LE, Joint Infections Flashcards
MC bacteria in human bites?
MC in fresh water?
Strep anginosus, Fusobacterium nucleatum, Eikenella
Aeromonas hydrophila
How do you know antibiotic treatment is working for osteomyelitis?
Abx dosed to serum level 8x greater than minimum inhibitory [ ]
What Abx have the best cure rates for osteomyelitis?
Oxacillin/nafcillin better than vancomycin
Can add Cipro/levofloxacin or 3rd gen cephalosporin
What is the Kocher criteria used for?
if 2 are met, what is chance?
3?
ID children w/septic arthritis of the hip
40%
93%
What are the 4 Kocher criteria?
Fever > 101F
Non weight bearing on side
ESR > 40
WBC > 12,000
What are the hard signs of vascular knee injury in a knee dislocation (tibiofemoral disruption)?
Absent pedal pulse
Cool, mottled foot
Expanding popliteal hematoma
Popliteal hemorrhage
How to treat knee dislocation that has normal ABI with no soft sign of vascular injury?
Posterior splint in 15 degrees flexion
What fracture represents a bone avulsion of the lateral tibial plateau?
Accompanied by what?
MC MOA?
Segond fracture (looks curvilinear)
ACL disruption/injury
Sports - knee flexion w/IR and Varus stress
Management of tibial plateau fracture in the ED?
Knee immobilization in non-circumferential splint, non-weight bearing
Ortho in ED or f/u
All fractures of the patella are considered what?
MC type?
Intra-articular
Transverse
What are the 4 compartments in the leg?
Anterior
Lateral
Superficial posterior
Deep posterior
What fracture is described by deltoid ligament tear/medial Malleolus fracture w/complete tearing of syndesmotic ligament of tib/fib and fracture of the proximal fibula?
Treat how? Why?
Maisonneuve fracture
ORIF, unstable ankle mortise
What is a Baker’s cyst?
What causes it?
Popliteal cyst that is a herniation of the synovial membrane through the posterior aspect of the knee capsule
Results from an enlarging knee effusion of any cause
What ankle fracture characteristic requires Ortho eval urgently (can be outpatient)?
Any abnormal measurement on ankle mortise view
- Talocrural angle 83 +/- 4
- Medial clear space >/= 4mm
- Talar tilt = 2mm
What kind of isolated lateral malleolar fracture requires ortho in the ED?
Danis-Weber type C —> fibular fracture proximal to tibiotalar joint line
Type B (at level of joint line) may consult Ortho also
What is a pilot fracture?
Occurs how?
Manage how?
Fracture of the distal metaphysis of the tibia
Fall from height, caused by axial compression
Requires ORIF, need ED ortho consult
What joint connects the midfoot to the Forefoot?
tarsometatarsal joint aka Lisfranc joint
What joint connects the hind foot to the midfoot?
Midtarsal aka Chopart’s joint
How many grades of Talar neck fractures? What system?
Significance of these?
4, Hawkins
Neck fox make up 50% of major talar fractures
What measurement to look for Calcaneal displacement/fracture?
Boehler’s angle (20-40 degrees)
What is a possible major complication in Lisfranc injury? Why?
vascular injury —> branch of dorsalis pedis artery dives bw 1st and 2nd metatarsal to form plantar arch
What is a nutcracker foot injury?
Occurs to the cuboid bone being wedged bw calcaneus and 4th and 5th metatarsal bases
Where does a Jones fracture occur?
Base of 5th metatarsal through the 4th and 5th intermetatarsal articulation
How many compartments in the foot?
When does compartment syndrome usually occur?
4 - medial, central, lateral, interosseous
15-30 hours but can occur as early as 2-6 hours
Lateral radiographs of the ankle may show what in Achilles’ tendon rupture?
Opacification of the triangular fatty-tissue space anterior to the tendon called Kager’s triangle
What are the Ottawa Foot Rules?
Tenderness over navicular
Tenderness at base of 5th metatarsal
Inability to bear weight for 4 steps after injury
What is the classification system called for Supracondylar fractures?
What grade requires Ortho for immediate surgery? Describe it
Gartland
III —> displaced with the cortex having no contact
