Ortho Flashcards
colles fracture
outstretched hand
smith fracture
back of flexed/inward hand
sign of a scaphoid fracture
(outstretched hand)
pain on palpation of the anatomical snuffbox
intra-articular two part fracture of the first metacarpal
bennett fracture
intra-articular comminuted fracture of the first metacarpal
rolando fracture
pain/swelling over the 4/5th metacarpal
suspect Boxer’s fracture
shoulder dislocation
humeral head is anterior, medial to normal position
loss of rounded shoulders
anterior dislocation (most common)
Phalen’s test
flexing the wrist and holding it like that
if positive: parasthesia in median nerve
used to test for Carpal tunnel syndrome
Tinels test
lightly tapping median nerve to elicit parasthesia
used to test for Carpal tunnel syndrome
progressive shoulder pain AND stiffness
reduced movement especially external rotation
frozen shoulder
adhesive capsulitis
pain on overhead activities
if drop arm test is + =
if - =
+ = rotator cuff tear
- = rotator cuff tendonitis
warm painful lump on thigh
systemic symptoms
adolescent male
Ewings sarcoma
imaging on ewings sarcoma
onion peel periosteal reaction
warm painful swollen knee
adolescent
osteosarcoma
imaging on osteosarcoma
sunburst appearance periosteal reaction
imaging on chondrosarcoma
fluffy popcorn calcification
osteoporosis Px, Ix, Mx
osteopenic disorder causing fragility fractures
DEXA score < -2.5
lifestyle changes, bisphosphonates
bisphosphonates MOA
inhibits an enzyme that allows osteoclasts to attach to the bone
osteopenia score on DEXA scan
-1 - -2.5
osteomalacia, bone profile results
vitamin d / phosphate deficiency
low calcium, low phosphate.
raised ALP, raised PTH
osteomalacia vs rickets
similar bone profile results
Rickets is a bone development disorder affecting children
Rickets px
frontal bossing
thickened wrists
bowed legs
delayed growth
deformity of bones, weakening
normal bone profile except isolated raised ALP
what is this???
Paget’s disease
Osteogenesis imperfecta PX
weak, brittle bones
blue sclera
hearing loss
proximal vs distal biceps tendon rupture
proximal = painless, retains function, manage conservatively
distal = painful, no function, surgery required
12 year old boy, limp, pain in the thigh. leg is held externally rotated
obese, hypothyroidism
minor trauma 2 months ago
Slipped upper femoral epiphysis
Ix and Mx of SUFE
X ray
Mx: surgery to correct femoral head position
3 common osteoporotic fractures
vertebral wedge fracture
Colles (wrist) fracture
neck of femur (hip) fracture
risk factors for osteoporosis
SHATTERED FAMILY
steroid use
hyperthyroidism
alcohol
low testosterone
thin
erosive bone disorder
renal failure
early menopause
diet
family history
male adolescent, sporty, unilateral anterior knee pain. have to stop and rest frequently. chronic.
what and Mx ????
Osgood-Schlatter disease
Mx: analgesia, modify activites
elbow pain, works as a carpenter (repetitive movements)
relieved by rest
+ve Cozens test
lateral epicondylitis
classic triad of fat embolus
confusion
hypoxemia
petechial rash
posterior hip dislocation Px
what nerve is injuried and effect
internally rotated
slightly flexed and adducted
sciatic nerve injury
reduced sensation in foot, posterior leg
weakness in foot dorsiflexion
anterior hip dislocation Px
what nerve is damaged and effect
externally rotated
slightly flexed, abducted
femoral nerve injury
impaired knee extensor function, sensory loss over femoral area
femur fracture Px
shortened leg, externally rotated
central retinal vein occlusion fundoscopy
stormy sunset (retinal hyperaemia & haemorrhages)
central retinal artery occlusion fundoscopy
pale retina with a cherry red spot
Px of carpal tunnel syndrome
numbness, tingling, pain in hand during night
Lateral epicondylitis Px
Pain upon resisted wrist extension
Pain upon passive wrist flexion
Point tenderness of the lateral epicondyle
Pain on outer part of elbow
fall on outstretched hand
radial fracture
dislocation of the radio-ulnar joint
galaezzi fracture-dislocation
child’s displaced supracondylar fracture of humerus MX?
reduction under anaesthesia
pin fixation
apply a. collar and cuff while arm is flexed
what level of vertebral fracture is associated with osteoporosis
below T4
what muscles are involved in shoulder abduction at what degrees
0-15: supraspinatus (rotator cuff)
15-90: deltoid
90-180: trapezius + serrates anterior (pulls scapula up)
decision to perform X ray on ankle is based on….
Ottawa ankle rules
- inability to weight bear
-point tenderness at posterior edge of lateral/medial malleolus
red flags for back pain
thoracic pain
new onset pain in <20 or >55
progressive neurological deficit
bladder or bowel dysfunction
supracondylar fractures cause damage to what nerve
what is the effect
median nerve
loss of sensation to palmar aspect of 1st and 2nd fingers (can’t make a fist - hand of benediction)
weakened wrist flexion
mid humerus shaft fractures cause damage to what nerve
what is the effect
radial nerve
wrist drop
poor extension of forearm
medial humeral epicondyle injury causes damage to what nerve
what is the effect
ulnar nerve injury
loss of sensation to fifth finger
what vertebral level is spine of scapula
t3
what vertebral level is superior aspect of iliac crest
l4
dupuytrens contracture
caused by tendon thickenings
fingers will curl into hands
Risk factors: alcohol, smoking, hand trauma
McMurray test
patient lays flat on bed, knee bent
proximal hand holds the knee
distal hand extends it, internally and then externally rotates it
test for meniscal tears
imaging modality for suspected meniscal tears
MRI
potts disease Px and Mx
spinal tuberculosis
most common extra pulmonary manifestation of TB
Px: back pain, issues with mobility, reduced bladder/bowel function -> this stems from the increased load on the vertebral column
Mx: TB drugs + spinal immobilisation
What is osgood schlatter disease
knee pain in athletically immature child
traction of the patellar tendon at the tibial tubercle (happens during growth spurt)
skiiers/gamekeepers thumb
Px
tear of the ulnar collateral ligament
occurs on forceful abduction of the thumb
weak pincer grip
de quervains tenosynovitis
idiopathic inflammation of the extensor pollicus brevis and the abductor pollicus longus
how to do posterior drawer test
+ indicates ?
palpate the joint line with the patient lying supine and knee flexed at 90degrees
push the tibia back posteriorly in an explosive movement
+ test = PCL tear
management of slipped capital femoral epiphysis
in situ screw fixation
rickets bone profile results
low vit D
low Ca
Low PO
high ALP
high PTH
osteoporosis bone profile results
normal all
malignant hypercalcemia bone profile results
high Ca
low PO
high ALP
high PTH
hyperparathyroidism bone profile results
high Ca
low PO
high PTH
high ALP
pagets disease bone profile results
normal Ca
normal PO
high ALP
normal PTH
how does spinal cord injury present initially
flaccid limb paralysis below the level of the lesion + autonomic features (bradycardia, hypotension)
this wears off
then presents with upper motor signs: hyperreflexia, spasciticty
reactive arthritis
px and causes
urethritis, arthritis, conjunctivitis
causes: chlamydia, salmonella, shigella, campylobacter
autonomic dysreflexia
cause, assoc, px
occurs in spinal cord lesions above t6
it is caused by a reaction below the spinal lesion e.g. UTI, full bladder, changing catheter
Px: bradycardia, or tachy, severe hypertension, sweating, flushinh
in what joints do bunions appear
metatarsophalangeal
3 types of ankle fractures and how to manage
Weber A: fracture of fibula below the level of the syndesmosis
Weber B: fracture at the level of the syndesmosis
Weber C: fracture above the syndesmosis
Weber C can also px with diastasis of fibula and talus displacement
Mx: Weber A = below knee cast
Weber B + C = ORIF, plates + screws
mx of hip dislocation
reduced under GA within 4 hrs
fat embolism px
fever
resp : hypoxia,
neurological: confusion
petechial rash
4 risk factors for congenital hip dislocation
- breech presentation
- oligohydramnios
- first born
- female gender
Pain on the radial side of the wrist/tenderness over the radial styloid process
suspect de quervains tenosynovitis
scaphoid fracture suspected, imaging inconclusive what to do
wrist splint
follow up in 7 days
late sign of cauda equina
urinary incontinence
Twisting sporting injuries followed by delayed onset of knee swelling and locking
meniscal tear
During a tackle he is twisted with his knee flexed. He hears a loud crack and his knee rapidly becomes swollen
ACL rupture
salter harris classification
type 1 = Straight across epiphyseal plate
type 2 = Above the epiphysis
type 3 = Lower than the epiphysis
type 4 = Through the epiphysis
type 5 = ERasure of the growth plate
Urate lowering therapy
allopurinol with colchicine cover
