Ortho Flashcards
how is displacement of a # described
direction of translation of the distal fragment
ant, post, med, lat
describing displacement of a # if in forearm or hand
ant = volar post = dorsal med = ulnar lat = radial
what is angulation of a #
the direction the distal frag points towards
varus angulation of a lower limb #
distal fragment points TOWARDS midline
valgus angulation of a lower limb #
distal fragment points AWAY from midline
general Mx of open #
clean wound, excise non-viable tissue
external fixation for # stability
general Mx of displaced stable #
closed reduction + plaster
general Mx of non-displaced stable #
plaster cast
general Mx of displaced unstable #
ORIF
salter-harris classification of childrens #
S = straight through growth plate A = through growth plate and Above into metaphysis L = through growth plate and Lower into epiphysis T = Through both metaphysis and epiphysis R = goes Round physis
green-stick #
incomplete #, bone bent
median nerve S and M function
S = 2nd & 3rd fingers M = LOAF muscles
LOAF muscles
Lateral 2x lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
radial nerve S and M function
S = dorsal 1st web space M = extensor muscles
ulnar nerve S and M function
S = little finger M = abduction/ adduction finger power
Way of assessing neurovascular status in children
rock (median)
paper (ulnar)
scissors (radial)
what is a nightstick #
isolated # of ulna shaft
monteggia # dislocation
of ulna + dislocation of the radial head at the elbow
galeazzi # dislocation
of the radius + dislocation of the distal ulna
Colles #
distal radius #
FOOSH with wrist extended
causes dorsal displacement or angulation
Neurovascular injury risk in colles #
median nerve / carpal tunnel syndrome
Late complication of colles #
rupture of extensor pollicis longus tendon
smith #
distal radius #
FOOSH with wrist flexed
causes ventral displacement or angulation
barton’s #
intra-articular radial #
carpal bones
Some = scaphoid Lovers = lunate Try = triquetrum Positions = pisiform That = trapezium They = trapezoid Can't = capitate Handle = hamate
classic Hx od scaphoid #
young male in high energy contact sport, FOOSH
tenderness in anatomical snuffbox
neurovascular injury risk in scaphoid #
radial artery (retrograde blood supply)
how many x-ray views in scaphoid #
4 (AP, lat, x2 oblique)
x-ray may be normal until days after injury
area most common for proximal humerus #
SURGICAL neck
anatomical neck v rare
what is a garth view
axial oblique view used when evaluating shoulder trauma
most common - ant or post shoulder dislocation
anterior
bankart lesion
injury to anterior glenoid labrum due to anterior shoulder dislocation
hill-sachs lesion
impaction # of post humeral head due to anterior shoulder dislocation
neurovascular injury risk in shoulder dislocation
axillary nerve
sign of posterior shoulder dislocation on xray
lightbulb sign
Mx clavicle # or ACJ #
sling for a few weeks
neurovascular injury risk in humeral shaft #
radial nerve (in spiral groove) - wrist drop
Mx humeral shaft #
functional humeral brace if not displaced
ORIF if displaced
child, heavy fall onto outstretched hand - #?
supracondylar # (distal humerus)
Mx of supracondylar #
reduction under anaesthesia, fix with pins
+ collar and cuff with arm in flexion
neurovascular injury risk in supracondylar #
median nerve (unable to make OK sign) brachial artery
spinal shock
complete loss of sensation motor and reflexes below level of injury
psychologic response to injury
resolves in 24h
neurogenic shock
blockage of sympathetic outflow
priapism
complete cord injury
no sensory or motor function below injury level
central cord injury presentation
corticospinal tract affected
Arms > Legs
anterior cord injury presentation
corticospinal and spinothalamic affected
dorsal column preserved
posterior cord injury presentation
loss of dorsal column
brown-sequard syndrome
cord hemisection
ipsilateral dorsal column & corticospinal
contralateral spinothalamic
Mx intra-capsular hip #
hemiarthroplasty or THR
Mx extra-capsular hip #
DHS
proximal femur # (incl sub-trochanteric)
IM nail
posterior hip dislocation presentation
shortened, internally rotated
anterior hip dislocation presentation
no shortening, externally rotated
Holding Mx of femur #
thomas splint
Mx of femoral shaft #
IM nail
Mx of femoral shaft # in child <18m
Gallows Traction (think NAI)
Mx of femoral shaft # in child 2-6 y
Thomas splint
Mx of femoral shaft # in child 6-12y
flexible IM nail
Mx of femoral shaft # in child >12y
adult IM nail
neurovascular injury risk in patella dislocation
common peroneal nerve - foot drop
old man falls @ home, # of L inferior and superior pubic rami but femur intact - Mx?
analgesia and active mobilisation
Mx fibula #
mostly can leave alone BUT if above level of syndesmosis then Tx
Mx tibia #neurovascular injury risk in
IM nail
Toddler’s #
undisplaced spiral # of tibial shaft
pilon #
intra-articular distal tibia #
Mx pilon #
plate fixation
bimalleolar # Mx
ORIF
talar shift
widening of space between talus and medial malleolus
seen in ankle #
obese 32 y/o tripped on kerb - eversion of R foot , displaced # of medial malleolus and # of fibula above level of tibio-fibular joint - Mx?
ORIF
Lisfranc #
of midfoot
bones composing midfoot
cuboids and cuneiform
Jone’s #
of base of 5th metatarsal
neurovascular injury risk in posterior hip dislocation
sciatic nerve
impingement syndrome
pain at 60-120 degrees of abduction
impingement of rotator cuff tendons (usually supraspinatus)
Mx impingement syndrome
NSAIDs, physio, steroid inj into subacromial space
presentation rotator cuff tear
difficulty initiating abduction (as usually supraspinatus affected)
Mx rotator cuff tear
conservative - physio, injection
or
surgery
test for cubital tunnel
froment’s test - grip test of thumb on paper (weak adductor pollicis, so patient flexes their flexor pollicis longus to maintain grip strength)
test for carpal tunnel
tinels test (tap median nerve)
phalen’s test (hyper-flex wrist to reproduce pain)
tennis elbow
lateral epicondylitis
due to wrist always EXTENDED
golfers elbow
medial epicondylitis
due to wrist always FLEXED
de Quervain’s tenosynovitis
inflammation of two tendons that control thumb movement
test for de Quervain’s tenosynovitis
Finkelstein’s test - sharp ulnar deviation reproduces pain
sign of AVN on x-ray
hanging rope sign
knee extensor mechanism
tibial tuberosity, patellar tendon, patella, quadriceps tendon, quadriceps muscle
body builder, heavy lifting caused sudden leg pain - Dx?
extensor mechanism rupture (most probably patella), assumed chronic steroid abuse
carpet fitter, has swelling and pain in knee - Dx ?
bursitis
mulder’s click test
for morton’s neuroma - squeezing the forefoot produces a click
predispositions to achilles tendonitis
quinolone Abx, RA, gout
simmond’s test positive
achilles tendon rupture
squeezing the calf muscles doesn’t cause plantarflexion of the foot
Mx plantar fasciitis
rest, physio, steroid injection
Man with high BMI was running and now has pain in foot - Dx?
gastrocneumius tendon tear
inheritence of osteogenesis imperfecta
AD
defect in marfans
fibrillin gene
defect in ehler’s danlos
elastin and collagen
inheritence of DMD
x-linked recessive
erb’s palsy
high brachial plexus injury (C5,6)
knocks out everything except subscapularis - unopposed internal rotation
“waiter’s tip posture”
erbs palsy
klumpke’s palsy
low brachial plexus injury (C8 & T1)
paralysis of intrinsic hand muscles and finger flexors +/- horner’s syndrome
Ortolani’s test
reducing a dislocated hip by abduction and anterior displacement
Barlow’s test
dislocataBle hip by pushing the hip Back when flexed
Ix for DDH if Ortolani or Barlow +ve
USS
presentation transient synovitis
reluctance to weight bear on affected side, restricted ROM, post viral
Mx transient synovitis
NSAIDs, rest
presentation Perthe’s
pain and limp, loss of int rotation, +ve Trendeleberg test
Mx perthes
regular x-ray avoid physical activity
SUFE presentation
can present with pain purely in groin or knee, loss of int rotation
Mx SUFE
pinning of femoral head
Mx AVN of femoral head
bone not collapsed - drilling to relieve pressure
bone collapsed - joint replacement
Ix osteomyelitis
MRI
presdisposing conditions to osteomyelitis
sickle cell anaemia DM IVDU immunocompromised alcohol
Mx osteomyelitis
fluclox 6 weeks
Pavlick harness
Mx of DDH
Ponseti technique
Mx of club foot
Mx intertrochanteric hip #
DHS (extracapsular #)
low back pain worse on walking - Dx?
spinal stenosis
Ix spinal stenosis
MRI
drug that can be used for spasticity in CP
baclofen
most common cause of osteomyelitis
s. aureus
cause of osteomyelitis in sickle cell pts
salmonella
