Ortho Flashcards
Should cast be circumferential in OR?
“Posterior mold / Splint “
Never - this is reserved for doc who will be following the patient long term
- This allows for swelling
- Should follow up as o/p in a week
Which joints should be immobilized?
Both above and below
What does ER cast / posterior mold consist of?
- Padding
- Plaster
- Ace bandage
What to always do after casting?
Repeat neurovascular exam
What does axial loading of thumb check for?
Snuff box injury: push thumb down towards wrist to check for pain
Why are we worried about scaphoid injury?
Blood supply to scaphoid is only coming from the radial artery
- At extremely high risk for avascular necrosis from this
What is an occult fracture?
So small that can not be screened on xray
- Should be visible in 7-10 days in callus formation if there was a fracture
How to treat scaphoid injury?
Thumb - spica immobilization
What does a thumb spica entail?
- ABduct thumb (holding wine glass)
- Distal to IP joint of thumb
- Proximal along distal 2/3 radial forearm
- Wrist at 20 degrees
- Pad along radial aspect of arm
What is the ulnar collateral ligament?
Ligament running on medial aspect of thumb
How to check for ulnar collateral injury?
Flex thumb and apply radial stress to check for laxity of ulnar ligament and tenderness over ligament
When is thumb spica used?
- Ulnar collateral ligament injury
- Scaphoid injury
- Lunate injury
- Quervain tenosynovitis
- 1st Mc fracture
What is the last joint on index finger?
“DIP”
Distal interphalangeal joint
What is mallet deformity?
DIP droops down
- Can be from hammering it “mallet”
- Or from blunt trauma to end of finger (softball)
How to treat mallet injury?
Prolonged stint with finger in extension (6-8 weeks)
- Do not take off for any reason
What is clam digger?
Splint that looks like your holding a sandwich
- Fingers are flexed at MCPs so you dont limit ROM of collateral ligaments upon removal
- MCP at 90
When is sugar tong used?
Distal ulnar or radius fracture
How to place sugar tong?
- Palmar MCP, Around Elbow, Dorsal MCP
- Elbow at 90 - use sling
- Hand in functional positioning
When is posterior mold used?
- Elbow fracture or soft tissue injury
2. Proximal radius / ulnar injury
How to place posterior mold?
- Distal hand at palmar crease
- Along forearm proximal to humerus
- Elbow 90
- Wrist and hand neutral
- Abduct thumb, Wrist at 20
What views to get when imaging extremities?
- A/P
- Lateral
- Oblique
First things to do if neurovascular compromise expected?
Straighten out the limb!
What caulse an avulsed fracture?
A ligament pulling a piece of bone off
Leigh man term for shattered bone?
Comminuted
Difference between open and closed fracture?
Open needs to go to OR - much higher risk of infection and complication
What abx for open fracture?
Cefazolin or ancef
What can cause compartment syndrome?
Anything that can restrict blood supply
- Casts
- Fractures
- Swelling
Signs of compartment syndrome?
If you wait till all present it is too late:
- Pain - there is no way to control it and it gets worse
- Paresthesias
- Pallor
- Pulselessness
- Poikilothermia
Bacteria in septic joint?
- Staph
2. Neisseria
Diagnosis septic joint?
- Lactate over 10
2. WBC over 50k
When is MRI needed in back pain?
- Weakness not related to pain
- Loss of bladder function
- No fever / suspected epidural abscess
- Saddle anesthesia
Who to xray in low back pain?
- Over 50
- Cancer
- Drug use
- Osteoporosis
- Fever
Bedrest or bending activity better for low back pain?
Activity avoiding painful activities
Nexus criteria?
- No tenderness posterior midlines
- No neurologic deficit
- Normal alertness
- No intoxication
- No distracting injury
What can a fracture at base of fifth metatarsal mimic?
Ankle fracture
Risk supracondylar fracture in peds?
Brachial artery and medial nerve compromise w/ posteriorly displaced fracture
What is nursemaid’s elbow?
Toddler with arm yanked, or fall
- Arm held at side slightly flexed at elbow, semiflexed, prone
What does the lachmans test examen?
Injury to ACL
