MSK Flashcards
Fracture management?
resuscitation: A to E,, neurovascular status, analgesia, open fractures needs abx, cleaning
reduction: open or closed
restriction: splint, cast, internal and external fixation
rehabilitation: physios and OTs
Fracture complications?
Causes of malunion?
Early: compartment syndrome, infection, complications of bed resr
Late: mal union, avascular necrosis, joint loosening, osteonecrosis
malunion causes: vascular impairment, infection, poor reduction, diabetes, steroids, smoking
Shoulder dislocation management?
95% anterior - FOOSH, trauma
5% posterior - seizure
associated injuries:
-> Bankart lesion (avulsion of glenoid labrum anteriorly)
-> Hill-sachs lesions (damage to humeral head)
-> axillary nerve palsy
-> rotator cuff tear
Reduction: analgesia then scapular manipulation, external rotation, traction countertraction
Post-reduction: re-examine sensation, pulses, movement.
Immobilise for 1 week if >30 or 3 weeks if <30.
At home rehab exercises
MRI or US if ongoing sx at 2 weeks for possible rotator cuff injury.
Supracondylar management?
Radial head fractures management?
FOOSH
SAIL SIGN FRACTURE
Gartland classification
type 1: cast immobilisation with elbow at 90 degrees for 2-4 weeks, may be followed by posterior splint
type 3 and most type 2: reduce via MUA (closed) and immobilise with K wires
Open fracture - open reduction with pinning
same
Mason classification (radial head)
1: non-displaced or displaced <2mm
2. displaced >2mm
3. big displacement
Wrist fracture management?
undisplaced: cast immobilisation for 6 weeks
displaced: reduction first then cast
closed with MUA or surgical reduction and fixation if unsuccessful e.g. MUA plus K wires, external fixation, open reduction and internal fixation with plates and screws
Ankle pain causes?
Achilles tendonitis:
- obesity, T2DM,, ankylosing spond, quinolones, statins, FHx
- posterior heel pain +/- thickened achilles
- anaglesia, stop aggravating, failure to improve after 3-6 months is surgical referral
Plantar fasciitis:
- heel pain
- bilateral in 30%
- anaglesia and rest, steroids injections
posterior heel pain: retrocalcaneal bursitis, posterior ankle impingment,, achilles rupture/tear (calf squeeze test positive)
osteoarthritis, crystal, PVD, peripheral neuropathy
Ankle sprain management?
Ix:
- stress testing
- ottawa ankle rule on xray
Mx:
- RICE
- immobilise with splint or below knee cast
- rehab and mobilise as early as you can
- surgery if still pain
Most common types of shoulder impingement?
The four most commonly described types of shoulder impingement are anterior acromial impingement, posterosuperior glenoid rim impingement, subcoracoid impingement and suprascapular nerve (at the spinoglenoid notch) impingement.
What are the compartments of the knee?
medial, lateral, patellofemoral
Unicompartmental knee arthroplasty (UKA) is a surgical technique used for the treatment of osteoarthritis in one compartment of the knee, most commonly in the medial compartment. In contrast, a total knee arthroplasty (TKA) is used for the treatment of osteoarthritis in all three compartments of the knee.
What is Kocher’s criteria?
distinguishes septic arthritis from transient synovitis in children
- non-weight bearing
- temp over 38.5 degrees
- ESR >40
- WBC >12,000 cells
How do you get a MCL tear?
damage to lateral knee
also associated with medial meniscus tear (mcmurray’s)
gold standard is MRI
What is a Baker’s cyst?
popliteal cyst is a synovial fluid filled swelling in the popliteal fossa
primary – there is no communication between the distension of the bursa and the knee joint
secondary – communicates freely between the bursa and the knee joint, almost all popliteal cysts are secondary
USS
MRI - for internal structures
bed rest and simple analgesics may be required initially
identifying and proper treatment of the underlying condition may resolve the condition in most adults
needle aspiration of the joint effusion and subsequent injection of steroids into the cyst may help
Lateral knee pain ddx?
Patellofemoral syndrome?
Iliotibial band syndrome e.g. runners knee
non-operative surgical treatment consists of reduction and/or changing of activity, correction of structural abnormalities. cooling of the inflamed area, administration of anti-inflammatory medication, steroid injections and physical therapy including stretching
surgery can be considered after unsuccessful non-surgical treatment
PFS can be defined as retropatellar or peripatellar pain resulting from physical and biochemical changes in the patellofemoral joint
anterior knee pain
the Q angle is the angle between a line joining the anterior superior iliac spine and the centre of the patella, and a line joining the centre of the patella and the tibial tuberosity. This is a clinical measurement and reflects the degree of valgus transitional force upon the patella. The normal value is 15°
some investigators believe that a “large” Q angle is a predisposing factor for patellofemoral pain
What is a bunion?
aka hallux valgus
A bunion is a protective bursa that develops over the metatarsal head where a shoe rubs.
Mx: comfortable shoes, possible surgery to remove
hallux valgus can be present early on if there’s fhx or secondary in elderly due to rheumatoid or other bony changes
Causes of reduced bone density?
Smoking. Drinking excessive amounts of alcohol. Low physical activity. Poor diet, low in vitamins and calcium.
