ortho Flashcards
management intracapsular #NOF
undisplaced → DHS
displaced + < 65yrs → reduction + DHS
displaced + > 65yrs + independent → total hip replacement
displaced + > 65yrs + less independent → hemiarthroplasty
management extracapsular #NOF
intertrochanteric → DHS
subtrochanteric → proximal femoral nail
causes of #NOF
osteoporosis
trauma
McMurray’s test: how + what does it test
medial meniscus: flexion + internal rotation then extension → pain / click over medial joint line
lateral meniscus: flexion + external rotation then extension → pain / click over lateral joint line
principles of fracture management
- resuscitation
- reduction: open / closed
- restriction: closed (plaster, traction) / fixation (internal: plates, nails / external)
- rehabilitation: movement + physiotherapy
osteoarthritis management
cons: exercise + physio, weight loss, orthotics / walking aids
med: analgesia (WHO ladder), steroids (intra-articular injections)
surg: arthroplasty
signs on exam osteoarthritis
heberden's nodes (DIP) bouchard's nodes (PIP) squaring at base of thumb varus / valgus deformities crepitus joint tenderness / reduced ROM
common joints for OA
weight bearing: hips, knees, shoulders
special tests for hip
trendelenburg’s: weak hip abductor causes drop on opposite side
Thomas test → fixed flexion deformity (passive hyperflexion of leg w hand under spine): NOT in pts w hip replacement (risk dislocation)
special tests shoulders
impingement: Kennedy-Hawkins (internal rotation of shoulder w elbow at 90)
supraspinatus: beer car empty
intraspinatus: external rotation against resistance
teres minor (hornblower’s): external rotation against resistance w arm in horizontal plane
subscapularis: internal rotation against resistance (Gerber lift-off test)
special tests knee
McMurray’s → menisci
anterior / posterior drawer → cruciates
valgus / varus stress tests → collateral ligaments
fracture complications
local: non-union / mal-union injury to surrounding structures: neurovascular injury, tendon / muscle injury pain / restricted movement around joint local infection
general: fat embolus, sepsis immobility → pressure sores, DVT
stages of fracture healing
- haematoma + inflammation
- soft callus formation: connective / fibrous tissue
- bony callus formation
- remodelling: osteoblasts / clasts
management of open fractures
(resus) extent of injuries + any associated injuries control haemorrhage neurovascular assessment xray analgesia + IV ABx + tetanus wound irrigation (saline) stabilisation (external fixator) definitive: washout, debridement + fixation in theatres
RFs for fracture non-union / poor bone healing
infection
intercurrent disease: diabetes, malignancy
too little / too much movement
smoking
approaches for hip arthroplasty
anterolateral: risk superior gluteal nerve injury → trendelenburg gait
posterior: risk sciatic nerve injury → foot drop
complications arthroplasty
infection, bleeding, VTE neurovascular injury dislocation, fracture, pain wearing of arthroplasty arthrofibrosis: postoperative limitation of range of motion from scar tissue formation
indications for hip arthroplasty
pts over 65 w displaced hip fracture
THR if independent (risk of dislocation w particular movements)
hemiarthroplasty if not
types of hip arthroplasty
- Total hip replacement: replacement of femoral head + neck + acetabulum
- Hemiarthroplasty: replacement of femoral head + neck
- Hip resurfacing: replacement of surface of femoral head
indications for knee arthroplasty
to reduce pain in:
osteoarthritis
inflammatory arthritis: rheumatoid, psoriatic
post-traumatic degenerative joint disease
types of knee arthroplasty
- total knee replacement
2. unicompartmental knee replacement: if disease confined to 1 compartment
management carpal tunnel
cons: physiotherapy, avoidance of repetitive movements
wrist splint
med: steroid injections
surg: carpal tunnel release (flexor retinaculum transection)
causes of carpal tunnel
idiopathic
mechnical compression: repetitive movements, acromegaly
radial fracture
diabetes
inflammation: rheumatoid, gout
altered fluid balance: renal failure, hypothyroidism, pregnancy, obesity
salter harris classification
for epiphyseal fractures (paediatric) I: straight across (physis) II: above (metaphysis, most common) III: lower (epiphysis) IV: through everything (physis, metaphysis, epiphysis) V: cRush (worst prognosis)
dupuytren’s contractures causes / associations
idiopathic FHx alcoholism / liver cirrhosis diabetes hand trauma / manual labour phenytoin
management dupuytren’s contracture
cons: splints, physio
med: analgesia
surg: surgical resection / fasciectomy (may recur + risk of neurovascular damage)
carpal tunnel syndrome signs on examination
thenar eminence wasting
motor: reduced thumb abduction
Tinel’s sign: tapping of nerve → paraesthesia in median nerve distribution
positive Phalen’s test (wrist flexion > 90degrees → paraesthesia)
investigations for compartment syndrome
compartment pressures
> 20mmHg = abnormal
> 40mmHg = diagnostic
actions of rotator cuff muscles + special tests
supraspinatus → abduction (inital 20degrees): empty can test (Jobes)
intraspinatus → external rotation: against resistance
teres minor → external rotation + adduction: passive w elbow at 90
subscapularis → internal rotation + adduction: Gerber lift-off test
presentation rotator cuff impingement
pain on overhead activity popping / snapping / grinding sensation stiffness tenderness over greater tuberosity / supraspinatus reduced ROM difficulty initiating abduction painful arc (60-120 degrees of abduction) \+ve empty can (Jobes) test \+ve Hawkins-Kennedy test
