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Block 3: MSK > Clin Med: Msk 2 - Lower Body > Flashcards

Clin Med: Msk 2 - Lower Body Flashcards

1
Q

Hip Fractures Dx

A

x-ray

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2
Q

What type of hip fractures are commonly seen?

A

subcapital & intertrochanteric fractures

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3
Q

Hip Fractures Tx

A

Surgery almost always indicated, exceptt:
–> Severely debilitated, at end of life, medical illness that cannot be corrected for surgery
–> Surg w/n 48 hrs assoc. w/ decr mortality

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4
Q

Hip Dislocations Tx

A
  • reduction under sedation
  • if unable - OR
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5
Q

Pelvis Fractures Dx

A

x- ray

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6
Q

Pelvis Fractures Tx

A

Surg

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7
Q

Legg Calve Perthe Disease Dx

A
  • x-ray,
  • MRI more sensitive for severity & staging
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8
Q

Legg Calve Perthe Disease Tx

A
  • Conservative tx (NSAIDS, PT)
  • Depending on degree of necrosis, may req surgery
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9
Q

Slipped Capital Femoral Epiphysis Dx

A

x-ray

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10
Q

Slipped Capital Femoral Epiphysis Tx

A

Surgery (screw fixation)

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11
Q

Femoral Shaft Fractures Dx

A

X-rays
- Femur: AP & lateral views
- Hip: AP, lateral, frog leg lateral views
- Knee: AP & lateral views

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12
Q

Femoral Shaft Fractures Tx

A
  • In line traction (EMS or ER)
  • Intramedullary nailing
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13
Q

Distal Femur Fracture Dx

A
  • x-ray
  • CT to further describe the fracture, used for pre-op planning
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14
Q

Distal Femur Fracture Tx

A
  • ORIF
  • Intramedullary nail
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15
Q

MCL and LCL Injuries Dx

A
  • x-ray
  • MRI provides ligament injury
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16
Q

Describe Ottawa Knee Rules/criteria for MCL/PCL films

A
  • pt >55yo
  • tenderness at head of fibula
  • isolated tenderness of patella
  • can’t flex knee to 90 degrees
  • can’t transfer weight for 4 steps immediately after & in the ED
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17
Q

MCL/LCL Injuries Conservative Tx

A
  • NSAIDS
  • Ice/elevation
  • Early ROM
  • Hinged knee brace (varus/valgus constrained) 3-4 weeks
  • WBAT, crutches if needed 3-4wks
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18
Q

MCL/LCL Injuries Surgical Tx

A
  • After 4 wks
  • Surgery indicated for complete tears, tears w/ meniscus or ACL injury, knee instability
  • Repair or reconstruction of MCL
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19
Q

ACL injury Dx

A

MRI

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20
Q

ACL injury acute stage Tx

A
  • reduce pain, edema & hemarthrosis w/ NSAIDS
  • aspiration of blood may be used to reduce symptoms
  • delay of 2-4 wks b/t acute phase of injury & surgical correction is common
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21
Q

Who can be considered for PT for an ACL injury?

A
  • older individuals
  • pts w/ sedentary lifestyle
  • pts who are willing to modify their sports activity & participate in swimming, running & cycling
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22
Q

ACL injury surgical Tx

A

Autograft or allograft replacement of the tendon

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23
Q

PCL Injury Dx

A

MRI

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24
Q

PCL Injury Tx

A
  • RICE, NSAIDS, hinged knee brace, PT
  • Surg rarely needed &often not very successful
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25
Q

Meniscus Tears Dx

A

MRI

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26
Q

Meniscus Tears Conservative Tx

A
  • RICE
  • knee sleeve or brace
  • crutches as needed
  • PT
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27
Q

Who can get conservative Tx for Meniscus Tears?

A
  • Degenerative tear
  • Poor surg candidate
  • Acute tear (conservative tx for 6 wks)
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28
Q

Meniscus Tears Surg Tx if

A
  • conservative tx fails - up to 6 wks
  • symp &/or displaced meniscal body tears, in knees free from severe degenerative knee OA
  • symp meniscal root tears w/ goal of preventing/slowing progression of OA
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29
Q

What is the surgery for Meniscal tears?

A

Knee arthroscopy w/ meniscal repair or meniscectomy

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30
Q

Patella Fracture Dx

A
  • x-ray
  • CT if x-ray (-) & high suspicion
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31
Q

Patella Fracture Tx

A
  • immobilization if non displaced
  • surgery if displaced
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32
Q

Patellar Tendon Rupture Dx

A
  • X-ray
  • MRI if suspicion of more injury
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33
Q

Patellar Tendon Rupture Tx

A
  • Place in knee immobilizer
  • Immediate operative repair (by 3 days)
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34
Q

Quadriceps Tendon Rupture Dx

A
  • X-ray
  • MRI if suspicion of more injury
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35
Q

Quadriceps Tendon Rupture Tx

A
  • Place in knee immobilizer
  • Immediate operative repair (by 3 days)
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36
Q

Patella Dislocation Dx

A

x-ray

37
Q

Patella Dislocation Tx

A
  • Closed reduction
  • Knee immobilizer
  • Crutches
  • PT
  • Some pts may develop chronic/recurrent patella subluxation & require surg
38
Q

Knee Dislocation Dx

A
  • X-ray
  • ABI
  • arteriography - if concern for vascular injury
39
Q

Knee Dislocation Tx

A
  • Closed reduction
  • Emergent vascular surg consult if
    –> Diminished pulses
    –> ABI <0.9
    –> Abnormality on angiography
40
Q

Osgood Schlatter Disease Dx

A
  • clinical
  • X-ray can confirm
41
Q

Osgood Schlatter Dz conservative Tx

A
  • Activity modification
  • NSAIDS
  • PT
42
Q

Osgood Schlatter Dz surgical Tx

A

if conservative tx fails (must wait for the growth plate to close)

43
Q

Bakers Cyst Dx

A

clinical

44
Q

Bakers Cyst Tx

A
  • Conservative tx (RICE, NSAID)
  • correction (poss. surgery) of underlying knee pathology
45
Q

Knee Bursitis Dx

A
  • clinical
  • if sepsis concern: CBC, ESR/CRP
46
Q

Non-septic prepatellar bursitis Tx

A
  • supportive care & avoidance of recurrent injury
  • Occasionally, steroid injection
47
Q

Septic prepatellar bursitis Tx

A
  • Abx
  • May req repeat aspiration, if bursal effusion persists
  • In severe or refractory cases, pts can be referred for surgical I&D or bursectomy
48
Q

Pes Anserine Bursitis Tx

A
  • RICE, PT
  • Steroid Injection
  • Rarely, surgery is req
49
Q

Chondromalacia Dx

A
  • clinical
  • x-ray can help (lat view)
50
Q

Chondromalacia Tx

A
  • Acute care: RICE, refrain from high impact activities, NSAIDS
  • PT
  • Knee taping/foot orthotics (pronated feet)
  • Surg rarely performed, but may be done if 6-12 mos of conservative tx fails (arthroscopy & removal of damaged cartilage)
51
Q

Iliotibial Band Syndrome Dx

A

clinical

52
Q

Iliotibial Band Syndrome Tx

A
  • ice, NSAIDS, stretching, activity mod (bicycle modification, foot orthotics)
  • Surgical release of ITB rarely needed
53
Q

Tibial Plateau Fractures Dx

A
  • X-ray
  • CT: further info/surg planning
  • MRI look for ligamentous injury
54
Q

Tibial Plateau Fractures Tx that is stable & minimally displaced

A
  • splint
  • long leg cast
  • cast brace for 8-12 wks
55
Q

Tibial Plateau Fractures surg indicated for intra-articular fractures with…

A
  • > 2 mm joint depression/separation
  • open injuries
  • fractures w/ vascular injury
  • fractures w/ assoc. ligamentous injuries req stabilization
56
Q

Tibial Plateau Fracture Surg Tx

A

Depending on fracture:
- external fixation
- ORIF
- screw fixation

57
Q

Maisonneuve Fracture Dx

A
  • x-ray
58
Q

Maisonneuve Fracture Tx

A
  • Immediate reduction of ankle w/ long leg splint, NWB & referral to ortho
  • Definitive tx: surgery
    –> Fixation of ankle w/ screws
    –> Fibula fracture doesn’t req surgical fixation
59
Q

Ankle Sprain Dx

A
  • x-rays indicated if bony tenderness or if the pt is unable to bear weight
  • MRI may also be used in pts w/ persistent symp or if suspected
    –> high-grade ligament injuries
    –> osteochondral defects
    –> occult fracture
60
Q

Ankle Sprain Grade 1 (minimal impairment) Tx

A
  • weight bear as tolerated
  • PT
61
Q

Ankle Sprain Grade 1 (moderate impairment) Tx

A
  • Immobilize w/ air splint
  • PT
62
Q

Ankle Sprain Grade 3 (severe impairment) Tx

A
  • Immobilization
  • PT
  • Poss. surg reconstruction
63
Q

Achilles Tendonitis Dx

A
  • testing usually unnecessary, but consider imaging studies when hx & PE are not sufficient for dx
  • imaging in pts w/ insertional tendinopathy
    –> x-ray findings may include calcaneal spurs or calcific tendinosis at tendon insertion
  • magnetic resonance imaging
64
Q

Achilles Tendonitis Tx

A
  • Conservative tx: RICE, NSAIDS, activity mod
  • PT
  • Surg as a last resort (removal if inflamed tendon)
65
Q

Achilles Tendon Rupture Dx

A
  • x-raysmay be used to rule out concomitant fractures, calcific tendon changes, or other abnormalities
66
Q

Achilles Tendon Rupture Tx

A
  • Splint in slight plantar flexion, NWB
  • Surg repair
67
Q

Ankle Dislocation Dx

A

x-ray

68
Q

Ankle Dislocation Tx

A
  • reduced quickly to avoid neurovascular compromise w/ post reduction films
  • Splint
  • Likely req surg due to instability & concomitant injuries
69
Q

Ankle Fracture Dx

A
  • X-ray
  • CT if complex fracture or suspicion of talus fracture
70
Q

Ankle Fracture Tx

A
  • Isolated lateral malleolus fracture: –> Boot or cast, NWB
  • All others likely req surg
71
Q

Stress Fractures Dx

A
  • x-rayas the initial test; however, this test is often normal for ≥ 3 months from symptom onset
  • MRI if not visible on x-ray
72
Q

Stress Fractures Tx

A
  • 6-8 wks of NWB w/ immobilization for incomplete fractures or complete fractures that are nondisplaced
  • Displaced fractures or fractures at high risk of malunion (metatarsals) may req surg
73
Q

Plantar Fasciitis Dx

A
  • clinical
  • x-ray may show calcaneal bone spur
74
Q

Plantar Fasciitis Tx

A
  • NSAIDS
  • Ice
  • Stretching
  • Steroid injection
  • If no relief after 6-12 mos, may consider plantar fascia release
75
Q

Bunions Dx

A
  • based on PE
  • x-ray can help determine severity
76
Q

Bunions Tx

A

accommodative shoes, orthoses, surgery if needed

77
Q

Hammer Toes Tx

A

Initial tx goal:relieve pressureon deformity
–> shoe mod, padding, splinting, or orthotics

  • Surgery as a last resort
78
Q

Charcot Foot Dx

A
  • Foot x-ray w/ weight bearing views
  • MRI if x-ray inconclusive or if there is concern for osteomyelitis
  • Bone biopsy if dx is unclear after imaging (can differentiate b/t neuropathic arthropathy & osteomyelitis)
79
Q

Charcot Foot Tx

A
  • Offloading (w/ total contact cast)- designed for NWB foot 6-8 wks, then…
  • Orthosis or Charcot specific shoes
  • Surgery indicated if:
    –> Non healing ulcers
    –> Un-braceable deformity
    –> Osteomyelitis
    –> Amputation sometimes unavoidable
80
Q

Morton Neuroma

A
  • clinical
  • X-rays not helpful
  • MRI can show inflammation, but usually not needed
81
Q

Morton Neuroma Tx

A
  • Avoid compressive shoes
  • Steroid injection
  • Last resort is surg removal
82
Q

Jones Fracture

A

x-ray

83
Q

Jones Fracture Tx

A

Operatively or non operatively
Non operative
- Short leg cast (NWB) for 6-8 wks

Operative tx (in active individuals)
- Screw fixation

84
Q

Lisfranc Injury Dx

A
  • X-ray
    Widening of the space b/t the 1st & 2nd metatarsal base > 2mm
  • If dx unclear w/ x-ray–> CT
85
Q

Lisfranc Injury Tx

A

Acute tx:
- Immobilization (short leg splint)
- NWB

  • URGENT orthopedics consult
    Req surgery (ORIF)
86
Q

Phalanx Fracture Dx

A

x-ray

87
Q

Phalanx Fracture Tx

A
  • If stable & non-displaced, can be splinted (“buddy taped) & placed in a hard sole shoe
  • If displaced, closed reduction & splinting- if unable to reduce will req operative fixation
88
Q

Calcaneus Fracture Dx

A
  • X-ray
  • CT - characterize fracture & operative planning
89
Q

Calcaneus Fracture Tx

A
  • Most req operative tx, as they are intraarticular &/or displaced
  • Non displaced, non intraarticular fractures–> immobilized for 6-8 wks
  • Initial splinting should be very bulky to allow for swelling

Block 3: MSK (10 decks)

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