Ortho Flashcards
When there is a fracture, which X-rays do you request?
request BOTH AP and lateral films
- Radiographs must be orthogonal (at right angles) request AP and lateral films
- Need images of joint above and joint below #
what are the indications of an open reduction (+ internal fixation) ?
Intra-articular #s 2#s in 1 limb Bilat identical #s Open #s Failed conservative Rx
What are the indications for external fixation?
- Ex-Fix better for OPEN SOFT TISSUE injuries - want to reduce infection risk
- burns
- complex peri-articular #
In rehabilitation, what is the reasoning behind removal from splints/casts before full healing?
Quick return to function ↓s later morbidity
Get them using the limb before they lose full function.
what are the complications of fractures?
Intra-operative:
• Neurovascular injury
• Visceral damage
Early post-operative (<30 days):
• Compartment syndrome
• Infection (esp. with In-Fix) “osteomyelitis”
• Fat embolism ( ARDS)
Late post-operative (>30 days): • Non-union / Delayed union • Avascular necrosis (AVN) • Growth disturbance • Post-traumatic osteoarthritis • Complex regional pain syndromes • myositis ossificans
A patient has a fracture and presents with foot drop. which nerve injury could be implicated?
Hip dislocation - Sciatic nerve
Fibula neck # or Knee dislocation - Peroneal nerve
what are the presenting symptoms and signs of compartment syndrome?
which fractures are commomnly associated?
pain on passive flexion and extension (of digits?),
warm, erythematous, swollen,
weak/absent pulses, Increased CRT
fractures:
• Supracondylar fractures
• Tibial shaft fractures
usually caused by crush injury
diagnosis involves measureing compartment pressure
what is the mangement and complications of compartment syndrome?
Mx: elevate limb, remove all bandages/splint/etc.
–> fasciotomy
Complications: rhabdomyolysis, Volkmann’s contractures (fibrosis)
what are the causes of non-union?
- Ischaemia: poor blood supply or AVN
- Infection
- Interfragmentary strain (increased)
- Interposition of tissue between fragments
- Intercurrent disease (e.g. malignancy)
presentation and cause of myositis ossificans?
is calcification at sight of injured muscle
pain, focal swelling, tenderness
-> return to activity too early after injury
what are the causes and presentations of complex regional pain syndrome?
Causes:
• Injury: #s, CTS release, Dupuytren’s treatment
• VZV, MI, Idiopathic
Signs & symptoms (weeks-months after an injury):
• Not the traumatised area that is affected – this affects a NEIGHBOURING AREA
• Pain = hyperalgesia (inc. sensitivity), allodynia (pain to objects that don’t cause pain)
• Vasomotor = hot and sweaty, cold and cyanosed
• Skin = swollen, atrophic and shiny
• NM = weakness, hyper-reflexia, dystonia, contractures
Management of complex regional pain syndrome?
Pain team referral
Medical -> amytriptyline, gabapentin (neuropathic pain)
Surgical -> regional nerve blocks (use with caution according to NICE)
Presentation and management of fat embolisms?
Signs & symptoms (looks like a PE but with neurological signs):
•Hx multiple fractures, <24 hours dyspnoea, hypoxia, tachypnoea
•CNS – confusion, agitation, retinal haemorrhages, fat globules
•Dermatological – red/brown petechial rash (25-50%) – least common
Ix: nil
Mx: DVT prophylaxis, supportive care
What are the Ottawa knee rules – “X-ray only indicated if…”
o Age 55+; OR
o Isolated patellar tenderness; OR
o Cannot flex to 90 degrees, OR
o An inability to bear weight both immediately and in the emergency department for four steps
What are the Ottawa Ankle rules – “X-ray only indicated if…”
Pain AND Tenderness in malleolus OR inability to bear weight both immediately and in the emergency department for four steps
OR
Pain at midfoot
Tenderness at Base of 5th MTT OR Navicular
List causes/mnemonic for NOF fractures?
S Steroids H Hyperthyroid/hyperparathyroidism A Alcohol/Smoking T Thin (BMI <22) T Testosterone LOW E Early menopause R Renal/Liver failure E Erosive/inflammatory bone disease (RhA, MM) D Dietary Ca2+ low / malabsorption, DM
How would a NOF # present?
o O/E: shortened, externally rotated
o N.B. short + internally rotated = post. dislocation
How do we ivx a possible NOF # and what are we looking for?
1st -> XR (orthogonal; AP + lateral films): Shenton’s lines [L = N; R = broken] Intra- or extra-capsular? Displaced or non-displaced? Osteopoenic?
o 2nd CT
how would you describe a # distal to intertrochanteric line?
what is the significance of this?
minimal risk to blood supply and AVN
How do we manage Hip #s?
ORIF everything - reduce and internal fixation
Unless >65, Intracapsular -> Total hip replacement or hemiarhtroplasty if less fit
name some risk factors for osteonecrosis of femoral head?
Direct:
(irradiation, trauma (i.e. NOF), haematological disease (i.e. SCD, leukaemia), dysbaric conditions)
Indirect:
(ETOH, hypercoagulable, steroids, SLE, transplant/immunosuppressed, viral, idiopathic)
managment of AVN?
Non-operative bisphosphonates
Operative: THR, or resurfacing of femoral head etc.
How may a humeral fracture present? mechanism?
List some complications of humeral fractures?
Presentation: Elbow swollen and held semi-flexed
Mechanism: FOOSH, Osteoporosis, Elderly
o NV injury:
Brachial artery
Median nerve (ant. interosseous branch)
• Deep flexors = FPL, lateral FDP, pronator quadratus
Radial nerve
o Compartment syndrome:
S/S: early sign = pain on passive extension of fingers
Management of humeral fracture?
<2 parts: collar and cuff
> 2 parts - fixation
-> if high risk non-union => athroplasty
Supracondylar fracture - emergency:
Undisplaced - (plaster backstab)
Diisplaced - open fixation
what are the mechanisms of Colle’s and Smith’s fracture?
Both are fractures of distal radius
Colle’s:
falling on an extended wrist (FOOSH)
- dorsal/posterior displacement of radius (towards palm)
- dinner fork deformity
Smiths:
falling on an flexed wrist
- volar displacement of radius (towards palm)
Which are the intra and extra-articular fractures?
Extra:
Colle’s and Smith’s
Intra:
Bartons
name this fracture: # of proximal 3rd of ulna shaft + anterior dislocation of proximal head of radius
Monteggia #
name this fracture: # of distal 3rd of radial shaft + dislocation of distal radio-ulna joint (DRUJ)
Galeazzi #
when would a cast/splint be indicated in radial/ulna fracture
Temporary - before fixation
Definitive (minimally displaced, extra-articular #)
How are scaphoid fractures often obtained?
presenting symptoms?
FOOSH or contact sports
age = 22 (9-35yo)
5 main signs [strong sensitivity/specificity when used together]:
o [1] Pain in the anatomical snuffbox
o [2] Wrist joint effusion
o [3] Pain on telescoping thumb (push thumb into its joint)
o [4] Tenderness on scaphoid tubercle
o [5] Pain on ulnar deviation of wrist
How do we manage scaphoid fractures?
Before XRays:
1st: Futuro splint / below-elbow back-slab (beer glass hand) – done before the XR has taken place
After X-ray:
o XR +ve:
Undisplaced (at scaphoid waist) cast for 6-8 weeks (union in 95%)
Displaced (at scaphoid waist) ORIF
Undisplaced/displaced (at proximal scaphoid pole) ORIF
List complications of scaphoid fractures?
o AVN of scaphoid (retrograde blood supply)
S/S: stiffness and pain at the wrist
o Early osteoarthritis
complications of tibial plataeu fractures?
mx of these fractures?
o Concomitant ligamentous / meniscal injury can occur
mx;
- ORIF + Hinged knee brace
- External fixation if soft tissue injury
What is the most common long bone #?
Tibial # = most common long bone #; most common long bone open fracture (21%)
List fractures involving ankle joint?
1o Pott’s fracture = a bimalleolar fracture (an umbrella term)
2o Cotton’s fracture = a trimalleolar fracture (an umbrella term)
3o Pilon fracture = a fracture of the distal tibia involving the articular surface
4o Maisonneuve fracture: high fibular fracture
How do we manage ankle fractures?
Weber classification - position of fracture in relation to syndesmosis
A - (these are more stable)
oWeber A or B (non-displaced) -> Boot OR below-knee POP (A: weight-bearing as able, B: non-WB for 6 weeks)
oWeber B (displaced) or C ORIF ± syndesmosis repair
How does a Lisfranc injury present?
Gross midfoot swelling
Severe midfoot pain
Unable to WB
Medial plantar bruising
how would you ivx a pelvic fracture?
XR, urethrogram, CT ± angiography;
Signs & symptoms of a patellar fracture?
what XRay views may you want?
o Palpable patellar defect o Haemarthrosis (significant) o Loss of SLR (Straight Leg Raise) = loss of extensor mechanisms
Xrays - AP, Lateral, skyline
when is operative repair needed in patella fracture?
Loss of SLR, open #, displacement -> ORIF
Comminution
What is primary bone healing? Under which conditions may this take place?
This is when bone beals without callus formation.
Can take place if fracture is reduced well and stabilised rigidly so that the fracture gap is very small. Also occurs if fracture was very minor.
Which ankle fractures require ORIFs?
Disruption of the syndesmosis
Dusplaced and involvong shift of talus
What makes up the ankle joint
Tibia (medial malleolus)
Fibula (laterla malleolus)
Talus
List the type of fractures
Stress fractures aka incomplete
Fragility fractures
Insufficiency fractures
How do you tell difference in superficial vs deep indection in ortho/radiology?
Deep infections:
Intracapsular - septic arthritis
Bone infections eg osteomyelitis
Signs and symptoms of compartment syndrome?
o Pain, especially on movement (even passive)
o Excessive use of breakthrough analgesia (should raise suspicion for compartment syndrome)
o Paraesthesia, pallor, paralysis
o Arterial pulsation may still be felt as the necrosis occurs as a result of microvascular compromise (i.e. the presence of a pulse does not rule out compartment syndrome) – muscle death occurs in 4-6 hours
how do we ivx compartment syndrome?
Delta pressure <30mmHg = compartment syndrome (relative indication)
- delta pressure (DBP – ICP (Intra-compartmental pressure)
Absolute pressure >30mmHg = compartment syndrome
What is the management of comaprtment syndrome?
o Non-operative:
Ensure normotension (fluid resuscitation)
Remove circumferential bandages and casts
Maintain limb at level of heart – as elevation reduces arterial inflow and tissue perfusion
o Operative:
Fasciotomy
List complications of compartment syndrome
Volkmann’s contractures Sensory loss Weak dorsiflexors Chronic pain Claw toe Amputation
How do you know if there is syndesmosis injury in the ankle?
the following have high sensitivity:
- inability to walk
- inability to hop
- mechanism of injury involving dorsiflexion or external rotation
what are the signs and symptoms of subacromial impingement?
o Painful arc (60-120),
o Reduced ROM RCM = Rotator Cuff Muscles
o Weakness
o Hawkins test +ve (90 shoulder and elbow flexion + passive internal rotation of the arm pain = +ve)
cause - overuse in sport
aetiology - impingement of rotator tendons
list some differentials for a painful arc
Subacromial impingement
Frozen shoulder - adhesive capsulitis
Calcific tendonitis (can see ca2 deposit on X-ray)
Rotator cuff:
- supraspinatus tear
- Supraspinatus tendon impingement (@ 60-120deg abduction)
OA, septic arthritis,
gout/pseudogout, RhA
list the causes of a rotator cuff tear?
Chronic degeneration - due to age
Chronic impingement
Avulsion injury - eg after a fall
Iatrogenic eg after surgery
signs and sx of rotator cuff injury?
most common muscle torn?
o Partial tears → painful arc
o Complete tear:
Shoulder tip pain, full range of passive movement
Inability to abduct arm but active abduction possible following passive abduction to 90
Lowering the arm beneath this → sudden drop - “drop arm” sign
usually Supraspinatus commonly affected
Mx of rotator cuff injury?
o Non-operative (analgesia, physiotherapy, subacromial steroid injections)
o Operative:
Shoulder arthroscopy (subacromial decompression + rotator cuff debridement)
Rotator cuff repair
list signs and sx of rotator cuff athropathy
o Night pain with weakness/stiffness
o Supraspinatus/infraspinatus atrophy
o Limited ROM ± crepitus ± inability to abduct
o Hornblower +ve
what is rotator cuff athropathy
aetiology?
combination of:
rotator cuff insuffiency
glenohumeral cartilage destruction
superior migration of humeral head
subchondral osteoporosis
What are the signs and sx of frozen shoulder - aka adhesive capsulitis?
management?
o Stage 1: freezing (pain) gradual onset of diffuse pain
o Stage 2: frozen (stiff) decreased ROM
o Stage 3: thawing gradual return of ROM approx 5 months and later
o Decreased ROM: external rotation, abduction
o Shoulder pain (esp. at NIGHT – cannot lie on affected side)
o Associated with DM (& connective tisisue diseases) and lack of movement
Mx - self limiting
signs of a shoulder dislocation?
most common angle dislocated?
o Shoulder contour lost (square shoulder)
o Bulging infraclavicular fossa
o Arm supported by hand + severe pain
Arm in fixed internal rotation (posterior dislocation)
Most commonly; anterior dislocation - often trauma
complications of shoulder dislocation?
o Axillary nerve palsy (young):
At time of presentation (due to trauma)
Iatrogenic (due to manipulation)
Delayed onset (due to evolving haematoma)
o Rotator cuff tears (elderly)
o Recurrent dislocation (90% <20yo with traumatic dislocation)
o Bankart lesion (soft or bony; due to damage to labrum and/or glenoid)
o Hill-Sachs lesion (damage to humeral head)
how does bicep tendon rupture present?
o “Pop” sound… followed by pain, bruising and swelling
…at shoulder (proximal/long tendon - most common)
…at the antecubital fossa (distal tendon)
o ‘Popeye’ deformity (proximal tendon rupture) muscle bulk results in a bulge in the middle of the upper arm
o Weakness in shoulder and elbow
o Difficulty with supination
how do we ivx a bicep tendon rupture?
o Biceps squeeze test (for dsital tendon rupture - if tendon is intact, this will cause a supination)
o 1st -> MSK USS
o Suspected distal tendon rupture pathology -> urgent MRI
what causes medial and lateral epicondylitis?
microtears at origin of muscles
lateral - racquet sports, labourers with heavy tools
ivx:
USS
Presentation of lateral epicondylitis?
Insidious onset pain on lateral epicondyle
Affects the dominant arm more often
Worse on wrist extension, gripping
Decreased grip strength
Presentation of medial epicondylitis?
Insidious onset of pain on medial epicondyle
Worsened on wrist flexion, gripping
Numbness/tingling in 4th/5th finger with ulnar n. involvement
management of epicondylitis?
Conservative (95% success):
- Rest, forearm clasp, NSAID gels, physiotherapy
Surgical
List risk factors for Carpal tunnel sydnrome?
Diabetes mellitus Hypothyroidism Acromegaly Rheumatoid arthritis Amyloidosis Pregnancy
presentation of Carpal tunnel sydnrome?
o Pins/needles in 1st, 2nd, 3rd digits
o An ache or pain in your fingers, hand or arm
numb hands
o “Shaking the hand at night” relieves the pins and needles
MEDIAN nerve entrapment
ivx of Carpal tunnel sydnrome?
o 1st -> EMG
-> prolongation in sensory and motor axons;
o Clinical examination = weak LOAF (muscles supplied by median nerve)
Weak thumb abduction (Abductor pollicis brevis)
Wasting thenar eminence
Tinel’s sign
Phalen’s sign
signs and sx of ulnar nerve entrapment? risk factors?
o At wrist = Guyon Canal Syndrome
RFs: cycling, ganglion cyst pressure
o At elbow = Cubital Tunnel Syndrome
RFs: leaning on elbow, prolonged elbow flexion
o Pins/needles in 4th, 5th digit
o Claw hand
Wartenburg sign & Froment sign
What is De Quervain’s Tenosynovitis ?
Ivx and Mx?
• Aetiology = sheath containing extensor pollicis brevis (EPB) + abductor pollicis longus (APL) tendons becomes inflamed
• Signs & Symptoms:
o Tenderness over radial styloid and radial side of wrist
o Abduction of thumb (against resistance) painful
• Investigations Finkelstein’s test:
• Management:
o Activity modification, analgesia
o Steroid injections + thumb splint (Spica) -> surgery
what is dupytren’s contracture?
presentation ?
progressive, painless and fibrotic thickening of the palmar fascia
fixed flexion contracture of 4th and 5th MCPJ.
skin puckering and tethering
how do we mx dupytren’s contracture?
o Percutaneous needle fasciotomy (good in early disease; risk of artery/nerve damage)
o Collagenase injection (inject -> return 24 hours later for MUA; risk of tendon rupture)
o Partial fasciectomy
presentation of trigger finger?
- Fixed flexion deformity (usually 3rd and 4th or 5th digits);
- stiffness when bending the finger(s)
- hear snapping and popping when moving the finger
- sensation of locking and catching upon bending/straightening
associated with Rheumatoid Arthritis, DM, Older age
how do we mx trigger finger?
o Steroid injection (high recurrence)
o Surgical release of 1st pulley
causes of knee intra-articular bleeding?
- 1d (spontaneous bleed) > coagulopathy (warfarin, haemophilia)
- 2d (traumatic):
Immediate: ACL (80%), Patella dislocation (10%), Intra-articular #
Delayed: meniscal injury (10%)
possible differentials for swelling/effusion on knee?
o Synovial fluid (n = 5mL) - Synovitis, gout, pseudogout
o Pus - Septic arthritis
o Haemarthroses
How do tears of the cruciate ligaments present?
ACL rupture
- Rotational or deceleration sporting injury
- Hears a pop followed by knee giving way & inability to continue activity
- Pain
- RAPID swelling (heamarthrosis) as acl contains artery
PCL rupture
- Hyperextension injury (i.e. car accident)
- Tibia lies posteriorly to femur
- Paradoxical anterior draw test
MCL rupture
- Lateral blow forces leg into valgus
- Knee unstable in valgus stress test
How do meniscal injuries present?
Torn meniscus
- Twisting/Rotational sporting injury
- DELAYED knee swelling eg overnight
- Joint locking (pt. may be able to unlock) or catching
- Giving way
- Reduced ROM
- Recurrent pain / effusions
- McMurray’s test +ve
How do patella injuries present?
Chondromalacia patellae Patellofemoral pain syndrome - Teenage girls - Following injury to knee (i.e. dislocation) - Pain on going downstairs / at rest - Tenderness and quadriceps wasting
Dislocated patella
- RAPID swelling (heamarthrosis)
Mx of ACL rupture?
- Conservative
- including physio and brace - Surgery (Auto-graft repair)
Aetiology of bakers cyst?
The underlying mechanism involves the flow of synovial fluid from the knee joint to the gastrocnemio-semimembranosus bursa, resulting in its expansion.
Presentation of bakers cyst?
complications?
Swelling and pain behind the knee, or knee stiffness.
If the cyst ruptures:
- pain may significantly increase with swelling of the calf.
- may also cause bruising below the medial malleolus of the ankle (Crescent sign).
Rarely complications such as deep vein thrombosis, peripheral neuropathy, ischemia, or compartment syndrome
Presentation and ivx of low and high ankle sprains?
Low ankle sprains (most commonly (90%), inversion injury affecting the ATFL):
o pain, swelling, tenderness over affected ligaments
o XR (Ottawa ankle rules; 15% sprains associated with fractures) -> MRI
High ankle sprains (injury to syndesmosis is rare (0.5%) & severe):
o S/S: painful weight-bearing
Management of low and high ankle sprains?
Low ankle sprain
o Mx: RICE (Rest, Ice, Compression, Elevation)
High ankle
- Cast
- May need surgery
Diagnostic triad in achilles tendon rupture?
- Calf squeeze (Thompson Simmonds’ test; injury -> does not elicit plantarflexion) 98%
- Angle of declination (injury -> greater dorsiflexion in injured foot) 88%
- Gap (injury gap in tendon path)
presentation of mortons neuroma?
shooting/stabbing/burning pain in the ball of the foot, numb toes
o Commonly between 3rd and 4th tarsal bones
pain/tenderness of heel and sole of foot – worse after periods of inactivity (e.g., sleeping) and better with exercise is?
plantar fasciitis
what is the most common foot deformity?
presentation?
Hallux valgus aka bunion
MTP joint deviated laterally
Soft tissue/bone swelling at MTP - bunion
Later - pain and gait disturbance
what is charcots joint? aetiology?
degeneration of a weight-bearing joint, a process marked by bony destruction, bone resorption, and eventual deformity due to loss of sensation.
- common in peripheral neuropathy
- diabetes is most common cause
best ivx for rotator cuff tear?
MRI or USS dependeing on which is available first/easiest
L2/3 lesion would cause?
weakness of hip flexion - its a high lumbar lesion
not necessarily a cord compression as its lower down
osteoporotic vertebral collapse is unlikely to cause which types of symptoms?
neurologic symptoms
List the aetiology of acute osteomyelitis?
Haematogenous spread - most common
Direct inoculation - surgery, trauma, implant
What is sequestra?
And involucrum?
When do they appear?
When osteomyelitis leads to formation of dead/infarcted bone filled with pus
Involucrum is periosteal new bone formation
These are complications of chronic osteomyelitis
Which organisms must we also consider (in addition to staph aureus) in special cases eg sickle cell?
Salmonella - sickle cell
Pseudomonas - IVDUs
N gonnorhea - STIs
See peads notes for ivx and Mx osteomyelitis
Okay
What are the complications of osteomyelitis?
Septicaemia
Pathological fracture
Reccurence (especially if late diagnoses)
Osteoarthritis
Chronic osteomyelitis
Altered bone growth
How does subacute osteomyelitis present?
Insidious onset with pain over some weeks Less symptoms (milder due to less virulent organism - still s. aureus)
Blood test normal in 50%
Brodie’s abscess on X-ray (if so excise n drain)
Exclude bone tumour
Most common sites for osteomyelitis?
Distal femur
Proximal tibia
What are the features of chronic osteomyelitis?
Systemic features of infection Localised pain and discharge Thickened tissue Bone deformity Joint contracture
Mx of chronic osteomyelitis?
Specialist bone infection centre involvement
Soft tissue - plastics for tissue flaps
Antibiotics
Bone debriefing and reconstruction
what is a marker of pain of muscular origin?
pain/tenderness that is reproducible on plapating the area
list the orthopaedic emergencies?
Compartment syndrome
Shoulder dislocation
Supracondylarr fractures - kids
Cauda equina syndrome
Hip dislocation
Locked Knee or Knee dislocation
what is the presentation and risks of a dislocated hip?
90% posterior disloation Pain Cant weight bear Leg slightly flexed, initernally rotated Fall from great height, dashbaord injury
Must be reduced within 6 hours otherwise risk:
- > Avascular necrosis
- > Recurrence
- > sciatic nerve damage
- > Postraumatic arthritis
How do we mx dislocated hip?
Treat as Major truama via ATLS - advanced trauma life support
- Closed reduction
- Surgical reduction if above fails
Presentaiton and causes of a locked knee?
True locked knee - cant fully extend knee actively or passively (get pain if try)
Affects active individuals
Causes:
Twisting injury - hear a “pop”
Mechanical - menisceal, ligament injury (from sport), loose bodies
Non-mech - neurological, exaggeration
Best ivx for locked knee?
MRI - best
X-rays - show loose bodies well
examination - mcmurray’s, Apleys grind (note will cause much pain - therefore may be inapropriate)
What is the significance of being able to weight bear or not after an injury
If can’t weight bear immediately after injury - inidcates more serious injury
Mx ffor locked knee?
dislocated knee?
Non-operatve: ice, compression, cricket pad splint
Operative (arthroscopy exam n repair)- meniscal tears.
Dislocated knee:
REduction under GA +- fixators
what are the golden rules with supracondylar fractures?
- A pulseless white hand should go IMMEDIATELY to the theatre
- Compartment syndrome should go IMMEDIATELY to the theatre
others:
A Pink pulseless hand should go urgently to the theatre
- check sats regularly
When a patient presents with fracture, what are important things to check?
- Neurovascular status of limb:
- Perfusion distal to fracture (colour, pulses)
- Nerve function (for supracondylar #, do okay and lucky signs)
- Muscle compartments;
- Soft tissues - for signs of open fractures.
What is the difference between a septic arthritis and osteomyelitis?
Septic arthritis - inflammation of synovial membrane secondary to infection in the joint space
osteomyelitis - bone infection
risk factors forr septic arthritis?
IVDU
Rheumatoid arthritis
Immunocompromise
Advanced age
Pathology of septic arthritis?
Only synovial joints affected due to high vascularity.
Enzymes in our begin to destroy cartilage hence ‘athritis’
reversible if treated early.
what are the complications of septic arthritis?
30% adults - reduced RROM, chronic pain
Growht disturbance + deformity - kids
Osteoarthritis, ankylosis - due to cartilage destruction
indicators of poor outcome in septic arthritis?
RhA
Delayed treatment
Age >60
Infection of hip or shoulder joint
List some signs and sx of cauda equina syndrome and red flags
uni/bilaterla leg pain
saddle anaesthesia
urinary/bowel/sexual dysfunction
Lower limb weakness
red flags:
loss of anal tone
foot drop
malignancy, FLAWS
which nerve is at risk in the following:
Humeral shaft fracture
Supracondylar humeral # kids
Humeral shaft fracture - Radial
Supracondylar humeral # - Median, Ulnar
which nerve is at risk in the following:
Anterior shoulder dislocation
Knee dislocation
Anterior shoulder dislocation - Axillary
Knee dislocation - Common peroneal
what is the unhappy triad?
The unhappy triad, also known as a blown knee, refers to a sprain injury which involves 3 structures present in the knee joint.
These structures include;
anterior cruciate ligament (ACL),
medial meniscus and tibial (medial) collateral ligament.
what may present as:
Back pain (standing > sitting) Leaning forward relieves Neuropathic pain Neurogenic claudication Preserved distal pulses
Lumbar spinal stenosis
pain is worse on walking
what may present as:
Back pain
Systemic features (sepsis)
Neurological sx
mx?
Discitis
Iliopsoas abscess
mx: IV abx -> usually staph
(also drain if abscess)
How does Cord compression present?
UMN signs
Malignancy hx
what may present as:
Ipsilateral paralysis
Ipsilateral loss of proprioception & fine touch
Contralateral loss of pain & temperature
Brown-Sequard syndrome
what are the principles of mananging any fracture/trauma?
- Follow ATLS regime:
- > Initial ABCD assessment etc - Assess neuerological status of open fracture
- > urgent surgery if compromised - IV Abx ithin 3hours
- Definitive treatment
