Orthopaedics Flashcards
Indication to manipulate Colles
> 20 degrees angulation
Shortening >5mm
Displacement >2/3 radius
Clavicle MOI and resulting fracture
Force through acromion - middle 1/3
Force from above - lateral
Inferior force - comminuted
Posterior force single fracture
Referral for clavicle fracture
> 2cm shortening
100% displaced
Shoulder dislocation position
Anterior - abduction, external rotation
Posterior - flexion, internal rotation
Most common osteoporotic fractures
- distal radius
- vertebral
- proximal humerus
MOI brachial plexus
Traction
Compression
Direct blow to supraclavicular fossa
Stretching > neuropraxia
Rupture > full/partial tear - roots still connected to spinal cord
Avulsion > Complete detachment of root from spinal cord
Patterns of brachial plexus injuries
Erb’s palsy - C5-6 +/- C7
Klumpke’s palsy C8-T1 +/- C7
Total palsy - C5-T1
Horner’s syndrome - sympathetic chain C8-T1 root avulsion
Bauman’s angle
Supracondylar fracture - coronal plain deformity:
Angle between longitudinal humeral shaft and lateral condyle physis
Normal 70-75 deg
Nerve at risk in Monteggia fracture/dislocation
Posterior interosseous nerve
Weak finger extension
Weak thumb extension
Wrist extension > radial deviation
Galeazzi fracture - clues to DRUJ injury
Widening of DRUJ
Fracture base of ulna styloid
Dislocation/subluxation of ulna on lateral
>5mm shortening of radius compared to ulna
4 stages of carpal disruption: Mayfield classification
- Scapholunate dissociation
- Lunocapitate disruption
- Lunotriquetral disruption = perilunate dislocation
- Lunate dislocation + median nerve compression
Associated fracture with perilunate dislocation
Scaphoid in 61%
Tendons involved in De Quervains tenosynovitis
EPB
APL
TFCC articulation
Ulna + triquetrum
Radius + lunate
Signs of TFCC injury
Pain between ulnar styloid + pisiform/FCU - Ulna fovea sign
Pain on supination lift test
Decreased wrist power, decreased forearm rotation
Prominence of ulna head
Canadian C spine rules
> 65, dangerous mechanism, paraesthesia
Low risk factors - sitting, ambulatory, delayed onset pain, no midline tenderness, low speed MVA
Check active rotation 45 deg
Young and Burgess classification of pelvic ring fractures
Anteroposterior compression - open book
Lateral compression - windswept pelvis
Vertical shear - Malgaigne fracture, bucket handle fracture
Combination
Avulsion fractures of pelvis, muscles attach:
Iliac crest
ASIS
AIIS
GT
LT
Ischial tuberosity
Pubic symphysis
Iliac crest - abdominal wall
ASIS - Sartorius
AIIS - rectus femoris
GT - glute medius and minimus
LT - Iliopsoas
IT - hamstrings
pubic symphysis - adductors
Garden classification for intraarticular NOF#
I - valgus impacted
II - undisplaced complete fracture
III - partially displaced
IV - fully displaced
Risk factors for SUFE
Obesity
Adolescents - 10-16
Male
African American, Pasifika, Latino
Prior radiation to area
Symptoms and signs of SUFE
Groin pain
Knee pain
Limp - trendelenburg/waddling gait
Limited internal rotation
Drehmann sign - external rotation with passive flexion of hip
Thigh atrophy
Estimated for closed and open femur and tibia fractures
Closed femur 1-1.5L
Open femur 2-3L
Closed tibia - 0.5-1L
Open tibia 1-2L
Ottawa knee rule
Xray if any of:
Age >55
Isolated patella tenderness
Tenderness at fibula head
Unable to flex to 90 deg
Unable to weight bear >4 steps
Associated soft tissue injuries in tibial plateau fracture
ACL rupture
Lateral meniscal injury
Medial collateral ligament tears are associated with what other ligament tear?
ACL
Risk factors for Osgood Schlatter’s
Girls 8-12
Boys 12-15
Atheletic - jumping sports/sprinting
Oestern + Tscherne classification for soft tissue injury in closed fractures
0 - minimal soft tissue injury
1 - Superficial contusion/abrasion, simple fractures
2 - Deep abrasions, muscle/skin contusions, direct trauma, impending compartment syndrome
3 - Excessive skin contusion, muscle destruction, crushed skin, subcutaneous degloving, acute compartment syndrome, rupture of major blood vessel/nerve
Risk factors for Achilles tendon rupture
“Weekend warrior”
Steroid injections
Fluoroquinolone antibiotics
Risks for compartment syndrome
Fractures/crush injuries to limb
Circumferential 3rd degree burns
Limb reperfusion injury
DVT
Cast, splints, constrictive dressings
Male
<35
Symptoms of compartment syndrome
6 P’s
Pain
Pallor
Pulselessness
Poikylothermia
Paralysis
Paraesthesia
Intracompartment reading for compartment syndrome
Normal 0-4mmHg
With exertion - up to 10mmHg
Acute compartment syndrome: >30mmHg
Ottawa ankle rules
Tenderness on:
Posterior edge/tip distal 6cm lateral mall
Posterior edge/tip distal 6cm medial mall
Base of 5th MT
Navicular
Inability to bear weight >4 steps
Ankle injury in pronation + external rotation
Medial malleolar, consider Maisonneuve
Ankle injury in inversion and external rotation
Distal fibular
Ankle injury in abduction/forced eversion
Deltoid ligament
Ankle injury in adduction
LCL tear/tip of fibula avulsion
Ankle injury with inversion on plantar flexed foot
Lateral ligament complex sprain
Conservative management of calcaneus fractures
<1cm extraarticular fracture, <2mm displacement, intact Achilles
Sanders I - non displaced posterior facet
Anterior process fracture <25% calcaneocuboid joint
Non smoker, non diabetic, no PVD
Bohler’s angle
Gissane’s angle
Bohler’s - normal 20-40
Reduced = collapse of posterior facet
Gissane’s angle - normal 120-145
Increased = collapse of posterior facet
Snowboarder’s fracture
Lateral process of talus
Dorsiflexion, inversion
5th metatarsal fracture mechanisms
Zone 1 Base of 5th metatarsal - inversion with traction avulsion from peroneus brevis
WBAT stiff soled shoe
Zone 2 Jones fracture - Forefoot adduction
Cast NWB
Zone 3 Proximal diaphysis - march fractures - repetitive stress
Cast NWB
Lisfranc injury mechanism
Axial loading on plantar flexed foot
Fixed hindfoot, rotational force forefoot
Direct trauma
