Orthopaedics Flashcards
Baker’s Cyst
Painless Popliteal Mass
Rupture cause pain and Mimic DVT
Secondary to Osteoarthritis or Rheumatoid arthritis
Dx is clinical and USG
Resolve itself
Can also be excised
Paget Disease Vs Osteoporosis Vs Osteomalasia
NCa2 NPo4 ↑ALP Vs All normal Vs ↓Ca2 ↓Po4 ↑ALP
Osteoporosis: NORMAL serum calcium, serum phosphate & serum ALP
Paget’s Disease: Normal serum calcium & serum phosphate HIGH serum ALP
Bone pain + isolated elevated ALP
Osteomalacia: LOW serum calcium & phosphate HIGH serum ALP
Paget Disease
Normal Ca & PO4 but High ALP + Kyphosis + Heart Failure + Conductive Deafness + Hat size ↑ +
Associated with Osteosarcoma + Usually adults +
Due to ↑ osteoclast activity & defective bone modelling +
X ray : Blade of grass V shaped on long bones +
Cotton wool spots on Skull (Fluffy sclerotic patches) due to poor trabeculae +
Rx : Bisphosphonates (1st line)
Osteoarthritis - AGING BONE ARTICULAR CARTILAGE
(Old age ) Impaired homeostasis between bone resorption and formation
Walk - pain and most pain before sleeping
Rest - relief
OLD AGE -
EXACERBATED BY EXERCISE & RELIEVED BY REST (PAIN AT THE END OF DAY)
-SINGLE JOINT -OSTEOPHYTE -CREPITUS -
Heberden's nodes ( DISTAL interphalangeal joint ) BOUCHARD NODES (PROXIMAL interphalangeal joint ) -
XRAY (LOSS) : 1- L : LOSS OF JOINT SPACE (DEGENERATIVE) 2- O : OSTEOPHYTE 3- S: SUBCONDRAL CYST 4- S: SUBCONDRAL SCLEROSIS
TREATMENT :
Non pharmaco =EXRECISE and PHYSIO
Pharmaco = PARACETAMOL / NASIDs (Celecoxib ) + PPI
NSAID ( TOPICAL/ORAL)
SURGERY
Achilles tendon rupture (Simmon’s Triad LOOK FEEL SQUEESE )
H/O
burst of sudden activity, repetitive jumping, audible snap, someone kicked their heels
Dx >> Simmon's Triad : 1. Dorsiflexed affected leg 2. palpable gap on the heel 3. calf muscle squeeze > No plantar flexion
*Mx : Refer to orthopedic ( x-ray to exclude calcaneal avulsion, US to confirm dx, MRI rarely needed) thrombo-prophylaxis could be given to prevent DVT
Sudden onset of Lower back pain During Bending Forward or similar movement
(Like Getting up form Bed )
Sciatica (Not a condition it is irritaiton of the sciatic nerve by herniated intervertebral disc)
Most common dt - Intervertebral disc herniation (L5/S1)
Aggregated by - Sitting / Standing / Leg raising
Relieved by - Lying down / Walking
Best Inx - MRI
Dx - Leg raising test / Pain within 30-70 degree
Best Treatment
Rest for 1 month
Physical therapy
Analgesics
Surgery if Progressive or Disabeling pain > 6 months
Gamekeeper’s thumb = Skier’s thumb (liagment injury )
UCL injury
gamekeeper’s thumb = skier’s thumb
- ulnar collateral ligament injury
- collateral laxity
- thumb is hyperextended and laterally deviated
RX:
-incomplete injury/ tear = immobilisation 4-6 weeks
- complete tear = surgery
Tennis Elbow (Lateral epicondylitis ) Painter - pain upon resisted wrist extension and tenderness on Lat epi condyle Golfers Elbow (Medial epicondylitis )
Lateral epicondyl - Wrist extension / while grasping with hand
Tennis elbow –>laTeral epicondylitis –> wrist exTensors
(muscle is in the forearm but function is wrist extension not forearm extension which is done by Triceps muscles)
Extensor Carpii Radialis brevis Muscle.
Insertion =lateral epicondyle of humerus
****Found in the forearm***
Function = Abduction and Extension of the wrist.*******
the opposite to this is :
GloFer’s elbow –> medial epicondylitis –> wrist Flexors add this
Distal Radial Fracture (Old lay fall into pavement with wrist Swollen )
C
Minimal Displacement - Closed Reduction / Immobilization / Plaster below elbow backslab )
Below elbow back slab uses
Supracondylar fracture
Distal Radial and Ulnar fracture
Colle’s fracture
Hip dislocation after Surgery and types
Hip dislocation-
Do X ray (MRI -Controversial)
After Hip SURGERY FOR **6 MONTHS*** avoid bending,
Don’t use LOW toilet / SHOE LACING
Anterior hip dislocation- FABER -
flex ion / abduction / external rotation
Posterior hip dislocation - FADIR -
flex ion / addiction / internal rotation
Time line for Hip Problems in CHILDHOOD
< 3 years
DDH = Girl /Painless / Breech deli / Unequal skin folds /
Septic arthritis = Fever / Unwell / Systemic / Acute pain
Toddlers fracture =
3-9
Transient synovitis if ACUTE = Mild Fever / After viral URTI / Well systemically / Pain on weight bearing but not at rest
Pertheus if CHRONIC = Boy / Slowly developing pain / Stiffness and ↓ROM
> 9
Slipped upper Femoral Epiphysis = Painful / Obease /
Other Juvenile idiopathic arthritis = arthritis in <16 and last >3month Blanching RASH(salmon pink) /
Bone Tumours
Benign
Malignant
MALIGNANT
Osetosarcoma = Sunburst app in Growth plate/ Metaphysis / adolescent
Ewings Scrcoma = eWings Onion peeling of periosteum / adolescent 10-20 / Translocation 11/22 and Neuroectodermal cells + (blue cells with large nucleus)
Chondrosarcoma = ( Old age/ moth eating pelvis )
BENIGN
Osteochondroma (Growth plate tumor)
Extoses overgrowth from growth plate
Giant Cell Tumour ( Osteocytes tumor / eat up bones )
Soap bubble in Epiphysis (Hollow epiphysis )
(Osteoblast tumor ) Osteroid Osteoma(N<2.5) / Diaphysis of tibia / No erosion Osteo Blastoma(N>2.5) / produce prostaglandin= pain / Erosion of Mandible
Fast grow of new bone cells problem = Forming NIDUS (Trabeculae + blood vs + osteoid)
Child hood fracture (Falling with outstretched Hands )
Most common 1st fracture GREEN STICK FRACTUE
Most common =
If # distal to the bone - Torus / Buckle fracture
-Junction of Metaphysis and Diaphysis
The harder diaphysis pushed in softer metaphysis resulting in SLIGHT BULDGE (Transverse line and budging in X ray )
If # middle of the Diaphysis - Green stick fracture OR 4085
not a complete fracture
GreenStick : Child - No Deformity - No Swelling - Only Tenderness.
the common fractures in children depending on age:
➠toddler (1-3Y): Spiral Fc
:midtibial may not be seen on x-ray
➠child (4-10Y): -buckle (torus): most common at this age gp, radial metaphyseal -greenstick: mid-diaphyseal in forearm or leg
Acute Hot / Painful joint / SPETIC ARTHRITIS
Septic arthritis is a Orthopedic emergency
Pt with DM / RA patient taking Methotrexate
Always go for Aspiration of Joint fluid and culture
X- ray limited or no value
IV for 1 week
Fluoxacillin …
if pencillin allergic use Clindamycin
Give IV antibiotics for 1 week.
After cultures become negative and swelling resolved
switch to oral antibiotics for following 4 weeks
Osteoporosis is PAINLESS (DEXA scan <= -2.5)
Osteomalasia is Painful
STEROID CAUSES: 1- OSTEOPOROSIS 2- PEPTIC ULCER 3- INCREASE BLOOD SUGER 4- CATARACT
OSTEOPOROSIS: SILENT TILL CAUSE FRACTure
OSTEOP. ALSO AFFECT DENTAL AND GUM HEALTH
Dermatomes and Sciatic nerve compression
Most common compresion site
L4-L5 = L4 will be compressed / 4 = knee ********************** L5-S1 = L5 will be compressed / 5 = Dorsum of foot (except little toe / Planter foot = S1)**************
Spinal fracture and Cauda equina syndrome= S1-5 / Loss of sensation around Anus
Bowel incontinences / Urinary retention / saddle paresthesia ******(Medical emergency )
Other dermatomes
Half back face - C2 Upper neck -C3 Lower and base of neck -C4 Biceps lateral half - C5 Forearm lateral half - C6 Thumb - C7 Index / Middle - C8 Ring / Little and Medial half of Forearm and biceps - T1 chest - T2-T12 xiphoid - T7 Umbilicus - T10 Pubic / groin - L1 Ant thigh - L2,3 Knee - L4 Anter / Dorsum of shin and feet - L5 Little finger / Plantar of feet / posterior foot / thigh up till gluteus - S1,2 Around the Anus - S3,4,5
Myotone or Jerks area
1,2 buckle my shoe— ankle (S1, S2)
3,4 kick the door——– knee (L3, L4)
5,6 pick up sticks ——– biceps (C5,C6)
7,8 lay them straight——— triceps (C7,C8)
OR 1320 recheck
Ca breast remission / bone metastasis without Neurological symptoms
INITIAL -inv: serum calcium Ca2+
DIAGNOSIS - Bone mets gold standard : MRI or BONE SCINTIGRAPHY
But, if multiple bones are involved (for eg. spine+shoulder), do BONE SCINTIGRAPHY as MRI whole body would be costly.
But, if neurological signs +, go for MRI first.
Usually, MRI done within 7 days if only bone pain present
but done within 24 hrs if Bone pain + neurological involvement is present.
60 year old patient fall on side of the road # 2 days ago
BMI 22 non smoker all good
Would like to decrease his risk for fracture in the future
history of fracture»_space; Dexa scan ,
DEXA scan should be requested for any patient > 50 years who has a FRAGILITY FRACTUE (low impact #)
If DEXA <= -2.5 (start Bisphosphonate )
no fracture history but history of family # »_space; calculate FRAX score
If >10% next step DEXA scan
Ultrasound in ORTHO
US in ortho: -
baker’s cyst - + Foutcher’s sign (tense when knee extension and softens on knee flexion )
DDH -
tenosynovitis
Scaphoid fracture :
(fall outstretched hand)
tender snuff box,
pain thumb base,
**ulnar deviation or supination against resistence***
Mx: X-Ray is usually -ve (1st 2 wks)
(X ray positive is only 7%)(Scaphoid # is infamous for non union and -ve X ray )
so immobilization for 2 wks then repeat x-ray
if becomes +ve»_space; then cast for another 4 wks .
Total period of immobilization is 6 wks
To watch before answering Ortho
Knee anatomy
Elbow anatomy
https: //www.youtube.com/watch?v=_q-Jxj5sT0g
https: //www.youtube.com/watch?v=XeiApVseric
