Ortho Flashcards
Tx of open fracture
IV ABx, photography and sterile gauze
In surgery- debride, washout, external fixation
Tender snuffbox but no fracture on X ray
Plaster for 10 days
Repeat x ray
Smith vs colles
Smith- volar displacement
Colles- dorsal displacement
Complications of colles fracture
Median nerve injury
Complex regional pain syndrome
EPL reputure
Colles Sx
Dorsal displaced
usual 1 inch from radio-carpal joint
Dinner fork abnormality
Doesn’t matter if ulnar is broken too
Test for De Quervain’s tenosynovitis
Finkelstein test
Sx and Tx for De Quervain’s tenosynovitis
Tenderness over the radial styloid process
Abduction of the thumb against resistance is painful
Analgesia
Steroid injection
Monteggia and Galleazzi fracture
M- proximal ulnar shaft fracture, radial head dislocation (proximal end)
G- distal radial fracture and dislocation of RU joint
Bicep tendon rupture Sx
Distal reverse popeye
Proximal- Popeye
Hook test +
Gartland scoring
Supracondylar fracture
1- non displaced
2- angulated, post inf intact
3- displaced not in tact
Mx of supracondylar fractures
Displaced- fix with wires
Not displaced- flex as much, collar and cuff 3 wks
Mx of fractures
Resus
Reduction- local
Restriction
Rehabilitate
Length of time of cast for scaphoid, colles and smith fx
6 weeks
Sx of compartment syndrome
Pain
Usually few hours after fracture- CRPS is days/weeks
Pain on passive muscle stretching
Warm, erythematous, swollen limb
Tx of compartment syndrome
Fasciotomy
Causes of malunion
Ischaemia
Infection
Disease
Tissue in-between
Salter Harris classification
1-straight
2- above
3- lower
4-through
5-crush
Sx of NOF fracture
External rotation and shortening
Garden classification
1- incomplete
2- complete- undisplaced
3- partial displaced
4- complete
Tx of NOF fracture
Intracapsular- 1,2- ORIF, cancellous screws
3,4- total, hemi if less mobile
Extracapsular- ORIF- DHS
Sx of hip dislocation
Posteriori- shortened, internal
Anterior- external and abducted
Fat embolism sx
Usually after fracture of long bones
Resp- sinus achy, hypoxia 72 hours, neuro- retinal haemorrhages, confusion, petechiae
What SE can bisphosphonates cause
oesophagitis
Osteonecrosis of the jaw
Increased risk of atypical stress fractures of the proximal femoral shaft in patients taking alendronate
Sx and causes of shoulder dislocation
Anterior- trauma
Bulge in infraclavicular fossa
Hills Sachs lesion- cortical depression of posterolateral humeral head
Bankark- labrum tear
Posterior- epileptics
Tx of shoulder dislocation
Reduction under sedation
Hippocratic or Kocher
Sling 3-4 wks
Recurrent
TUBS- bankark- surgery
Impingement Sx
Painful arc -60-120
Tender shoulder on palpation
Frozen shoulder sx
Poor external rotation <30 and abduction <90
Rotator cuff tear sx
Partial- painful arc -can be <60
Complete- inability to abduct, can active after passive to 90
Drop arm sign
Weber classification and Tx
A- below - boot
B- on- boot 6wks
C- above- reduction and fixation
Ottawa rules
Malleolar pain and tender 6cm distal posterior tib/fib or inability to weight bare
Bony tenderness on fifth metatarsal or navicular
Achilles rupture sx
Simmonds triad
Greater dorsiflexion
Calf squeeze
Gap of tendon
Ix of achilles rupture
Ultrasound
Spinal stenosis Sx
UMN lesions
Relief sitting forward, going up hill
Radiates to calves
Cauda equina sx
LMN
Red-Bilateral sciatica, perianal parasthesia, urinary, bowel
Ix and Tx of caudal equina
MRI and spinal decompression
Dermatomes of leg
L1- groin
L2- ant thigh
L3- knee
L4- medial
L5- lateral
S1- little toe and heel
S3- bum
Myotomes of leg
Hip flexion- L1,2
Knee extension-L3, L4
Ankle dorsiflexion-L4
Big toe - L5
Plantae- S1
Reflexes and roots in leg
L3, L4- kick the door- knee
S1,S2- buckle my shoe- foot plantar
Myotomes Upper limb
Shoulder abduction- C5
Elbow flexion- C5,6
Elbow, wrist and finger- extension- C7
Wrist and finger flexion- C8
Finger abduction- T1
Malignancies that can cause bone mets
BLT with proper Ketchup
Breast, lung, thyroid, prostate, kidney
Treatment of Acromioclavicular damage
I-II- conservative with sling and rest
IV-VI- surgical
Mx of carpal tunnel
Splinting +/- steroids- 6 weeks
Severe- surgical decompression
Tx of achilles tendinitis
Rest NSAIDs 7 days
Then Physio after
If rib fracture not managed by IV analgesia
Nerve block
Fracture most at risk of causing radial nerve damage
Humeral shaft
Red flags of back pain
Thoracic back pain
>50
Unexplained Wt loss
Local tenderness
Focal neurology
Median nerve damage in colles vs radial head
Colles- loss of sensation and weak thumb
Radial head- more proximal
Inability to pronate, weak wrist flexion, ulnar deviate,
First line for back pain
NSAIDs
Most common part of bones affected by osteomyelitis in children
Metaohysis
Imaging of ostemyeltiits
MRI
Tx of osteomyelitis
Fluclox 6 weeks
Most common cause of discitis
Staph aureus
Ix if thinking of OP veterbral fracture
X ray of spine
Ganglion presentation
Cyst usually on dorsal aspect of wrist
Firm well circumscribed, transilluminates
Mx of ganglion
Reassurance
Should disappear after several months
Can surgically remove if not going
Causes of Raynauds
Vibrating tools
Scleroderma
RhA
SLE
Medication making you more prone to achilles tendon rupture
Ciprofloxacin
Analgesia of hip fracture
Iliofascial nerve block
With LA
Reduced opioid effects in elderly
When can you commence bisphosphonate without DEXA scan
> 75 with fragility fracture
Olecranon bursitis sx
Swelling over posterior aspect of elbow
Pain, erythema
Nerve most likely damaged in knee arthroplasty
Common perineal nerve
Spondylolisthesis vs spondylosis
Sponylothesis- move forward from stress fracture
Spondylosis- fracture of pars interarticularis
Differentiating spinal root lesion vs peripheral lesion in hand/arm
Ulnar/radius/median- supply sensory only to hand
If forearm- root lesion
Adhesive captulitis sx
Pain on coracoid palpation and impairment of external rotation
DM, thyroid, female
Coronoid process
Alternate side to olecranon in radius
Fracture of radial head sx
Fracture of the radial head is common in young adults.
FOOSH
Local tenderness over the head of the radius
Impaired movements at the elbow, and a sharp pain at the lateral side of the elbow at the extremes of rotation (pronation and supination).
Differentiating L5 vs S1 vs Sciatic nerve damage
Most cause pain all down leg
L5- weak hip abduction, foot drop
Positive straight leg test
Sensory loss- big toes and dorsum
Scaitic- loss of ankle reflex
Loss of knee flexion
Anterior thigh sensation
S1- little toe
Ankle reflex
Straight leg test
Positive- pain
Nerve compression
Acetabulum labrum tear
After trauma in younger adults
hip/groin pain
snapping sensation around hip
there may occasionally be the sensation of locking
Rf for avascular necrosis
long-term steroid use
chemotherapy
alcohol excess
trauma
Tear of ligaments vs meniscus
Meniscus- pain on palpation of joint line
Slower swelling
Ligamanet- rapid
Fractures most commonly associated with compartment syndrome
Tibial and supraconylar
Fragility fracture prescription
Alendronate
Ca and Vit D correcte first
Only prescribed if low or diet inadequate
Avascular necrosis on X ray
Smaller femoral head
Epidural abscess Ix
MRI whole spine
Fracture when pucnhing
Fracture of fifth metacarpal
Communated fracture imaging for surgery
CT
Stress fracture metatarsal
2nd meta
Repeated strain
Better on rest
Best x ray for cervical fracture
Lateral
FDP vs FDS
FDP flexes DIP joint
FDS flexes PIP joint
If cut finger what are you most likely to damage
Digital nerve
