Ortho Flashcards
FOOSH
schapoid fracture - can lead to avascular necrosis and non-union of proximal pole
- tenderness in anatomic snuffbox
- xray at time of injury has low sensitivity –> get CT/MRI to confirm fracture
- immobilize wrist in thumb spica splint - and get repeat imaging in 7-10d
supracondylar fracture of humerus - kids
- brachial artery injury, medial nerve injury
- less common complications are cubitus varus deformity and compartment syndrome (volkmann ischemic contracture)
- note - mid-distal humerus fractures also risk radial injury (wrist drop)
clavicle fracture - occurs with FOOSH or direct blow to shoulder
- usu fracture of middle third of the clavicle
- tx by brace, rest, and ice
- fractures of the distal 3rd may required ORIF because of risk of non-union - careful exam because of close proximity to subclavian artery and brachial plexus
- if you hear a bruit - need to rule out vessel injury
shoulder injury - FOOSH can lead to shearing of shoulder bones
tendon injuries
penetrating injury or with extreme loading of digit (jamming a finger on a ball)
stress fracture
risk factors - repetitive activities, abrupt increase in physical activity, inadequate Ca or vitamin D intake, decreased caloric intake
- female athlete triad - low caloric intake, hypomenorrhea/amenorrhea, low bone density
px - insidious onset of localized pain, point tenderness at fracture site
- XR may be negative in first 6 weeks management
- rest and analgesics (acetaminophen)
- reduce weight bearing for 4-6 wks or cast (and repeat xray in 2 wks)
- refer to ortho for fracture at high risk for malunion (anterior tibial cortex, 5th metatarsal, manage with casting or internal fixation)
medial tibial stress syndrome (shin splints) - anterior leg pain, but diffuse tenderness
- also more common in overweight individuals
meniscal tear
due to twisting force with the foot fixed or degeneration of meniscal cartilage (older)
- pts will generally report a popping sound, followed by acute pain
- meniscus tear = crepitus, locking, cathcing
- associated sxs - reduced extension, sensation of instability
- late knee effusion (which will become apparent after a few hours) medial meniscus injury is more common than lateral injury
dx - xray will be normal in young pts (sometimes exam will be normal, but use clinical suspicion)
–> confirm with MRI or arthroscopy
tx - mild sxs, older pts - rest, NSAIDs, and activity modification
- persistent sxs (3-4wks), impaired activity
- surgery, to reduce risk of further joint injury
knee pain/injury
ACL - forceful hyperextension of knee
- will have effusion and hemarthrosis
patellofemoral pain syndrome = chronic anterior knee pain
- pts present with pain worsened by activity or prolonged sitting (in flexion)
- may have crepitus with motion of patella, pain is reproduced during knee extension (patellofemoral compression test)
- tx - exercises to stretch and strengthen the thigh muscles
patellar tendonitis = jumpers knee - anterior knee pain and tenderness
tibial plateau fracture - pt will be unable to bear weight on that knee
patellar fracture - inability to extend knee
pes anerinus syndrome - pain and tenderness at anterior medial knee (distal to joint line)
- strongly associated with diabetes
prosthetic joint infection
leukocytes count will be >1000 (but not as high as in a septic joint >50K)
<3mo onset - acute pain, wound infection or breakdown - S aureus, gram negative rods (pseudomonas), anaerobes
3-12 mo - chronic joint pain, implant loosening, sinus tract formation
- S. epi, propionibacterium, enterococci
>12 mo - acute sx in previously asx joint, recent infection at distant site (UTI)
- S. aureus, gram negative rods, b-hemolytic strep
MCL and LCL
vaLgus = applying lateral stress
MRI is the most sensitive test but reserved for pts being considered for surgical intervention
- uncomplicated MCL tears can be managed non-operatively (RICE)
ortho kids
Legg-Calve-Perthes disease - avascular necrosis of capital femoral epiphysis
- age 6, limping, decreased hip motion, hip (or knee) pain
- tx - by containing the femoral head in acetabulum by casting or crutches
slipped capital femoral epiphysis - 13 yo M, lanky, limping, decreased hip motion, hip/knee pain
- affected foot points in
- pin back in place
septic joint - wont move hip
- aspiration and drainage
acute hematogenous osteomyelitis
- MRI gives prompt dx
others:
bowlegs - nl till age 3
knock knee - nl till 4-8
Osgood-Schlatter - RICE
club foot - serial casting, achilles tenotomy
scoliosis - bracing is used to arrest progression, severe cases may need surgery
ortho fractures/dislocations
fractures of growth plate (kids) - ORIF
anterior shoulder dislocation - more common, “shaking hands” position
Colles - FOOSH, dorsally angulated radius fracture
Monteggia - ulnar fracture, anterior dislocation of radial head
- Galeazzi is opp
- ORIF for break, closed reduction for dislocation for both of these fractures
rupture of achilles tendon - out of shape middle aged men who subject themselves to severe strain
trigger finger, De Quervains (thumb) - steroid injection
Dupuytren - steroid or collagenase
gamekeeper thumb - injury UCL of thumb –> cast
jersey finger is opp of mallet finger
bone tumors
pathologic fracture - fracture with almost no force = mets
MM - punched out lytic lesions
sarcoma - require wide local excision and radiation &chemo, mets to lungs
giant cell tumor of bone - soap bubble appearance, eccentric lytic area
- benign, locally aggressive skeletal neoplasm seen in young adults
- tumor contains cystic and hemorrhagic lesions
osteoi osteoma - sclerotic, cortical lesion with central lucency
- nighttime pain, pain unrelated to activity, and relieved by NSAIDs
- tx - surgery
bursitis
vulnerable to acute injury or chronic repetitive pressure
- may become inflamed…
- because they are located in exposed positions
- active ROM reduced, passive nl
housemaids knee = pre-patellar bursitis
- bursitis is generally non-infectious
- however this one is commonly due to S aureus (trauma, local cellulitis) aspirate and systemic abx (if pos gram stain)
shoulder pain
rotator cuff impingement or tendinopathy - pain with abduction, external rotation
- normal ROM, positive impingement tests
rotator cuff tear - *weakness* with external rotation, age >40
- weakness with above motions, drop arm test (drop below horizontal) - passive ROM is preserved
- FOOSH
- drop arm test - supraspinatus is commonly injured due to degeneration of tendon with age and impingement between humerus and acromion (during ABduction)
adhesive capsulitis - stiffness > pain
- can be due to rotator cuff tendinopathy, subacromial bursitis, paralytic stroke, DM, humeral head fracture
- reduction in passive and active ROM
biceps tendinopathy/rupture - anterior should pain, weakness is less common
glenohumeral osteoarthritis - trauma, gradual onset of shoulder pain
- decreased active and passive ROM
