Ortho Flashcards
Fracture management principles
4Rs
Resuscitation
Reduction
Restriction
Rehabilitation
Common palsy after anterior shoulder dislocation
Axillary nerve palsy
Sargeant’s patch numbness
weak abduction
Common palsy after humeral neck fracture
Axillary nerve palsy
Sargeant’s patch numbness
weak abduction
Common palsy after elbow dislocation
Ulner nerve palsy
claw hand
Common palsy after hip dislocation
Sciatic nerve palsy
foot drop
Common palsy after knee dislocation
Sciatic nerve palsy
foot drop
Common palsy after neck of fibula fracture
Sciatic nerve palsy
foot drop
Causes of non- or mal-union
5 Is
* Ischaemia: poor blood supply or AVN
* Infection
* ↑ interfragmentary strain
* Interposition of tissue between fragments
* Intercurrent disease: e.g. malignancy or malnutrition
Common sites of avascular necrosis of bone
femoral head, scaphoid, talus
Salter Harris Classification
- I - Straight across
- II - Above
- III - Lower
- IV - Through
- V - CRUSH
Osteoporosis risk factors
Age + SHATTERED
* Steroids
* Hyper- para/thyroidism
* Alcohol and Cigarettes
* Thin (BMI<22)
* Testosterone low
* Early Menopause
* Renal / liver failure
* Erosive / inflame bone disease (e.g. RA, myeloma)
* Dietary Ca low / malabsorption, DM
Types of intracapsular NOFs
subcapital
transcervical
basicervical
Types of extracapsular NOFs
intertrochanteric
subtrochanteric
Blood supply to femoral head
Retinacular vessels in capsule
Intramedullar vessels
Ligamentum teres
Garden classification of NOF
o 1 = incomplete #, undisplaced
o 2 = complete #, undisplaced
o 3 = complete #, partially displaced
o 4 = complete #, completely displaced
Surgical treatment of NOF
intracapsular fractures
Garden 1 & 2: ORIF w cancellous screws
Garden 3 & 4:
< 55 yrs: ORIF w screws in young, active pts, F/U & in case of AVN
55-75 yrs: THR in pts
> 75 yrs: hemiarthroplasty
extracapsular fractures: ORIF
extramedullary: sliding screw & plate = DHS
intramedullary: Gamma nail implants
Radiographic features of Colles’ fracture
transverse fracture of radius
dorsal displacement of distal fragment w dorsal angulation
normally 1 inch proximal to radio-carpal joint
± avulsion of ulnar styloid
± impaction
Scaphoid fracture management
place wrist in scaphoid plaster (beer glass position)
if initial XR -ve, pt. returns to # clinic after 10 days for repeat XR
o # visible -> plaster for 6 wks
o no visible # but clinically tender -> plaster for 2 wks
o no visible # & not clinically tender -> no plaster
Deformity complication of supracondylar humerus fracture
Gunstock deformity
Gunstock deformity
cubitus varus deformity
Differentials of painful arc
- Impingement
- Supraspinatus tear or partial tear
- AC joint OA
Monteggia’s fracture
proximal ulnar fracture associated w dislocation of proximal radioulnar joint
Galeazzi fracture
distal radial shaft fracture w associated dislocation of distal radioulnar joint
