Miscellaneous 3 Flashcards
4th-5th IMA
Normal = 7 degrees High = 8-10 degrees
5th metatarsal lateral deviation angle
Bisection of 5th metatarsal head and neck compared to medial cortical margin of proximal shaft
Normal = 3 degrees High = 8 degrees
Osteochondrosis
AKA Epiphyseal ischemic necrosis
- A disease of the growth or ossification center in children, which begins as a degeneration or necrosis and is followed by regeneration or recalcification
Blount’s disease
Osteochondrosis of medial proximal epiphyseal ossification center of the tibia
This can cause limping and lateral bowing of the leg
Infantile type
- Occurs before age 6
- Caused by early walking/obesity
Adolescent type
- Occurs at 8-15 years
- Caused by trauma and infection
Freiberg’s infarction
Osteochondrosis of the metatarsal head - most commonly 2nd (followed by 3rd, 4th and 5th)
- Sclerosis, fragmentation and flattening of articular surface
- Pain on ROM, swelling
- Treat with offloading, immobilization, removal of exostosis. MPJ implant if severe
Kohler disease
Osteochondrosis of the navicular
- More common in boys, occurs between 3-6 years
- Often asymptomatic, can cause pain/swelling
- Sclerotic/flattened appearance (con on edge, silver dollar sign)
- Self-limiting disease, recovery takes 2-4 years with normal shape/density restored
Legg-Calve-Perthes disease
Osteochondrosis of femoral head (most common osteochondrosis)
- Occurs between 3-12 years, 10% bilateral, younger onset = better prognosis
- Limping, groin pain, referred knee pain
Osgood Schlatter disease
Osteochondrosis of tibial tuberosity
- More common in boys, occurs 10-15 years
- Caused by excessive traction of the patellar ligament
- Local pain, swelling, tenderness
- Self limiting with symptomatic treatment
Sever’s disease
Osteochondrosis of the calcaneal apophysis
- Caused by excessive traction of the Achilles tendon
- Ages 6-12, more common in equinus
- Difficult radiographic diagnosis due to normal epiphysis potentially having 2+ centers, appearing fragmented, irregular borders, sclerotic
- Treat with RICE, NSAIDs, rest, heel lift, Achilles stretching
Islin’s disease
Osteochondrosis of 5th metatarsal base
Treve’s disease
Osteochondrosis of fibular sesamoid
Renandier’s disease
Osteochondrosis of tibial sesamoid
Lance’s disease
Osteochondrosis of the cuboid
Assmann’s disease
Osteochondrosis of the 1st met head
Ortolani’s sign
The hip is already out
With baby supine, hips and knees are flexed to 90 degrees, grasp thigh with middle finger over greater trochanter, lift and abduct thigh
If there is a palpable click, the test is positive, as the femoral head was out and the click was felt as it was relocated into the acetabulum
Barlow’s sign
Dislocatable hips
With baby supine, hips and knees are flexed, thumb placed on greater trochanter laterally, apply pressure down and lateral
The dislocatable hip becomes displaced with a palpable clunk as the head slips over the posterior acetabulum
Club foot (3 deformities)
Talipes equinovarus
- Ankle equinus
- Hindfoot varus
- Forefoot adduction
Radiographic angles in club foot
Kite’s ankle low
- Normal = 20-40 degrees
- Clubfoot = 0-15 degrees
Calcaneal inclination low
- Normal = 20-25 degrees
- Clubfoot = 17 degrees
Talar head/neck to body adduction high
- Normal = 10-20 degrees
- Clubfoot = 80-90 degrees
Talar head to body plantarflexion high
- Normal = 25-30 degrees
- Clubfoot = 45-65 degrees
Reduction of clubfoot deformity should be performed in the following order:
AVE “clubfoot AVEnue”
- Adduction
- Varus
- Equinus
Congenital vertical talus
- Primary dislocation of the navicular dorsally on the neck of the talus, locking the talus in a vertical position
- Forefoot is abducted and dorsiflexed at the midtarsal joint
- Calcaneus is in valgus and equinus
Treatment
- Closed reduction rarely successful
- Surgical reduction of TN joint and posterior release
Evans
Calcaneal opening wedge osteotomy 1.5 cm proximal to CC joint
Kidner
- Removal of prominent navicular tuberosity or accessory navicular
- Transplantation of posterior tibial tendon onto underside of navicular bone
Hoke
- Closing plantar wedge from navicular and medial and intermediate cuneiform
- Opposite of Cotton - plantarflexes forefoot to re-establish arch
- Performed with TAL
Miller
- Fusion of the navicular-medial cuneiform joint and the first TMTJ
- Take a plantar wedge out for each fusion in order to plantarflex the forefoot and re-establish an arch
- Posterior tibial tendon and spring ligament advancement using an osteo-periosteal flap
Young
Keyhole technique
- Reroute anterior tibial tendon through a keyhole in the navicular without detaching it from its insertion
- Posterior tibial advancement under the navicular
Skewfoot
- Adducted forefoot, normal midfoot, valgus hindfoot
- Usually aquired from gradual compensation of metatarsus varus that occurs with WB or improper manipulation/casting
Tarsal coalition
- Most common cause of peroneal spastic flatfoot (spasm results from immobilization of STJ)
- Incidence 1%, 50% bilateral
- TC and CN coalitions account for about 45% of coalitions each
- TN coalition rare
Talocalcaneal coalition
- Almost all involve the middle facet
- Begin at 12-18 years
- Pain at sinus tarsi or over middle facet
- Decreased ROM at STJ and MTJ
- Harris-Beath shows mid and post facets are not parallel, mid facet not well demarkated
- Lateral shows talar beaking, no mid facet, ball-and-socket ankle joint, halo sign or C-sign (sclerotic ring around sinus tarsi)
- Treat with immobilization, steroid injection, NSAIDs, resection, triple arthrodesis if DJD
Calcaneonavicular coalition
- Extraarticular coalition
- Begin at 8-12 years
- Pain at location of coalition
- Lateral shows prolonged anterior process of calcaneus - “anteater sign”
- Treat with immobilization, NSAIDs, resection, interposition of EDB, triple arthrodesis if DJD
Cerebral palsy
- A broad term used to describe several static NON-PROGRESSIVE neuromuscular disorders resulting from brain damage before, during or immediately after birth
- Scissors gait due to adductor spasticity
- Speech defects, retardation, seizures, visual defects
- Ankle equinus
- Treat with PT/OT, splinting, bracing
Muscular dystrophies
- Inherited, chronic, PROGRESSIVE myopathic disorders
- Progressive weakness, atrophy, loss of DTRs, contractures, deformity
Duchenne’s muscular dystrophy
- Onset 2-5 years
- Pelvic girdle weakness
- Rapid progression with wheel chair bound by 10 to 12 years old
- Die around 20 years (respiratory sepsis, cardiac arrest)
- Toe walking, difficulty with stairs, lordosis, wadling gait, Gower’s sign, decreased IQ, pulmonary disorder
Becker’s muscular dystrophy
- Age of onset 5-25 years (later than Duchenne’s)
- Weakness of pelvic girdle
- Less severe contractures/cardiac involvement than Duchenne’s
- Slow progression with wheel chair bound by 20-50 years
- Die around 40 years (some have normal life span)
- A milder form of Duchenne’s but no decrease in IQ
- Pes cavus in 60%
Silfverskoild test
Tests for gastroc equinus
- Passive dorsiflexion is measured with knees extended then with knees flexed
- If the dorsiflexion increases when knees are flexed, the equinus is due to a tight gastroc because the gastroc crosses the knee joint and is eliminated upon knee flexion
Lisfranc amputation
Remove metatarsals, leave all cuneiforms, cuboid and navicular
Chopart’s amputation
Remove all cuneiforms, cuboid and navicular, leave just talus and calcaneus
ChopartT = Calc and Talus
Symes
Remove both malleoli and distal tibia
Normal compartment pressure
5 mmHg
Can get as high as 50 mmHg during exercise
Pressure at which fasciotomy is indicated
30-40 mmHg
MPJ sequential release for hammer toe
1 - Release extensor expansion 2 - Tenotomy/lengthening of EDL/EDB 3 - Transverse MPJ capsulotomy 4 - Release of collateral ligaments 5 - Plantar plate release (McGlamry elevator)
Stress fracture on x-ray
May take 14-21 yeas to present radiographically after a bony callus has developed
Mondor’s sign
Ecchymosis from malleoli to the sole of the foot
Pathognomic for calcaneal fractures
Steida’s process/Shepard’s fracture
Stida’s process is the lateral tubercle of the posterior process of the talus
Shepard’s fracture is a fracture of the lateral tubercle of the posterior process of the talus - MOI forced plantarflexion where posterior process is compressed between posterior malleoli and calcaneal tuberosity
Toyger’s angle
A line drawn down the posterior aspect of the Achilles tendon should produce a straight line, but will be a curved line (<180 degrees) with achilles rupture
Burn depth
Partial thickness burn
- 1st degree
- 2nd degree
Full thickness burn
- 3rd degree
1st degree burn
Involves only the epidermis
- Superficial epidermis
- Appears erythematous with normal texture and pinprick sensation intact
- Heals in 5-10 days with no scar
2nd degree burn
Involves the dermis but does NOT penetrate the dermis
Superficial partial thickness
- Edematous blister with pinprick sensation intact
- Heals in 10-21 days with minimal scar
Deep partial thickness
- Pink or white in appearance with thick texture
- Heals in 25-60 days with a dense scar
3rd degree burn
Full thickness (damage extends through the dermis)
- Appears white, black or brown with leathery texture, no pinprick sensation intact,
- No spontaneous healing, usually requires skin graft and heals with a dense scar
Dog bites
- Staph, strep, pseudomonas
- Pasturella multocida
Cat bites
- Pasteurella multocida (responsible for the majority of infections)
- Cat scratch fever - bartonella henselae
Human bites
- Strep viridans
- Eikenella
Puncture wounds
- Staph aureus»_space; cellulitis
- Pseudomonas»_space; osteomyelitis
Medial compartment of the foot
- Abductor hallucis
- Flexor hallucis brevis
- FDL tendon
Central compartment of the foot
- FDB
- Lumbricles
- Quadratus plantae
- Adductor hallucis
- FDL, PT and PL tendons
Lateral compartment of the foot
- Abductor digiti minimi
- Flexor digiti minimi
Interosseous compartment of the foot
- All 4 dorsal interosseous muscles
- All 3 plantar interosseous muscles
Malignant hyperthermia
- Due to a reduction in the reuptake of calcium by the sarcoplasmic reticulum
- Most frequently seen when receiving a combination of muscle relaxant (succinylcholine) and inhalation general anesthetic (halothane)
- Treated with cool IV NS (not ringer’s) and IV dantrolene
