Ortho Flashcards
Fracture management
- Resuscitate - ATLS,
-trauma series in primary survey CT head c- spine chest abdominal pelvis. Fractures assessed in secondary survey
- neuro vascular status
-consider reduction and splinting before imaging - Reduction - displaced fractures - closed vs open manipulation
- Restriction metal vs non metal. Internal vs external
Collar and cuff, plaster, slings etc - Rehabilitation - use move strengthen weight bear
Physio, OT, social services
Open fracture management
Immediate : IV abx 1 hour, reduce + splint, photo and dress with saline gauze
Debridement
Immédiate - highly contaminated or vascular compromise
<12 hours : high energy fracture
<24 hours: low energy fracture
Fixation : ORIF if soft tissue intact, external if soft tissue damaged
Complications of fracture
Immediate - neurovascular injury, muscle/tendon injury
Early <30 days
- fat/ venous embolism
-immobility
-infection
Delayed >30 days
-non/mal-union
-degenerative changes
-complex regional pain
Causes of trendelenburg gait
Weak hip abductors e.g polio or paresis of superior gluteal nerve after total hip replacement
Structural hip joint probs e.g. congenital dislocation of hip
Painful hip joint problems e.g. osteoarthritis
Spondylosis vs spondylolisthesis
1 defect in pars articulatis of vertebral arch (degenerative)
2 one vertebral slipping anteriorly on inferior vertebra
Spondylosis vs spondylolisthesis
1 defect in pars articulatis of vertebral arch (degenerative)
2 one vertebral slipping anteriorly on inferior vertebra
Spinal pathology
Mechanical pain
Myelopathy
Degenerative disc disease
Osteoporotic fracture
Disc protrusion - look for cauda equina
Nerve root compression- radicular pain
Sacroiliac joint inflammation - pain in buttocks
Ankylosing spondylitis - extra articular
Spinal stenosis - relieved by rest and spinal flexion, narrowing of spinal canal due to degenerative changes in intervertebral discs and facet joints
TB infection
Malignancy
Emergencies - cauda equina , spinal cord compression
Lordosis and kyphosis
Cervical lordosis - hyper= degenerative joint disease
Thoracic kyphosis - hyper= scheuermann’s disease (congenital wedging of vertebrae
Lumbar lordosis - loss =sacroiliac joint disease e.g. ank spon
