Ortho Flashcards
Partial disruption of a joint, in which some degree of contact between the articular surfaces remains.
Subluxation
Complete disruption of a joint, such that the articular surfaces of the bones that comprise the joint are no longer in contact with one another.
Dislocation
A tearing injury to muscle fibers resulting from excessive tension or overuse.
Strain
A tearing injury to one or more ligaments of a joint, which occurs when the joint is forced beyond the limits of its normal planes of motion.
Sprain
“Fatigue” fractures from repetitive forces before the bone and supporting tissues have had time to adjust/accommodate to such forces
Stress fracture
Radiographs for stress fractures
often negative until weeks later - diagnose by presumption + point tenderness and swelling
Salter fractures aka
epiphyseal fractures - growth plate fractures in children
3 phases of fracture healing
inflammatory
reparative
remodeling
3 orthopedic emergencies - broad categories
- Open fracture
- Subluxation / dislocation
- Neurovascular injury
Potential major complication of open fracture
osteomyelitis
Urgency of reducing a dislocation / subluxation based on:
- Neuro / circular compromise - neurovascular bundle “kinked”
- Longer it’s dislocated, harder it is to reduce and less stable it will be (due to edema, muscle spasm, tissue changes)
Serious complication specific to hip dislocation
Avascular necrosis of femoral head
Why avascular necrosis of femoral head can occur in hip dislocation
Much of blood supply to femoral head is delivered through vessels that emerge from the acetabulum
Sling supplement to splint is useful for injuries to ___ and ___ because ____
wrist and forearm; because optimal immobilization includes joint above and below injury
On physical exam, patients with disruption of sternoclavicular joint or fracture of the humeral shaft may complain only of ___
shoulder pain
Common examples of fractures which may not appear on radiograph until 7-10 days post trauma
Fractures of scaphoid
Nondisplaced fracture of radial head
Stress fracture of metatarsal
“Fat pad sign” on elbow of adult often indicates
Radio head or neck fracture - most common cause of elbow joint effusions in adults
“Fat pad sign” on elbow of children often indicates
Supracondylar fracture - most common cause of elbow joint effusions in children
Clue in history to indicate posterior sternoclavicular dislocation
Shoulder pain + dysphagia
Mechanism: bilateral compression of shoulders, via MVA or “pile on” in football often results in ___
anterior (more common) or posterior (mediastinal structures at risk) sternoclavicular dislocation
Mechanism: direct blow to medial clavicle often results in ___
posterior sternoclavicular dislocation
Mechanism: fall, landing on apex of shoulder
acromioclavicular separation
Mechanism: direct blow to anterior shoulder; fall on outsretched arm; seizure or electroconvulsive muscular activity
posterior dislocation of shoulder
Mechanism: Sudden traction force to toddler’s arm
Subluxed radial head
sometimes causes pseudoparalysis of arm and therefore can be misdiagnosed as brachial plexus injury
Mechanism: fall, landing on outstretched arm or with elbow under body
Fracture of the radial head (may be occult on x ray)
Mechanism: Forced dorsiflexion of wrist
Colles fracture
Fracture of scaphoid
Lunate dislocation
Mechanism: striking knee against dashboard in MVA
Posterior dislocation of hip
Mechanism: landing flat on feet from a height
Calcaneus fracture
Tibial plateau fracture
Acetabular fracture
Vertebral compression fracture - lumbar
Mechanism: ankle inversion force
Fracture of any 3 of malleoli
Disruption of anterior tibiofibular ligament with proximal fibular fracture
Mechanism: Inversion or medial or lateral stress to the forefoot; axial load on the metatarsal heads with the ankle plantarflexed
Midfoot dislocation (Lisfranc injury)
One of the most common hip disorders in adolescents; often presents with hip pain but can present with groin pain, isolated thigh or knee pain.
Slipped capital femoral epiphysis Leg is externally rotated with an antalgic gait
What is “broken off” in Salter Harris Type I
entire epiphysis
What is “broken off” in salter Harris Type II
entire epiphysis along with portion of metaphysis
What is “broken off” in salter harris type III
portion of epiphysis
What is “broken off” in salter harris type IV
a portion of epiphysis along with a portion of metaphysis
What is “broken off” in salter harris type V
Compression injury of epiphyseal plate
Diagnosis of Type 1 Salter Harris
Presumptive - often not radiographically lucent
Based on tender and swelling at region of physis
Diagnosis of Type V Salter Harris
Often not radiographically apparent
qPresumptive with significant “axial loading” force coupled with significant tenderness in physis region
Open fracture antibiotic prophylaxis options
Cefazolin or Cipro
+ Gentamicin for > 10cm wound
+ Consider using Penicillin, metronidazole, or clindamycin if significant contamination with soil is present
When to consult ortho
Compartment syndrome
Dislocation with fracture
Circulatory compromise
Open fracture
Immobilization technique for shoulder dislocation, acromioclavicular separation, clavicle fracture, humeral neck fracture
Shoulder immobilizer - like a sling, but better
Immobilization technique used for a variety of upper-extremity injuries, in conjunction with other immobilization techniques; may be used alone for nondisplaced or clinically suspected fracture of the radial head.
Sling
Immobilization technique used for reduced elbow dislocation, displaced radial head fracture, supracondylar humeral fracture
Long-arm gutter
arm in sling position - elbow flexed at 90, palm facing abdomen
Immobilization technique used for wrist or forearm fracture
Sugar tong splint
** often supplemented w sling **
(arm in sling position - elbow flexed at 90, palm facing abdomen
Immobilization technique used for 4th - 5th ray metacarpal or proximal phalanx fracture
Ulnar short arm gutter splint
The metacarpophalangeal joints and interphalangeal joints are positioned in gentle flexion
Immobilization technique used for 2nd or 3rd ray metacarpal or proximal phalanx fracture
Radial shrot arm gutter splint
The metacarpophalangeal joints and interphalangeal joints are positioned in gentle flexion
Immobilization technique used for scaphoid fracture or thumb metacarpal/proximal phalanx fracture
thumb spica
Immobilization technique used for:
Fracture or reduced subluxation of patella
Knee dislocation, postreduction (temporary)
Tibial plateau fracture
Knee ligament injury
Suspected meniscal tear (provided the knee can be fully extended)
Knee immobilizer
Use of an immobilizer for more than a few days in the elderly or for more than a week or two in young patients may result in painful stiffness of the knee joint. For that reason, orthopedic follow-up should occur within approximately 7 days.
Immobilization technique used for:
Ankle dislocation or fracture-dislocation
Unstable ankle fracture (high distal fibular fracture or medial and/or posterior malleolar fracture)
Widened medial mortise (indicates disruption of stabilizing medial structures)
Metatarsal fracture (alternative immobilization dressings may be used)
Posterior ankle mold
* consider adjunctive use of ankle sugar-tong for unstable ankles*
While the dressing is setting, the ankle should be maintained in a position as close as possible to neutral dorsiflexion—that is, at 90 degrees to the leg. T
Immobilization technique used for:
Simple ankle sprain
Stable lateral malleolus fracture (below the superior border of the talus) without other ankle involvement (no medial swelling or tenderness, posterior malleolus intact)
Ankle stirrup
Immobilization technique used for:
Toe fracture
Some metatarsal fractures
Hard-soled shoe
Immobilization technique used for:
Some toe or foot contusions or fractures where weightbearing is allowed
Short-leg walking boot
When to get xray for neck pain
3-view cervical spine films in
- chronic, weeks to months neck pain (+/- trauma)
- history of malignancy or remote neck surgery
- neck pain and preexisting spinal disorders
When to get MRI for neck pain
MRI is indicated for patients with chronic neck pain with neurologic signs or symptoms regardless of the plain radiographic findings.5 MRI is also indicated when plain radiographs reveal bone or disk margin destruction, if there is cervical instability, and (with intravenous contrast) if epidural abscess or malignancy is suspected
Symptoms of acute cervical disk prolapse
neck pain, headache, pain distributed to the shoulder and along the medial scapular border, dermatome pain, and dysesthesia in the spinal root distribution to the shoulder and arm
What serious condition should be considered with neck pain in patients taking anticoagluants or bleeding disorder
Cervical spin epidural hematoma
