Ortho Flashcards
What is a fracture?
Break in the continuity of a bone
What is a colles fracture?
Distal radius +/- ulnar
What is a Smith fracture?
Distal radius
What is a Monteggias fracture?
Proximal 1/3 ulnar and dislocation radial head
What is a Galeazzi fracture?
Radial distal shaft and dislocation of radioulnar joint
What is a boxer’s fracture?
5th metacarpal bone
What is the presentation of a fracture?
Pain, swelling, deformity, neurovacsular disturbance, palpable step-off or gap, soft tissue injury
How is a fracture Dx on X-Ray?
2 views, 2 joints, pre- and post-reduction
Radio-lucent line
Cortical disruption
General principles of fracture management?
Analgesia
Wound care
Assessment of VTE risk
Fracture care - Reduction, fixation (open/closed), rehab
Immediate complications fractures?
Pain
Nerve/skin damage
Fat embolus
Soft tissue injury
Early complications of a fracture?
Compartment syndrome
Infection
DVT
Late complications of a fracture?
Stiffness Complex regional pain syndrome Malunion - abnormal position Delayed union - longer than expected Non-union - not healing after expected time
Mx Dislocation
Reduction - closed if possible
Mx Open Fracture
Tetanus IV Abx Photos of wound to prevent taking off dressings Saline-soaked gauze Ortho and plastics
Mx Compartment Syndrome
Fasciotomy, cool and position limb
Analgesia
Mx Vascular Injury
Angiography +/- Repair +/- Fasciotomy
What is the Gustilo-Anderson Classification of Open Fractures
Type 1: Clean, low energy wound < 1cm
Type 2: 1-10cm, moderate damage
Type 3: >10cm, high energy
What is compartment syndrome?
Pressure in fascial compartment leads to impaired tissue perfusion
Causes of Compartment syndrome?
Burns, fracture haematoma, constrictive bandages, reperfusion syndrome
Pathology - Compartment pressure > capillary pressure
–> Ischaemia –> Oedema and increased pressure –> cycle continues
What are the clinical features of compartment syndrome?
Pain out of proportion
Pain on passive stretching
Palpable tense compartment
Pulselessness - late –> 6Ps ischaemic limb
DDx Compartment Syndrome?
Rhabdomyolysis - High CK, LDH, myoglobin
DVT
Acute limb ischaemia
Septic Arthritis Aetiologies
Haematogenous/Direct spread
S Aureus
Clinical Features Septic Arthritis
Acute onset
Mono-arthropathy
Triad - fever, pain, decreased RoM
Ix Septic Arthritis
US-guided arthrocentesis - WCC >50 - yellow/green - send for biorefringence (gout)
Sepsis 6
Bloods - U&Es (urate)
Urethral, cervical and anorectal swabs - gonorrhoea
DDx Septic Arthritis
Gout
Pseudogout
OA
Haemarthrosis if anticoagulated in reactive arthritis
Mx Septic Arthritis
Abx for 2 or more weeks - Vanc/Ceftriaxone
Aspirate and drain
PTx
Complications Septic Arthritis
Joint destruction
Osteomyelitis
Sepsis
Acute causes of Spinal Cord Compression
Minutes - hours Fracture Herniation Trauma Haematoma
Insidious Causes of Spinal Cord Compression
Tumour
Abscess
Degenerative
Ix Spinal Cord Compression
MRI Spine
Clinical Features Spinal Cord Compression
Back/radicular pain
Neuro deficits below level of lesion
Sensory before motor
Painless retention and increased reflexes
Mx Spinal Cord Compression
Steroids - IV
Opioids
Decompression and stabilisation definitive
Inoperative - RTx
Mx of a Spinal Abscess
IV Abx
Drainage
Mx for Spine Mets
Steroids
RTx
Decompression
What is the cauda equina?
Nerve roots of Lumbar, sacral and coccyx spinal nerves
Supplies lower limbs, perineum and pelvic organs
Internal and external anal sphincter
Parasympathetic to bladder
What is the Conus Medullans
Caudal end of spinal cord - ends at L2
What is the cause of a Cauda equina syndrome?
Damage/compression of cauda equina (nerve roots L3-S5)
Trauma
Tumour
Large posteromedial disc herniation
Clinical features of a Cauda equina syndrome?
Gradual unilateral, severe radicular pain
Motor: asymmetrical leg reflexes - hypo to areflexic (LMN)
Sensory: Saddle anaesthesia, asymmetrical paraesthesia and numbness
Neurogenital: urinary retention, altered rectal tone, erectile dysfunction
Ix Cauda equina syndrome?
MRI within 4h to identify nature and site of lesion
Mx Cauda equina syndrome?
Surgery
Metastatic –> RTx
What is Carpal Tunnel Syndrome?
Peripheral neuropathy caused by acute or chronic compression of median n, deep to flexor retinaculum
What is the pathology in Carpal Tunnel Syndrome?
Carpal tunnel has carpal bones below and transverse carpal lig above
Contains flexor tendons and median n
Raised P compresses structures within
–> Decreased blood flow and axonal degeneration
Causes of a Carpal Tunnel Syndrome?
Distal radial fracture
DM
RA
Pregnancy
Clinical Features of a Carpal Tunnel Syndrome?
Palmar aspect of thumb, index, middle and radial half ring finger Burning Numbness Loss of sensation Worse at night Altered/weakened pinch grip Thenar atrophy
Ix of Carpal Tunnel Syndrome?
Tinnel’s sign - Repeatedly tap over
Phalen’s signs - Wrist in full flexion - Inverse prayer
NCS - prolongation in motor and sensory
Mx of Carpal Tunnel Syndrome?
Conservative: Immobilise, steroid injection and NSAIDs
Surgery: Median nerve decompression - release of transverse carpal lig, and flexor retinaculum
What is Flexor Tenosynovitis?
Inflammation tendon and synovial sheath
Cause of Flexor Tenosynovitis?
Overuse or systemic disease
What is Dupytren’s Disease?
Common fibroproliferative disorder of the palmar fascia of the fourth and fifth fingers.
What is the pathology of Dupytren’s Disease?
Fibroproliferative disorder
Nodules adhere to overlying dermis
Leads to characteristic skin puckering
Nodules then lead to cords, and contractures
Clinical Features of Dupytren’s Disease?
Skin tethering near the proximal flexor crease of the fourth and fifth fingers
Palmar nodules in cords
Fixed contractures
Ix for Dupytren’s Disease?
BM
LFTs
Mx Dupytren’s Disease?
Conservative: Splint and PT
Medical: Intra-lesional steroid injections; PO Steroids; Collagenase injection
Surgery: Fasciotomy or fasciectomy if functional disability
What is the surgical neck of the humerus?
Circumferential constriction between the tubercles
What runs in surgical neck of humerus?
Axillary n.
Circumflex humeral vessels
What is the mechanism of injury to the surgical neck of humerus?
Common in elderly - OP
High velocity FOOSH in young
How are fractures to surgical neck of humerus classified?
Via Neer’s classification
Defines comminution
Anatomical neck, shaft, greater- and lesser tuberosity
How to Dx surgical neck of humerus fracture?
AP and lateral X-Rays
X-Ray findings in supracondylar fracture?
Sail sign (ant fat pad) Posterior fat pad
Mx of surgical neck of humerus fracture?
Conservative: Collar and cuff (non-displaced, closed)
Surgical: (displaced, comminuted) ORIF or Hemiarthroplasty
Complications of surgical neck of humerus fracture?
Adhesive capsulitis
AVN humeral head (axillary a. injury)
Axillary n. palsy
3 Signs of an Axillary n. palsy?
Flat deltoid
Decreased sensation over regimental badge area
Reduced shoulder abduction to 15 degrees
Complications of Humeral Shaft Fracture?
Wrist drop - Radial n. palsy –> Decreased wrist strength and decreased sensation over dorsal hand
Complications of Distal Humeral Fracture?
Brachial a. injury common
Radial/ulnar/median n. palsy
Most common joint dislocation?
Shoulder
Ant > Post
Causes of Shoulder Dislocation?
Head humerus larger than glenoid fossa
FOOSH
Recurrent dislocation - loose capsule and ligament damage
Post - Seizures and shocks
2 Lesions on X-Ray in shoulder dislocation
Hill-sach’s - Depression fracture humeral head
Bankart lesion - Damage to ant labrum head
Classification of Shoulder Dislocation
Anterior
- Subcoracoid:
- Subglenoid:
Posterior
Classification of Humeral Shaft/Diaphysis Fracture
According to Prox, middle, or distal 1/3
Or based on comminution - none (A), Butterfly (B), Proper comminution (C)
Presentation of a Shoulder Dislocation
Severe shoulder pain
Decreased RoM
Signs: Loss deltoid contour, Internally rotated and abducted is post disl., ant = abducted and external rotation
What is the most important aspect of Shoulder Dislocation Examination?
Neurovascular status - axillary n. and radial a. function prior to reduction
Regimental badge area, dorsal hand sensation and pulse
Ix for Shoulder dislocation
2 View Shoulder X-Ray - AP and Y view To exclude fracture Hill-sachs - Humeral head dents glenoid MRI - Bankart Anterior - 95% cases; Sit in front of acromion Posterior - Lightbulb sign
Mx Shoulder Dislocation
Immobilise with sling/splint
Reduction (Closed before open)
Surgery > Conservative - if failed closed; fracture; Hill-Sach lesions or neurovascular injury; posterior dislocation
Most common joint dislocations
1 - Shoulder
2 - Elbow
Causes of an elbow dislocation?
Trauma - FOOSH
Pulled elbow
Classification of elbow dislocation?
Posterior - 90%
Anterior - 10%
Clinical features of an elbow dislocation?
Pain and swelling Decreased RoM Prominent olecranon process Limb length discrepancy Nerve injury - any of 3 Lost triangle of med/lat epicondyle and olecranon
How is an elbow dislocation diagnosed?
2 View X-Ray - AP/Lateral
Exclude fracture
Posterior fat pad sign if fracture present
Mx of an elbow dislocation?
No fracture - closed reduction & immobilise
Fracture/instability - ORIF or closed in theatre setting
Epidemiology of a Distal Radial Fracture?
Bimodal peak incidence - 10-30, >65y
Aetiology of a Distal Radial Fracture?
High energy trauma in males (FOOSH)
Osteoporotic-related, low energy trauma
Fall on dorsi-flexed hand = Colles’
Fall on palmar-flexed = Smith’s
Classification of Distal Radial Fractures?
Colles' = Dorsal angulation and shortening distal fragment Smith's = Volar angulation and shortening distal segment
Clinical Features of a Distal Radial Fracture?
Tender, soft swelling at wrist Decreased RoM Deformity Colles' = Dorsal displacement and dinner fork deformity (Z) Smith's = palmar kink
Ix of a Distal Radial Fracture?
3 view X-Ray - AP, Lateral and Oblique
Examine joint above and below
3 DDx of a Distal Radial Fracture?
Scaphoid
Greenstick
Monteggia
Galeazzi
Most commonly fractured carpal bone?
Scaphoid - Middle 1/3
Mechanism of injury in Scaphoid Fracture?
FOOSH + hyperextended and radially deviated wrist
Clinical Features of a Scaphoid Fracture?
Wrist pain and swelling Pain over anatomical snuff box and scaphoid tubercle Pain on telescoping thumb Slight decreased RoM Painful pinching/grasping
Ix of a Scaphoid Fracture?
4 views - Scaphoid views
PA, lateral, 45, oblique
Significance of a normal X-Ray in a Scaphoid Fracture?
1/4 undetectable - immobilise and re-assess in 2/52
Mx of a Scaphoid Fracture?
Pain management
Undetectable, re-exam in 2 weeks
Immobilise: with a thumb spica or plaster
Surgery indications: Open fracture, evidence osteonecrosis or highly displaced
Surgery: Screw fixation
Complications of a Scaphoid fracture?
Proximal AVN - blood supply enters distally
Subsequent non-union/delayed union; post-traumatic arthritis
What is a Bennet’s fracture?
Most common thumb injury
Intra-articular fracture at base of 1st metacarpal with CMC subluxation
Mx of a Bennet’s fracture?
Closed manipulation and immobilisation
If fails - K wire
What is the cause of a Boxer’s fracture?
Striking solid object with closed fist - impact on 5th knuckle/metacarpal
Mx of a Boxer’s fracture?
Conservative
Splinting
Surgical: Make fist - if fingers overlap - surgery as means rotation or shortening
Mx of phalangeal fractures?
Conservative: Buddy tape or splint
Surgical: Closed reduction, percutaneous pinning or ORIF
What is the position of safety (phalangeal fracture)?
Flexed MCPs and extended PIP (crocodile hand)
What is the function of the position of safety (hand)?
Safe immobilisation of hand and prevent contracture formation
RFx for a NOF?
OP Elderly Impaired co-ordination Low Vit D Smoking Alcohol Muscle Weakness
Classification of a NOF?
Intra-capsular: - Displaced - Non-displaced Extra-capsular: - Intratrochanteric - Subtrochanteric
What is the significance of an intra-capsular NOF?
AVN - blood to femoral head disrupted
What are the clinical features of a NOF?
Groin pain
Inability to weight bare
Shortened and externally rotated hip
Ix for NOF?
MRI = gold standard
CT = 2nd best
Diagnosed on X-Ray - 2 views - AP/Lateral
If ?pathological fracture - X-Ray femur
When should a NOF be taken to theatre?
Within 48h unless medical cause that requires reversal - 36h
When would conservative Mx be offered in NOF?
Not fit for anaesthetic
Who is involved in post-op Mx of NOF?
PT OT Social work Family Orthopod Geriatrician
What is the Mx of an extracapsular NOF?
DHS (preferred) or IM nail
What is the Mx of an intracapsular NOF?
Old - hemi
Young - Total
3 Criteria for Hip replacement
Medically fit
No cognitive impairment
Mobilise outdoor with sticks or less
Complications of a hip replacement
General: AVN, VTE, infection
Hemi: Leg length discrepancy
DHS: failure of metalwork
How to prevent NOF?
Adequate OP prophylaxis
Falls risk assessment
Falls training - remove trip hazard, wear good shoes
RFx for OP?
Elderly Female Post-menopausal Steroid use/PPI Alcohol, smoking and malnutrition
What does a DEXA scan do?
Calculates BMD and gives answer as T-Score
Grade T-Scores
-1 to -2.5: Osteopenia
< -2.5: OP
Causes of a pelvic fracture?
High energy: bike accidents, crashes, crushes - unstable
Low energy: Osteoporotic falls - stable
Clinical Features of a pelvic fracture?
Pelvic pain Worse on compression iliac crest Leg length discrepancy Instability Tilted pelvis Haematoma
How to test for pelvic instability?
Hands on both ASIS - apply downward pressure - Springy resistance AKA organs
Common co-presenting injuries to pelvic fracture?
Urethral injury
Bladder injury
Neurovascular injury
Ix for pelvic fracture?
Pelvic X-ray - AP inlet and outlet views
CT in stabilised patients
Angiography in haemorrhages
Retrograde urethrogram - only suprapubic catheter in people with pelvic fracture
Mx of pelvic fracture?
Resus and stabilisation Application of pelvic binder Conservative: bed rest and PT Surgery: for unstable and open fractures - Stabilise and fix with ORIF/ external fixation
Complications of pelvic fracture?
Haemorrhagic shock
Intra- and retroperitoneal bleeding
Abdo compartment syndrome (>7mmHg)
Hip Dislocation
Posterior 90%
- Associated with femoral head fractures
- Causes: Dashboard injury, Forces against internally rotated, adducted and flexed hip
- Presentation: Hip pain, shortened, internally rotated and adducted hip
- Management: Closed reduction (decreases risk osteonecrosis), ORIF if closed fails
- Complications: Sciatic and perineal n. injury
Anterior 10%
- Blow to posterior hip
- Lengthened, externally rotated hip
- Complications: Femoral n. injury
Femoral n. injury S&S
Sensory loss and paresis over anteromedial lower limb
Decreased hip flexion and knee extension
Why are knee dislocations under reported?
They self reduce
Being obese RFx
Causes of a knee dislocation?
High energy - RTA; dashboard and crush injuries
Obesity + walking - low energy
Clinical features of a knee dislocation?
Knee pain and instability
Deformity
Dimple sign - medial fem condyle pokes through medial capsule
Vascular injury - immediate reduction (popliteal)
Ix for a knee dislocation?
AP and Lateral + 45 degree oblique if ?fracture
May also have avulsion fracture/ asymmetrical joint space
Mx for a knee dislocation?
Conservative: Closed reduction + Vasc assessment
Most require theatre stabilisation
Surgical: ORIF / External fixation (compartment) + Ligament repair
Causes of Femoral Shaft Fractures?
High impact trauma - RTA
Low impact trauma - Fall from standing (<1m)
Clinical Features of a Femoral Shaft Fractures?
Painful, swollen and tense thigh Haematoma Reduced RoM Shortening Distal NV deficits FAT EMBOLI - Change mental status, SoB, Hypoxia, Petechiae
Ix of Femoral Shaft Fractures?
Plain X-Ray unless suspect pathological
Mx of Femoral Shaft Fractures?
Emergency - skin traction and long-leg post splint
Definitive - IM rod with interlocking nail or External fixation then an IM nail
Classification for Tibial Plateau Fracture?
Schatzker Classification
Most common long bone Diaphyseal Fracture?
Tibial
3 kinds of Tibial Fracture?
Proximal/Plateau
Shaft
Distal
Classification of Tibial Fractures?
Isolated
Combined tib/fib
Plateau
Clinical Features of Tibial Fractures?
Fracture signs - Pain, swelling, reduced RoM
Tibial Plateau have high risk open fracture and compartment syndrome
Why do Tibial Fractures have high risk open fracture?
Min soft tissue
Why do Tibial Fractures have high risk compartment syndrome?
Surrounded by all 4 of the anterior, lateral, deep and superficial
Ix for Tibial Fracture?
X-Ray - knee and ankle
2 views
Lipohaemarthrosis fat fluid level (plateau)
Aspiration - haemarthritic material with fatty spots (in osteochondral plateau fracture)
Consider MRI - ligamentous/ meniscal injury
Mx for Tibial Fracture?
Conservative: Fibula - Splint; Prox tibia - Hinged knee brace; Shaft - Long-leg cast
Surgical: If open or displaced - irrigation, debridement, ORIF/Ex Fixation
Complications of Tibial Fracture?
Compartment syndrome - kept for overnight watch
Fat embolism
Peroneal n. injury - foot drop
Cause of Ankle Fractures
Supination or pronation - twisted ankle
Classification of Ankle Fractures
Weber - According to level of fibula fracture, related to level of syndesmosis
Weber A - Below (intact)
Weber B - At level of (?injury)
Weber C - Above (Injury - ruptured syndesmosis and torn interosseous membrane)
What is a Maisonneuve fracture?
Weber C (Ruptured syndesmosis and torn interosseous membrane) + Medial malleoulous fracture + deltoid ligament tear
How can ankle fractures be classified by stability?
Isolated medial/lateral malleolous –> Stable
Posterior Medial Malleolous –> Unstable
Bimalleolar - Unstable
Trimalleolar (Med/Lat/Post medial) - Unstable
What is Volkmann’s triangle?
Avulsion fracture from posterior tibia (medial)
What is a Pilon fracture?
Fracture of distal tibia and part of talocrural joint
Associated with fibular fracture
Clinical Features of an Ankle fracture?
Pain
Swelling
Haematoma
Tenderness over malleoli, syndesmosis or posterior ankle joint
Skin abnormalities - discolouration, bruising, tenting
Mx of Ankle Fractures
RICE - Rest, Ice, compression, elevation
Emergency - Reduction, backslab (sedate)
Weber A- Ankle support brace
Weber B - Operative fix if evidence of talar shift
Weber C - Operative fix (reposition, ORIF, or ex fix)
What is Talar Shift?
When talus no longer aligned with tibial articular surface on a mortice view
What is most common injury of foot?
Metatarsal fracture (5th most common, 2nd due to stress)
Causes of metatarsal fracture?
Crush injury
Clinical features metatarsal fracture?
Pain
Inability to weight bare
Tenderness
Important factors in metatarsal fracture?
Evaluation of soft tissue injury
Malrotation and overlapping
Monofilament for neurovascular status
Mx of a metatarsal fracture?
Goals - maintain foot arches, restore alignment
Conservative: Stiff toed shoes if weight baring tolerated
Surgery: If displacement - pinning (percutaneous or ORIF)
Associated conditions with metatarsal fractures?
Stress fractures
Lisfranc fracture
What is a Lisfranc injury?
Tarso-metatarso fracture dislocation
Disruption between articulation between cuneiform and 2nd metarsal head.
Cause of Lisfranc?
MVA
Fall from heigh
Athletic injuries
(High energy)
Clinical features of a Lisfranc?
Severe pain Inability to weight bear Medial plantar bruising Mid foot swelling Tenderness over TMT joint Intability tests
What are the instability tests for Lisfranc injuries?
Metatarsal squeeze test
Dorsal subluxation
Talar dislocation.
Rare.
High energy.
Medial - locked in supination.
How can you classify rotator cuff disorders?
Greater tuberosity
Supraspinatus - Abduction (before deltoid, 15 degrees)
Infrarpinatus - ex rotation
Teres Minor - ex rotation
Lesser tuberosity
Subscapularis - int rotation
What is the pathology of calcifying tendotinits?
Calcium deposits most commonly in supraspinatus tenson
Clinical features of calcifying tendonitis?
Asymptomatic
Acute or chronically painful shoulder
Worse with activity
Investigations for calcifying tendonitis?
X-ray shows calcium deposits in the tendon
Management of calcifying tendonitits?
Majority resolves with conservative management
What is chronic tendonitits?
AKA Impingement Syndrome
Tendon is compressed against the coracoacromial arcj
Clinical features of impingement?
Gradual onset
Pain with overhead activities
Management of impingement?
Conservative - physio, NSAIDs, subacromial steroid injection
Operative - subacromial decompression +/- tendon repair
How does a biceps tendon rupture present?
Usually rupture of long head of biceps
Popeye sign with muscle contraction
Visible bulge in the middle of biceps due to retraction of ruptured tendon
What are the 3 stages of adhesive capsulitis?
Painful phase - night pain, gradual onset
Frozen phase - progressive decreased ROM, esp ER
Thawing phase - progressive increased ROM and pain
Clinical Features of adhesive capsulitis?
Reduced RoM - ex Rotation
Ix adhesive capsulitis?
X-ray - exclude other Dx
Mx adhesive capsulitis?
Analgesia
Steroid injections
PT
Consider arthroscopy for resistant cases
Mx for Hip OA
THR/Hemi
Two kinds of knee replacement?
Constrained
Non-constrained - TKR
RFx for Hip AVN
Irradiation Trauma Haematological malignancy Decompression sickness Alcoholism Steroids
Clinical Features in <6m with DDH
Barlow and Ortolani
Clinical features of DDH 6-18m
Asymmetrical gluteal folds
Inability to abduct hip
Clinical features DDH >18m
Waddling trendelenberg gait
Leg length discrepancy and pain
Ix DDH
< 4m - USS
>4m - X-ray
Mx DDH
<6m - Brace/Pivlik harness
>6m - Closed reduction and spica cast
Cause of Quads tendon rupture
Contraction of quads when knee partly flexed and foot planted
Clinical Features of Quads tendon rupture
Pain and swelling knee joint
Palpable gap tendon
Inability to flex knee
Mx Quads tendon rupture
Surgical suturing
Causes Patella tendon rupture
Trauma to infrapatellar region
Clinical Features of Patella tendon rupture
Pain, swelling, palpable gap
High riding patella
Mx of Patella tendon rupture
Partial tears - immobilise
Complete tears - suture
Clinical Features of Meniscal tear
Clicking, locking, popping
Effusion
Medial > Lateral
How to differentiate meniscal tear from ligament damage
Pop = Ligament Lock = meniscus
Mx Meniscal tear
RICE
NSAIDs
PT
Arthroscopy
Knee ligament Causes and RFx
ACL >PCL
Females
Audible pop
Knee ligament Mx
RICE
Arthroscopy
Knee brace and crutches
What is the unhappy triad?
ACL, Medial meniscus, Medial collateral
Cause of Achilles tendon rupture?
Sudden plantar flexion with forced dorsi flexion
Occurs intermittently active individuals
Clinical features of Achilles tendon rupture?
Loud pop
Feel of being kicked back of legs
Simmons test negative
Mx Achilles tendon rupture?
Non-op: serial casting with foot in full equinous then start stretching
Op: Tendon repair
3 DDx Mechanical back pain
Disc protrusion - nucleus moves against annulus fibrosis
Disc herniation - annulus fibrosis torn and extrudes
Disc sequestration - bit of nucleus breaks off and compresses spinal n
Clinical features mechanical back paion
Acute onset severe back pain Radiates legs and arms Stabbing/electric shock-like Loss deep tendon reflexes - LMNL Short walks and changing position helps
Ix Mechanical back pain
MRI
Straight leg raise - Sciatica
Neck compression test - cervical spine radiculopathy
Mx Mechanical back pain
Conservative: PT, local heat, NSAIDs
Surgical: Decompression, discectomy
Mx Malignant Spinal Cord Compression (MSCC)
Contact MSCC Team Rehab and transition home Steroids RTx Decompressive surgery
Cause of Discitis?
Strep Pyogenes
Clinical Features of Discitis?
Back or neck pain not relieved by rest
Worse at night
Extension contracture protective posture
Early signs of NF?
Diffuse redness
Swelling
Extreme tenderness
Late signs NF?
Crepitus
Purple discolouration
Loss of sensation
Cause of NF?
Polymicrobial
Group A strep - Pyogenes
S aureus
Mx NF
ITU
Broad spectrum Abx
Extensive debridement
Complications NF
Sepsis DIC AKI Severe necrosis Amputation
What are Incomplete fracture in paeds?
Fractures where fracture line absent or doesnt cross width of bone - intact of periosteum on one side
3 Types:
Torus - Disruption of cortex on side of compressive force (presents as bulge) - cast/splint
Greenstick - Disruption of cortex on side tension, intact on side on compression - cast or reduce
Bowing - No disruption of cortex but angulation
