Ortho Flashcards
what are the 2 main types of NOF #s?
intracapsular (intramedullary nail, DHS)
extracapsular (?undisplaced/displaced) -> internal fixation - cannulated screws, hemiarthroplasty, THR
Management of a trauma call
Trauma team leader leads trauma call
- someone will be managing bloods
- someone will scribe
- someone will manage survey
- anaesthetist will manage airway
most patients will get a pan CT
patient will be immobilized with blocks and neck stabilisation
ATLS approach -> advanced trauma life support
A->E
AMPLE hx
Allergies
Medications
PMH
Last ate
Events that led up to injury/problem
Management of open #
Broad spectrum IV abx within 1h of coming to ED
assess tetanus status/vaccinate
document neurovascular status (if concerns, escalate!)
take picture
remove debris, place saline soaked gauze over wound
reduce #, immobilize
prepare for theatre (NBM, consent, mark, stop anticoagulation, G&S, clotting)
In theatre:
- washout, debridement, closure, ORIF / external fixation (orthoplastics)
when admitted make sure to think about VTE prophylaxis
Management of a hot, swollen joint
-> SA
admit
joint aspiration -> send for culture, MC&S, crystals
blood cultures, FBC, CRP, LFTs, U&E
+/- sepsis 6
abx (flucloxacillin)
analgesia
VTE assessment
prep for theatre (NBM, bloods, consent)
washout
fat pads in elbow fractures
???
good for diagnosing supracondylar #
What is very important to document when you are an ortho FY1/SHO when examining a patient?
a focused neurovascular examination
What is the crescent sign on x-ray pelvis pathognomonic for?
vascular necrosis of the femoral head
What can you see O/E in a hip fracture?
leg is shortened and externally rotated
1st line ix for ?achilles tendon rupture
USS
What are the indications/benefits of external fixation?
- In extensive soft tissue damage
- lets you see and treat infection much sooner
What are the complications for fractures?
General:
- fat embolus
- DVT
- Infection
- prolonged immobility (UTI, chest infections, sores)
Specific:
- neurovascular
- nonunion/ malunion
- arthritis
- reflex sympathetic dystrophy/ chronic regional pain syndrome
Cause of NOF #
osteoporosis
trauma
combination of both
Hx in NOF #
age
comorbidity
meds
functional baseline, ADLs
social hx (relatives, stairs, ETOH)
describe hemiarthroplasty vs THR on x-ray
Causes of knee effusion
Explain how you would perform the sweep test on the knee
What is used to stabilise a shoulder that was reduced following dislocation?
broad arm sling is most suitable
Mx of trochanteric fractures
they have a good chance of healing well so generally you would opt for a DHS (dynamic hip screw) - not hip replacement
Normal ROM in hip examination
flexion: 120 dg
extension: 10-20 dg (proned)
adduction: 30dg
abduction: 45 dg
int rotation: 40dg
external rotation: 45 dg
How do you perform a Trendelenburg test in aa hip exam?
- ask the patient to stand, can but their arms on their shoulders for stabilisation
- place your fingers/hands on their ASIS bilaterally
- ask the patient to lift one leg up
interpretation:
- ASIS on same level or slightly higher on side of raised leg: normal
- ASIS on side of raised leg drops: hip abductor weakness
How do you perform Thomas’ test?
ask if the pt had ever had a hip replacement! if yes, do not do this test as there is a risk of posterior hip dislocation.
- put your hand under the patients back with the palm facing up
- ask the patient to flex their hip by bringing their knee to the chest
interpretation: look at knee
-> flexion of the knee and lifting off of the knee would show
positive (abnormal) if there is fixed flexion deformity (knee/thigh lifts off)
