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Ortho Flashcards

0
Q

Legg-Calve-Perthes disease: a vascular necrosis of capital femoral epiphysis

A 
Around age 6
Insidious onset limping, decreases hip motion, and hip/knee pain
Antalgic gait 
Passive motion of hip guarded
Dx with AP/lat X-ray of hip
Casting and crutches
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1
Q

Developmental dysphasia of the hip

A

Runs in families
Should be dx at birth
Uneven gluteal folds
Easily dislocated posterior with jerk and click and returned with snap
U/S is diagnostic
Tx w/ abduction splint w/ pavlik harness 6 mo

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2
Q

Slipped capital femoral epiphysis

A 
Ortho emergency
Chubby boy age 13 
Pain in groin or knee with limp
Dangle legs, sole of foot on affected side points to other foot
Limited hip motion
When hip flexed thigh externally rotates and can't be rotated internally
Dx with X-ray
Tx with pins in femoral head
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3
Q

Septic hip

A

Emergency
Toddlers who’ve had febrile illness then refuse to move hip
Hold hip flexed slight abduction and ext rotation
Won’t allow passive movt
Elevated sed rate
Dx: aspiration under anesthesia
Open drainage if pus

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4
Q

Acute hematogenous osteomyelitis

A

Kids with febrile illness
Severe localized pain in bone no trauma
MRI dx
Antibiotics tx

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5
Q

Genu varum

A

Bowlegs
Normal to age 3, no tx
Beyond age 3 often Blount disease-disturbance of medial proximal tibial growth plate
Surgery to tx

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6
Q

Genu valgus

A

Knock knee
Normal age 4-8
No surgery

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7
Q

Osgood schlatter disease

A

Teens with persistent pain over right tibial tubercle
Aggravated by quads contraction
Localized tenderness over tibial tubercle
No swelling
RICE if unsuccessful then cast

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8
Q

Club foot

A

Seen at birth
Both feet turned in, ankle plantar flexed, adduction of forefoot, tibia internal rotation
Tx with serial casts in infant
Often Achilles tenotomy and long term braces
If no response, surgery 9-12mo

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9
Q

Scoliosis

A 
Adolescent girls spine curves to RT
Seen from Behind while bending over
Progresses until skeletal maturity
Severe cases decrease pulmonary fxn
Braces stop, surgery if severe
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10
Q

Supracondylar fractures of humerus

A

Hyperextension of elbow in child w/ FOOSH
Neurovascular injuries can easily occur
Can lead to Volkmann contacture (claw like deformity due to necrosis of flexors)
Tx w/ casting or traction, seldom surgery
Must monitor neurovascular integrity and compartment syndrome

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11
Q

Growth Plate Fractures

A

CLosed reduction if epiphysis and plate displaced laterally from metaphysis in one piece
Open reduction with internal fixation if in 2 pieces

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12
Q

Osteogenic sarcoma

A

most common primary malignant bone tumor
Ages 10-25
Usually around knee- lower femur or upper tibia
Sunburst pattern on x ray

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13
Q

Ewing Sarcoma

A

2nd most common primary malignant bone tumor
Ages 5-15
Grows on diaphysis of long bones
Onion skinning on x ray

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14
Q

Adult Malignant bone tumors

A

Most metastatic
From breast in women (lytic)- pathologic fracture
From prostate in men (blastic)
MRI best dx

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15
Q

Multiple Myeloma

A

Old men w/ fatigue, anemia, localized pain on several bones
X ray shows multiple punched out lytic lesions
Bence-jones proteins in urine
Abnormal immunoglobulins
Tx w/ chemo, if fails, use thalidomide

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16
Q

Soft Tissue Sarcoma

A 
Relentless growth anywhere in body 
Firm, fixed to surrounding structures
Mets to lungs but NOT LNs
MRI may dx
Very wide excision with radiation
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17
Q

Clavicular Fractures

A

Junction of middle and distal 3rd
Treated with sling
Young females with displaced fx may have surgery

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18
Q

Anterior dislocation of the shoulder

A

By far most common type
Hold arm close but rotated out as if to shake hands
May have numbness over deltoid from stretching axillary nerve
AP/lateral X ray dx

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19
Q

Posterior dislocation of shoulder

A

Rare- often seizure or electrical shock
Arm held close with internal rotation
Axillary views or scapular lateral views to dx

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20
Q

Colles Fracture

A

FOOSH in old ladies
Deformed wrist looks like dinner fork
Dorsally displaced and angulated fracture of distal radius
Tx w/ closed reduction and long arm cast

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21
Q

Monteggia fracture

A 
Direct blow to ulna 
Diaphyseal fx of proximal ulna
Anterior dislocation of radial head
Open reduction and internal fixation if fx
Closed reduction if only dislocated
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22
Q

Galeazzi Fracture

A

Distal 3rd of radius direct blow w/ fx
Dorsal dislocation of distal radioulnar joint
Open reduction and internal fixation if fx
Closed reduction if only dislocated

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23
Q

Scaphoid fracture

A

Young adult FOOSH
Wrist pain and tenderness in anatomic snuff box
Undisplaced: spika thumb cast even if neg xray
Displaced and angulated: open reduction internal fixation
Very high rate of nonunion

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24
Metacarpal neck fracture
``` Typically 4th or 5th or both Closed fist hits hard surface Hand swollen and tender; X ray dx Closed reduction and ulnar gutter splint if mild K wire or plate fixation if bad ```
25
Hip fracture
Little old ladies fallen and can't get up | Affected leg shortened and externally rotated
26
Femoral neck fracture
Compromise femoral head blood supply | Best tx is femoral head replacement
27
Intertrochanteric hip fractures
Less likely to lead to avascular necrosis Open reduction and internal fixation' Immobilization has high risk of DVT and PE- anticoagulation recommended
28
Femoral shaft fractures
Intramedullary rod fixation Can have substantial blood loss If open, emergency req OR cleaning and closure <6h May lead to fat embolism
29
Collateral ligament injuries
Sideways blow to knee Medial blow disrupts lateral ligaments vice versa Swollen localized pain on palpation Abduction pain (valgus stress) shows medial tear Adduction pain (varus stress) shows lateral tear Hinged cast; surgery if several tears
30
ACL injuries
``` More common than PCL Severe swelling and pain Anterior drawer test and Lachman test MRI dx Tx with arthroscopic reconstruction ```
31
PCL Injuries
Less common Severe swelling and pain Posterior drawer test MRI dx
32
Meniscal Tears
Seen on MRI Protracted pain and swelling after knee injury Catching and locking and clicking when forcefully extended Repair done to save as much meniscus as possible Complete meniscectomy leads to late development of degenerative arthritis Injury to medial meniscus, MCL and ACL ofter simultaneous
33
Tibial stress fractures
Young men forced marches Tenderness to palpation over specific bone point X ray normal, repeat 2 wk Cast and crutch
34
Leg fracture of tibia and fibula
``` Pedestrian hit by car Angulation on exam Dx X ray Casting if easily reduced Intramedullay nail if not aligned Lower leg can get compartment syndrome ```
35
Ruptured achilles
out of shape middle age men working thru strain Loud pop with plant and pivot; fall and clutch Limited plantar flexion, pain, swelling, limp palpation of tendon reveals gap Casting in equius position or surgery
36
Ankle fracture
Fall on inverted or everted foot Both malleoli break Dx: AP lateral and mortise x rays Open reduction and internal fixation if displaced fragments
37
Compartment syndrome
``` Often forearm and lower leg Causes: crush or trauma; lower leg fx w closed reduction Pain and limited use Feels tight and TTP Excruciating pain w/ passive extension Emergency fasciotomy ```
38
Open fractures
Req cleaning in OR within 6 hrs
39
Posterior dislocation of hip
Femur driven backwards like head on crash Hip pain w/ leg shortened, adducted and internally rotated Emergency reduction to avoid avascular necrosis
40
Gas gangrene
Deep penetrating dirty wounds 3 dats later sick, toxic, moribund Tender swollen discolored and gas crepitus Tx IV penicillin, emergency surgical debridement
41
Radial nerve injury
Oblique fracture of middle to distal 3rd humerus If reduction improves dorsiflexion then no surgery If paralysis after reduction then Surgery
42
Popliteal artery injury
Posterior dislocation knee Pulses by Doppler ct angio Prompt reduction minimize vascular compromise
43
Carpal tunnel syndrome
Women w repetitive hand work Numbness and tingling in hands esp at night Esp radial 3.5 fingers-median nerve distro Phalens and tynells signs X-ray to r/o others Initial splints and anti inflammatory Surgery w/ preop EMG
44
Trigger finger
Favors women Acutely flexed and unable to extend Must pull out to extend- painful snap Steroid injection first. Surgery last
45
DeQuervain tenosynovitis
Young mothers carrying baby with wrist flexion and thumb extension Pain in radial wrist and first dorsal compartment Reproduce by thumb inside fist and ulnar deviation Splint and anti inflammatory or steroid injection
46
Dupuytren contracture
Old Norwegian men Contracture of Palm of hand, with nodules and cords Surgery if advanced and can't place palm flat
47
Felon
Abscess of fingertip pulp from penetrating injury Throbbing pain w abscess symptoms-fever Multiple fascial trabeculae, pressure can build and cause necrosis Urgent surgical drainage
48
Gamekeeper thumb
Ulnar collateral ligament injury from forced hyper extension of thumb Often skiing Collateral laxity at thumb MCP joint Untreated can lead to dysfunction, pain, and arthritis Casting done
49
Jersey finger
Flexor tendon injury when finger forcefully extended When making fist, dista phase doesn't flex Splinting
50
Mallet finger
Extended finger forcefully flexed & extensor tendon rupture-volleyball Tip flexed when fingers extended Splinting
52
Traumatic amputation of digits
Surgically reattach Cleaned with sterile saline, wrapped in saline moist gauze put in a bag and placed on ice No antiseptic, no alcohol, no dry ice Use electric nerve stim to preserve neuromuscular fxn
53
Lumbar disk herniation
Almost exclusively at L4-5 or L5-S1 Incidence age 45-46 Several month aching pain from pressing anterior spinal ligament Then sudden onset neurgenic pain from movt Electric shock down the leg to big toe (L4-5) or little toe (L5-S1) Pain exacerbated by cough, sneeze, poop Cannot ambulate or flex affected leg Excruciating pain w/ straight leg test MRI to confirm tx: 3wk bed rest and pain control (nerve block) Surgery if persistent neurologic deficits Emergency if cauda equina symptoms- distended bladder, flaccid rectal sphincters, saddle anesthesia
54
Cauda Equina syndrome
distended bladder, flaccid rectal sphincters, saddle anesthesia Surgical emergency req immediate decompression
55
Ankylosing spondylitis
``` Young men 30-40 Chronic back pain and morning stiffness Pain worse at rest and improves with activity Progressive symptoms Xray shows bamboo spine eventually Anti inflammatories and PT HLA B27 antigen Associated with uveitis and IBD ```
56
Metastatic malignancy to spine
``` Elderly Progressive back pain worse at night Unrelieved with rest or position change Weight loss Women: lytic breast cancer mets at pedicles Men: blastic prostate mets MRI best dx ```
57
Diabetic ulcers
Typically indolent Located at pressure points: heel, metatarsal head, tips of toes Start due to neuropathy Fail to heal b/c microvascular disease Heal with good diabetic control, clean, elevated leg for many weeks Often get worse and lead to amputations
58
Ulcers from arterial insufficiency
Usually at tips of toes Dirty, pale base devoid of granulation tissue Other symptoms of arteriosclerotic occlusive disease: absent pulses, trophic changes, claudication or pain at rest Doppler studies looking for pressure gradient CT angio, MRI angio, or arteriograms Surgical revascularization angioplasty, or stents
59
Venus stasis ulcers
In chronically edematous, indurated and hyperpigmented skin above medial malleolus Painless with granulation bed Patient has varicose veins and frequent cellulitis Duplex scan Tx: support stockings, ace bandages unna boot Surgery: vein stripping, ulcer graft Endovascular ablation
60
Marjolin ulcer
Squamous cell carcinoma of skin developing in chronic leg ulcer Setting of chronic healing and breakdown such as untreated 3rd degree burns, chronic draining sinus Dirty, deep ulcer, healing at edges Biopsy dx Wide local excision and skin grafting
61
Plantar Facitis
``` Older, over weight Disabling sharp heel pain when foot strikes Worse pain in AM Xray shows bony spur at location of pain Exquisite TTP over the spur Spontaneous resolution 12-18mo Symptomatic tx until resolves Podiatrist remove bony spurs ```
62
Morton neuroma
Inflammation of common digital nerve at 3rd interspace b/t 3rd & 4th toes Neuroma is palpable at very tender point there Caused by pointed high-heels that bunch toes Conservative: analgesics and sensible shoes Surgery to remove
63
Gout
Swelling, redness, exquisite pain of sudden onset at 1st MTP joint Middle age obese man with high serum uric acid Uric acid crystals in joint fluid Acute tx is indomethacin and colchicine Long term allopurinol and probenicid

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