Ortho emergencies

Question 1

What is compartment syndrome?

Answer 1

The pressure in a fasical compartment (which holds blood vessels, nerves, muscle) is too high which can lead to a lack of blood flow and tissue necrosis

Question 2

How does compartment syndrome present?

Answer 2

Usually after crush injury/ fracture
5Ps!!
Pain disproportionate to injury, worse on passive stretch muscle
Paraesthesia 
Pale 
Pressure
Paralysis (late)

Question 3

How do you mx compartment syndrome?

Answer 3

Escalate
Remove dressings
elevate leg
Maintain BP
fasciotomy and debridgement

Question 4

Where does the cauda equina start/ spinal cord end?

Answer 4

L2/L3 is where spinal cord tapers off into conus medullaris

Question 5

What are some causes of cauda equina syndrome?

Answer 5

Herniated disc
Trauma
Infection
Tumour 
Spondylolisthesis (where vertebra NOT disc is displaced)

Question 6

What are the red flag signs for cauda equina?

Answer 6

Saddle paraesthesia 
Incontinence 
Bilateral sciatica 
Reduced anal tone
Bilateral weakness

Question 7

What is the mx of Cauda equina?

Answer 7

Admit
MRI emergency
Surgery

Question 8

What is the difference between metastatic cord compression and cauda equina?

Answer 8

Cauda equina: LMN issue; surgical issue

MCC: originates from cancer; UMN issue; back pain worse on coughing; treat with dexamethasone; refer oncology

Question 9

Summarise Septic Arthiritis

Answer 9

Pathophysiology: Infection of a joint. Important complication of joint replacement.

Presentation: Acute, red, painful, swollen joint, fever, systemic sx, stiff, reduced ROM

Cause: S.aureus (most common), N. gonorrhoea (esp in young), s. pyogenes

Differentials: gout, reactive arthiritis, haemarthrosis

Ix: Aspirate joint (crystal microsocpy, culture, gram staining, antibiotic sensitives), inflammatory markers

Mx:
1) IV flucloxacillin (vancomycin in prosthetics) + rifampicin 3-6 weeks

Question 10

Summarise Osteomyelitis

Answer 10

Pathophysiology: Inflammed bone/ bone marrow. Spread via haematogenous (seeing from blood) or direct contamination (e.g. # or operation). S.aureus most common.

RF: open #, surgey, DM, PAD, IVDU, immunosuppressed

Presentation:
Fever, pain, erythema, swelling, non-specific

Ix:
XR often normal but can show periosteal reactions, localised osteopenia, destruction. MRI best, inflammatory markers, blood cultures positive, bone cultures find organism.

Mx:
Debridgmenet and abx (flucloxicillin)