Ortho Flashcards
genu valgus is normal b/w what ages?
b/w 4-8
Genu varum is normal up until what age?
Bow legs
nl up to age 3
diagnosis and treatment of septic hip in children
- aspiration of joint
- further open drainage if pus is obtained and use of broad spectrum antibiotics
diagnosis and treatment of slipped capital femoral epiphysis?
Xrays are diagnostic and emergent surgical treatment to pin the femoral head back in place
recognizing septic hip in children
seen in little toddlers who have a febrile illness and then refuse to move the hip. They hold their leg w/ the hip flexed and don’t let anybody try to move it passively.
what type of pt. is slipped capital femoral epiphysis normally seen in? classic physical exam findings?
-typically a chubby (or lanky) boy around age 13 that complains of groin (or knee) pain and are noted to be limping.
- limited hip motion
- as hip is flexed it goes into external rotation and cannot be internally rotated
- when legs dangling, sole of affected leg points toward other leg
how to diagnose and treat Legg-Calve-Perthes disease?
- AP and lateral hip xrays showing fissure and necrosis at the epiphyseal plate
- casting (to contain femoral head within the acetabulum) and crutches
treatment of developmental dysplasia of the hip
abduction splinting w/ Pavlik harness for about 6 months
what is developmental dysplasia of the hip?
genetic disorder in which children have uneven gluteal folds and physical exam of the hips shows that they can be easily dislocated posteriorly with a jerk and a “click” and returned to normal with a “snapping”
what is Legg-Calve-Perthes disease and around what age is it normally seen in a pt.?
avascular necrosis of the capital femoral epiphysis…occurs around 6 yrs old w/ limping, decreased hip motion, and hip (or knee) pain.
only areas where children have special problems w/ fractures
supracondylar fractures of the humerus and fractures of any bone that involve the growth plate
mechanism of injury for supracondylar fractures of the humerus? management of these fractures?
- hyperextension of the elbow in a person who falls on the hand w/ the arm extended
- casting w/ careful monitoring of vascular and nerve integrity and watching for development of compartment syndrome
management of fractures that involve growth plate
- if growth plate is in one piece: closed reduction (cast)
- if growth plate is in two pieces: precise alignment needs to be provided by open reduction and internal fixation (surgical reduction and fixation)
primary malignant bone tumors…what population? symptoms? diagnosis? treatment?
- affects young people (children and young adults)
- persistent low grade pain occurring for months
- Xray will show invasion into adjacent soft tissues w/ a “sunburst” pattern or periosteal “onion skinning” depending on which type
- treatment: highly specialized and left to expert oncologists
most common primary malignant bone tumor? where is it commonly seen? pattern seen no xray?
- osteogenic sarcoma
- lower femur or upper tibia
- sunburst pattern
Ewing sarcoma: where do they grow? pattern on xray?
- diaphyses (shaft) of long bones
- onion skinning pattern
soft tissue sarcomas: characteristics? commonly met. to where? diagnosis? treatment?
- firm, fixed to surrounding structures which grows w/in several months
- MRI can show malignancy but biopsy is diagnostic
- wide local excision, radiation and chemo
- metastasize to lung NOT lymph nodes
general management for adult fractures
if broken bones are not badly displaced or angulated or can be satisfactorily aligned by external manipulation should undergo closed reduction (cast). If not then open reduction and internal fixation (surgery)
management of clavicular fracture
place arm in sling
posterior shoulder dislocation: mech. of injury? diagnosis?
- rare; usually happens after massive uncoordinated muscle contractions, like epileptic seizure or electrical burn
- axillary views or scapular lateral views of xrays
colles fracture: mech. of injury? treatment?
- fall on an outstretched hand (usually in osteoporotic ppl).
- closed reduction and long arm cast.
Fracture of the scaphoid: mech. of injury? diagnosis? treatment?
- falling on outstretched hand
- diagnose w/ Xray
- –if not initially displaced: then xray will be negative so give thumb cast if history is good and physical shows tenderness over snuff box
- –if initial Xray is displaced and angulated: open reduction and internal fixation are needed.
metacarpal neck fractures: usual mechanism of injury? diagnosis? treatment?
- closed fist hitting a hard surface (4th or 5th fingers typically damaged)
- Xray for diagnosis
- treatment depends on degree of angulation, displacement, or rotary malalignment:
- –closed reduction and ulnar gutter splint for mild ones
- –Kirschner wire or plate fixation for bad ones
Hip fractures: mech. of injury? diagnosis? treatment?
- falling down by older person
- pt’s position in a stretcher w/ affected leg being shorter and externally rotated as a clue and Xray as confirmed diagnosis
- treatment depends on specific location
how to promote faster healing and earlier mobilization w/ femoral neck fractures
-replace femoral head w/ a prosthesis
intertrochanteric fracture management
open reduction and internal fixation, w/ post op anticoagulation b/c of post op DVT risk w/ immobilization
femoral shaft fractures treatment?
intramedullary rod fixation; if the fracture is open, then ortho emergency and require surg.
Physical exam test for collateral ligament injuries…treatment of these injuries?
valgus stress test (abduction while knee is flexed) and varus stress test (adduction while knee is flexed)….for isolated injuries treat w/ hinged cast and when several ligaments are torn surgical repair
treatment for ACL tears
immobilization and rehab for sedentary pts, whereas athletes require surgical repair
-open for exam purposes arthroscopic is an option
treatment for ankle fractures?
external fixation unless the fragments are displaced, at which point open reduction and internal fixation needs to occur
compartment syndrome…symptoms?…treatment?
pain and limited use of extremity, the area feels tight and tender to palpation. Excruciating pain w/ passive extension…….emergency fasciotomy
treatment for Open fractures (broken bone sticking out through a wound)
cleaning in the OR and suitable reduction w/in 6 hours from time of injury
posterior dislocation of the hip…physical signs of dislocation? treatment?
pt has hip pain and lies in stretcher w/ leg shortened, adducted and internally rotated (vs broken hip where leg is also shortened but it’s externally rotated)….treatment is emergent reduction to avoid avascular necrosis
gas gangrene usually occurs when?…signs of this?…treatment?
usually occurs w/ deep, penetrating, dirty wounds…..pt. is extremely sick, looking toxic and near death. The affected site is tender, swollen, discolored and has “gas crepitation”….treatment: copious IV penicillin, extensive surgical debridement, and hyperbaric oxygen
radial nerve injury: associated with what type of fracture? treatment?
oblique fractures of the middle to distal thirds of the humerus….reducing the fracture should bring about relief but if nerve paralysis remains after the reduction, then surgery is needed to free entrapped nerve.
carpel tunnel syndrome: how to recognize?….next step?…initial treatment?…if that doesn’t work?
ppl complain of numbness and tingling in their hands, particularly at night, and in the distribution of the median nerve…next do wrist xrays (including carpel tunnel view) to rule out other things…splints and anti-inflammatory agents…if that doesnt work surgery might be needed and an electromyography should precede this (electro-diagnostic studies of nerve conduction)
What is trigger finger and how do you treat it?
Pt. wakes up in the middle of the night w/ a finger acutely flexed and they are unable to extend it unless they pull it w/ the other hand and they hear a loud snap…treatment is steroid injection and if not enough then surgery
De Quervain tenosynovitis: when does it normally happen?…symptoms?…treatment?
when wrist flexion and thumb extension is held for a long time (usually seen in mothers carrying baby’s head)…complain of pain along radial side of the wrist and first dorsal compartment….treatment w/ steroid injection is best
gamekeeper thumb: what is it?…treatment?
injury of the ulnar collateral ligament sustained by forced hyperextension of the thumb…casting
what is jersey finger?
injury to the flexor tendon sustained when the flexed finger is forcefully extended.
mallet finger
injury when the extended finger is forcefully flexed and the extensor tendon is ruptured. the tip of the affected finger remains flexed while the hand is extended
Lumbar disk herniation usually involves what spinal levels?
L4-L5 or L5-S1
symptoms of lumbar disk herniation
vague aching back pain and later on sharp neurogenic pain precipitated by forced movement; feels like electrical shock that shoots down the leg.
diagnosis and treatment of lumbar disk herniation
straight leg test can give diagnosis and MRI can confirm it….treatment is bed rest for 3 weeks; if neurologic deficits are progressing (progressive muscle weakness) surgery may be needed
cauda equina syndrome treatment
surgical emergency requiring immediate decompression
ankylosinig spondylitis: who does this normally affect? symptoms? diagnosis?
normally affects young men in 30s and 40s…℅ chronic back pain and morning stiffness that’s worse at rest and improves with activity, sometimes have uveitis and IBD….xrays are diagnostic and will eventually show a “bamboo spine” but initially MRI shows inflammation @ SI joints; many also have HLA B-27 antigen
typical location of these types of ulcers: diabetic ulcers, ulcers from arterial insufficiency, venous stasis ulcers
diabetic: usually located at pressure points (heel, metatarsal head, tips of toes)
arterial insufficiency: as far away from heart as possible like tips of toes
venous stasis: usually above the medial malleolus
management of diabetic foot ulcers
can be healed w/ good control of diabetes and by keeping them clean w/ leg elevated for many weeks or months….if it gets worse then may lead to amputations
management of ulcers from arterial insufficiency
workup begins w/ dopplers to look for pressure gradient (if there isn’t one, there is microvascular disease not amenable to surgical therapy). Then CT angio, MRI angio or arteriograms, and surgical revascularization or angioplasty and stents
management of venous stasis ulcers
physical support to keep veins empty: support stockings, ace bandages, unna boot…if really bad surgery or endovascular ablation w/ laser may be used
marjolin ulcers: what is it? how to diagnose it? treatment?
squamous cell carcinoma of the skin developing in a chronic leg ulcer that usually happens in the setting of many years of healing and breaking down…biopsy is diagnostic….wide local excision and skin grafting.
plantar fasciitis: symptoms?…diagnosis?…treatment?
℅ disabling, sharp heel pain every time their foot strikes the ground. the pain is worse in the mornings…xray shows a bony spur matching the location of pain and physical shows exquisite tenderness to palpation over the spur….spontaneous resolution can be expected in 12 to 18 months and otherwise pain control
morton neuroma: what is it?..treatment?
inflammation of common digital nerve at the space b/w the third and fourth toes. the neuroma is palpable..conversative management w/ analgesics and better shoes but if needed surgical excision can be done.
If genu varum extends past age ___, it is indicative of what disease?
How is this disease tx?
Bowlegs
Past age 3- consider Blount disease (disturbance of medial proximal tibial growth plate)
Tx w/ surgery
How long can pts with a femoral neck fracture delay surgery?
72 hrs to provide time for medical clearance if otherwise stable
What is a positive trandelenberg sign? What does it tell us?
When standing on one foot and contra lateral hip drops, indicative of gluteus media and minimis weakness or lack of innervation from superior gluteal nerve
Positive arm drop test is indicative of
Rotator cuff injury
Abduct arm greater than 90 degrees, if arm falls down instead of being lowered slowly–>positive test
what is Osgood-Schlatter disease? treatment?
-osteochondrosis of the tibial tubercle, seen in teenagers with persistent pain right over the tibial tubercle (w/o knee swelling) which is aggravated by contraction of the quads.
Tx: conservative initially-RICE( rest, ice, compress. Elevate)
If that fails then consider…
-extension or cylinder cast for 4 to 6 weeks
