Ortho Flashcards
Partial or full patellar tendon tears F/U
Knee immobilizer and given urgent orthopedics follow-up
Tendon pathology, including rupture, which antibiotic class?
Fluoroquinolones
Rhabdo fluid replacement
Goal UOP of 3 cc/kg/hour or 200 to 300 cc/hr to prevent acute renal failure
Normal ABI
> 0.9
Humeral shaft fractures most common nerve affected
Radial nerve (wrist drop)
Primate bite treatment and why?
- Monkeys carry Cercopithecine herpesvirus 1, also called Herpesvirus simiae or more simply, B virus
- Fatal to humans if not treated early.
- Treatment is with acyclovir
- Pain with overhead movement.
- Pain with arm in 180 degrees forward flexion, followed by internal rotation
- Pain with arm in 90 degrees abduction, elbow flexed at 90 degrees, followed by internal rotation
Subacromial bursitis 2/2 overuse causing impingement
Weakly positively birefringent and rhomboid shaped crystals
Calcium pyrophosphate crystals = pseudogout
Needle like and negative birefringent crystals
Uric acid crystals = gout
Most common cause of septic arthritis
Staph Aureus
In a patient with sickle cell disease presenting with septic arthritis, what additional organism must be considered?
- Salmonella.
- Patients with sickle cell anemia require vancomycin and ciprofloxacin for better coverage for salmonella.
What nerve is most commonly injured in a perilunate dislocation?
Median nerve.
Fracture of the distal radius paired with a dislocation of the distal radioulnar joint.
Galeazzi fracture
Fracture of the proximal ulna, paired with dislocation of the radial head
Monteggia fracture
Flexor tenosynovitis treatment
IV ampicillin-sulbactam (Unasyn) and vancomycin
- Symmetrical swelling of the involved finger
- Finger held in flexion at rest
- Tenderness along the flexor tendon sheath
- Pain with passive extension
Flexor tenosynovitis
- Loss of motor, pain, and temperature below injury
- Proprioception and vibration intact
Anterior Cord Syndrome
Fluoroquinolone S/E
- Prolongation of the QTc
- Spontaneous tendon rupture
Clay-shoveler fracture
- Avulsion of the spinous process of C6 or C7
- Stable fracture
Unstable cervical spine fractures
Jefferson bit off a hangman’s thumb
- Jefferson burst fracture
- Bilateral facet dislocation
- Odontoid type II and type III fractures, any fracture with a dislocation
- Hangman fracture
- Teardrop fracture
Septic joint ESR and CRP
ESR is normal in up to 30% of patients and CRP is normal in up to 12% of patients.
Finkelstein test
- Flexion of the thumb across the palm and then ulnar deviation of the wrist.
- Sharp pain at the dorsal compartment suggests a positive test and a diagnosis of de Quervain’s tenosynovitis.
Hawkins-Kennedy test
- Shoulder flexed to 90° and their elbow flexed to 90°.
- Clinician grasps proximal to the wrist and elbow and then quickly rotates the arm internally.
- Positive test suggests subacromial impingement syndrome.
Felon treatment
- S.aureus is the most common bacterial pathogen
- Most effective treatment is incision and drainage and trimethoprim-sulfamethoxazole
Compartment pressure: normal?
0-10 normal, <30-40 associated with tissue necrosis
Delta pressure to assess for compartment syndrome
DBP - direct compartment pressure, if <30 consistent with acute compartment syndrome
Most common electrolyte abnormality in rhabdomyolysis
Hypocalcemia
Plantar puncture wounds: most common organism and treatment
Pseudomonas aeruginosa, Levofloxacin
Parkland formula for fluid resuscitation in burns
Total Body Surface Area Burned x Weight (kg) x 4mL. First half is administered in first 8 hours followed by the second half in the next 16.
Upper motor neuron findings, such as hyperreflexia, clonus, spasticity, and a positive Babinski sign.
Conus medullaris syndrome
If there is no history of trauma or previous infection as the cause of flexor tenosynovitis, what additional antibiotic coverage should be considered?
Ceftriaxone for disseminated gonorrhea.
