Ortho Flashcards
Immediate Complications of fractures
Immediate:
General: Haemorrhage
Shock
Fat embolus
Specific: Neurovascular injury
Muscle/tendon/ligament injury
Compartment syndrome
fracture complications Early <30days
General: DVT/pe
Infection/sepsis
UTI
pressure sores
Specific: local infection
Fracture late complications
General: DVT/PE Infection/sepsis UTI Pressure sores
Specific: Arthritis Reflex sympathetic dystrophy Non/malunion Contractures Avascular necrosis growth disrurbance
Causes of NOF fractures
Osteoporosis
Trauma
Hx from NOF
Age Comorbidity Preinjury mobility Current meds Mental state reason for fall Social hx: relatives, stairs, etoh
Mx of Extracapsular fracture
Dynamic hip screw
Mx of Intracapsular fractures
Undisplaced (garden 1/2): Fix with screws/DHS
Displaced:
<55 -> open reduce and fix with screws
FU with arthroplasty if AVN in future.
> 65 -> fit and mobile (1 stick or less, no cognitive impairment): THR
Less fit-> Hemiarthroplasty
Describe a fracture XR
Location
Pieces (simple/multifragment)
Pattern (transverse oblique, spiral)
Displacement (Shortening, translation, angulation, rotation)
Gustilo anderson classification open fractures
- <1cm
- > 1cm minimal soft tissue damage
- Extensive soft tissue damage
C. perfringens-gas gangrene
Benpen, clindamycin
Debridement
Hip arthroplasty scars
Anterolateral - via abductors and superior gluteal nerve -> trendelenburg gait post op.
Posterior - higher risk of dislocation, sciatic nerve damage-> foot drop.
Mx of osteoarthritis
Conservative: Lose weight
Physio
Medical: Analgesia: WHO pain ladder. check U+Es before NSAIds, and not old wo PPI
Steroid injections
Surgical: arthroscopic washout - knees, trim cartilage, remove loose bodies. Realignment osteotomy Arthroplasty Arthrodesis Microfracture Autologous chondrocyte implantation
osteoarthritis definition and features
Degenerative loss of hyaline cartilage and new bone formation
Rfs: age, obesity, joint abnormality
Pain worse w movement, worse at end of day
Stiff after resting, lasts 30mins
deformity
decreased ROM, first lost is IR
exclude Rheum disease - FBC, ESR, ANA< Rhf
XR: LOSS D
Garden Classification
Intracapsular NOFs
- Incomplete/impacted injury w valgus distal angulation
- complete, undisplaced.
- Complete, partially displaced
- Complete - totally displaced.
Rheumatoid on XR
Soft tissue swelling
Periarticular osteopenia
Periarticular erosions
Severe deformity
Complications of Hip arthroplasty
Immediate: Nerve injury
fracture
Cement reaction
Early:
DVT, infection - sepsis
dislocation
Late: loosening, leg length discrepancy, metallosis, revision.
Salter classification
growth plate fractures
- Straight across (top)
- Above (metaphysis)
- lower/Below (epiphysis)
- Two/through (all)
- Erasure /crush
Complications of TKR
Immediate
- fracture
- cement reaction
- nerve injury - common peroneal - foot drop
- vascular injury - SFA, popliteal
Early
- DVT
- Infection
Late
- Maltracking
- loosening
- instablitity
- periprosthetic fractures
- reduced ROM
True leg length
ASIS - medial malleolus
- shortened - NOF, hip dislocation, growth disturbance tib/fib (osteomyeleitis)
surgery, SUFE, Perthes
Apparent leg length
Xiphistenum to medial malleolus
- Scoliosis of spine.
Thomas test
FFD = OA/NOF
Trendelenburg test
Abductor injury - OA, superior gluteal nerve injury, DDH
Carpal tunnel causes
Idiopathic Pregnancy, Hypothyroidism Radial fracture Inflammation (rheumatoid, gout) Soft tissue swelling (lipoma, acromegaly, amyloid) Toxic (alcohol, DM)
Mx Carpal tunnel syndrome
Conservative: Wrist splint neutral position at night
medical: local steroid injections
surgical: decompression by division of flexor retinaculum
Colles fracture
radius - distal dorsall displacement
Smiths fracture
distal volar displacement
Barton fracture
intraarticular fracture of distal radius
Scaphoid fracture signs
Tender anatomical snuffbox
Risk of AVN
non union and arthritis
Monteggia fractures
Ulna fracture and dislocation of proximal radial head
Galeazzifracture
Radius fracture and dislocation of distal ulnar
Complications of shoulder dislocation
Hill sachs - cortical depression in humeral head
Bankart - glenoid labrum defect
Disc herniation mx
Conservative
- max 2 days bed rest
- encourage activity and physio
Med:analgesia
diazepam (relaxant)
facet joint injections
Surg:
Percutaneous Microdiscectomy
Endoscopic discectomy
Hemilaminectomy + discectomy.
Causes of charcot foot
Central: syringomyelia
Tabes dorsalis
Peripheral
-DM, peripheral nerve injury, leprosy.
Ix NOF
ECG
FBC U+E, clotting
Cross match
XR pelvis/hip
Signs of NOF
Shortening of leg
External rotation of leg
Swelling of hip
Initial mx of NOF
Analgesia IV fluids Skin traction Urinary catheter O2 prn NBM
Initial mx femoral shaft fracture
Analgesia IV fluids FBC U+Es Cross match 2 units XR pelvis/femur Splintage affected limb Check pedal pulses Check evidence other injuries
Tibial fracture mx
Analgesia Bloods: clotting, FBC, U+E. Splint NBM IV fluids
Internal/external fixation
if not displaced/minimal -> manipulation/plaster immobilisation
Mx achilles tendon rupture
Equinus cast
Positive fromets sign
Claw hand
Extension of 4th and 5th fingers at MCPs, and flexion at interphalangeal joints.
Ulnar nerve injury
distal to wrist
flexor digitorum profundus intact, not countered by small muscles of hand.
Features of adhesive capsulitis
frozen shoulder DM External rotation affected most active and passive affected painful freezing phase bilateral 20% 6m -2y NSAIDS, physio, steroids.
Claudication buttocks and thighs
atrophy of leg muscles
impotence
Leriche syndrome
-atherosclerosis of aorta iliac vessels
Ix: Angiography, mX - stents
wrist pain after FOOSH, normal XR
hyperextended wrist
radially deviated.
loss of grip/pinch strength
Point tenderness over anatomical snuffbox. wrist effusion pain on telescoping thumb tender scaphoid tubercle. pain on ulnar deviation.
normal XR
repeat XR 7-10days.
Scaphoid #
gradually worsening pain
refer to Ortho, for MRI + surgery.
XR: AP, Laterla. oblique with wrist pronated at 45 deg, ziter view - PA with wrist in ulnar deviation and beam angulated at 20deg.
MRI
MX: Immobilisation with futuro splint/below elbow backslab.
referral to ortho , futher imaging MRI 7-10 days
Undisplaced: cast 6-8w.
displaced - surgery
proximal pole - surgery
