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Rheumatology > Common orthopaedic injuries > Flashcards

Common orthopaedic injuries Flashcards

1
Q

Anterior shoulder dislocation

A

Most common dislocation
a/w axillary nerve injury (problems w/ abduction; lateral shoulder sensory deficit)
Pt holds arm in abduction and external rotation

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2
Q

Shoulder abduction deficit

Sensory deficit of lateral shoulder

A

Axillary nerve injury

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3
Q

Posterior shoulder dislocation

A

a/w seizure and electrocution

pts hold arm in adduction and internal rotation

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4
Q

Anterior hip dislocation

A

rarer than posterior dislocation

can injure the obturator nerve

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5
Q

Posterior hip dislocation

A

More common
occurs via posteriorly directed blow to a flexed, adducted, internally rotated hip
a/w sciatic nerve injury
a/w AVN

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6
Q

Sciatic nerve injury is associated with?

A

Posterior hip dislocation

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7
Q

Colles’ fracture

A

Fx of the distal radius
2/2 fall onto outstretched hand leading to a dorsally displaced, dorsally angulated fx
common in elderly 2/2 osteoporosis and children
tx: closed reduction normally; open reduction if fx is intra-articular

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8
Q

Scaphoid fracture

A

Most common carpal bone fx
May take 2 weeks to show up on X-ray, so a negative X-ray doesn’t tell you anything
Assume a fx if there is TTP in the anatomic snuffbox
Tx: thumb spica cast

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9
Q

Proximal-third scaphoid fx associated with?

A

AVN

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10
Q

Boxer’s fracture

A

Fx of the fifth metacarpal 2/2 punching something with closed fist
Tx: closed reduction and ulnar gutter splint; percutaneous pinning if fx is excessively angulated
If the skin is broken, assume pt punched a person’s mouth; tx w/ antibiotics that will cover Eikenella (human oral pathogen)

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11
Q

Humerus fracture

A

2/2 direct trauma to humerus
May have radial nerve palsy (wrist drop, loss of thumb extension, and sensory deficit of the dorsum of the first three fingers)

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12
Q

Nightstick fracture

A

Fx of the midshaft ulna in defensive response

Tx: ORIF

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13
Q

Monteggia fx

A

Proximal ulna fx w/ subluxation of the radial head

Tx: ORIF

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14
Q

Galeazzi fx

A

Radial fx w/ dislocation of the distal radioulnar joint
2/2 direct blow to radius
Tx: ORIF

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15
Q

Hip fracture

A

a/w osteoporosis
p/w shortened and externally rotated leg
radiograhpically occult: positive hx w/ negative x-ray -> get CT
displaced femoral neck fx = increased risk of AVN
a/w DVTs
-anticoagulate to prevent DVT

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16
Q

Femoral fx

A

2/2 trauma
beware of fat emboli: fever, AMS, dyspnea, hypoxia, petechiae, and decreased platelets
tx: intramedullary nailing of femur

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17
Q

Tibial fx

A

2/2 direct trauma

watch for compartment syndrome

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18
Q

Open fx

A

ortho emergency: OR within 8-24 hours

tx w/ antibiotics and tetanus ppx

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19
Q

Achilles’ tendon rupture

A

Popping sound
Exam: limited plantar flexion
-positive Thompson’s sign: squeezing gastroc leading to absent foot plantar flexion (normally foot will plantarflex)

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20
Q

ACL injury

A

2/2 noncontract twisting mechanism, forced hyperextension, or impact to an extended knee
+anterior drawer and Lachman tests
r/o: MCL injury (which would have + valgus test) and meninscal injury

MRI, surgery w/ graft from patellar tendon or hamstring tendon

21
Q

MCL vs. LCL injury

A

+valgus vs. + varus

22
Q

Unhappy triad of knee injuries

A

ACL tear, medial meninscal tear, and MCL tear

23
Q

PCL tx

A

Surgery for highly competitive athletes; otherwise conservative treatment

24
Q

Radial nerve injury

-motor, sensory, cause, clinical findings

A

Motor: wrist extension
Sensory: distal forearm and first 3 fingers
Cause: humerus fracture
Clinical: wrist drop

25
Q

Median nerve injury

-motor, sensory, cause, clinical findings

A

Motor: Pronation, thumb opposition
Sensory: palmar surface of first three fingers
Common causes: carpal tunnel syndrome
Clinical findings: weak wrist flexion and flat thenar eminence

26
Q

Ulnar nerve injury

-motor, sensory, cause, clinical findings

A

Motor: Finger abduction
Sensory: Palmar and dorsal surface of 4-5 metacarpal
Common cause: elbow dislocation
Clinical findings: claw hand

27
Q

Axillary nerve injury

-motor, sensory, cause, clinical findings

A

Motor: Abduction
Sensory: lateral shoulder
Common cause: anterior shoulder dislocation

28
Q

Peroneal nerve injury

-motor, sensory, cause, clinical findings

A

Motor: dorsiflexion, eversion
Sensory: dorsal foot and lateral leg
Common causes: knee dislocation
Clinical findings: foot drop

29
Q

Common sites of bursitis

A 
Subacromial
Olecranon
Trochanteric
Prepatellar
Infrapatellar
30
Q

Common sites of tendinitis

A

Biceps, patellar, Achilles = most common

wrist extensor, supraspinatus, IT band, posterior tibial

31
Q

Tennis elbow

A

Wrist extensory tendinitis

aka lateral epicondylitis

32
Q

Clavicle fx

A

a/w brachial nerve palsy
usually involves middle third of clavicle, w/ proximal fx end displaced superiorly
Tx: figure of eight sling vs. arms ling

33
Q

Greenstick fx

A

Fx of a young, soft bone where the bone bends and only partially breaks

34
Q

Nursemaid’s elbow

A

Radial head subluxation
occurs as a result of being pulled or lifted by the hand
p/w pain and refusal to bend elbow

Tx: manual reduction by gentle supination of the elbow at 90 degrees of flexion

35
Q

Torus fx

A

Buckling of the compression side of the cortex of a long bone 2/2 trauma
Occurs in distal radius or ulna
Tx: cast immobilization for 3-5 weeks

36
Q

Supracondylar humerus fx

A

Most common pediatric elbow fracture
Usually at 5-8 years
Proximity to brachial artery increases risk of Volkmann’s contracture (results from compartment syndrome of forearm)
Beware of brachial artery entrapment

37
Q

Osgood-Schlatter disease

A

Overuse apophysitis of the tibial tubercle
Localized pain, especially w/ quadriceps contraction in active young boys

Tx: decrease activity for 2-3 months until asymptomatic

38
Q

Salter-Harris Fracture

A 
Fx of growth plate in children
Types:
I: Physis (growth plate)
II: Metaphysis and physis
III: Epiphysis and physis
IV: Epiphysis, metaphysis, and physis
V: Crush injury of the physis
39
Q

Duchenne’s muscular dystrophy

-pathophys, PE, Dx, labs

A

dystrophin deficiency, onset 3-5, life expectancy in teens
PE: axial and proximal muscles affected more than distal; Gower’s maneuver, waddling gait
-pseudohypertrophy of gastrocnemius 2/2 fibrosis
-mental retardation

Dx: negative dystrophin immunostain, increased CK, muscle necrosis
EMG: polyphasic potentials, increased recruitment

40
Q

Becker’s muscular dystrophy

A

Abnormal dystrophin gene
Onset in 5-15, life expectancy in 30s-40s
Mental retardation uncommon
Normal dystrophin levels

41
Q

Barlow’s maneuver

A

Posterior pressure placed on inner aspect of abducted thigh
Hip is adducted, leading to an audible clunk as femoral head dislocates
To check for developmental dysplasia of the hip

42
Q

Ortolani’s maneuver

A

Thighs are abducted from the midline w/ anterior pressure on the greater trochanter
Soft click signifies reduction of femoral head into acetabulum
To check for developmental dysplasia of the hip

43
Q

Allis’ sign

A

knees are at unequal heights when hips and knees are flexed

-sign in developmental dysplasia of the hip

44
Q

Developmental dysplasia of the hip

-dx, tx

A

U/S after 10 weeks is helpful
Radiographs are unreliable until >4 months

Tx:

  • 60 degrees to prevent AVN
  • 6-15 months: spica cast
  • 15-24 months: open reduction followed by spica cast
45
Q

Legg-Calve-Perthes dz

A

Idiopathic AVN of the femoral head in young boys
Pts develop a painless limp
Pain in groin or anterior thigh or referred to knee
Limited abduction and internal rotation; atrophy of affected leg
-usually unilateral

Tx: observation if normal ROM and limited femoral head involvement
-if more serious or decreased ROM, consider bracing, hip abduction w/ a Petrie cast, or an osteotomy

46
Q

Pediatric limp ddx

A 
STARTSS HOTT
Septic joint
Tumor
AVN (Legg-Calve-Perthes)
Rheumatoid arthritis/JRA
Tb
Sickle cell disease
SCFE
HSP
Osteomyelitis
Trauma
Toxic synovitis
47
Q

SCFI

A

The proximal femoral epiphysis (long bone) separates through the growth plate -> inferior and posterior displacement of the femoral head
Risks: age 11-13, obesity, male gender, African American
a/w hypothyroidism and other endocrinopathies

Hx: acute/insidious groin or knee pain + painful limp

  • restricted ROM and inability to bear weight
  • inability differentiates unstable from stable
  • bilatera in 40-50% cases

Dx: radiograph both hips in AP and frog-leg lateral views

48
Q

Scoliosis

-dx

A

Dx: radiographs of the spine

can cause restrictive lung disease

49
Q

JIA

A

Juvenile Idiopathic Arthritis

Nonmigratory, nonsuppurative mono- and polyarthritis w/ bony destruction
Pts 6 weeks

Hx/PE: fever, nodules, erythematous rash, pericarditis, fatigue
Subtypes:
-Pauciarticular: asymmetric arthritis. involves < 4 joints; increased risk of iridocyclitis -> blindness if untreated
-Polyarticular: resembles RA; >5 joints, symmetric distribution; decreased risk of iridocyclitis
-Acute febrile (Still’s dz): least common; arthritis + daily high, spiking fevers and a maculopapular, evanescent, salmon-colored rash; may have hsm and serositis; no iridocyclitis; remission in 1 year

Dx:
-no diagnostic test
-+RF in 15%, ANA may be +
-Increased ESR, leukocytosis, thrombocytosis
Imaging: soft tissue swelling

Tx: NSAIDs and corticosteroids
-MTX is second line

Rheumatology (5 decks)

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