Ortho Rosh Flashcards
Ottawa Ankle Rules: ankles
pain in the malleolar region with any of the following:
bone tenderness at the posterior edge of the distal 6 cm or the top of the lateral malleolus
bone tenderness at the posterior of the distal 6 cm or the tip of the medial malleolus
inability to bear weight for at least 4 steps both immediately after the injury and at the time of the evaluation
Ottawa Ankle Rules: foot
pain in the mid foot region with any of the following:
bone tenderness at the navicular bone
bone tenderness at the base of the 5th metatarsal
inability to bear weight for at least 4 steps both immediately after the injury and at the time of evaluation
sx of plantar fasciitis
pain in the plantar region of the foot that is worse in the morning and when initiating walking
points of discrete tenderness at the anteromedial calcaneus where the proximal plantar fascia inserts
heel pain with dorsiflexion (pointing toes up at the sky)
MC ankle injury
lateral ankle sprain
mechanism for lateral ankle sprain
plantar-flexed foot is inverted
Kanavel signs for Flexor tenosynovitis (surgical emergency)
pain on passive extension of the affected finger (often the first finding)
finger held in partial flexion
tenderness of the full tendon sheath
fusiform swelling of the digit
tx for flexor tenosynovitis
intravenous antibiotics such as vancomycin plus extended-spectrum penicillins
emergency hand surgery consultation
how to diagnose gout and pseudogout
arthrocentesis
MC shoulder dislocation
anterior shoulder dislocation
how will the shoulder appear with anterior shoulder dislocation
The acromion will appear prominent and the shoulder often loses its normal rounded contour
Which nerve is most commonly injured in shoulder dislocations?
axillary nerve
Bankart vs Hill-sachs deformities
Bankart lesions occur when a bony fragment is avulsed from the glenoid labrum during a dislocation. A Hill-Sachs deformity is a cortical depression in the humeral head created by the glenoid rim during dislocation.
initial treatment for a nondisplaced humerus fracture
immobilization in a sling
what is the most severe complication associated with knee dislocations
injury to the popliteal artery
MC nerve injury in knee dislocation
peroneal nerve
sx if peroneal nerve damage
decreased sensation to the dorsum of the foot
weakness with dorsiflexion at the ankle
predisposing conditions for septic arthritis
a history of surgical replacement of the joint, skin infection, other joint surgery, rheumatoid arthritis, age > 80 years, diabetes mellitus, and kidney disease
MC bacterial cause of septic arthritis
staph aureus
do you need imaging for radial head subluxation
no
sx osteoarthritis
symmetric, polyarticular, mild joint pain, and stiffness that worsens with use and ultimately leads to joint deformity and loss of locomotion in advanced disease. It most commonly affects the distal interphalangeal (DIP) joints, the thumb, knees, and hips
Heberden’s nodes - bony, hard swelling of the distal interphalangeal joints
Which hand joints are most commonly affected in rheumatoid arthritis?
Metacarpophalangeal and proximal interphalangeal joints.
mallet finger injury results from
forced flexion of the distal interphalangeal joint –> inability to actively extend the dorsal interphalangeal joint
What views should radiographs of a mallet finger injury include?
Anterior-posterior, lateral, and oblique views
tx for mallet finger
splinting the distal interphalangeal joint in full extension without flexion at any time for a period of six to eight weeks
tx for scaphoid fx/tenderness over anterior snuffbox
immobilized in a thumb spica splint and referred for repeat clinical evaluation and radiographs in approximately 7–10 days
3 MC features of septic arthritis
joint pain, joint swelling, and fever
olecranon bursitis vs septic bursitis
Patients with olecranon bursitis will lack significant tenderness and erythema overlying the bursa and will not have fever. Passive range of motion should be normal. If the diagnosis is in question, bursal fluid should be aspirated for analysis
smith fx vs colles fx
Smith fracture also involves the distal radius, however palmar (volar) displacement is seen rather than dorsal displacement
Colles fractures are characterized by dorsal displacement of the distal radius fragment; dinner fork deformity
What is the most common fracture site in the upper extremity?
the distal radius
Which rotator cuff muscle is most commonly injured, inflamed, or torn?
The supraspinatus muscle.
what 2 tests are best for shoulder impingement
hawkins-kennedy
neer
positive obrien test may indicate
labral tear
a positive speed test may indicate
bicipital tendonitis
how to perform: the clinician has the patient elevate the arm against resistance when the elbow is extended and the forearm is supinated
PE for ruptured biceps tendon
weak flexion and supination of the injured arm
What is the innervation of the biceps muscle?
The musculocutaneous nerve. The nerve roots for the musculocutaneous nerve are C5, C6, and C7
MC fracture involved in compartment syndrome
tibia
Normal compartment pressure
10-12 mmHg
sx of compartment syndrome
Passive stretching of involved muscle groups produces intense pain, as does manual compression of an affected compartment. Active movement is likely to be painful as well, while the nerves passing through the affected compartment may be compromised and produce paresthesias. Paresis and muscle weakness are late findings. Pulses are usually maintained unless the presentation is particularly late
5 ps: pain, paresthesias, pallor, pulselessness, and paresis
delta pressure and compartment syndrome
obtained by subtracting the intracompartmental pressure from the DBP
A delta pressure ≤ 30 mm Hg is regarded as concerning and indicative of needing fasciotomy
Compartment syndrome of the deep posterior compartment of the lower leg will lead to which passive movement producing intense pain?
toe extension
tx greenstick fracture
immobilization
buckle (torus) fracture
the bony cortex on the side opposite the force is compressed and “buckles” outward without true cortical disruption
tx buckle/torus fracture
removable splint
function of deep peroneal nerve
deep peroneal nerve provides sensation between the first and second toes and motor function to the tibialis anterior (dorsiflexion and eversion of the ankle) and extensor hallucis longus (extension of the great toe)
what nerve is commonly damaged after femur head fx
common peroneal nerve
brachial plexus consists of nerve roots
C5 - T1which merge and divide to form the median, ulnar, and radial nerves
The primary function of the ACL is
to control anterior translation of the tibia
MC injured ligament of the knees
ACL
Three physical exam maneuvers help test the ACL stability:
the Lachman test, pivot shift, and the anterior drawer.
Lachman»_space;>
Lachman test is performed with the knee flexed to 30 degrees, followed by stabilization of the distal femur with one hand while pulling the proximal tibia anteriorly with the other hand. The pivot shift test is performed by having the clinician hold the lower leg with one hand and internally rotating the tibia, while applying a valgus stress to the knee with the other hand. Then, while maintaining these forces, the clinician flexes the knee, and in ACL-deficient patients, this causes a reduction of a subluxed tibia resulting in a “clunk.” This test is highly specific for ACL rupture, but is very difficult to perform in an awake patient due to patient guarding and pain. The anterior drawer test is performed with the patient lying supine and the knees flexed to 90 degrees. The proximal tibia is grabbed with both hands and pulled anteriorly.
Lisfranc joint (tarsometatarsal joint complex) is comprised of
articulations of the bases of the first three metatarsals with the cuneiforms and the fourth and fifth metatarsals with the cuboid, joined together with multiple ligaments
sx for lisfranc dislocation
severe pain in the midfoot and inability to bear weight. Ecchymosis on the plantar surface of the foot is often considered pathognomonic for Lisfranc injuries
what X-ray views should be ordered for lisfranc
Anterior-posterior, lateral, and oblique radiographs
dx lisfranc
Any widening or malalignment > 1 mm in these areas is considered pathological.
tx lisfranc
immobilization with a short-leg cast, elevation, and pain control. The patient should be non-weight bearing. Orthopedic consultation is necessary
What technique may improve the chance of diagnosing a Lisfranc injury on plain radiograph?
Including weight-bearing (stress) views
What is the antibiotic regimen of choice if an open fracture is deemed to be large (> 10 cm) or very contaminated?
First-generation cephalosporin and gentamicin
otherwise, can just do 1st generation cephalosporin (cefazolin)
olecranon bursitis is also called
student elbow
tx olecranon bursitis
joint protection and anti-inflammatory medications
The most common complication from a midshaft humerus fracture
radial nerve injury
radial nerve injury sx
radial nerve palsy with wrist drop
tx humeral shaft fx
coaptation splint and sling and swathe
what does patella Alta indicate
patellar tendon rupture
what nerve can be damaged during shoulder dislocation and reduction?
Axillary nerve
what does patella Baja indicate
quadriceps tendon rupture
tx for patella tendon rupture
rest, ice, compression, elevation, analgesics, non-weight-bearing status with crutches, and prompt orthopedic referral
Characteristic findings of osteomyelitis on plain radiograph
periosteal reaction, periosteal elevation, and lytic lesions or sclerosis
what imaging modality has the greatest sensitivity for osteomyelitis
MRI
tx osteomyelitis
debridement and antibiotics with a prolonged duration of therapy
