Introduction to Ortho Flashcards
Orthopedics is the study of
The study of the musculoskeletal system including bone, joints, ligaments, tendons, muscles, and supporting neurological and vascular structures
Sprain
Common where?
Uncommon in who?
Treatment of sprains
Sprain is injury to ligaments (connects 2 or more bones) and typically occurs in the ankle, knee, or wrist as result of trauma.
Uncommon in children or those with osteoporosis dt bone being more fragile than ligament.
I: Partial tear, no instability, symptomatic tx
II: Partial tear, instability, immobilize to protect.
III: Complete tear, immobilize/repair
strain:
Common where?
Grades I -IV
Strain is injury to tendon (connects muscle to bone).
Commonly seen with gastrocnemius, hamstring, and quadriceps.
I: Tear of a few muscle fibers
II: Tear of moderate amount of muscle fibers
III: Tear of all muscle fibers
IV: Tear of all muscle fibers – “rupture”
what is the clinical presentation of sprain or strain?
With sprain and strain, have hx of traumatic event with reports of snapping, popping, tearing sensation at time of injury
Associated with pain, swelling, stiffness, difficulty bearing weight. Ecchymosis may appear.
what are you PE findings of sprains and strains
Compare exam findings of swelling/tenderness w/contralateral side & examine for joint instability. Able to contract affected musculature- if they can’t its a higher grade strain
what is used for diagnosing strains and sprains?
X-ray to r/o fracture.
Consider w/II, III, IV strain or II, III sprain
MRI to evaluate soft tissue injury
what are the Ottawa Ankle Rules
guidelines of when to get an X-ray
if 1 or more of the following is + pain at lateral malleolus pain at medial malleolus cannot bear weight for 4 steps pain at navicular Pain in the mid foot at the base of the 5th metatarsal
Treatment of sprains and strains
PRICE
Minor: sprains can be treated with elastic compression bandage, bracing or brief periods of immobilization
Strains should be immobilized where muscle is stretched to minimize bleeding of injured muscle
What types of strains or sprains do you reef?
grade III or severe grade II
Contusion
Result of:
Presents with:
-Result of direct, blunt trauma causing bleeding & soft tissue damage
Presents with activity related pain, swelling, ecchymosis, possible hematoma
Diagnostic evaluation of a contusion?
X-ray to rule out fracture
Treatment of a contusion?
Conservative treatment, drainage if large hematoma
Monitor for compartment syndrome and join instability
Fracture
describe:
Often a/w:
Described as a Disruption in continuity or structural integrity of bone that occurs when stress applied to bone is greater than bone’s intrinsic strength
Often time is a/w injury to surrounding tissue (muscle, blood vessels, neurological structures)
Closed v Open Fractures
Closed: Skin over and near the fracture is intact
Open: Skin over or near fracture is lacerated or abraded by injury & requires expedient care & evaluation by specialist.
types of fractures 1: 2: 3: 4: 5:
Non displaced: In alignment
Displaced: Not in alignment
Angulated: Fractures are malaligned and angulated
Bayonetted: Distal fragment overlaps proximal fragment
Distracted: Distal fragment separated from proximal by gap
Treatment of fractures:
Specialist to determine if manipulation, reduction, stabilization is needed
Depends on bone involved- in general involves immobilization, reduction and rehab
Immobilize, reduction, rehab. Open fractures → URGENT tx
Open fractures are
URGENT treatment!
What are some factors that improve stability/ increase likelihood of good prognosis?
Young,
1 fracture in forearm/lower leg,
nondisplaced,
Thoracic spine fracture
What factors that worsen tability/ increase likelihood of poor prognosis?
Older, displaced, compartment syndrome, osteonecrosis, oblique, neurologic/vascular injury
Stress Fractures:
Occurs as a result of:
May occur with hx of:
Present:
Occurs as a result of repetitive stress loads to healthy bone
May occur with hx of prior stress fracture, < level of fitness, > volume/intensity of activity, female, menstrual irregularity, poor diet of calcium, poor biomechanics, poor bone health
Present insidiously compared to acute fracture
What will a stress fracture present as?
May report > in activity level, gradual onset of localized, activity related pain that progresses to pain at rest
what is the Diagnosis of stress fractures?
It will take 2-3 weeks to show up on Radiograph, it is recommended as initial study, but if it is negative and highly suggestive MRI is the diagnostic study of choice
what is the treatment of stress fractures?
early intervention
Low risk
High risk
Re - evaluate
Early intervention : < pain, promote healing, prevent future damage
Conservative management is recommended for low risk: 2nd-4th metatarsal shaft, posteriormedial tibial shaft, fibula, proximal humerus or shaft, ribs, sacrum, pubic rami
Specialist consult for high risk or complete or want to return quickly: Pars interarticularis (between vertebrae), femoral head or neck, patella, anterior tibia, medial malleolus, talus, proximal 5th metatarsal, sesamoids on great toe, base of 2nd metatarsal
Reevaluate every 1-3 weeks, Possible >12 weeks for return of activity
Dislocations
Joint injury that forces ends of bones out of position, commonly dt trauma. May involve ankle, knee, shoulder, hip, elbow, jaw, and finger.
what is the clinical presentation of a dislocation?
Pain, swelling, deformity, < ROM, numb/tingling if nerve involved
what is the treatment of a dislocation?
Depends on severity and joint involved – Emergent, Analgesia, Manipulation and/or surgical intervention followed by immobilization & subsequent rehab
Subluxation
Occurs when a joint begins to dislocate (partial dislocation) and can occur d/t trauma or underlying conditions that predispose to join laxity
Arthritis
cause:
manifestations:
Most common types:
Degenerative process a/w aging or acute infections & inflammation
Disability can range from minimal to crippling
Most common are osteoarthritis and rheumatoid arthritis
Septic Arthritis
aka:
caused by:
Commonly affected joints:
define: an infection of the going space
Also called pyogenic or suppurative arthritis
caused by infection to the joint space by either direct inoculation, hematogenous spread, or extension from adjoining bone infection.
Common joints include knee, hip, shoulder, elbow, wrise
Risk factors for septic arthritis?
> 80 y.o., DM, RA, gout, prosthetic joint, skin infection, > alcohol
Bacteria in septic arthritis?
Virus, bacteria, or fungi.
Staph Aureus is the most common in those 2 y.o. and older
Presentation of septic arthritis?
Early on:
Children:
Systemic Symptoms:
Symptoms early on are typically mild
join pain, swelling, < ROM.
Children may refuse to bear weight or move affected joint.
Systemic symptoms such as fever & tachycardia
PE findings of Septic Arthritis?
Red hot swollen joint that doesn’t move
Watch for possible primary infection – skin defect, penetrating injuries, skin abscess, tooth abscess
Dx of septic arthritis?
- > WBC, > ESR, > CRP, Blood culture
- If you suspect gonococcus, need cultures from other than mouth, cervical or utrethra
Joint aspiration: crystal analysis, gram stain, culture, cell count (>50,000)
Radiographs are often normal, may see soft tissue swelling
US, CT, MRI may reveal joint effusion
Treatment of septic arthritis
Empiric IV ABX for 14 days, then 14 days of oral abx
Surgical decompression, splinting of joint
