Clin Med 3 Flashcards
complications of calcaneal fx
wound dehiscence, lost talar motion, dystrophy/CRPS, inc heel width, sural n. injury
Maison fx
prox 1/3 of fib, tear in syndesmosis/inteross mem –> widening tibfib overlap, GET KNEE XR
pilon fx. tx? how do you get it?
intraarticular distal tibial fx, assoc w/ fib fx. IN/EXTERNAL FIXATION/ligamentotaxis if swollen –> then ORIF. high energy trauma
calcaneal fx
high energy collisions; intraarticular –> CT –> surgery; extraarticular –> nonop –> PT, non wtbearing; tongue type –> threat to skin –> emergency –> immediate surgical reduction
dx of talar fx/aviator fx: XR vs CT vs MRI. tx? complications?
AP, lateral, mortise of ankle; AP, lateral, oblique of foot vs characterize fx pattern and displacement vs AVN (b/c fx gives high risk). nondisplaced –> cast/boot; displaced –> immediate closed reduction d/t AVN, ORIF for open fx. AVN, infxn, osteonec, delayed union/non/malunion, foot cmpt syndrome
Hawkins classification of talar fx: type I vs II vs III vs IV
nondisplaced vs subtalar sublux; displaced talar neck fx vs subtalar + ankle sublux vs type III + talonavic sublux; AVN
Lisfranc injury
disruption b/w base of 2nd metatarsal and middle cuneiform d/t axial/rotational load on plantarflexed –> splaying MT, plantar ecchymosis
diag XR for lisfranc: AP vs lat standing vs medial 30 degree oblique
greater than 2 mm b/W base of 1st and 2nd MT (nml = medial border of second MT base and intermediate cuneiform line up) vs superior border 1st MT should align w/ superior border of medial cuneiform vs medial border 4th MT should align w/ cuboid; if suspected injury –> weight-bearing, AP view of both feet
tx of lisfranc: nonop vs op. complications?
Sprains → short leg cast (SLC) or boot for 8-12wks vs Displacement > 2 mm of the tarsometatarsal joint → anatomic reduction, stable fixation; ORIF, screws/pins. post-traumatic arthritis, compartment syndrome, infection, CRPS, neurovascular injury, hardware failure
Forefoot fx (5th MT fx): zone 1 vs 2 vs 3
dancer fx, avulsion of peroneus brevis –> cast/boot, hard soles vs Jones fx, metaphyseal-diaphyseal jxn; watershed line fx –> poor blood supply –> longer to heal; nonop –> boot/cast w/ non wtbearing, displaced –> surgery, sports related vs diaphyseal stress fx, longer healing time –> inc risk of malunion; cavovarus deformities and sensory neuropathies; usually nonop except displaced or mult MT fx
charcot joint arthropathy. risk factors vs tx?
Chronic and progressive joint disease following loss of protective sensation, asx. DM, alc, syphilis/syringomyelia vs Non-op: splinting/casting/edema control; Op: fusions/osteotomies/amputations; Often mistaken for infection and treated with antibiotics
turf toe. classifications? indic of surg tx? outcomes?
hyperex of plantar plate and sesamoid complex of 1st MTP –> tear of capsular-ligamentous-sesamoid complex off of prox phalanx (NOT 1ST MTP). 1/2/3: sprain/partial tear/complete tear of plantar plate. GRADE 3, sesamoid retraction, sesamoid fx, loose frag. post op non wtbearing, progressive ROM & physiotherapy, can return to sports in 3-4mo
tarsal coalition/peroneal spastic flat foot. types? dx? tx?
embro failure of mesen segmentation –> structural “fusion” of 2-3 tarsals –> rigid flatfoot, flat longitudinal arch, abducted forefoot, valgus hindfoot, anteater sign, talar breaking, recurrent ankle sprain. 2 types: congenital, acquired (degen, trauma, infxn). XR, CT (best). medial arch support, hindfoot alignment, NSAIDS, cast; surgery –> coalition resection with interposition graft, +/- correction of associated foot deformity –> Calcaneal osteotomy; Arthrodesis (fusion) –> Subtalar vs triple (subtalar, talonavic, calcaneocuboid)
achilles tendon rupture on exam
deficit in distal calf, palpable sulcus proximal to calcaneus, Thompson+
tibial shaft stress fx. dx? tx? at risk ppl?
overuse –> microfx. XR, MRI. restrict activity, protected wtbearing, avoid NSAIDs b/c slows bone healing; surgical intramedullary nail if ant tib tension-sided stress fx (dreaded black line). military recruits, athletes, runners
tibial stress syndrome: shin splints. dx? tx? risk factors?
overuse in shin area –> dull anterior leg pain. tender at posteromedial distal tibia, worse w/ plantarflex; XR or bone scan to r/o stress fx. nonop –> NSAIDs, rest, activity mods; op –> prophylactic fasciotomy and periosteal release. runners without enough shock absorption, training errors, previous LE injuries, overpronation or inc tibial IR
ages for tarsal fusion
3-5yo –> talonavicular
8-12yo –> calcaneonavicular
12-16yo –> talocalcaneal
causes of in-toeing vs out-toeing
o Internal femoral torsion (anteversion)
o Internal tibial torsion
o Metatarsus adductus
o Talipes equinovarus (clubfoot)
o Developmental dysplasia of the hip (DDH)
vs
o External femoral torsion
o External tibial torsion
o Calcaneovalgus foot
o Hypermobile pes planus (flatfoot)
o Slipped capital femoral epiphysis (SCFE)
indic of total hip replacement. how is it done? absolute vs relative contraindic?
OA/DJD, posttraumatic arthritis, AVN, osteonec in sickle cell, ankylosing spondylitis. replace femoral head and acetabulum. active infxn vs BMI >40, hgbA1c >8, neuro dz
complications of total hip replacement
heterotropic oss (bone outgrowth into tissue like glut min/med –> stiff, pain), blood transfusion/vasc injury/hematoma, fx/dislocation/infxn, limb length discrepancy, sciatic palsy, aseptic loosening w/o infxn, pseudo tumor –> metal on metal (not used anymore)
causes of hip AVN
corticoids, alc, poor bloodflow to femoral head, fx/dislocation/infxn, posttraumatic
how to dx vs tx AVN hip?
XR vs NSAIDs, rest, activity modification; Surgery: core depression of the femoral neck, hip arthroplasty
ddx of exertional leg pain
o Ant/med tib stress syndrome
o Tibfib stress fx
o Exertional cmpt syndrome
o Leg tendinopathy
o Sural n entrapment
o Lumbar radiculopathy
3 principles of homeopathy: law of similar vs minimum dose vs individualize tx
something that caused dz can cure person w/ similar sxs vs dilute substance –> enhance curative properties & minimize side effects vs blank
glucosamine
in healthy cartilage, prevents loss of cartilage –> dec OA sxs; don’t use w/ chondroitin
omega 3 FA
for bodily functions including muscle activity, blood clotting, digestion, fertility, and cell division and growth; helps OA, RA, macular degen, brain dz, psych conditions
aloe vera
for burns, IBS, ulcerative colitis; may inhibit surgical wound healing
SAMe
reduce OA pain and improve joint function; can interact w/ antidepressants and pain meds
electromagnets
for OA; interferes w/ pacemakers, insulin pumps, medical devices
anti inflamm diet contains?
variety, fresh/limit process, fruits & veggies, omega 3 PUFA, whole grains
flexible vs correct to neu vs no improvement txs. what does it tx?
observe vs stretch, special shoes vs (rare) surgery –> soft tissue release or osteotomy at 4-6yo. MT adductus
full vs mild vs severe ROM restrict txs. what does it tx? what else do you need to chk for? do you need XR?
none vs stretch vs serial cast. calcneoval. chk hips for DDH. no
acupuncture is thought to do what? (3)
o Relieve muscle tension
o Improve circulation
o Regulate inflammation
how to tx mild vs mod/severe SLE?
NSAIDs, hydrochloroquine vs corticosteroids
HSP/igA vasculitis
from URTI or strep. palpable purpura, arthritis/ralgia (no warm red effused joints). leuko/thrombocytosis, high ESR/WBC/RBC. corticosteroids, pain ctrl, hydrate, bland diet. GI introsusception, bowel obstruction; nephrotic syndrome
