Ortho revision Flashcards
Principles of all ortho
trauma-
ATLS-reduce hold rehabilitate
Exam-
look,feel,move
Clinical sign of Fractures
Pain, constant. Pain on palpation, and moving
Swelling, deformity (visible bone)
Bruising
crepitus when you feel
Neurovasc damage
Ix of fractures
Radiograph/xray
rule of thumb- CT>MRI/xray for bones
MRI>CT for soft tissue
Describing a fracture
Which bone? and which part of the bone (meta, epi or diaphysis)
Are there fragments-single or many (multifragmentory)
are the fragments in place, has the bone moved appart? (translation-anterior 3 dimensions and where they move etc)
And then pattern (spiral/oblique)
examinors love–varus- distal part away from midline, valgus-towards
General fracture management and overview
Reduce-open-cut skin and push it back together
closed-pull on skin and pull the bone and let it go back to right place (can be with a pin as well)
hold- metal or not
Hold-traction/plaster or metal fixation
fixation can be internal or external
Internal-medullary (in bone) or extramedullary
Generally-soft tissue damage=External fixation
Rehabilitate-
USE
Move
stenghten
weight bear
Complications of fractures
General or specific (at site)
immediate, intermediate or late
Immediate-Neurovasc, tendon, fat embolus, infection, compartment
intermediate- prolonged immobility and things
late-malunion/nonunion, infection, arthiritis
NOF hx and exam most importants
Causes- old (osteoporosis-falls)
Young-trauma
and co-morbitidies
and PRE-INJURY MOBILITY
and general house stuff (can they, how)
NOF anatomy and relation to NOF fracture
Femoral head, neck, and then the split for the capsule-halfway up the neck
capsule/Femoral head has all the blood supply coming around–extracapsular doesnt compromise blood supply
displaced intra- worried head dies- hip replace- hemi if co-morbid die soon or full (young and live for long)
extracapsullar- nails- usually dynamic hip screw, intramedullary nail
OA hx
most important
how bad is pain, is it at night (v severe)
and what ADLs that they want to do they cant
Trauma of infection?
What previous treatment do they have?
Other joints and inflam sx anywhere (in case)
OA exam/assess
Look -varus, valgus, scars for replacements
feel-patellar tap/effusion, pain etc
move- Range of movement-angle of FLEXION (staight is 0 not 180)
special tests
hips and knees very very common for PACES
OA PACES plans mx
weight bearing xrays if you can
CT scan-too much radiation
MRI can be easier
bloods if infection, rheumatic
Rememeber OA xray- loss of joint space, sclerosis, cysts and osteophytes
Medical and surgical
go all the way to medical
analgesic, physio, walking aid, avoid activity, steroids injection
if fail/too severe- operations
usually- remove touching parts and replace, realign, Fuse,
Shoulder exam and conditions
look-deformity, swell etc
feel
move
special-external rotation resist, belly press
AND MORE
conditions-<35- trauma,
<65- frozen etc
>65-OA,pinch
