Ortho - NDH Hospital Learning/ Guidelines Flashcards
Where does ulnar nerve run in relation to elbow?
Runs on posterior medial aspect of elbow
Where does median nerve run in relation to elbow?
Runs anterior to cubical fossa
Splint Mx for compound tibia #?
- Backslab for 8/52
2. PTB for 4/52
How does wt bearing help in # healing?
- Causes micro-stress
2. Helps form and strength callous
How long in general to keep POP/backslab for?
6/52
When to do above elbow backslab?
When any radius or ulna # affecting the diaphysis
When to do below elbow backslab?
When any radius or ulna # involving epiphysis or metaphysis
Kanavel cardinal signs of flexor sheath infection:
- A finger held in slight flexion
- Fusiform swelling of the affected digit
- Tenderness along the flexor tendon sheath
- Pain with passive extension of the digit.
Indications for surgery for ankle #:
- Compound #
- Syndesmotic #/ Weber C
- All bimalleolar #s
- Trimalleolar #
- Failure of non-op Mx
- Loss of medial buttress
- Ipsilateral # (relative indication)
Which carpal bone dislocations are emergencies and need immediate intervention?
- Lunate dislocations
2. Perilunate dislocations
- [ ] Mx open #:
- [ ] ATLS
- [ ] ATT
- [ ] Analgesia
- [ ] ABx:
- [ ] Ranzol first line
- [ ] Add Flagyl + Genta for triple cover
- [ ] Check renal Fx before starting genta
- [ ] Washout:
- [ ] With N/S
- [ ] Can add some iodine
- [ ] Wash until macro clean
- [ ] Dress wound:
- [ ] Jelonet + gauze
- [ ] No jelonet - N/S soaked gauze or betadine ointment on gauze
- [ ] Then crepe
- [ ] Immobilise
- [ ] Back slab since lots of swelling
Mx of closed # requiring OT:
- Immobilise
- Analgesia
- Limb elevation
- Soft tissue R/V
- Once swelling reduced - ORIF
Compartments of the forearm:
3 in total
- Volar - most commonly affected
- Dorsal
- Mobile wad - lateral
Hand compartments
10 in total
- Hypothenar
- Thenar
- Adductor pollicis
- dorsal interosseous (x4)
- Volar (palmar) interosseous (x3)
What’s is osteoporosis?
- Decrease in bone mass
2. With disrupted bone microarchitecture
Dx of osteoporosis:
- Diagnosis is made with a lumbar-based DEXA scan
2. T-score >2.5 standard of deviations below the peak bone mass of a 25-year-old individual
Zones of the hand:
I: Distal to FDS insertion
II: FDS insertion to distal palmar crease/proximal A1 pulley
III: Palm
IV: Carpal tunnel
V: Carpel tunnel to forearm
Classification of tibial plateau #:
Schatzker Classification:
Type I - Lateral split fracture
Type II - Lateral Split-depressed fracture
Type III - Lateral Pure depression fracture
Type IV - Medial plateau fracture
Type V - Bicondylar fracture
Type VI - Metaphyseal-diaphyseal disassociation
Classification of tibial plafond #:
Ruedi and Allgower Classification:
Type I - Nondisplaced
Type II - Simple displacement with incongruous joint
Type III - Comminuted articular surface
What is a tibial plafond #?
- Fracture of the distal end of the tibia
- Most commonly associated with:
- Comminution
- Intra-articular extension
- Significant soft tissue injury.
Primary ligaments of ankle include:
Medial:
Deltoid ligament
Calcaneonavicular ligament (Spring Ligament)
Lateral: Syndesmosis (includes AITFL, PITFL, TTFL, IOL, ITL) Anterior talofibular ligament (ATFL) Posterior talofibular ligament (PTFL) Calcaneal fibular ligament (CFL) Lateral talocalcaneal ligament (LTCL)
Syndesmosis components
- Anterior-inferior tibiofibular ligament (AITFL)
- Posterior-inferior tibiofibular ligament (PITFL)
- Transverse ligament
- Transverse tibiofibular ligament(TTFL)
- Interosseous ligament (IOL)
Classification of lateral malleolus fractures:
Danis-Weber (location of fibular fracture)
A - infrasyndesmotic (generally not associated with ankle instability)
B - transsyndesmotic
C - suprasyndesmotic
Classification of supracondylar fractures:
Gartland classification
Type I - Undisplaced
Type II - Displaced in 1 plane
Type III - Displaced in 2 or 3 planes
Type IV - Complete periosteal disruption with instability in flexion and extension
Orders of ossification centers of elbow
CRITOE
Capitellum - 1 yr
Radial head - 3 yr
Internal epicondyle - 5 yr
Trochlear - 7 yr
Olecranon - 9 yr
External epicondyle - 11 yr
Classification of NOF #:
Garden Classification
Type I - Incomplete fx (valgus impacted)
Type II - Complete fx, nondisplaced
Type III - Complete fx, partially displaced
Type IV - Complete fx, fully displaced
Types of hand sepsis:
- Felon infection (pulp space)
- Paronychial infection
- Tenosynovitis
- Superficial palmar sepsis
- Deep palmar sepsis