Ortho Flashcards
Axillary nerve,
Motor, sensory, root
M: deltoid, teres minor, triceps long head
S: lateral upper arm
R: C5, C6
Musculocutaneous nerve
Motor, sensory, root
M: biceps, brachialis
S: lateral forearm
R: C5, C6
Median nerve
Motor, sensory, root
M: Wrist flexor, Wrist abductor, flexion of 1,2,3 digits
S: palmar thumb to radial half of 4th digit. Dorsal tips of digit 1 to radial half of digit 4 OK sign (AIN)
C6, C7
Ulnar nerve
Motor, sensory, root
M: wrist flexor, wrist adductor, Flexion of 4th, 5th digit
S: medial palm, dorsum of hand, 5 th digit and medial half of 4th digit
Spread fingers
R: C8, T1
Radial nerve
Motor, sensory, root
M: triceps (medial/lateral heads). Wrist, thumb, finger extensors
S: lateral dorsum of hand. Medial upper forearm. Thumbs up (PIN)
R: C5, C6,C7, C8
Tibial nerve
Motor, sensory, root
M: ankle plantar flexion, knee flexion, great toe flexion
S: sole of foot
R: L5, S1
Superficial peroneal nerve
Motor, sensory, root
M: ankle eversion
S: dorsum of foot
R: L5, S1
Deep peroneal
Motor, sensory, root
M: Ankle dorsiflexion and eversion
S: 1st web space
R: L5-S1
Sural nerve
Motor, sensory, root
M: -
S: lateral foot
R: S1, S2
Saphenous nerve
Motor, sensory, root
M: -
S: anteromedial ankle
R: L3, L4
Signs suggestive for open fx
Continuous bleeding from puncture site
Fat droplets in blood
Angulation in transverse fx
< 30°
Angulation in oblique fx
30-60°
Fx description
- Name of injured bone
- Integrity of skin/soft tissue
- Location in bone
- Orientation/pattern
- Alignment
Indications for open reduction
Non-union
Open fx
Neurovascular compromise
Displaced intraarticular
Salter-Haris 3,4,5
Polytrauma
Failed close reduction
Not able to cast or apply traction due to site
Pathologic fx
Potential for improved function with ORIF
Evaluation of fx healing
No longer tender on palpation/ stressing
Xray: teabecula cross fx site, visible callus
Normal healing time course of fx
0-3 wk: hematoma, macrophages
3-6 wk: osteoclasts remove sharp edges. Callus forms
6-12 wk: Bone forms within the callus, bridging fragments
6-12 mo: cortical gap bridged by bone
1-2 y: normal architecture achieved through remodeling
CRPS/RSD clinic
Exaggerated response to an insult
Hyperalgesia
Allodynia
Autonomic dysfunction:
Temperature asymmetry
Mottling
Hair/nail changes
Swimmer’s view Xray
Helps to see C7-T1 junction
Controversial Initial Mx if open fx
1st generation cephalo or clinda. Upon arrival until 24 h after each debridement.
Culture from: delayed injury (>24 h), infected injury
Debridement of open fx ASAP
Wound closure: within 7 d ( after soft tissue stabilization and all non-viable tissue removal
Negative pressure wound therapy: decreases infection rate
Initial Mx of open fx
ABC, primary survey
Removal of obvious foreign material
Irrigate with NS
Cover with sterile dressing
Immediate IV AB
Tetanus
Reduce and splint fx
NPO and prepare for OR:
Blood work, consent, ECG, CXR
Operative irrigation and debridement within 6-8 h
Wound left open to drain OR vacuum-assisted closure dressing
Re-examine + irrigation + debridement in 48 h
AB for open fx
If < 10 cm: Cefazolin for 3 d Or Quinolone (if penicillin allergy) Or Vanco (if MRSA positive)
If > 10 cm:
Cefazolin + Genta for 3 d
+ penicillin if soil contamination (clostridium)
Time of muscle necrosis in compartment syndrome
4-6 h
First symptom of compartment syndrome
Pain out of proportion to injury