Ortho/Rheum Summary Q's Flashcards
Key facts about Shoulder dislocation
anterior is most common
posterior is as result of seizure or electric shock
always check nerves and pulses (before reducing)
complications of shoulder dislocation
hill-sacks (chunk of humeral head)
bankhart (labrum injury)
Slap-tear (labrum)
Axillary nerve injury
Key facts about proximal humerus fx
assess if humeral head in several pieces
either CONS = sling / 8-12 weeks + splint
or SURG int fixation
Radial nerve injury can occur = wrist drop
AVN can also occur // axillary artery
Key facts about Supra Cond Fx
often kiddo’s falling
assess post fat pad/radio-cap + ant hum lines
keep elbow in extension so as no damage to brachial artery
*radial/median nerve palsies are rare!
Key facts about Elbow Fx
often not seen on X-ray, look for anterior fat pad (sail sign)
joint is swollen and tender
if no fx seen, but effusion seen on X-ray, sling for 14 days then repeat xray
Key facts about Radial Head Fx
sup and pronation hurts, effusion seen on X-ray + assess ant hum/radio cap line
what is the concern about a medial area clavicle fracture?
damage to neurovascular: brachial plexus, subclavian vessels +/- pneumothorax
young patient presents after falling, pain and lump in upper chest suspected clavicle fracture, with assoc tachpnea. what other condition may be present?
pneumothorax
most common fracture with FOOSH of older patient
colles wrist
Key facts about clavicle fx
usually young person FOOSH
managed conservatively unless very lateral and requires int fixation (non-union)
cuff and collar / 3 weeks
risk factors for fractures
osteoporosis, falls risk?, post-menopausal?
scphoid Fx CF and management
tender snuff box
hard to see on xray so ??CT, or POP cast and return in 14 days for repeat xray
concern with scaphoid fractures
AVN –> SNAC and SLAC
distal radius fx - key facts
elderly FOOSH
dinner fork/ dorsal deformity
if displaced, reduce (GA or Haematoma block) +/- ORIF
then immob in dorsiflexion
possible complication - median nerve damage, ruptured tendon, mal-union
blood supply to femoral head
branch of femoral art –> medial and lateral circumflex artery is main supply // branch of obturator artery supplies head
management of patient with hip fracture
ABC - patient can be shocked so RESUS
- analgesia (10-15mg morphine IM) + anti-emetic (metaclop)
- cross-match/ FBC/ U&E/ ECG
- radiography (xray/CT)
Contra-Ind to surgery
Severe Dementia/ severe functional disability / current infection/ ??osteoporosis/ alcoholism (wont rehab properly)
Why might a hemi arthro be done instead of total?
Poor general health
Severe osteoporosis
Mentally handicapped
Pre-existing hip disease
how might hip fractures in elderly be prevented?
decrease osteoporosis -bisphos/ calcium/ vit D
more exercise = better balance
better lighting in house
RF for pathological fx’s
Bone Mets Osteoporosis osteomalacia myeloma rheumatoid arthritis
patient attends A&E with open fracture, what intial steps will you take in managing once ABC are complete?
- control any bleeding from wound
- give abx’s cover
- immobilise fracture
- analgesia +/- anti-emetic
- examine for neurovasc compromise
- radiograph once stable
what might be seen on examination of patient with ??fracture
swollen, deformed, tender area, with decreased ROM, decreased sensation and no weight bearing.
what will crush syndrome eventually result in if untreated?
HYPERkal + HYPOvol –> AKI/ DIC/ Met Acidosis
where might compartment syndrome affect?
ant low leg/ deep post low leg/ volar forearm
CF of compartment syn?
Pain (even passively) , parasthesia, paralysis, pallor (pulse will still be felt)
why might a patient be initially immobilised in a backslab before a full cast applied?
decrease risk of compartment syn
what is important to exclude when assessing acute knee?
Multi Lig Inj/ Fractures/ Tendon Inj/ Dislocation (damage pop art)/ ((in kids epiphyseal fracture))
best imaging for soft tissue inj?
MRI
Neurovasc Inj from Diff Fractures?
- Shoulder Dis
- Humeral
- Distal Radial
- Distal Ulnar
- elbow
- hip dis
- upper fibular
shoulder - axillary nerve damage = numb deltoid
humeral - radial nerve damage = wrist drop
Distal Rad - Median = NO Pincer sign
Distal Ulnar - Ulnar = claw hand/ numb pinky
Elbow - brachial art = must be kept in extension
Hip dis - sciatic nerve = foot drop
upper fib - perineal = foot drop
mortality of hip fracture
50% in elderly
Patient attends with pain in shoulder, there is NO fracture, name 3 possible causes?
- rotator cuff damage (partial or complete tear) painful arc
- nerve impingement (pain on abduction resistence)
- frozen shoulder (won’t move active or passively)
swollen elbow that isnt fractured, causes? also what might you do in clinic to relieve any pain?
- bursitis (tennis-lat or golfers-med)
- olecrenon bursitis
intra artic steroid injection
3 common sites for AVN?
Hip, Scaphoid, knee, ankle
what abx’s might be used for osteomyelitis?
IV Cefotaxime and Vanc until cultures known.
indications for total hip replacement (in context arthritis)
- prox neck of femur fracture
- non-operative treatment failure
- pain causing decreased function
- joint disease severly impacts quality of life
why might a hemi arthroplasty be done instead of a total?
- poor health
- severe osteoporosis
- pathological hip fx
- pre-existing hip disease
risk factors for septic arthritis
prosthetic joint, ivdu, DM, recent intra-artic injection, joint disease, immunocomp
main differentials of hot swollen red joint?
what is key investigation?
what shown in each condition?
septic and gout (+/- haemarthrosis)
joint fluid aspirate BEFORE abx’s started
septic = pyogenic fluid
gout = negatively birifringent needles/urate crystals
what is the basic pretense of causing gout?
anything that causes the increased leaving of fluid from the body:
Diuretics, dehydration, alcohol excess, dietary (fasting/purine rich-meats)
treatment of gout?
NSAIDS (diclofenac) but if CI then give Colcihine (slower)
if patient has renal problems give steroids instead
Prevent further attacks by lifestyle mods and Allopurinol
why not use allopurinol straight away?
can cause an attack, so wait 3 weeks thn give with NSAIDS cover
diagnostic test (s) for SLE
anti DS-DNA / ANA / C3-C4
reiter triad?
arthritis, conjunctivitis, urethritis
psor arthritis CF/ o/e
sacroilitis, unilateral DIP, nail changes, psoriasis, swelling, dactylitis,
GCA signs? and immediate management?
jaw claudication, scalp tenderness, headache +/- unilat blindness
ESR and give oral PRED
red flags back pain?
neuro defecit, hx of CA, age 55, bladder incont, weight loss/ systemic
RF for osteoporosis
SHATRD
Steroids Hormones (sex hormones) Alcohol excess Thin Rheumatoid Arth Dietary
clinical features of spinal cord compression
saddle anaes, bladder, buttock pain,
bamboo spine = ?
ank spond
