Orho Flashcards
<p>Intracapsular hip fracture management</p>
<p>Extracapsular hip fracture management</p>
<p>Reverse oblique fracture</p>
<p>Colles fracture</p>
<p>1. Transverse fracture of the radius<br></br>
2. 1 inch proximal to the radio-carpal joint<br></br>
3. Dorsal displacement and angulation</p>
<p>Smiths fracture</p>
<p>Garden spade deformity</p>
<p>Vollar angulation</p>
<p>Bennet's fracture</p>
<p>Intra-articular fracture of the first carpometacarpal joint</p>
<p>Impact on flexed metacarpal, caused by fist fights</p>
<p></p>
<p>Monteggia fracture</p>
<p>Fracture of proximal 3rd of ulna + radial head dislocation</p>
<p>Outstretched hand with forced pronation</p>
<p>Galeazzi fracture</p>
<p>Distal 3rd fracture of radius with radioulnar joint dislocation</p>
<p>Barton's fracture</p>
<p>Distal radius fracture (Colles'/Smith's) with associated radiocarpal dislocation</p>
<p>Anterior cruciate ligament mech of injury</p>
<p>Twisting force on a bend knee</p>
<p>Posterior cruciate ligament mech of injury</p>
<p>Hyperextension</p>
<p>Medial collateral ligament mech of injury</p>
<p>Lateral force to the knee</p>
<p>Presentation of a meniscal tear</p>
<p>rotational sports injury</p>
<p>Acute pain, delayed swelling</p>
<p>Joint locking (pt may develop ways of 'unlocking' but it is not possible to do it passively)</p>
<p>Le Forte fractures</p>
<p>Nasal fracture mx</p>
<p>Rx epitaxis</p>
<p>If CSF rhinorrhoea-> abx</p>
<p>Allow bruising/oedema settle, consider manupulation of the deformity (within 10 days)</p>
<p>Gustillo-Anderson fracture classification use</p>
<p>open fractures classification</p>
<p>Gustillo-Anderson classification</p>
<p>1. low energy wound <1cm</p>
<p>2. >1cm with mod soft tissue damage</p>
<p>3. Extensive soft tissue damage:</p>
<p>3A- adequate soft tissue coverage</p>
<p>3B- Inadequate soft tissue coverage</p>
<p>3C- arterial injury</p>
<p>Gustillo-Anderson Grade 3B mx</p>
<p>Initially: debridement, stabilisation and external fixation</p>
<p>Skeletal and soft tissue reconstruction on a scheduled ortho-plastics list within 72 hours</p>
<p>Indication for urgent operation on an open fracture</p>
<p>Marine/sewage contamination</p>
<p>Vascular compromise</p>
<p>Polytrauma</p>
<p>Salter Harris</p>
<p>S</p>
<p>A</p>
<p>L</p>
<p>T</p>
<p>E</p>
<p>R</p>
<p></p>
<p>Intra growth plate fractures management</p>
<p>Stable Salter Harris 1: Conservative</p>
<p>Everything else: surgical reduction +/- fixation</p>
<p></p>
<p>Pott's fracture</p>
<p>Bimalleolar ankle fracture</p>
<p>Forced foot eversion</p>
<p>Holstein Lewis Fracture</p>
<p>Distal humerous fracture involving radial nerve</p>
<p>Weber ankle classification</p>
Ankle fracture mx
Weber A- Mobilise with ankle boot
Weber C- Nail and plate
Weber B- if unstable same as C
Grade 1 collateral ligament injury
Grade 1: negative laxity test.
Minor tearing of ligament
Grade 2 collateral ligament injury
Ligament laxity at 30 degree flexion
Stable when knee extended
Grade 3 collateral ligament injury
Complete laxity and instability of the joint
Mx of collateral ligament injury
Grade 1: physio + analgaesia
Grade 2: splinting and casting for 4-6 weeks
Grade 3: surgical reconstruction
Gritti stoke amputation
Through knee amputation
Symes amputation
ankle amputation
Osteoprosis mx
1st: bisphosphonate + Vit D and Calcium
2nd: Raloxifene, Stronium
Gardner's classification
Bankart leision
Suspect in recurrent anterior shoulder dislocation
Avulsion of the anterior glenoid labrum with an anterior shoulder dislocation
Pocket at the front of the glenoid forms that allows the humeral head to dislocate into it.
Mx of a minimally displaced proximal humeral fracture
If minimally displaced conservative:
- Immobolisation in a polysling and progressive mobilistation
- Pendular exercises at 14 days
- Active abduction from 4-6 weeks
Anteriorly dislocated shoulder mechanism
Abduction external rotation
Posterior shoulder dislocation xray finding
Light bulb
Less common than anterior
Hill Sach lesion
Chondral impaction on posteriosuperior humeral head from contact with gleonoid rim. Can be large enough to lock shoulder, requiring open reduction
Angle between femoral neck and shaft
130 in men
110 in women
McMurrey test
If positive: meniscal tear
Anatomical neck of humerus fracture mx
High risk of avascular necrosis
Hemiarthroplasty
Kocher's criteria for septic arthritis in children
WIFE
Wcc >12
Inability to wt bear
Fever
ESR>40
Septic arthritis mx
Surgical drainage
IV abx
Layers of periosteum
Fibrous: fibroblasts
Cambium: osteoblasts/chondroblasts
What attatches periosteum to bone
Collagenous fibres called Sharpey's fibre
Erbs palsy
Upper brachial plexus injury
C5-6
Waitor's tip
Signature fracture
aka depressed skull fracture
Scaphoid blood supply
From the distal non-articular end,
Branches of radial artery: dorsal ridge scaphoid branch (supplies 80% of the blood) and volar scaphoid branch (20%)
It is a uni-direction blood flow
Tibial plateau schatzker's classification
Mech of tibial plateau fractures
Knee is forced into varus or valgus, but fractures occur before ligament ruptures
Varus injury affects medial plateau and valgus affects lateral plateau
Gout aspirate
Negative bifirnges
Needle shaped crystals
Pseudogout aspirate
Positive birfiringes
Rhomboid crystals
Hemi-arthroplasty appraoch
anterolateral approach (modified hardinged)
Total arthroplasty appraoch
posterior
Posterior hip dislocation mech of injury
RTA
Hipe against dashboard
Tibial shaft fracture rx in children
If growth plate fused: intramedullary nail
If growth plate not fused: external fixation
Grade 1 collateral ligament injury and mx
Minor tear
Neg instability test
Cons mx
Grade 2 collateral lig injury
Lig laxity (when knee 30 degree flexion)
Knee stable when extended
Splinting/casting for 4-6 ws
Grade 3 collateral lig injury
Lig completely torn
Joint instability
Surgical reconstruction
Radiological features of OA
Joint space narrowing
Subchondral sclerosis
Subchondral cysts
Osteophytes
Compartment syndrome in which compartment if pain on passive plantar flexion
Anterior compartment
Stretching the extensor pollucis longus (by flexing the other way)
Kanavel cardinal signs
1. tender
2. fixed flexion
3. swelling (sausage finger)
4. pain on passive extension
flexor sheeth infection
Maisonneuve fracture
Proximal fibula fracture + sprained ankle
Most common type of salter Harris
Type 2 (75%)
Dorsal scapular nerve damage presentation
Weakened scapular retraction due to rhomboids and levator scapula being affected
Zones of flexor tendon
I- between DIP crease and middle phalanx
II- between zone I and distal palmar crease
III- between distal palmar crease and distal carpal tunnel margin
Zone IV- over carpal tunnel
Zone V - forearm and wrist up to priximal carpal tunnel
Absolute indications for primary amputation of tibia
Uncontrollable haemorrhage from open tibial injury
Crush injury exceeding a warm ischaemic period of 6 hrs
Possible indications for primary amputation
Avascular limbs with warm ischaemic time of 4-6hrs
Segmental muscle loss of more than 2 coompartments
Segmental bone loss of more than 1/3 of the length of tibia
Below knee amputation length
15cm of tibia ideal, 8 cm minimum for below knee prosthesis ti fit
Mx of Garden I and II #
Cannulated screw fixation
Mx of grade III and IV Gardner #
Hemiarthroplasty, or total
Mx shoulder dislocation
Kocher's or hippocratic manoevres
Anterior vs posterior shoulder dislocation, which more common
90% anterior
10 % posterior
Cause of posterior shoulder dislocation
epileptic fits
Bankart and Hill Sachs lesions on x-ray
Complications of recurrent anterior shoulder dislocation
Problems with blood supply in scaphoid fractures
% union rates from top to bottom post fractures: the more distal the fracture, the less chance of it healing, due to uni-directional blood supply
Kocher shoulder reduction method
Hippocratic shoulder reduction
Distal radius fractures
If stable: haematoma block or Biers block + reduction
If unstable: ORIF
Unstable distal radius fracture predictors?
Dorsal tilt of >20 degrees
Communited fracture
Injury to ulnar styloid
Intra-articular
Age cut off for a DEXA scan
Above 75, no need just vitd D, Ca, and Bisphosphonates
Below 75: DEXA first
Mirel scoring system def
Assesses risk of fractures from mets to bone
Mets to bones fracture mx
Mirel score:
9 or more: prophylactic fixation
8: consider
7 or less: non op mx
Mirel scoring system components
Site
Appearance
Width
Pain
Why get always get xray before aspiration of knee
To r/o effusion secondary to malignancy as otherwise risk seeding
CI to knee aspiration
presence of prosthetic
