Orthopaedics Flashcards
Hip fractures
- Extracapsular - Trochanter or sub trochanter
- Intracapsular - Femoral head
Intracapsular Mx
Displaced - Arthroplasty
- either hemi or full -
* Full recommended if patient is well
Non displaced - Internal fixation via screws
Extracapsular
- Intertrochanteric - Internal fixation with dynamic hip screw
- Subtrochanteric - Intramedually nail through greater trochanter and into medial shaft of femur
Osteoporotic fracture
- Commence on bisphosphates - no need for scan
- Achillies tendon rupture
Cx - sport in juries
* fluoroquinolone casa cause spontaneous rupoture in 48hrs of commencing*
Sx - sudden onset pain, feeling like something has hit them in back of calf, snapping sound and sensation
Ix - Simmons triad
calf squeeze - absence of plantar flexion
- feel for gap in tendon
- Angle of declination - prone with feet over bed - greater dorsiflexion
- US
Mx - conservative, same day referral to ortho
- may need surgery
Adhesive capsultis
- Frozen shoulder. causing reduced shoulder movement - can be due to trauma or idiopathic
Cx - fibrosis and scars tissue of joint casuing reduced movement
Sx - Active and passive movement limited
- External rotation more affected
* Pain for a day, stiffness, thawing phase
*Symptoms last 6 months and can persisted for 3 years
Mx - Physio, NSAIDs, steroids
- may need surgery to remove adhesions
Epicondylitis
- Inflammation where tendons meet the forearms at the epicondyles
- Tennis elbow and golf elbow
Cx - repeat strain to tendons
Sx - Lateral/tennis - pain down forearms, grip affected, numbness, extension and supination worse
Sx - medial/golf - Pain down forearms, affects grip, numbness, flexion and pronation worse
Mx - NSAID, rest,
Compartmet syndrome
- Pressure in fascia compartment is elevated >40mmHg - cutting of blood supply
Cx - Post acute injury
- fractures, crush injuries
Sx - pallor, pain, parasthesia, pressure, paralysis, pulseless
- passive stretch makes pain worse
Ix - needle manometry for pressure
Mx - emergency fasciotomy
- Can be chronic - episodic sx^ on exertion
Sarcomas
- Cancers originating in muscles, bones or connective tissue
Osteo… - most common bone
Chondro - most common cartilage
Ewing - bone and soft tissue - usually kids or young adults
Sx - soft tissue lump, growing, painful, large
- bone swelling
- Persistent pain
Ix - X ray, US, biopsy, CT
Mx - Surgery, radio, chemo
Spinal stenosis
- Compression of the spine canal causing compression of cord and nerve roots
Cx - congenital, degeneration of tissue, herniation, thickened ligaments, fractures, tumours
Sx - GRADUAL (compared to herniation and cauda equina), INTERMITENT
- lower back pain, bum and leg pain, leg weakness
* Can presents with sx of caudal equina when severe
Sx of peripheral cluadication
Absent when seated, come on standing and walking, bending forward makes it better and standing straight makes it worse.
Ix - Rule put PAD - ABPI, CTA
MRI for cx
Mx - Exercise, weightless, physio
- surgery to remove disc or bone compression
Meralgia paraesthetica
- Mononeuropathy - numbness, tingling, burning in outer thigh
Cx - compression of lateral femoral cutaneous nerve (L1,2,3)
Sx - burning, tingling, numbness, outer thigh
- localised hair loss
- aggravated by standing or walking
- worse on hip extension
Mx - conservation
- decompression
Osgood schlatter disease
- Inflammation at the tibial tuberosity where tendons insert
- Common in adolescents
Cx - patella ligament pulling away bone causing tiny avulsion fractures of tibia
Sx - Hardened lump over time, painful tibial tuberosity
- worse on activity, extension of the knee
Mx - Reduce, Ice, NSAIDs
Bakers cyst
- Usually 2nd to degenerative changes in the knee
Collection of synovial fluid - not own cyst - stay in soft tissue
Cx - MENISCAL TEARS**, OA, injuries, rheumatoid, idiopathic
Sx - localised to politest fossa
- pain, fullness, pressure, palpable lump, restricted range off motion
**Rule out DVT
Ix - US 1st line
MRI
Mx - NSAID, physio, steroid injections….
Plantar fasciitis
- Inflammation of the plantar fascia - thick fascia attached to calcaneus
Sx - gradual onset pain at heel, tender and worse when walking
Mx - Rest, ICE, NSAIDs,
Rotator cuff tears
- Full or partial tear or rotator cuff tendons
- Supraspinatus, infraspinatus, teres minor, subscapularis
Sx - Shoulder pain, weakness accruing to moment of muscle affected
- difficult to sleep at night
Ix - US or MRI for soft tissue
Mx - Rest, analgesia, physio
- surgery if failure^^
De Quervain’s tenosynovitis
- Inflammation of tendons at the wrist - primarily: APL and EPB
Cx - REACTIVE STRAIN
Sx - pain, tingling, itching, swelling, redness, weakness
Mx - Rest, analgesia, physio…
Dupuytren’s contracture
- Shortening of the soft tissue that leads to the joint have restricted movement
- Thickened fascia
Cx - microtrauma repat
Sx - Flexed position, cannot fully extent, hard nodules, ring finger most likely, no pain
Ix -
Mx - Conservative or surgery via fasciotomy
Ganglion cyst
- Collection of synovial fluid from tendons and joints. causing cysts
- Wrists and fingers mostly
Sx - can be rapid progression, up to 5cm, firm, smooth, non tender, transilluminates,
Ix - Clinically diagnosed
Mx - Conservatively, needle aspiration or excision
Meniscal tear
- Twisting whilst playing sport
Sx - tender on joint line, unstable, locking and giving way, flexion and extension reduced
GRADUAL effusion
Carpal tunnel
- Wrist splinting for moderate
- Steropids for serve
Hip dislocations
- Posterior - Shortened and internally rotated
Neck of femur fracture
- Shortened and externally rotated
OSTEOMYELITIS
- Bone biopsy
L5 ridiculopathy
- Weakness of hip abduction and foot drop
- no change to relfexes
Iliotibial band syndrome
- Common cause of lateral knee pain
very common in runners
Charcot joint
- Joint deformity due to sensory impairment
Cx - diabetes, alcohol…
Mx -
