Fx's / Conditions Flashcards
3 R’s of Fracture Management
Reduce, Retain, Rehab
Different types of Fracture
Compression/Avulsion/Greenstick/Transverse/Spiral/Comminuted/Segmental/Oblique/Torus or Buckle
Upper Limb/ Clavicle Fx WHO/HOW/WHAT/Comps
Young pt/ FOOSH/ Conservative management unless a plexus inj or an open fx/ COMPS- Palpable lump, long recovery, stiffness, neurovasc inj (if medial indicates large trauma so take care brachial plexus involved)
Shoulder Dislocation WHO/HOW/WHAT/COMPS
Ant>Post>Inf //
Young pt = High energy / old pt = low energy // often trauma or a fall //
First check nerves and pulses then xray and urgent reduction with analgesia //
COMPS- plexus injury (axillary nerve), Hillsachs (chunk of humeral head), Bankhart (labrum inj at bottom), SLAP tear labrum
Humerus Fx WHO/HOW/WHAT/COMPS
elderly // foosh // either neck or shaft of humerus. NECK is often stable but can involve hum head(NEER Class) SHAFT shows displacement and can result in radial nerve inj –> wrist drop // If hum head >3 pieces= int fixation or If simple = sling 8-12 weeks + splint // COMP- AVN
Distal Radius Fx WHO/HOW/WHAT/COMPS
young pt high energy or old with osteoporosis // FOOSH // either intra or extra - articular +/- comminution // WHAT affected by 3 factors (Radial height, inclination,tilt)COMPS - median nerve symps/ ruptured tendons
Colles Fx description
Dorsal angulation and displacement +/- avulsion or ulnar styloid
Scaphoid WHO/HOW/WHAT/COMPS
65% middle third / 25% Prox / 15% distalFOOSHPC - tender snuff box but often nothing seen on xrayWHAT - splint and re-xray in 14 daysCOMPS - AVN/ SNAC or SLAC??
Hip Fx
elderly (F>M) with 50% mortality in elderlyFalling or RTAAlways monitor vital signs for blood loss/shock, give analgesia, xray or CT, theatre for either hemi/total or DHS depending on where fx is located (INTRA - replace / extra = DHS)COMP - blood supply diminshed = AVN and blood loss
Hip Fx Classification
GARDEN - 1,2,3,41. Incomplete and undisplaced2. Complete and undisplaced3. Complete neck fx and displaced4. Fully displaced with prox fragment in neutral position
What is shentons line
trace through pubic ramus
Femoral Fx main concerns (artery and nerve) and how to confirm OK
Femoral artery (check distal pulses) and sciatic nerve
Femoral Fx WHAT
Intra med nail or MUA + thomas splint
Ankle Fx Classification
WEBBER A,B,CA. Below syndes, cons management, generally no medial involvedB. through syndes, SURG or CONS (assess for talor shift), maybe medial invlvedC. Above syndes, always SURG (wires/screws), often medial involved
Ankle Fx initial managment and WHAT options
Assess - reduce - retain - xray then reassessMUA + POP/ ORIF/ Ex Fix
Complications from Fx’s (Immediate/ Late Local and Late General)
Immediate: - Bleeding (Int and Ext) - Nerve Injury - Organ Injury - Vessel Injury (ischaemia of limb)
Later Local: - Skin necrosis - Pressure Sores - Infection of Wound - Non-union
Later General: - Infection/Shock - P.E - Pneumonia - Renal Stones
Compartment Synd - PC/I/T
Increased pressure in osteofascial compartment, most commonly volar forearm, deep posterior lower limb or anterior lower limb.Extreme pain, stiffness of skin, redness and heat - Necrosis of skin5 P’s!!!Serum CK and pressure of compartmentRelease dressings, analgesia, mannitol, fluid, fasiotomy or amputation
Crush Synd
Breakdown of muscle cells releasing toxins as result of severe crushing injury and then release of pressure.CF - Hypovolaemic shock and Hyperkalaemia
Rotator Cuff Injury - 2 main presentations, investigation
Partial - painful arc / complete - limited abduction // US and MRI
Frozen Shoulder - PC and T
Pain (worst at night) and decreased ROM both actively and passively.Treat with NSAIDS, Intra art inj, Physio, MUA, local nerve block
Nerve Impingement at Shoulder - PC / C / T
Pain on resisted abduction / Tendinopathy / Physio and analgesia
Tennis Elbow - PC / T
Pain at lateral elbow on WRIST and FINGER FLEXION + PRONATION / Injection at tendon origin + physio + brace
Golfer Elbow - PC / T (possible risk of T?)
Pain on medial elbow / Steroid Inj (can damage ulnar nerve and brachial art)
2 Main Spinal Deformities and Long term sequelae
Scoliosis - Decreased Lung Func/ Cosmetic / PainKyphosis - Cord Compression
Dupuytrens ?/C
painless fibrotic thickening of palmer fascia (ring and little finger) + fixed flexion at MCPGenetic/Alcohol/DM/ Smoking
De Quervains PC
Pain over radial styloid process and thickened tendons
Trigger Finger ?
Fixed flexion deformity (no active movement, only passive)
What is AVN, Cause, I, T
Hip knee or shoulder joint is most common. It is necrosis for bone as result of diminished blood supply.Caused by Intra artic fractures (20% of hip fx and 20% of long term NSAID use)Mr I is test of choiceTreat with immobilise, analgesia, and arthroplasty/bone graft.
Trochanteric Bursitis
pain just above greater trochanter, worst when lying on affected side.Rice treatement
Gait Abnormalities and Cause
Anatagical - painful limp
High Stepping - nerve palsy (peroneal/sciatic)
Trendelenburg - waddling, trunk tilts over affected side when walking (hip abductor strength derease)
Short Leg Gait
Meniscus Inj - 2 main causes/ CF/ T
Found between joint of knee, medial more commonly affected.Either traumatic(fall on flexed knee) or degenerative (older pts)Pain immediately after trauma or gradual pain. locked knee on examination as well as mechanical symptoms (locking, catching) Swelling/effusion may take days to become evident as intra-articular. Also joint line tenderness/mcmurraysRice and physio or arthroscopic repair/partial resection**often occurs With other ligament damage!
ACLAll - cause/CF/I/T
non-cntact twist or valgus strain. often with MCL and meniscus. Pt describes a ‘pop’ or ‘it just went’Instability, swelling, PAINLESS, effusion Lachlan and anterior drawer test positiveMRIEither Rice and physio or ACL reconstruction surgically (using hamstring or patellar tendon graft)
MCL - Cause/CF/T
Valgus strainVery quick swelling,but not normally effusion, pain and instabilityTenderness on valgus stressBrace 6 weeks and physio
The Acute Knne - what are most important Not To MISS?
- Dislocation2. Fx’s3. Extensor Mech Inj(quads tendon/patellar etndon)4. Mulit-ligament inj5. Epipyseal Inn (kids so will heal quicker than normal)
If patient complains of knee pain but examination is NORMAL, what would you suspect?
Hip referred pain
Osteomyelitis - ?/PC/C/I/ T/ complication
? - infection of bone (adults = cncellous/kids = vasclar)PC - Pain, decreased ROM, SIRS / warm, red, effusion around jointsC -Penetrative Inj/Surgical contamination/HIV/IVDUI - WCC/ESR/Culture / MRI can take >14 days to show changes (haziness/loss density/sub-periosteal chagne)T -Culture and treat empirically (vans and cefotaxime)then switch depending on results. most common organisms(staph/strep/pseudomonas) 6 Weeks treatment Complication - Septic Arthritis /Paths fx’s/ deformity/ chronic osteomyelitis
secondary bone tumors - common mets/ I/ T
Breast, Lung, Prostate, KidneyII - xray, bone scan, MRI,PET-CTTreat with combo of - chemo/radio/bisphos/surg/other targeted therapies
Muscular Dystrophies - inheritance / commonest/ CF and special test/ I
x linked recessive
Duchennes MD
Flexor muscles stronger than extensor + contracture + decreased motor development + decreased tone and reflexs
Genetic testing and muscle biopsy
Treatment is supportive - Physio, psycholgical, corticosteroids (delays symptoms) Surgery (contractractures)
Other form is Beckers
Carpal Tunnel - PC/C/ T/
Tingling of thumb and first 2 fingers especially at night as well as pain. Muscle wasting and decreased sensation.Phalanx and tinnelsRA, Acromegaly, DM, Prego, Tumor, Hypothyroid, amyloidosisWrist splint, steroid inj, NSAIDS, African release when permanent nerve damage is a concern.
What’s in carpal tunnel
Median nerve, 9 tendons (Flexor policies longus, Flexor digititorum profundus, Flexor digits rum superficialis)
what are Loaf muslces
Lubricans
Opponens pollicis
Abductor policies brevis
Flexor policies brevis
What is a radiiculopathy and some causes
compression or damage to a nerve at the nerve root, resulting in weakness, pain, tingling, decreased motor at a distal site.Causes - disc prolapse, OA, degeneration (commonly C6-8)
What is Entonox and list to CI’s
Gas and Air (NO and O2) and it shouldn’t be given to:
- Bowel Obstruction
- Pneumothorax
- Sinus or Middle ear disease
Elbow Fx Xray Assessment
Radio-capetellar line and anterior humeral line + fat pads (post)
- If no # seen on xray but post fat pad present treat in sling and re-xray in 10days
NeuroVascular Inj - MOTOR defecits (ulnar = …)
Ulnar - claw hand - distal ulna Fx
Radial - wrist drop - spiral humerus Fx
Median - no pincer grip - distal radius fx
Peroneal - foot drop - upper fibula fx
C2 - breathing
C3-4 - spontaneous breathing
C4-6 - shoulder flexion
NeuroVascular Inj - SENS defecits
C5 - deltoid,forearm, lateral upper arm C6 = RADIAL C7 - MEDIAN C8 - ULNA T4 - nips T8 - xiphoid T10 - naval L3 - ant/medial thigh L4 - ant low leg L5 - dorsal foot and lateral leg S1 - posterior leg S4-5 - perianal
ganglions commonly found where?
Volar wrist, dorsal hand
Acute Knee - what needs excluded immediately?
Dislocation, Multi-lig injury, Fx, extensor mech inj (tendons), epiphyseal inj (kids will heal quickly so needs sorted soon)
