chapter 42: orthopedics Flashcards
synthesize non mineralized bone cortex
osteoblasts
reabsorb bone
osteoclasts
stages of healing
1) inflammation
2) soft callus formation
3) mineralization of the callus
4) remodeling of the callus
receives nutrients from synovial fluid (osmotic)
cartilage
fractures: cross the epiphyseal plate and can affect the growth plate of the bone; need ORIF
Salter-Harris fractures 3, 4, and 5
fractures: closed reduction
Salter-Harris fractures 1 and 2
epiphysiolysis of the involved growth plate without associated fracture
salter-harris type 1 fracture
epiphysiolysis of the involved growth plate without associated fracture; additional metaphysical fracture fragment
salter-harris type 2 fracture
salter harris fracture: good prognosis and are usually treated with closed reduction and casting
type 1 and 2 fractures
injury results in a fracture through the growth plate and epiphysis
type 3 fracture
fracture cross the epiphysis, growth plate (physis), and metaphysis
type 4 fracture
injuries require careful ORIF if displaced
type 3 and 4 fractures
involves a crush of the growth plate without a fracture and is usually detected late by asymmetric or premature closure of the growth plate
type 5 injury
fractures associated with avascular necrosis (AVN)
scaphoid, femoral neck, talus
fractures associated with nonunion
clavicle, 5th metatarsal fracture (Jones’ fracture)
fractures associated with compartment syndrome
supracondylar humerus, tibia
biggest risk factor for nonunion
smoking
LE nerve: hip adduction
obturator nerve
LE nerve: hip abduction
superior gluteal nerve
LE nerve: hip extension
inferior gluteal nerve
LE nerve: knee extension
femoral nerve
presents with back pain, sciatica
herniated nucleous pulposus
nerve root compression affects 1 nerve root below disc
lumbar disc herniation
Lumbar disc herniation: weak hip flexion
L3 nerve compression (L2-3 disc)
Lumbar disc herniation: weak knee extension (quadriceps), weak patellar reflex
L4 nerve compression (L3-4 disc)
Lumbar disc herniation: weak dorsiflexion (foot drop), decreased sensation in big toe web space
L5 nerve compression (L4-5 disc)
Lumbar disc herniation: weak plantar flexion, weak Achilles reflex, decreased sensation in lateral foot
S1 nerve compression (L5-S1 disc)
dx: lumbar disc herniation
patients with neurologic findings need MRI
tx: lumbar disc herniation
NSAIDs, heat, and rest; surgery for substantial / progressive neurologic deficit, refractory cases, severe sciatica, or disc fragments that have herniated into the cord
motor: intrinsic musculature of hand (palmar interpose, palmar brevis, adductor pollicis, and hypothenar eminence); finger abduction (spread fingers); wrist flexion
sensory: all of 5th and 1/2 4th fingers, back of hand
ulnar nerve
injury results in claw hand
ulnar nerve
- motor: thumb apposition (anterior interosseous muscle, OK sign); finger flexors
- sensory: most of palm and 1st 3 and 1/2 4th fingers on palmar side
median nerve
nerve involved in carpal tunnel syndrome
median nerve
- motor: wrist extension, finger extension, thumb extension, and triceps; no hand muscles
- sensory: 1st 3 and 1/2 4th fingers on dorsal side
radial nerve
motor to deltoid (abduction)
axillary enrve
motor to biceps, brachialis, and coracobrachialis
musculocutaneous nerve
cervical radiculopathy: neck and scalp pain
C1, C2, C3 and C4 nerve compression (C1-2, C2-3, C3-4 discs)
cervical radiculopathy: weak deltoid and biceps
- weak biceps reflex
C5 nerve compression (C4-5 disc)
cervical radiculopathy: weak deltoid and biceps, weak wrist extensors
- weak biceps reflex and brachioradialis reflex
C6 nerve compression (C5-6 disc)
cervical radiculopathy: weak triceps
- weak triceps reflex
C7 nerve compression (most common, C6-7 disc)
cervical radiculopathy: weak triceps, weak intrinsic muscles of hand and wrist flexion
- weak triceps reflex
C8 nerve compression (C7-T1 disc)
radial nerve
C5-8
median nerve
C6-T1
ulnar nerve
C8-T1
musculocutaneous nerve
C5-7
axillary nerve
C5-6
on the superior portion of the brachial plexus
radial nerve roots
on the inferior portion of the brachial plexus
ulnar nerve roots
tx: clavicle fracture
usually just treated with sling (risk of vascular impingement)
shoulder dislocation: risk of axillary nerve injury
- tx?
anterior (90%) - tx: closed reduction
should dislocation: risk of axillary artery injury
- tx?
posterior (seizures, electrocution)
- tx: closed reduction
tx: acromioclavicular separation
sling (risk of brachial plexus and subclavian vessel injury)
tx: scapula fracture
sling unless gleaned fossa involved, then need internal fixation
tx: midshaft humeral fracture
sling for almost all
tx: adults - supracondylar humeral fracture
ORIF
tx: children - supracondylar humeral fracture
nondisplaced -> closed reduction; displaced -> ORIF
proximal ulnar fracture and radial head dislocation
- tx: ORIF
monteggia fracture
fall on outstretched hand, distal radius
- tx: closed reduction
colles fracture
subluxation of the radius at the elbow caused by pulling on an extended, pronated arm
- tx: closed reduction
nursemaid’s elbow
adults: combined radial and ulnar fracture
ORIF
children: combined radial and ulnar fracture
closed reduction
snuffbox tenderness; can have negative XR
scaphoid fracture
tx: scaphoid fracture
all patients require cast to elbow, may need fixation; risk of avascular necrosis