Common orthopaedic injuries Flashcards
Anterior shoulder dislocation
Most common dislocation
a/w axillary nerve injury (problems w/ abduction; lateral shoulder sensory deficit)
Pt holds arm in abduction and external rotation
Shoulder abduction deficit
Sensory deficit of lateral shoulder
Axillary nerve injury
Posterior shoulder dislocation
a/w seizure and electrocution
pts hold arm in adduction and internal rotation
Anterior hip dislocation
rarer than posterior dislocation
can injure the obturator nerve
Posterior hip dislocation
More common
occurs via posteriorly directed blow to a flexed, adducted, internally rotated hip
a/w sciatic nerve injury
a/w AVN
Sciatic nerve injury is associated with?
Posterior hip dislocation
Colles’ fracture
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
Scaphoid fracture
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
Proximal-third scaphoid fx associated with?
AVN
Boxer’s fracture
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)
Humerus fracture
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)
Nightstick fracture
Fx of the midshaft ulna in defensive response
Tx: ORIF
Monteggia fx
Proximal ulna fx w/ subluxation of the radial head
Tx: ORIF
Galeazzi fx
Radial fx w/ dislocation of the distal radioulnar joint
2/2 direct blow to radius
Tx: ORIF
Hip fracture
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
Femoral fx
2/2 trauma
beware of fat emboli: fever, AMS, dyspnea, hypoxia, petechiae, and decreased platelets
tx: intramedullary nailing of femur
Tibial fx
2/2 direct trauma
watch for compartment syndrome
Open fx
ortho emergency: OR within 8-24 hours
tx w/ antibiotics and tetanus ppx
Achilles’ tendon rupture
Popping sound
Exam: limited plantar flexion
-positive Thompson’s sign: squeezing gastroc leading to absent foot plantar flexion (normally foot will plantarflex)
ACL injury
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
MCL vs. LCL injury
+valgus vs. + varus
Unhappy triad of knee injuries
ACL tear, medial meninscal tear, and MCL tear
PCL tx
Surgery for highly competitive athletes; otherwise conservative treatment
Radial nerve injury
-motor, sensory, cause, clinical findings
Motor: wrist extension
Sensory: distal forearm and first 3 fingers
Cause: humerus fracture
Clinical: wrist drop
Median nerve injury
-motor, sensory, cause, clinical findings
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
Ulnar nerve injury
-motor, sensory, cause, clinical findings
Motor: Finger abduction
Sensory: Palmar and dorsal surface of 4-5 metacarpal
Common cause: elbow dislocation
Clinical findings: claw hand
Axillary nerve injury
-motor, sensory, cause, clinical findings
Motor: Abduction
Sensory: lateral shoulder
Common cause: anterior shoulder dislocation
Peroneal nerve injury
-motor, sensory, cause, clinical findings
Motor: dorsiflexion, eversion
Sensory: dorsal foot and lateral leg
Common causes: knee dislocation
Clinical findings: foot drop
Common sites of bursitis
Subacromial Olecranon Trochanteric Prepatellar Infrapatellar
Common sites of tendinitis
Biceps, patellar, Achilles = most common
wrist extensor, supraspinatus, IT band, posterior tibial
Tennis elbow
Wrist extensory tendinitis
aka lateral epicondylitis
Clavicle fx
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
Greenstick fx
Fx of a young, soft bone where the bone bends and only partially breaks
Nursemaid’s elbow
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
Torus fx
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
Supracondylar humerus fx
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
Osgood-Schlatter disease
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
Salter-Harris Fracture
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
Duchenne’s muscular dystrophy
-pathophys, PE, Dx, labs
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
Becker’s muscular dystrophy
Abnormal dystrophin gene
Onset in 5-15, life expectancy in 30s-40s
Mental retardation uncommon
Normal dystrophin levels
Barlow’s maneuver
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
Ortolani’s maneuver
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
Allis’ sign
knees are at unequal heights when hips and knees are flexed
-sign in developmental dysplasia of the hip
Developmental dysplasia of the hip
-dx, tx
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
Legg-Calve-Perthes dz
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
Pediatric limp ddx
STARTSS HOTT Septic joint Tumor AVN (Legg-Calve-Perthes) Rheumatoid arthritis/JRA Tb Sickle cell disease SCFE HSP Osteomyelitis Trauma Toxic synovitis
SCFI
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
Scoliosis
-dx
Dx: radiographs of the spine
can cause restrictive lung disease
JIA
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
