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Ortho/ Paeds Rheum > Fx's / Conditions > Flashcards

Fx's / Conditions Flashcards

1
Q

3 R’s of Fracture Management

A

Reduce, Retain, Rehab

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2
Q

Different types of Fracture

A

Compression/Avulsion/Greenstick/Transverse/Spiral/Comminuted/Segmental/Oblique/Torus or Buckle

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3
Q

Upper Limb/ Clavicle Fx WHO/HOW/WHAT/Comps

A

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)

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4
Q

Shoulder Dislocation WHO/HOW/WHAT/COMPS

A

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

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5
Q

Humerus Fx WHO/HOW/WHAT/COMPS

A

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

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6
Q

Distal Radius Fx WHO/HOW/WHAT/COMPS

A

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

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7
Q

Colles Fx description

A

Dorsal angulation and displacement +/- avulsion or ulnar styloid

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8
Q

Scaphoid WHO/HOW/WHAT/COMPS

A

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??

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9
Q

Hip Fx

A

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

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10
Q

Hip Fx Classification

A

GARDEN - 1,2,3,41. Incomplete and undisplaced2. Complete and undisplaced3. Complete neck fx and displaced4. Fully displaced with prox fragment in neutral position

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11
Q

What is shentons line

A

trace through pubic ramus

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12
Q

Femoral Fx main concerns (artery and nerve) and how to confirm OK

A

Femoral artery (check distal pulses) and sciatic nerve

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13
Q

Femoral Fx WHAT

A

Intra med nail or MUA + thomas splint

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14
Q

Ankle Fx Classification

A

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

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15
Q

Ankle Fx initial managment and WHAT options

A

Assess - reduce - retain - xray then reassessMUA + POP/ ORIF/ Ex Fix

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16
Q

Complications from Fx’s (Immediate/ Late Local and Late General)

A

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

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17
Q

Compartment Synd - PC/I/T

A

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

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18
Q

Crush Synd

A

Breakdown of muscle cells releasing toxins as result of severe crushing injury and then release of pressure.CF - Hypovolaemic shock and Hyperkalaemia

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19
Q

Rotator Cuff Injury - 2 main presentations, investigation

A

Partial - painful arc / complete - limited abduction // US and MRI

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20
Q

Frozen Shoulder - PC and T

A

Pain (worst at night) and decreased ROM both actively and passively.Treat with NSAIDS, Intra art inj, Physio, MUA, local nerve block

21
Q

Nerve Impingement at Shoulder - PC / C / T

A

Pain on resisted abduction / Tendinopathy / Physio and analgesia

22
Q

Tennis Elbow - PC / T

A

Pain at lateral elbow on WRIST and FINGER FLEXION + PRONATION / Injection at tendon origin + physio + brace

23
Q

Golfer Elbow - PC / T (possible risk of T?)

A

Pain on medial elbow / Steroid Inj (can damage ulnar nerve and brachial art)

24
Q

2 Main Spinal Deformities and Long term sequelae

A

Scoliosis - Decreased Lung Func/ Cosmetic / PainKyphosis - Cord Compression

25
Q

Dupuytrens ?/C

A

painless fibrotic thickening of palmer fascia (ring and little finger) + fixed flexion at MCPGenetic/Alcohol/DM/ Smoking

26
Q

De Quervains PC

A

Pain over radial styloid process and thickened tendons

27
Q

Trigger Finger ?

A

Fixed flexion deformity (no active movement, only passive)

28
Q

What is AVN, Cause, I, T

A

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.

29
Q

Trochanteric Bursitis

A

pain just above greater trochanter, worst when lying on affected side.Rice treatement

30
Q

Gait Abnormalities and Cause

A

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

31
Q

Meniscus Inj - 2 main causes/ CF/ T

A

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!

32
Q

ACLAll - cause/CF/I/T

A

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)

33
Q

MCL - Cause/CF/T

A

Valgus strainVery quick swelling,but not normally effusion, pain and instabilityTenderness on valgus stressBrace 6 weeks and physio

34
Q

The Acute Knne - what are most important Not To MISS?

A
  1. Dislocation2. Fx’s3. Extensor Mech Inj(quads tendon/patellar etndon)4. Mulit-ligament inj5. Epipyseal Inn (kids so will heal quicker than normal)
35
Q

If patient complains of knee pain but examination is NORMAL, what would you suspect?

A

Hip referred pain

36
Q

Osteomyelitis - ?/PC/C/I/ T/ complication

A

? - 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

37
Q

secondary bone tumors - common mets/ I/ T

A

Breast, Lung, Prostate, KidneyII - xray, bone scan, MRI,PET-CTTreat with combo of - chemo/radio/bisphos/surg/other targeted therapies

38
Q

Muscular Dystrophies - inheritance / commonest/ CF and special test/ I

A

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

39
Q

Carpal Tunnel - PC/C/ T/

A

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.

40
Q

What’s in carpal tunnel

A

Median nerve, 9 tendons (Flexor policies longus, Flexor digititorum profundus, Flexor digits rum superficialis)

41
Q

what are Loaf muslces

A

Lubricans
Opponens pollicis
Abductor policies brevis
Flexor policies brevis

42
Q

What is a radiiculopathy and some causes

A

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)

43
Q

What is Entonox and list to CI’s

A

Gas and Air (NO and O2) and it shouldn’t be given to:

  • Bowel Obstruction
  • Pneumothorax
  • Sinus or Middle ear disease
44
Q

Elbow Fx Xray Assessment

A

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

45
Q

NeuroVascular Inj - MOTOR defecits (ulnar = …)

A

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

46
Q

NeuroVascular Inj - SENS defecits

A 
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
47
Q

ganglions commonly found where?

A

Volar wrist, dorsal hand

48
Q

Acute Knee - what needs excluded immediately?

A

Dislocation, Multi-lig injury, Fx, extensor mech inj (tendons), epiphyseal inj (kids will heal quickly so needs sorted soon)

Ortho/ Paeds Rheum (2 decks)

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