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Internship > Ortho - Toronto Notes > Flashcards

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
Q

Saphenous nerve:

  1. Nerve roots
  2. Sensory
A
  1. L3, L4

2. Anteromedial ankle

26
Q

Compartment Syndrome - most common cause:

A
  1. # s - account for 69-75% of cases
27
Q

Compartment Syndrome - when do nerve Sx occur?

A
  1. Paraesthesia as early as 30 min

2. Irreversible damage as early as 12 hrs

28
Q

How to describe fracture:

A
  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
Q

Fracture complications

A

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
Q

What is AVN?

A
  1. Ischemia of bone
  2. Due to disrupted blood supply
  3. Commonly - femoral neck, talus neck, proximal scaphoid
31
Q

What are the Ortho emergencies?

A

VON CHOP

  1. Vascular compromise
  2. Open #
  3. Neurological compromise
  4. CS
  5. Hip dislocation
  6. OM/ septic arthritis
  7. Pelvic # - unstable
32
Q

Open # - definition:

A
  1. Fractured bone & haematoma in communication with the external environment
33
Q

Open # - Mx:

A
  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
Q

Classification of open #s:

A

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
Q

Open #s - ABx Rx:

A

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
Q

OM - Def:

A
  1. Bone infection

2. With progressive inflammatory destruction

37
Q

OM - Aetiology:

A
  1. Most common - S. Aureus
38
Q

OM - Mechanism of spread:

A
  1. Haematogenous - most common
  2. Direct inoculation
  3. Contiguous
39
Q

OM - Risk factors:

A
  1. Recent trauma/ surgery
  2. Immunocompromised
  3. DM
  4. IV drug user
  5. Poor vascular supply
  6. Peripheral neuropathy
40
Q

OM - XR findings:

A
  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
Q

OM - Clinical features:

A
  1. Sx- pain
  2. Sx - fever
  3. Signs - erythema
  4. Signs - tenderness
  5. Signs - oedema
  6. Signs - abscess/ sinus
42
Q

OM - Dx:

A
  1. XRs
  2. Raised WCC/ ESR/ CRP
  3. Positive blood/ bone/ aspiration culture
43
Q

Acute OM - Rx:

A
  1. InD

2. IV ABx

44
Q

Chronic OM - Rx:

A
  1. Surgical debridement

2. ABx - local (beads) + systemic (IV)

45
Q

Septic arthritis - Def:

A
  1. Joint infection

2. W/ progressive inflammation & joint destruction if left unRx

46
Q

Septic arthritis - aetiology:

A
  1. S. Aureus - most common
  2. CN staph w/ prev joint replacement
  3. N. Gonorrhoea in sexually active patients
47
Q

Septic arthritis - route of infection:

A
  1. Haematogenous
48
Q

Septic arthritis - RFs:

A
  1. Recent surgery
  2. Recent trauma
  3. Skin infection/ ulcer
  4. RA
  5. Prosthetic joint
  6. IV drug user
  7. Prev intra-articular steroid injection
  8. Immune compromise - cancer, DM, alcohol
49
Q

Septic arthritis - most commonly affected joints:

A
  1. Knee
  2. Hip
  3. Elbow
  4. Ankle
50
Q

Septic arthritis - Clinical features:

A
  1. Unable to wt bear
  2. Localized joint pain
  3. Erythema
  4. Warmth
  5. Swelling
  6. Pain on active + passive ROM
  7. Fever
51
Q

Septic arthritis - XR findings:

A
  1. Early (< 3/7): Usually normal

2. Late (4-6): joint space narrowing, destruction of cartilage

52
Q

Septic arthritis - Investigations:

A
  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
Q

Septic arthritis - Rx:

A
  1. IV ABx
  2. Non-operative: therapeutic joint aspiration
  3. Operative: InD

Internship (10 decks)

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