Ortho Flashcards
Presentation of carpal tunnel syndrome
Sensory loss on first three digits +/- thenar wasting. Exacerbated by hyperflexion and tapping carpal tunnel
How to diagnose carpal tunnel syndrome?
Nerve conduction velocity
How to treat carpal tunnel syndrome
Splinting, injected steroids, release surgery.
DeQuervain’s Tenosynovitis presentation
Thumb pain
How to diagnose dequervain’s tenosynovitis?
Fist + ulnar deviation
How to treat dequervain’s?
NSAIDs + splinting
Steroids if unresponsive
Trigger finger pathogenesis?
Inflammation of middle finger fascia
How does trigger finger present?
Patient unable to extend finger, pop when extended
Treatment for trigger finger?
Steroids
Jersey finger pathogenesis
Torn flexor tendon
Jersey finger presentation
Can’t flex finger.
How to treat jersey finger?
Splinting
Mallet finger pathogenesis
Torn extensor tendon
Presentation of mallet finger?
Can’t extend finger
Treatment for mallet finger?
Splinting
Dupuytren’s contracture pathogenesis?
Fascia of palm hardens
Typical dupuytren’s contracture patient?
Old, scandanavian, alcoholic with palpable nodules on palm
How to treat dupuytren’s contracture?
Surgical release
Felon. Patient presentation?
Abscess of finger pulp that develops post penetrating injury. Finger is exquisitely tender to palpation. Patient has leukocytosis and fever.
How to treat felon?
I+D and antibiotics
Plantar fasciitis typical patient
Old overweight with heel pain when walking that’s worse in the morning.
How to diagnose plantar fasciitis?
Foot XR reveals bony spur, but true pathogenesis is still unknown.
How to treat plantar fasciitis?
Wait 12-18 months, possibly remove bony spur.
Morton neuroma pathogenesis?
Inflammation of common digital nerve at the 3+4th toe space. From wearing shoes like cowboy boots.
Presentation of morton neuroma?
Tender and palpable nodule.
How to treat morton neuroma
Better shoes, pain control. Surgery eventually
Age, presentation, diagnosis, treatment of developmental dysplasia of hip
Newborn, pt has clicky hip on barlow and ortolani, diagnose with ultrasound. Treatment with a harness.
Age, presentation, diagnosis, treatment of Legg-Calve-Perthes
Age 6, presentation insidious with antalogic gait, diagnosis with XR, treatment with casting.
Age, presentation, diagnosis, treatment of slipped capital femoral syndrome
Age 13, presentation is in fat kid/growth spurt with atraumatic hip and knee pain, diagnose with frog leg XR, treat with surgery
Age, presentation, diagnosis, treatment of septic hip/
Any age, presentation with fever and hip pain, dx with arthocentesis, treat with drainage and antibiotics
Osgood schlatters pathogenesis?
Osteochondrosis
Presentation of osgood schlatters/osteochondrosis?
Teenage athlete with knee pain and swelling.
Treatment of osgood schlatters?
Two options: work through it, will cause permanent palpable nodule. Rest and cast is completely curative
Scoliosis presentation
In teenage girl, if moderate only cosmetic deficit. If severe can cause shortness of breath.
How to diagnose scoliosis?
Adam’s test, have patient bend down, feel spine. Look for different shoulder height?
Then get XR
How to treat scoliosis
Wear a brace. That’s all that’s necessary. No surgery or rods.
Ewing’s sarcoma pathology and location
t (11,22), midshaft bone lesion with onion skinning on pathology
Presentation of Ewing’s sarcoma?
Atraumatic focal bone pain.
Diagnosis of ewing’s sarcoma
XR/MRI. Then take a biopsy
Treatment of ewing’s sarcoma
Surgery
Osteosarcoma pathology and location?
Rb gene (patient may also have had retinoblastoma), sunburst pattern on XR. Location is metaphyseal and usually around the knee, distal femur/proximal tibia.
Presentation of osteosarcoma
Atraumatic focal bone apin
Diagnosis of osteosarcoma
XR/MRI. Biopsy is necessary
Treatment of osteosarcoma?
Surgery.
How to treat fracture in kids
If involves the growth plate, ORIF is needed. If it doesn’t involve the growth plate, only casting needed.
Acute hematogenous osteomyelitis patient and presentation
Usually in kids that have had febrile illness. Usually around metaphysis
How to diagnose acute hematogenous osteomyelitis
MRI is best because XR isn’t telling for several weeks.
Genu Varum, normal until what age? What happens after
Bow-legs, normal until age 3. Past age 3, there is a concern for blount disease (which is a disturbance of medial growth plate function). Treat with surgery
Genus Valgus, normal until what age
(Knock knees) Normal from 4-8. No treatment needed
Club foot and treatment
Can be seen at birth (in equinovarus). Treat with serial casting.
One of the worst childhood fractures. Why?
Supracondylar humeral fracture. Occurs with hyperextension of elbow during fall on outstretched arm. High frequency of vacsular and nerve damage and can cause a Volkman contracture (claw hand).
How to treat supracondylar humeral fracture in children?
Treat with casting or traction with special attention to neurovascular status.
Can childhood fractures that involve growth plate be subject to closed reduction
Yes if they don’t penetrate the growth plate or cross the joint.
Location of soft tissue sarcoma mets?
Lung, not lymph nodes.
How to treat soft tissue sarcoma?
Wide excision, radiation, chemo
Most common location of clavicular fractures?
Between middle and distal thirds. Treat with sling
Common complication of anterior shoulder dislocation
Numbness of deltoid from axillary nerve injury
How to ensure posterior shoulder dislocation isn’t missed
Get axillary or scapular views on XR
Colles Fracture and tx
Common in elderly after fall on outstretched hand. Dorsally displaced dorsally angulated distal radius fracture. Treat with closed reduction and long arm cast.
Monteggia Fracture
Occurs when ulna gets direct blow. Proximal ulnar fracture with dislocation of radial head at elbow.
Galeazzi fracture
Direct blow to radius causes distal radius fracture followed by anterior dislocation of ulna at wrist.
How to treat monteggia and galeazzi fractures
ORIF of broken bone, closed reduction of dislocation
Scaphoid fracture and treatment
From fall on outstretched hand, pain in anatomic snuffbox. Treat with thumb cast but careful because scaphoid fractures have high rate of nonunion.
What causes a metacarpal neck fracture?
Fist hitting wall.
Appearance of patient with hip fracture
Leg is shortened and is externally rotated.
How to treat femoral neck fracture.
Blood supply will probably be compromised so femoral head must be replaced
Intertrochanteric femur fracture treatment
Treat with ORIF because less risk of AVN. Ensure post operative anticoagulation.
Femoral shaft fracture treatment
Treat with intramedullary rod fixation.
Complications of femoral shaft fracture
If bilateral and comminuted can cause shock. If open, take patient for emergency surgery within 6 hours.
How to treat knee ligamentous injuries?
Fix if athletes, otherwise immobilize and rehab.
Meniscal tear presentation
Pain and slow swelling. Click when knee is tended.
Presentation of tibial stress fracture?
Very specific point tenderness. From forced marches.
Compartment syndrome presentation and causes
Seen in forearm and lower leg, Pulses may still be present but patient will have numbness and tingling first. Caused by crush injuries, reperfusion injury, trauma.
How to treat compartment syndrome?
Emergency fasciiotomy.
Action if pain under cast?
Remove and examine
Open fractures?
OR cleaning and reduction within 6 hours.
How does posterior dislocation of hip occur?
Femur driven backwards after head-on collision.
Appearance of patient with posterior dislocation of hip? Treatment?
Leg is shorted and INTERNALLY rotated. Need to treat emergently because it can disrupt blood supply
How to treat gas gangrene
IV penicillin, hyperbaric O2, emergency debridement.
What injuries damage the radial nerve? Patient presentation? Treatment needed?
Fractures at middle and distal 1/3 of humerus. Patient can’t extend wrist. If function back after closed reduction then no surgery needed, if not, then surgery needed
Popliteal artery can be injured when?
Posterior dislocation of knee. Prompt reduction is best but prophylactic fasciotomy may be needed to avoid compartment syndrome.
How to diagnose developmental hip dysplasia? Why use that technique?
Sonogram because hip joint isn’t calcified yet.
Which malleolus breaks in an ankle injury?
Both!!!!
Most reliable physical finding for compartment syndrome?
Excruciating pain with passive extension
How to deal with pain under a cast?
Removal of cast
Next step if patient has a facial fracture or closed head injury?
Evaluate the c spine!
