MSK Flashcards
most common cause of osteomyelitis
in normal
in px w sickle cell
normal - staph aureus
sickle cell - salmonella
imaging for osteomyelitis
MRI best for dx
mx osteomyelitis
surgical debridement of infected bone + tissues
acute =
flucloxacillin 6 wks
clindamycin if penicillin allergic
Vancomycin or teicoplanin when treating MRSA
chronic =
3 months+ abx
if assoc w prosthetics = complete revision surgery to replace
sx + s of ACL injury
Damaged during a twisting injury to knee
Sudden painful ‘popping’ sensation with rapid swelling
Inability to return to activity
Lateral knee and joint line tenderness
Lachman test often positive
Anterior drawer test may be positive
osteoporosis RFs
SHATTERED FAMILY
Steroid use >5mg/day prednisolone
Hyperthyroidism; hyperparathyroidism, hypercalciuria
Alcohol and tobacco use
Thin (BMI <22)
Testosterone low (e.g. anti androgen in cancer of prostate)
Early menopause (oestrogen is protective against it)
Renal or liver failure
Erosive/inflammatory bone disease (e.g. RA or myeloma)
Dietary Ca low/malabsorption or DMT1
Fhx
+ve simmonds sign
archilles tendon rupture
what maneuver is used for reduction of dislocated shoulders
Stimson
mx of diff grades of Acromioclavicular joint injury (shoulder hit in collision sports or FOOSH)
(rockwood classification used)
Grade I and II injuries are very common and are typically managed conservatively including resting the joint using a sling.
Grade IV, V and VI are rare and require surgical intervention.
III = either
when to do ankle x ray
if there is pain in the malleolar zone and:
1. Inability to weight bear for 4 steps
2. Tenderness over the distal tibia
3. Bone tenderness over the distal fibula
weber classification of ankle fractures
Related to the level of the fibular fracture.
Type A = below the syndesmosis - leaves it in tact
Type B = at the level of the ankle joint – the syndesmosis will be intact or partially torn
Type C = above the ankle joint – the syndesmosis will be disrupted
mx of ankle fractures
All ankle fractures should be promptly reduced to remove pressure on the overlying skin and subsequent necrosis
Weber A&B: cast/boot and weight bear as tolerated
Weber C (unstable): open reduction internal fixation
Follow-up in 6-8 weeks
what is a buckle fracture
incomplete fractures of the shaft of a long bone that is characterised by bulging of the cortex
head parts flattened out a bit due to pressure
typically occur in children aged 5-10 years
what is a greenstick fracture
occurs when a bone bends and cracks, instead of breaking completely into separate pieces. Most common in children under 10.
usually has a wedge + bit still hanging on
what is a salter harris fracture
A fracture that involves the epiphyseal plate or growth plate of a bone. Childhood fracture most common in the long bones.
what is spinal stenosis
refers to the narrowing of part of the spinal canal, resulting in compression of the spinal cord or nerve roots.
by tumour, disk prolapse or other similar degenerative changes.
presentation of spinal stenosis
gradual onset
Intermittent neurogenic claudication is a key presenting feature of lumbar spinal stenosis with central stenosis. It is sometimes referred to as pseudoclaudication. Typical symptoms are:
Lower back pain
Buttock and leg pain
Leg weakness
The symptoms are absent at rest and when seated but occur with standing and walking.
Bending forward (flexing the spine) expands the spinal canal and improves symptoms.
Standing straight (extending the spine) narrows the canal and worsens the symptoms.
Lateral stenosis and foramina stenosis in the lumbar spine tends to cause symptoms of sciatica.
always need MRI to confirm
how to mx suspected scaphoid fractures (maximal tenderness over anatomical snuff box)
immobilisation using a below-elbow back slab and repeat radiographs in 7-10 days/Futuro splint
subacromial impringement - where is the pain
a rotator cuff injury
= painful arc of abduction between 60 + 120 deg
where is the pain in rotator cuff tears
in the first 60 deg in arc of abduction
will also be weakness compared to opp arm, muscle wasting + tenderness
what is compartment syndrome
complication that may occur following fractures (or following ischaemia reperfusion injury in vascular patients)
- raised pressure within a closed anatomical space -> compromised tissue perfusion -> necrosis
most common fractures to result in compartment syndrome
supracondylar fractures and tibial shaft injuries.
features of compartment syndrome
Bone fracture or crush injury
Pain, especially on movement (even passive), disproportionate
- excessive use of breakthrough analgesia should raise suspicion for compartment syndrome
Parasthesiae
Pallor
Arterial pulsation may still be felt as the necrosis occurs as a result of microvascular compromise
Paralysis - worrying
limb swelling
dx compartment syndrome
usually clinical
measurement of intracompartmental pressure measurements using needle manometry
>20mmHg is abnormal and >40mmHg is diagnostic
tx compartment syndrome
essentially prompt and extensive fasciotomies