ortho Flashcards
commonly replaced joints
knee
hip
shoulder
indications for joint replacement
OA
fracture
septic arthritis
bone tumour
RA
hemiarthroplasty
half the joint is replaced
what happens in a total hip replacement
lateral incision
metal/ceramic replacement head of femur
stem cemented or uncemented
acetabulum hollowed out and replaced with metal socket
what happens in a total knee replacement
vertical anterior incision
articular surfaces of femur and tibia removed and replaced with metal
spacer added
what happens in a total shoulder replacement
usually anterior incision
head of humerus replaced and glenoid socket replaced my metal
what is a reverse shoulder replacement
sphere in glenoid and cup to replace head of humerus
VTE prophylaxis THR
LMWH 28d
VTE prophylaxis TKR
LMWH 14d
common cause prosthetic joint infection
staph aureus
RF prosthetic joint infection
prolonged operation
obese
DM
mx prosthetic joint infection
irrigation
debridement
replacement
+abx
what is a compound #
skin broken
what is a stable #
sections of bone still in allignment
types of fracture
transverse
oblique
spiral
segmental
comminuted
compression
typically only in children
greenstick
buckle
what # can only happen in children
salter-harris (growth plate)
what is a colles fracture
transverse # distal radius and the distal portion displaces posteriorly (up) = dinner fork deformity
cause colles #
fall onto outstretched hand
common cause scaphoid #
fall onto outstretched hand
sx scaphoid #
tenderness in anatomical snuffbox
why is there a risk of avascular necrosis and non union with scaphoid #
retrograde blood supply
bones with vulnerable blood supply
scaphoid, femoral head, humeral head, talus, navicular, 5th metatarsal
weber classification for # lateral malleolus
A=below ankle joint therefore syndesmosis intact
B=at joint therefore syndesmosis intact or partially torn
C=abive joint therefore syndesmosis disrupted
major complication pelvic ring #
intra abdo bleeding
what bones commonly # in pathological #
femur
vertebral bodies
cause of pathological #
osteoporosis
pagets
tumour - prostate, renal, thyroid, breast, lung metastasise to bone
fragility #
withou approproate trauma, due to osteoporosis
ix for #
2 view XR
CT if inconclusive
fracture mx
- mechanical aligment: open or closed reduction
- relative stability: cast, k wire, intramedullary nail, screw
early # complications
damage to local structures
haemorrhage
compartment syndrome
fat embolism
VTE
long term # complications
delayed union
malunion
non-union
avascular necrosis
infection
joint instability/stiffness
contractures
arthritis
chronic pain
complex regional pain syndrome
when/how does a fat embolism occur
24-72hr after #
# long bone -> fat globules released ->lodged in vessels->obstruction
criteria for fat embolism
GURDS
major=resp distress, petechial rash, cerebral involvement
minor inc jaundice, thrombocytopenia, fever, tachycardia
RF hip #
age
osteoporosis
F
mx hip #
sugrery within 48h
analgesia
VTE mx
orthogreis MDT
wt bear and physio
types hip #
extracapsular
intracapsular-femoral neck
extracapsular hip #
outside capsule so blood supply to head of femur intact
mx extracapsular hip #
intertrochanteric=screw
subtrochanteric=nail
intracapsular hip # classification
GARDEN
1. incomplete # non displaced
2. complete # non displaced
3. partial displacement
4. full displacement
intracapsular hip # mx
non-displaced=screw
if 3 and 4 then vessels damaged so head of femur needs replacing
sx hip #
> 60y
fall - why
pain in groin/hip
cant wt bear
shortened, abducted externally rotated leg
ix hip #
XR - AP and lateral views
on AP seee disruption to shentons line in nof
what causes compartment syndrome
usually # or crush injury
increased pressure in fascial compartment due to bleeding/oedema
cuts off blood supply
where does compartment syndrome usually occur
legs
sx compartment syndrome
5 PS!!
disproportionate pain
paraesthesia
pale
pressure
paralysis
ix compartment syndrome
needle manometry
mx compartment syndrome
elevate
good BP
emergency fasciotomy
debridement every few d
wound closure in weeks
chronic compartment syndrome
on exertion
sx chronic compartment syndrome
pain, numbness, paraesthesia
mx chronic compartment syndrome
fasciotomy
what is osteomyelitis
inflammation bone and bone marrow
common cause osteomyelitis
staph aureus
RF osteomyelitis
open#
operation
DM
PAD
IVDU
immunosuppressed
sx osteomyelitis
fever
pain
erhythema
swelling
XR findings osteomyelitis
none
periosteal rxn
localised osteopenia
destruction
best ix osteomyelitis
MRI
mx osteomyelitis
surgical debridement + abx (6w fluclox)
most common bone tumour
osteosarcoma
chondrosarcoma
cancer from cartilage
ewing sarcoma
cancer of bone and soft tissue in children and young aduls
rhabdomyosarcoma
skeletal muscle tumour
leimyosarcoma
smooth muscle tumour
sx sarcoma
soft tissue lump, bone swelling, persistant bone pain
ix sarcoma
XR
CT or MRI
biopsy
mx sarcoma
surgery
chemo
radio
causes mechanical backpain
muscle/ligament sprain
facet joint dysfunction
SIJ dysfunction
herniated disc
spondylolisthesis
scoliosis
degeneration
spondylolisthesis
anterior displacement vertrba
causes neck pain
muscle/ligament strain
torticollis
whiplash
cervical spondylosis
red flag causes back pain
spinal #
cauda equina
spinal stenosis
ankylosing spondylitis
infection
other causes of back pain
pneumonia
ruptured AAA
kidney stone
pyelonephritis
pancreatitis
prostatitis
PID
endometriosis
sciatic nerve root
L4-S3
sx sciatica
unilateral pain from buttock down
paraeshtesia
numbness
weakness
causes of sciatica
compression sciatic nerve - herniated disc, spinal stenosis, spondylolisthesis
mx sciatica
physio
analgesia
amitryptiline
duloxetine
injections
surgical decompression
mx lower back pain
if mechanical no further ix
if unsure cause - XR, CT
STarT screening=risk developing chronic
educated, exercise, physio, analgesia (NSAID, codeine)
cauda equina cause
compression (herniated disc, tumour) of cauda equina
sx cauda equina
saddle anaesthesia
loss bladder/bowel sensation and control
urinary retention
bilateral sciatica
weakness
decreased anal tone
LMN SIGNS
mx cauda equina
emergency
MRI and surgucal decompression
features metastatic spinal cord compression
UMN SIGNS AS HIGHER
back pain and motor and sensory deficits
worse when cough/strain
mx metastatic spinal cord compression
MRI
high dose dexamethasone
surgery
chemo
radio
what is spinal stenosis
narrowing spinal cannal
usually cervical or lumbar
types of spinal stenosis
central stenosis=central canal
lateral stenosus=nerve root canals
foraminal stenosis=intervertebral foramina
causes spinal stenosis
congenital
degeneration
herniated disc
thickened ligamentum flavum or post longitudinal ligament
spinal #
spondylolisthesis
tumour
sx spinal stenosis
gradual onset
in central stenosis=intermittent neurogenic claudication (LBP, buttock and leg pain, weakness)
worse standing/walking, better bending forward
ix spinal stenosus
MRI
mx spinal stenosis
exercise
analgesia
physio
decompressive surgery
what is meralgia paraesthetica
compression lateral femoral cutaneous nerve (L1-3)
sx meralgia paraesthetica
sensory sx on anterior upper outer thigh - burning, numbness, paraesthesia
aggravated by walking/standing/hip extension
mx meralgia paraesthetica
wt loss
physio
analgesia - paracetamol, nsaids, amitriptyline
injection
surgery
sx trochanteric bursitis
middle aged
lateral hip/thigh pain
aching
worse with activity
tender
trendelenburg positive
pain on resisted abduction/internal rotation/external rotation hip
mx trochanteric bursitis
ice
rest
analgesia
physio
steroid injections
causes bursitis
friction from movement
trauma
RA
infection = septic bursitis
cause meniscal tear
sport
twisting ->pop
sx meniscal tear
pain
swelling
stiffness
decreased ROM
locking
instability
O/E: tender joint line, Mc Murrays and Apley grind test
mx meniscal injury
conservatibe
nsaids
physio
surgery - arthroscopic repair or resection
ottawa knee rules
XR if: >55y, patella tenderness, fibular head tenderness, cant felx knee to 90 degrees, cant wt bear
ACL
originated from lateral aspect intercondylar notch of femur and attaches to anterior intercondylar area tibia
stops tibia sliding forward
PCL
originates from medial aspect intercondylar notch of femur and attaches to posterior intercondylar area tibia
stops tibia sliding back
cause ACL inury
twist
sx ACL injury
pop when happens
pain, swelling, instability
positive anterior draw and lachmans
mx ACL injury
conservatibve
nsaids
physio
arthroscopic surgery often required - tendon graft from hamstrong/quad
osgood schlatters
inflammation at tibial tuberosity where patella ligament inserts due to multiple small avulsion #
sx osgood schlatters
10-15y
m
hard tender lump
ant knee pain in activity/kneeling/extension
mx osgood schlatters
rest
ice
nsaids
physio
what forms popliteal fossa
semimembranosus and semintendanosus tendons, biceps femoris tendon, medial and lateral heads gastrocnemius
where is bakers cyst
popliteal fossa
causes bakers cyst
non
secondary to degeneration - meniscal tear, OA, RA
sx bakers cyst
pain
palpable lump
reduced rom
fouchers sign=lump smaller when knee flexed to 45 degrees
can rupture = swelling and pain (rarely compartment syndrome)
ix bakers cyst
uss
mx bakers cyst
none
nsaids
physio
injecion
types achilles tendinopathy
insertion (within 2cm of insertion)
mid-portion (2-6cm from insertion)
RF achilles tendinopathy
certain sports
inflammation -RA
DM
high cholesterol
flouroquinolone abx - ciprofloxacin
sx achilles tendinopathy
pain
stiff
tender
swelling
mx achilles tendinopathy
rice
physio
extracoroporeal shock wave
AVOID steroid injection s- increased risk rupture
RF achilles tendon rupture
sports
increased age
achilles tendinopathy
fhx
fluoroquinolone abx
systemic steroids
sx achilles tendon ruptire
pain
snapping sound
feel like hit in back of leg
O/E: dorsiflexed, palpable gap, weak plantar flexion, cant tip toe
positive simmonds calf squeeze
mx achilles tendon rupture
rice
non-surgical: 6-12 weeks in boot, start in plantarflexion the move to neutral and rehab
surgery: reattach then rehab
sx plantar fascitis
gradual onset pain in plantar heel and tender
mx plantar fasciits
rice
nsaids
physio
cause fat pad atrophy
impact
obesity
steroid injecyions
sx fat pad atrophy
pain and tender on plantar heel
mx fat pad atrophy
custom shoes
lose wt
what is mortons neuroma
dysfunctional nerve between 3rd and 4th metatarsal
sx mortons neuroma
pain
sensation of alump
burning
paraethesia
O/E: deep pressure, metatarsal squeeze=pain, mulders sign=painful click
mx mortons neuroma
analgesia
insoles
steroid injection
surgery
hallux valgus
bunions
deformity at 1st MTP ->bony lumo
mx hallux valgus
bunion pad inshoe
analgesia
surgery
adhesive capsulitis
frozen shoulder
primar or secondary to trauma
inflammation and fibrosis in joint capsule ->adhesion
RF adhesive capsulitis
middle age
DM
phases of sx in adhesive capsulitis
1=pain
2=stiff - ext rptation
3=thawing - improves
ix adhesive capsulitis
USS=thickened joint capsule
mx adhesive capsulitis
nsaids, physion, intra articular steroid injection, surgery
rotator cuff mucles
supraspinatus - abducts
infraspinatus - ext rotation
teres minor - int rotation
subscapularis - int rotatio
cause rotator cuff tear
injury
degeneration
overhead activities
sx rotator cuff tear
shoulder pain and weakness
mx rotator cuff tear
surgery useful in acute or full thickness
rice
nsaids
physio
subluxation
partial shoulder dislocation
types shoulder dislocation
mostly anterior
posterior - electrc shocks and epilpesy
associated injuries with shoulder dislocation
labrum tear
bankart lesion
hills sachs lesion
axillary nerve damage
#
rotator cuff tear - older adults
bankart lesion
tear to ant labrum, occur with repeated anterior subluxation od dislocation
hills sachs lesion
compression # posterolateral head of humerus
less stable so risk further dislocations
sx shoulder disliocation
patient usually knows
acute
deltoid appears flattened
apprehension test for instability - not in acute phase
mx shoulder dislocation
relocate
sling
physio
+/- stabilisation surgery
cause olecranon bursitis
leaning on elbow
students, certain jobs
sx olecranon bursitis
swollen, warm, tender, fluctuant at elbow
mx olecranon bursitis
aspirate if think infection
rice
avoid leanin gon
aspiraye
steroid injections
what is a repetitive strain injury
soft tissu irritation, microtrauma and strain due to repetitive activities (small movements, vibration, awkward)
sx repetitive strain injury
pain
ache
weak
cramping
numbness
mx repetitive strain injuet
rice
rest and adapt activity
nsaid
phusio
lateral epincondylitis
tennis elbow
where extensory attach
test for lateral epicondylitis
pain ain weakness
mills test=palpate lateral epincondyle and flex their wrist
cozens test=resistance with hand in fist
medial epincondylitis
golfers elbow
where flexers attach
mx epindondylitis
rest and adapt activities
physio
steroid/FRP injection
what is de quervains tenosynovitis
swelling and inflammation of abductor pollicus longus and extensor pollicus brevis tendons
sx de quervains tenosynovitis
at radial aspect base of thumb-pain, weak, numb
finkelsteins test: make fist with thumb in and adduct wrist
mx de quervains tenosynovitis
rest
spints
nsaids
physio
steroid injectin
rarely surgery to release extensory retinaculum
what is trigger finger
stenosing tenosynovitis
nodule on tendon at A1 pulley at MCP catches tendon in extension so gets stuck
sx trigger finger
finger stuck flexed and pops when released
mx trigger finger
rest
splint
steroid injection
surgery
dupuytrens contracture
nodules and thickening and tighetning palmsar fascia so flexes
ring finger most affected, index lease
RF dupuytrens contracture
agre
fhx
m
vibrating tools
DM
epilepsy
smoking
alcojol
test for dupuytrens conctracture
table top test - cant flatten
mx dupuytrens contracture
none
surgery
carpal tunnel syndrome
compression median nerve in carpal tunnel
RF carpal tunnel syndrome
obesity
repetitive
strain
perimenopause
RA
DM
acromegaly
hypothyroid
sx carpal tunnel
start with at night
worse at night
sensory sx on thumb and 1st, 2md and half 3rd fingers
motor sx = weakness and wasting thernal muscles
tests for carpal tunnel
phalens
tinnels
ix carpal tunnel
nerve conduction studies
mx carpal tunnel
rest
splint
steroid injections
surgery
thernal muscles
abductor pollicis brevis
opponens pollicis
flexor pollicis brevis
bilateral carpal tunnel causes
screen for - RA, DM, acromegaly, hypothyroid
ganglion cysts
synovial fluid from tendon sheath or joint
often in wrist and fingers
sx ganglion cysts
painless
well circumscribed
transilluminate
mx ganglion cysts
USS
resolve spontaneously
needle aspiration
surgucal excision
Describing a fracture
Site: bone and which bit (metaphyses, diaphyses, articular)
Displacement: distal relative to proximal
Soft tissue: open or closed, complications
Principles fracture management
Reduce
Stabilise
Rehab
