ortho summary Flashcards
how to describe an x-ray
- type of X-ray (AP, lateral etc.)
- what bone
- patient details
- “this is of adequate technical quality”
- the most prominant finding is __
- feaatures of the fracture (displacement, angulation, rotation, open/closed, shortened)
- other fractures/malignancy/density
- soft tissues: effusion, gas, dislocation
- 2 veiws, 2 joints, 2 occasions
ways of referring to places on a bone
fracture patterns
salter-harrris classifiication
colles fracture
dorsally angulated, extra-articular distal radius fracture
management of colles fracture
non operatiive: closed reduction and immobilisation for non-comminuted, extra articular fractures
operature: for unstable, intra artiicular, communinuted significant displacement or shortening
scaphoid fracture
tenderness in the anatomical snuffbox
tenderness on axial loading of thumb
cast or operate if instable, displaced, proximal or comminuted
shenton line
garden classification
for NOF fractures
pelvic fracturre
high mortality due to injury to intra-abdominal organs, major arteries and veins
all patients require exmination of rectum, perineum and genitalia, lower limb neuro and abdo exam on secondary survey
management of pelvic fracture
A-E assessment
pelvic stabilisation with pelvic binder
CT scan
fast for theatre then ICU
ankle fractures
use weber classifcation:
weber A
below syndesmosis, usually stable
a medial malleolus fracture may be present
weber B
at level of syndesmosis, may be stable or unstable depending if the deltoid ligament rupture or medial malleolus fracture
weber C
proximal to syndesmosis, unstable, usually associated wit deltoid ligament or medial malleolus fracture
associated withh higher fibula fracturres
which weber class is unstable
weber C
which weber class is stable
weber A
management of non operatuve ankle fracture
weber A and some weber B
splint cast
CAM boot
management of operative ankle fracture
weber C, weber B is there is talar shift, open fractures
ORIF or external fixation
ORIF
open reduction and internal fixation
talar shift
when requesting ankle pathology ask for ‘mortise’ view’
to assess for talar shift
talar shift indicated instability of the joint
perthes disease
blood supply to the head of the thigh bone is disrupted
occurs in aged 4-10
short child with knee, thigh and groin pain and a limp
may also sow thing/calf atrophy and shortening of the leg
developmental dysplasia of the hip
at birth
identified by barlow and ortolani’s signs
treated with harness, abduction splint or open/closed reduction
slipped capital femoral epiphysis
9-13 years
overweight male teenager
knee, thigh, groin pain and limp
treated with surgical pinning
symptoms of compartment syndrome
six ps
pallor
pain out of proportion (worse on passive stretch)
parasthesia
pulselessness
perishingly cold
paralysis
management of compartment syndrome
call senior
remove plaster and dressing
do not elevate the limb
measure compartment pressure
preapre for surgicl intervention (fasciotomy) as definitive treatment
prep for theatre - comprtment syndrome is a clinical diagnosis
mnagement of open fractures
A-E assessment and stabilise patient
analgesia and immoblise
- clean wound and irrigate
- IV Abs as according to local guideleines (likley cephalosporin)
- tetanus
- urgent ortho review
- prep for theatre
complications of fractures
mal-union
non-union
chronic regional pain syndrome
neurovascular injury
fat emboli
post-trauma osteoarthritis
DDx for painful swollen joint
septic arthritis
gout
pseudogout
haemarthrosis
cellulitis
investigations for red swollen joint
bloods and CRP
athrocentesis - joint aspiration for synovial fluid analysis
what to ask for on the path form for athrocentesis
WCC, BC, microscopy and culture
protein, LDH, glucose, crystals
management of septic arthritis
A-E
IV abs
analgesia
operating theatre for joint drainage
osteomyelitis risk factors
T2DM, PVD, IVDU, recent surgery
can be bacterial, mycobacterial or fungal - usually staph aureus
osteomyelitis manaagement
determrine is acute or chronic - sinus tract indicates chronic
x-ray only shows findings after 10-14 days post infection
identify soucre - heamatogenous spread? direct inoculation?
medical management - V long course antibiotics, start empirical then pecific
ssurgical - prep for theatre for surgical debridement of necrotic tissue
steps when prepping for theatre
- nil by mouth (six hours of no food and no drink for 2 hours)
- IV access and IV hydration
- IDC
- inform patient and gain consent
- book theatre
- refer to DC anaesthetist
- discuss with surgical specialty
- pre-op bloods
- manage pre-op meds ie. anticoagulants, diabetic meds, steroids
pre-op bloods
FBC, UEC, LFT, coags, G+H, crossmatch
acute surgical patient in the ED management
A-E
IV access
fluidss
analgesia titrated to pain according to WHO ladder
immobilise fracture site
prep for surgery
if not for surgery: reduce frcture in the ED
tetanus, antibiotics
ICU if severe ot unstable
which pain meds should you give in the ED
analgesia titrated to pain according to the WHO ladder
types of casts/fixation
non-operative chronic ortho management
