

What is the treatment for acute paronychia?

A

early –> warm soaks and antibiotics
possible need for I&D in addition to abx

Do not incise if herpetic whitlow is suspected

187
Q

What is flexor tenosynovitis?

A

Infection of flexor tendon sheaths of the fingers
true surgical hand emergency

188
Q

What organisms most commonly cause flexor tenosynovitis?

A

S. aureus and streptococci

189
Q

What symptoms and exam are present in flexor tenosynovitis?

A

Symptoms/Examination (Kanavel Cardinal Signs)
■■ Flexed posture of the involved digit
■■ Fusiform swelling of the finger (“sausage digit”)
■■ Tenderness over the flexor tendon sheath
■■ Pain with passive extension

190
Q

What is the treatment for flexor tenosynovitis?

A
  1. immobilize and elevate
  2. IV abx – amp/sulbactam, keflex, or vanc
  3. consult hand surgery
191
Q

What is the treatment for high pressure injection injuries?

A

SURGICAL EMERGENCIES
splint and elevate
antibiotics, tdap
analgesia – NO digital blocks
EMERGENCT ortho consultation

ITE '23 (20 decks)

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