MS/ Orthopedic Surgery Flashcards
Back pain that is exacerbated by standing and walking and relieved with sitting and hyperflexion of the hips
Spinal stensis
Joints in the hand affected in RA
MCP and PIP joints, DIP spared
Joint pain and stiffness that worsen over the course of the day and are relieved by rest
OA
Genetic disorder that is associated with multiple fractures and blue sclerae and is commonly mistaken for child abuse
Osteogenesis imperfecta
Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Dx test?
Suspect ankylosing spondylitis
Check HLA-b27
Arthritis, conjunctivitis, urethritis in young men. Associated organisms?
Reactive (Reiter’s) arthritis
Bugs: Chlyamydia, also think Camplylobacter, Shigella, Salmonella, Ureaplasma
HLA B27
Can follow enteric infection
55 yo man has sudden excruciating MTP joint pain after a night of drinking red wine. Dx, workup, and chronic Tx?
Gout
Needle shaped negatively birefringent crystals
Chronic Tx: allopurinol or probenecid
Rhomboid shaped positively birefringent crystal on joint fluid aspirate
Pseudogout
Elderly woman with pain and stiffness in shoulders and hips, cannot lift arms above head. Labs show inc ESR and anemia
Polymyalgia rheumatic
Active 13 yo boy has anterior knee pain, Dx?
Osgood Schlatter disease
Bone fx in fall on outstretched hand
Describe position of Fx
Distal radius = Colles fracture - dinner fork
Dorsally displaced, dorsally angulated
Complication of scaphoid fracture
vasular necrosis
may not see on x-ray for 1-2 wks
Signs suggesting radial nerve damage with humeral fracture
Wrist drop, loss of thumb abduction
Young child presents with proximal mm weakness, waddling gait, pronounced calf mm
Duchenne muscular dystrophy
First born female born in breech position found to have asymmetric skin folds on newborn exam. Dx? Tx?
Developmental dysplasia of hip
If severe, consider Pavlik harness to maintain abduction
11 yo African Am boy presents with sudden onset of limp. Dx? Workup?
SCFE
AP and frog leg lateral X-rays
Most common primary malignant tumor of bone
Multiple myeloma
Anterior dislocation of shoulder hits what nerve
Axillary n
Anterior dislocation of shoulder- position pt holds arm in?
Abduction and ER
What would cause posterior dislocation of shoulder?
seizure, electrocution
Posterior dislocation of shoulder- hold in what position?
ADDuction and IR
Anterior dislocation of hip can damage what nerve
Obturator n
Most common hip dislocation
Posterior
Cause of posterior hip dislocation
Anteriorly directed force on IR, F, ADD hip = Dashboard injury
Risks of posterior hip dislocation
Sciatic n injury
Avascular necrosis
Tenderness in anatomical snuffbox
Fall on radially deviated outstretch hand
Assume scaphoid Fx
Tx scaphoid Fx
Thumb spica cast
Fx 5th metatarsal neck
Due to forward trauma of closed fist - punching a wall
Boxer’s Fx
Tx Boxer’s FX
closed reduction and ulnar gutter splint
If open: assume infection by human oral pathogens - irrigate, debridement, abx (cover Eikenella)
Humerus Fx caused by
Direct trauma
Neuro complication humerus Fx
Radial n palsy = wrist drop, loss of thumb extension
Tx humerus Fx
Hanging arm cast vs coaption splint and sling, bracing
Ulnar shaft Fx resulting from self defense with arm against blunt object
Tx
Nightstick Fx
ORIF if significantly displaced
Diaphyseal Fx of proximal ulna with subluxation radial head
Tx
Monteggia’s Fx
ORIF of shaft and closed reduction radial head
Diaphyseal fracture of radius with dislocation of distal radioulnar joint, 2/2 direct blow to radius
Tx?
Galeazzi’s fx
ORIF of radius and casting forearm in supination to reduce distal radioulnar joint
Hip Fx: What puts at increased risk? Presentation Major complications (2), esp if femoral neck Fx Radiology problems
Osteoporosis
Shorted leg and ER
DVT, AVN w/ femoral Fx
Can be radiographically occult, CT or MRI
Tx hip Fx
ORIF, may need hip hemiarthroplasty
Anticoagulate
Cause femoral Fx
Major complication
Direct trauma
Fat emboli
S/S fat emobli
Fever Changes mental status Dyspnea Hypoxia Petechiae Dec platelets
Cause tibial Fx
Major complication
Direct trauma
Compartment syndrome
Open fractures
Orthopedic emergency
Sudden pop like rifle shot, 2/2 decreased physical conditioning
Limited plantar flexion
+ Thompson
Achilles tendon rupture
Tx: long leg cast 6 wks
Unhappy triad
ACL
MCL
Medical meniscus
Causes ACL injury
Twisting mechanism
Forced hyperextension
Impact to extended knee
Cause PCL injury
Posteriorly directed force on flexed knee
Cause meniscal tears
Exam shows
Acute twisting or degenerative tear in elderly pts
Joint line tenderness, + McMurrays
Test of knee injuries
MRI
Cause Volkmann’s contracture of wrist and fingers
Compartment syndrome which can be 2/2 humeral Fx
Compartment pressure = compartment syndrome
> 30 mmHg
Tx compartment syndrome
Immediate fasciotomy
CTS nerve affected
Median
Association of CTS
Overuse wrist flexors, DM, thyroid, pregnant
Positive tests CTS
Phalen’s
Tinel’s
Raidal nerve Motor fcn Sensory Cause injury Clinical finding
Wrist extension
Dorsal forearm and first 3 fingers
Humeral Fx
Wrist drop
Median n Motor fcn Sensory Cause injury Clinical finding
Pronation, thumb opposition
Palmar surface first 3 fingers
Carp tunnel
Weak wrist flexion and flat thenar eminence
Ulnar Motor fcn Sensory Cause injury Clinical finding
Finger adduction, 4 and 5 finger flexion, lumbricals
Palmar and dorsal surface last 2 fingers
Elbow dislocation- medial epicondyle
Claw hand- clawed 4 and 5 digits
Axillary
Motor fcn
Sensory
Cause injury
Abduction
Lateral shoulder
Anterior humeral dislocation
Peroneal Motor fcn Sensory Cause injury Clinical finding
Dorsiflexion, eversion
Dorsal foot and lat leg
Knee dislocation
Foot drop
Wrist drop - n
Radial
Claw hand - n
ulnar
Foot drop- n
Peroneal
Causes bursitis - 4
Repetitive use Trauma Infection Systemic inflammatory disease TX: RICE
Rx with increased risk tendon rupture and tendonitis
Fluoroquinolones
Red flags LBP
age > 50 >6 wks pain Previous cancer Hx Constitutional Sx Severe pain Neuro deficits Loss of anal sphincter tone
Bowel or bladder dysfunction, impotence, saddle anesthesia
Cauda equina
Most common location herniated disc
L5-S1
L4
Motor
Sensory
Reflex
Foot dorsiflexion- tibialis anterior
Medial aspect lower leg
Patellar
L5
Motor
Sensory
Reflex
Big toe dorsiflexion - extensor hallucis longus; foot eversion (peroneus)
Dorsum foot and lat lower leg
None
S1
Motor
Sensory
Reflex
Foot eversion- peroneus longus and brevis; plantarflexion-gastrocnemius
Plantar and lat foot
Achilles
Most common benign bone tumor
Osteochondroma
Child 10-20 yrs of age with multilayered onion skinning on X-ray in diaphysis
Ewing sarcoma
Female 20-40 yrs w/ knee pain and mass; X-ray shows soap bubble appearance, epiphyseal/metaphyseal region long bones
Giant cell tumor
Male, 20-30, metaphyseal bone tumor in distal femur or proximal tibia, mets to lungs common, pain worsens at night
Osteosarcoma
Codman’s triangle
Triangular area of new subperiosteal bone that is created when a lesion, often a tumour, raises the periosteum away from the bone
Osteosarcoma
Ewing sarcoma
Onion skinning
Ewing
successive layers of periosteal development;
Soap bubble
Giant cell``
Most common organisms in septic arthritis
STAPH
Streo
Gram - rods
Tx septic arthritis
Ceftriaxone and vacomycin
Child w/ gout and inexplicable injuries
Lesch Nyhan syndrome
Type of crystal in gout
Monosodium urate crystals
Mechanism colchicine
inhibits neutrophil chemotaxis
good for acute flare
cause diarrhea, BM suppression - neutropenia
Fx of distal radius with fall on flexed wrist
Displaced ant or post
Smith
Ant
Major risk of pelvic fracture
Major blood loss
Deltoid malfunction- cannot extend or abduct arm or shoulder numbness after dislocation
axillary n injury
ANTERIOR DISLOCATION
Exertional compartment syndrome
Young athlete
Resolves when stop activity
Minimal risk tissue ischemia
6 P Compartment syndrom
Pain Paresthesias Paralysis Poikilothermia Pallor Pulselessness
C5
Motor
Sensory
Reflex
Deltoid and biceps
Ant shoulder
Biceps
C6
Motor
Sensory
Reflex
Biceps, wrist extensors
Lat forearm
Brachioradialis
C7
Motor
Sensory
Reflex
Triceps, wrist flexors, finger extensors
Post forearm
Triceps
C8
Motor
Sensory
Reflex
Finger flexors
4 and 5 fingers, medial forearm
NOne
T1
Motor
Sensory
Reflex
Finger interossei
Axilla
None
Erb Duchenne Palsy
Where is injury
Cause
Clinical
Super trunk: c5-c6
Hyperadduction of arm- birth = shoulder dystocia
Waiter’s tip: arm extended and adducted in pronation
Klumpke palsy
Where
Cause
Clinical
Posterior or medial cords:c8-t1
Hyperabduction of arm
Clas hand- poor wrist and hand fcn, assoc Horner syndrome
Etiology osteopetrosis vs Paget
Osteo: increased bone density due to impaired osteoclast
Paget: disorganized bone due to overactive osteoblast and osteoclast
Labs osteopetrosis vs Paget
Paget: Inc ALP, urine hydroxyprolone, normal Ca and Phos
Osteo: Dec H and H, inc acid phosphatase and CK
Tx osteopetrosis vs Paget
Osteo: transfuse marrow components to stimulate osteoclast
Paget: bisphosphonates, calcitonin
Leukocytes:
OA, trauma vs Inflammatory arthropathies (RA, pseudogout) vs septic joint
50000
Bouchard nodes
OA
DIP
Heberdon nodes
OA
PIP
Swan neck deformities
RA
flexed DIP plus hyperextended PIP
Boutenierre deformity
RA
Flexed PIP
Red heliotropic rash
Dermatomyositis/polymyositis
Bamboo spine
Ankylosing spondyltitis
Seronegative arthopathies
PEAR Psoriatic Enteropathic (IBD) Ankylosing Reactive
Tumors that met to bones
Permanently Relocated Tumors Like Long Bones Prostate Renal Thyroid Lung Lymphonma Breast
Sunburst on X-ray
Osteosarcoma
mixed lytic sclerotic pattern
Most effective Dx testing for developmental dysplasia of the hip
US, X ray no good until 4 months
2 types rickets
Hypocalcemic
Hypophosphatemic
Rickets with Inc ALP, Dec P, Dec Ca, Dec 25 Vit and 1, 25 Vit D, inc PTH
Hypocalcemic
Rickets with Inc ALP, Dec P, Increased 25 and 1,25 Vit D
Hypophosphatemic
Joints involved JRA: pauci, poly, systemic and ages of each
Pacui: less than 4 joints, 2-3 yrs
Poly: 5+ joints, 2-5 and 10-14 yrs
Poly: any number, < 17
Problem with Osgood schlatter
inflammation of bone-cartilage interface of tibial tubercle
Reduction of nursemaids elbow
Supinate, flex from 0-90
Club foot position
Inverted, planter flexion, adduction
Gower maneuver
push on hips to stand
Duchenne MD
Noninfectious vegetations seen on MV in SLE and antiphospholipid syndrome
Libman Sachs Endocarditis
SLE Criteria
DOPAMINE RASH Discoid rash Oral ulcers Photosensitivity Arthritis Malar rash Immunologic Neuro sx Elevated ESR ANA Serositis- pleural or pericardial Heme abnormal
CREST
Calcinosis Raynaud Esophageal dysmotility Sclerodactyly Telangiectasia
DIP: spared in, involved in = OA and RA
DIP spare RA
DIP affected OA
Felty’s syndrome
RA
Splenomegaly
Neutropenia
Charcot joint
DM
Mosaic lamellar bone pattern
Pagets
Caplan syndrome
RA + pneuoconiosis
20s man, painful oral and genital ulcers, uveitis, arthritis, erythema nodosum
Behcet
Tx: steroids
Dermatomyositis
S/S
Dx
Complication
Polymyositis plus skin (heliotrope rash around eyes with periorbital edema)
Trouble rising from chair/climbing stair b/c proximal mm affected
Dx: mm biopsy
Increased incidence of malignancy