Final: Orthopedic Procedures Flashcards
Sprain or strain: ligamentous stretching that causes tearing; may feel or hear a pop
Sprain
Sprain or strain: occurs when muscle is stretching and contracting at same time; “grabbing sensation”
Strain
What’s an important physical exam habit when looking at an extremity issue?
Compare BILATERALLY
What are the Ottawa Ankle Rules for x-ray?
Bone tenderness of distal 6 cm of tib/fib or medial/lateral malleolus
Inability to bear weight for four steps BOTH immediately after and in ER/office
What are the Ottawa Foot Rules for x-ray?
Bone tenderness at base of 5th metatarsal or navicular bone
Inability to bear weight for four steps BOTH immediately after and in ER/office
What is the best treatment option for sprains?
RICE Rest Ice Compress Elevate
Can add splint if necessary
How do you treat a third degree sprain?
Surgery
-complete tear that requires reattachment
Is an ACE bandage good for short or long term?
Short term only
Good for limited movement to remind pt to slow down
How do you apply an ACE bandage?
Start distally and move proximally w minimal stretching of bandage
When would you use the buddy taping method?
To stabilize non-displaced fractures of fingers and toes
What type of motion does an ankle stirrup still allow?
What type of injury is it good for?
Allows for flexion and extension; limits IR/ER
Good for mild to moderate ankle sprains
What type of injury is a posterior leg splint good for?
Foot and ankle fractures, or high grade sprains
What type of cast: fracture of carpal/metacarpal base
Short arm cast
What type of cast: fx of scaphoid, trapezium, 1st metacarpal
Short arm cast with thumb spica
What type of cast: fx of scaphoid, radius, or ulna; colles fracture
Long arm cast
What type of cast: fx of neck, shaft, or base of 4th/5th metacarpals
Ulnar gutter
If a patient has large joint septic arthritis, with a warm distended joint capsule and systemic symptoms then what is the likely diagnosis?
Septic arthritis
-most likely gonococcal
What are the therapeutic indications for joint arthrocentesis? (3)
Relieve pain
Improve diagnostic accuracy
Instill meds
Are intraarticular antibiotics recommended for septic arthritis?
nah fam
What are the diagnostic indications for joint arthrocentesis? (2)
Establish etiology of unknown joint effusion
Distinguish between infectious and non-infectious
What are the two contraindications for joint arthrocentesis?
Overlying skin lesions/infections
Bacteremia
-can seed the joint
Middle aged obese male; diet consists of meat and potatoes and drinks a six pack nightly comes in with intense pain in the big toe. Crystals are needly shaped negatively birefringent. Dx?
Gout
Elderly male with intense pain in the knee region; crystals are rhomboid shaped and positively biferengent
Pseudogout
Gout or pseudogout: has well-defined erosions with sclerotic margins
Gout
Gout or pseudogout: Radiodense deposits within meniscus or hyaline cartilage (chondrocalcinosis)
Pseudogout
OA or RA: asymmetric arthritis in weight bearing joints that is worse with use; DIP and PIP joints; eburnation
OA
OA or RA: symmetric arthritis in small joints of hands and toes; better with use; PIP and MCP; boutonniere and swan neck
RA
What landmarks do you use for shoulder arthrocentesis/injections?
Inferior and lateral to coracoid process, directed posterior towards joint space
What landmarks do you use for knee arthrocentesis/injections?
1 cm medial or lateral to superior 1/3 of patella
What is the appearance of normal synovial fluid?
Amber and transparent
Regardless of the appearance of synovial fluid, what three tests should be ordered?
CBC w diff
Crystal analysis
Gram stain w culture and sensitivity
Does a CBC w diff have any diagnostic value on its own?
NO
-simply tells you there is inflammatory process or not
Should a chemical analysis of synovial fluid (glucose, LDH, protein) be routinely ordered?
Nope, little discriminitory value
Does evaluation of serum uric acid level have any value for diagnosis of acute arthritis?
Nope
-can be normal or decreased in pt w gout
