Ortho Basics Flashcards
3 Basic Parts of the Bone
Epiphysis - end
Metaphysis - widening
Diaphysis - long, stick-like
Fracture Description
NO LARD
N - neurovascularly intact?
O - open or closed?
L - location (including direction of frax lines)
A - alignment / angulation / articular involvement
R - rotation (is it spiral?)
D - displacement (describe where the distal segment is displaced in relation to proximal segment, give % displacement)
Angulation Terms (Complete and Incomplete Frax)
COMPLETE
- transverse (straight across)
- oblique (diagonal line)
- spiral (like a staircase)
- comminuted (3+ pieces)
INCOMPLETE
- bowing
- buckle / torus (sticking out on both sides)
- greenstick (bent w/ partial linear break)
Alignment Terms
- Always describe the distal fragment in relation to proximal fragment
- Valgus = apex to midline
- Varus = apex away
Articulation Terms
Subluxation - partial loss of joint continuity
Dislocation - complete loss of joint continuity
Septic Arthritis
Sx: warm, swollen, dec ROM, cannot bear wt, RF (OM, direct inoculation, surgery, bacteremic)
Work-Up: tap joint + cx
Tx: vanc + ceftriaxone
When to call ortho urgently? if prosthetic call BEFORE tap, if tap unsuccessful but high suspicion
Flexor Tenosynovitis
4 kanavel signs:
- sausage digit
- in passive flexion position at rest
- pain w/ passive extension
- pain when palpate tendon sheath
Tx: vanc + ceftriaxone + ortho consult
Fight Bite
Human bacteria can seed hand; MCP most common
Tx: Unasyn +/- vanc, tetanus shot, X-ray, hand surgery consult
Compartment Syndrome
Sx: pain w/ passive stretch (most sensitive), 5 P’s rarely present in real life
Work-Up: measure compartment pressures (abnormal if >30 or delta of 30)
Tx: immediate ortho consult for fasciotomy
Open Frax Mgt
Neurovascular exam, tetanus irrigaate, abx
Sterile dressing and split
Gustilo Classification
I - open < 1 cm (1st gen cephalosporin)
II - open 1-10 cm (1st gen cephalosporin)
III - open > 10 cm (+ gentamicin or pip-tazo)
**If farm injury or bowel contamination add PCN for clostridium coverage
Traumatic Finger Amputation Mgt
- If < 1 cm with no bone exposed … heal on own
- If > 1 cm with no bone exposed … suture shut
- If small bone exposure distal to DIP joint w/o flexor tendon involvement can cover w/ surrounding soft tissue –> d/c with oral abx and ortho follow-up
- If proximal to DIP or flexor tendon involvement … hand surg consult
Galeazzi Frax
Involves distal 1/3 radius and distal radial-ulnar joint b/c ligaments disrupted
Usually from FOOSH
Ortho consult
Monteggia Frax
Involves proximal 1/3 ulna w/ radial head dislocation
Peds»_space; adults
Usually from FOOSH
Splint
Perilunate v. Lunate Dislocation
Peri-lunate = dorsal swelling Lunate = volar swelling
Look for acute carpal tunnel
Closed reduction + splint + ortho consult
Clavicle Frax
Look for subclavian artery injury, brachial plexus injury or PTX
Need ORIF
How can posterior sternoclavicular dislocation present?
tracheal or esophageal injury
need CT surgery
Lisfran Injury
Any tarsal-metatarsal joint frax or dislocationi
Mech: axial load on hyper-plantar flexed foot
Sx: bruising of mid-plantar foot, cannot bear wt
If displaced … ORIF
If not displaced on wt bearing films and no bony injury on CT scan … d/c with orders for non-WB immobilization and ortho follow-up
Knee Dislocation
Check popliteal artery (delayed loss of pulses) and peroneal nerve injury
Reduce immediately (50% reduce spont) and CT angio (popliteal injury?) and immobilize
Hip Dislocation
Post»_space; ant
Posterior - limb is shorter and interiorly rotate
Anterior - limb externally rotated
**should be reduced with 6 hrs to avoid avascular necrosis (try to do on own before consulting ortho)
