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Ortho - Toronto Notes Flashcards

1
Q

Varus meaning:

A

Distal end towards midline

vaRus = towaRds

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2
Q

Valgus meaning:

A

Distal end away from midline

vaLgus = distaL

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3
Q

Quick motor exam of fingers with nerve supply:

A
  1. Thumbs up = PIN (Radial nerve)
  2. Okay sign = AIN (Median nerve)
  3. Spread fingers = Ulnar nerve
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4
Q

Rule of 2s for XRs:

A

2 sides = bilateral
2 views = AP + lat
2 joints = joint above + joint below
2 times = before + after reduction

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5
Q

Why do we splint?

A
  1. Pain control
  2. Reduces further damage to vessels, nerves & skin
  3. Decreases risk of converting closed # to open #
  4. Aids in patient transport
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6
Q

Indications for open reduction:

A

NO CAST

  1. Non-union
  2. Open #
  3. Compromise - N/V
  4. Displaced intra-Articular #
  5. Salter Harris 3, 4, 5
  6. Trauma - poly
  7. Failed closed reduction
  8. Unable to apply cast - hip #
  9. Pathological #
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7
Q

Axillary nerve:

  1. Nerve roots
  2. Motor
  3. Sensory
A
  1. C5, C6
  2. Deltoid/ teres minor/ triceps long head
  3. Lateral upper arm - sergeants patch
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8
Q

Musculocutaneous nerve:

  1. Nerve roots
  2. Motor
  3. Sensors
A
  1. C5, C6
  2. Biceps/ brachialis
  3. Lateral forearm
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9
Q

Radial nerve:

  1. Nerve roots
  2. Motor
  3. Sensors
A
  1. C5, C6, C7, C8
  2. Triceps (medial & lateral heads)/ wrist/ thumb/ finger extensors
  3. Lateral sprain of hand/ medial upper forearm
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10
Q

Compartment Syndrome - Def:

A
  1. Increased interstitial pressure
  2. In a closed osteofascial compartment
  3. Where interstitial pressure exceeds capillary perfusion pressure
  4. Resulting in muscle necrosis (4-6 hrs)
  5. And eventually nerve necrosis
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11
Q

Compartment Syndrome - aetiology:

A
  1. Intracompartmental - fractures (tibial shaft/ paeds supracondylar/ forearm #), crush injuries, gunshot wounds
  2. Extracompartmental - constrictive dressings (circumferential cast), circumferential burn
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12
Q

Compartment Syndrome - pathophysiology:

A
  1. Increased intracompartmental pressure due to bleeding & swelling
  2. Decreased venous & lymphatic drainage
  3. Intracompartmental pressure exceeds capillary perfusion pressure
  4. Muscle & nerve anoxia
  5. Acidosis
  6. Muscle & nerve necrosis
  7. Leaky basement membranes
  8. Transudation into tissue & surrounding compartment
  9. Further increases intracompartmental pressure
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13
Q

Compartment Syndrome - Clinical features:

A

5 Ps

  1. Pain out of proportion to injury & not relieved by analgesics (first Sx)
  2. Paraesthesia
  3. Paralysis (late)
  4. Pallor (late)
  5. Pulselessness (late)
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14
Q

Compartment Syndrome - most NB sign:

A
  1. Pain with passive stretch
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15
Q

Compartment Syndrome - most NB Sx:

A
  1. Pain out of proportion to injury
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16
Q

Compartment Syndrome - Investigations:

A
  1. Is a clinical diagnosis

2. Compartment pressure measurements (in unconscious/ polytrauma/ child) - pressure > 30 mmHg of DBP

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17
Q

Compartment Syndrome - Mx:

A
  1. Initial Mx - remove constrictive dressings (casts, splits)/ keep limb at level of the heart (prevents hypoperfusion), supplemental O2
  2. Definitive Mx - urgent fasciotomy
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18
Q

Compartment Syndrome - Cx:

A
  1. Volkmann’s ischemic contracture - ischemic necrosis of mm, followed by fibrosis, finally calcification
  2. Rhabdomyolysis
  3. Renal failure secondary to myoglobinuria
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19
Q

Median nerve:

  1. Nerve roots
  2. Motor
  3. Sensory
A
  1. C6, C7
  2. Wrist flexors/ wrist abductors/ flexion of 1st, 2nd, 3rd digits
  3. Palmar thumb to radial half of 4th digit/ dorsal tips of digits 1st to radial half of 4th digit
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20
Q

Ulnar nerve:

  1. Nerve roots
  2. Motor
  3. Sensory
A
  1. C8, T1
  2. Wrist flexors/ wrist adductors/ flexion of 4th & 5th digits
  3. Medial palm & for sum of hand/ 5th digit & medial half of 4th digit
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21
Q

Tibial nerve:

  1. Nerve roots
  2. Motor
  3. Sensory
A
  1. L5, S1
  2. Ankle plantar flexion/ knee flexion/ great toe flexion
  3. Sole of foot
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22
Q

Superficial peroneal nerve:

  1. Nerve roots
  2. Motor
  3. Sensory
A
  1. L5, S1
  2. Ankle eversion
  3. Dorsum of foot
23
Q

Deep peroneal nerve:

  1. Nerve roots
  2. Motor
  3. Sensory
A
  1. L5, S1
  2. Ankle dorsiflexion/ ankle inversion/ great toe extension
  3. 1st web space
24
Q

Sural nerve:

  1. Nerve roots
  2. Sensory
A
  1. S1, S2

2. Lateral foot

25
Saphenous nerve: 1. Nerve roots 2. Sensory
1. L3, L4 | 2. Anteromedial ankle
26
Compartment Syndrome - most common cause:
1. #s - account for 69-75% of cases
27
Compartment Syndrome - when do nerve Sx occur?
1. Paraesthesia as early as 30 min | 2. Irreversible damage as early as 12 hrs
28
How to describe fracture:
1. Open vs closed 2. Displaced vs Undisplaced 3. Fracture type/pattern: Transverse: straight across the bone Oblique: an oblique line across the bone Spiral: looks like a corkscrew (rotational force) Comminuted: more than 2 parts to the fracture Bowing: the long bone has been bent Buckle: the fracture is of the concave surface Greenstick: the fracture is on the convex surface Salter-Harris: fractures that involve the growth plate 4. Location - distal/ proximal/ mid-shaft/ intra vs extra-articular 5. Name of bone 6. Alignment - impacted/ distracted/ angulated/ shifted/ rotated
29
Fracture complications
Early local: 1. CS 2. Neurovascular injury 3. Infection 4. Fracture blisters Early systemic: 1. Sepsis 2. DVT 3. PE 4. ARDS secondary to fat embolism 5. Haemorrhagic shock Late local: 1. Non-union 2. AVN 3. OM 4. Heterotopic ossification (formation of bone in abn. location) 5. Post traumatic OA 6. Joint stiffness/ adhesive capsulitis 7. CRPS
30
What is AVN?
1. Ischemia of bone 2. Due to disrupted blood supply 3. Commonly - femoral neck, talus neck, proximal scaphoid
31
What are the Ortho emergencies?
VON CHOP 1. Vascular compromise 2. Open # 3. Neurological compromise 4. CS 5. Hip dislocation 6. OM/ septic arthritis 7. Pelvic # - unstable
32
Open # - definition:
1. Fractured bone & haematoma in communication with the external environment
33
Open # - Mx:
1. ATLS principles 2. Removal of obvious foreign material 3. Irrigate with N/S 4. Cover wound with sterile dressings 5. IV ABx 6. ATT 7. Reduce & splint # 8. NPO & prepare for OT (Bloods, ECG, CXR) 9. Operative irrigation & debridement w/in 6 hrs 10. Wound left open w/ vac dressing 11. +/- rpt irrigation & debridement in 48 hrs
34
Classification of open #s:
Gustilo-Anderson Classification I: Wound < 1 cm Minimal contamination & soft tissue injury II: Wound 1-10 cm Moderate contamination & soft tissue injury III: Wound > 10 cm A - extensive ST injury w/ adequate ST to cover wound B - extensive ST injury w/ bone exposure; in adequate ST to cover wound C - vascular injury
35
Open #s - ABx Rx:
I: 1st gen cephalosporin (Kefzol) for 3/7 I: 1st gen cephalosporin (Kefzol) for 3/7 III: 1st gen cephalosporin (Kefzol) for 3/7 + gentamicin for at least 3/7 For soil contamination - add penicillin for clostridium cover
36
OM - Def:
1. Bone infection | 2. With progressive inflammatory destruction
37
OM - Aetiology:
1. Most common - S. Aureus
38
OM - Mechanism of spread:
1. Haematogenous - most common 2. Direct inoculation 3. Contiguous
39
OM - Risk factors:
1. Recent trauma/ surgery 2. Immunocompromised 3. DM 4. IV drug user 5. Poor vascular supply 6. Peripheral neuropathy
40
OM - XR findings:
1. Soft tissue swelling 2. Lyric bone lesions 3. Periosteal reaction - formation of new bone 4. Sequestrum - devitalised bone that serves as a nidus for infection 5. Involucrum - formation of new bone around area of bony necrosis
41
OM - Clinical features:
1. Sx- pain 2. Sx - fever 3. Signs - erythema 4. Signs - tenderness 5. Signs - oedema 6. Signs - abscess/ sinus
42
OM - Dx:
1. XRs 2. Raised WCC/ ESR/ CRP 3. Positive blood/ bone/ aspiration culture
43
Acute OM - Rx:
1. InD | 2. IV ABx
44
Chronic OM - Rx:
1. Surgical debridement | 2. ABx - local (beads) + systemic (IV)
45
Septic arthritis - Def:
1. Joint infection | 2. W/ progressive inflammation & joint destruction if left unRx
46
Septic arthritis - aetiology:
1. S. Aureus - most common 2. CN staph w/ prev joint replacement 3. N. Gonorrhoea in sexually active patients
47
Septic arthritis - route of infection:
1. Haematogenous
48
Septic arthritis - RFs:
1. Recent surgery 2. Recent trauma 3. Skin infection/ ulcer 4. RA 5. Prosthetic joint 5. IV drug user 6. Prev intra-articular steroid injection 7. Immune compromise - cancer, DM, alcohol
49
Septic arthritis - most commonly affected joints:
1. Knee 2. Hip 3. Elbow 4. Ankle
50
Septic arthritis - Clinical features:
1. Unable to wt bear 2. Localized joint pain 3. Erythema 4. Warmth 5. Swelling 6. Pain on active + passive ROM 7. Fever
51
Septic arthritis - XR findings:
1. Early (< 3/7): Usually normal | 2. Late (4-6): joint space narrowing, destruction of cartilage
52
Septic arthritis - Investigations:
1. XR 2. WCC 3. CRP 4. ESR 5. Blood cultures 6. Joint aspirate - WCC > 50 000, neutrophils > 90%, no crystals, +ve positive culture
53
Septic arthritis - Rx:
1. IV ABx 2. Non-operative: therapeutic joint aspiration 3. Operative: InD

Internship (10 decks)

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