orthopaedics Flashcards
salter harris fractures TYPE II,IV, V
cross the epiphseal plate
TX: open reduction, internal fixation
Salter harris fx TYPE I and II
TX closed reduction
fractures associated with AVN
schaphoid, femoral neck, talus
fractures associated with nonunion
clavicle, 5th metatarsal (Jones fx)
fractures associated with compartment syndrome
supracondylar humerus and tibia
biggest risk factor for nonunion
smoking
obturator nerve
hip adduction
superior gluteal nerve
hip abduction
inferior guteal nerve
hip extension
femoral nerve
knee extension
lumbar disc herniation
herniated nucleus pulposus
L3 nerve compression
weak hip flexion
L4 nerve compression
weak knee extension (quadriceps), weak patellar reflex
L5 nerve compression
weak dorsiflexion (foot drop), decreased sensation in big toe web space
S1 nerve compression
weak plantar flexion, weak achilles reflex, decreased sensation in lateral foot
ulnar nerve`- motor
intrinsic musculature of hand (palmar interosssei, palmaris brevis, adductor pollicis, and hypothenar eminence) finger abduction, wrist flexion
injury - claw hand
ulnar nerve - sensory
back of hand, all of 5th and 1/2 4th
Median nerve motor
thumb apposition (OK sign), thumb abduction and finger flexors
median nerve sensory
most of palm 1st and 3 1/2 fingers palm
radial nerve motor
wrist extension, finger extension, thumb extension, and triceps no hands muscle
radial nerve sensory
1st and 3 1/2 fingers on dorsal side
musculocutaneous nerve
motor to biceps, brachialis, coracobrachialis
axillary nerve
motor to deltoid (aBduction)
C5 nerve decompression
weal deltoid and biceps
C6 nerve compression
weak deltoid and biceps, weak wrist extensors and brachioradialis reflex
C7 nerve compression
weak triceps
C8 nerve compression
weak triceps, weak intrinsic muscles of hand and wrist flexion
Radial nerve from
C5-C8
ulnar nerve from
C6-T1
musculocutaneous nerve from
C5-C7
axillary nerve from
C5-C6
anterior shoulder dislocation nerve compression
axillary nerve
TX closed reduction
posterior shoulder dislocation
can happen with seizures, electrocution
axillary artery injury
TX closed reduction
monteggia fracture
proximal ulnar fracture and radial head dislocation
colles fracture
fall on outstretched hand, distal radius fx
TX closed reduction
nursemaids elbow
subluxation of radius at the elboz caused by a pulling on an extended, pronated arm
TX closed reduction
scaphoid fracture
snuffbox tenderness
TX cast to elbow, may need fixation
risk of avascular necrosis
volkmanns fracture
supracondylar humerus fracture
occludes anterior interosseous artery
TX closed reduction of humerus- can lead to reperfusion injury, edema, and forearm compartment syndrome TX with fasciotomy
dupuytrens contracture
progressive proliferation of the palmar fascia of hand results on contractures that usually affect the 4th and 5th digits (can not extend fingers)
- associated with diabetes, ETIOH
- TX NSAIDs, steroid injections, excision
carpal tunnel syndrome
median nerve compression by transverse carpal ligament
TX splint NSAIDS steroid injections, carpal ligament release
trigger finger
tenosynovitis of the flexor tendon that catches at the MCP joint when trying t extend finger
suppurative tenosynovitis
infections that spread along the flexor tendon sheaths.
- 4 classic signs: tendon sheath tenderness, pain with passive motion. swelling along sheath and semiflexed posture pf the involved digit.
TX elevation splinting and antibiotics, I&D
rotator cuff tears
supraspinatus infraspinatus teres minor and subscapularis
forearm fasciotmies
need to open volar and dorsal compartments
paronychia
infection under nail bed, painful
TX antibiotics, remove nail if purulent
felon
infection in the terminal joint space of the finger
TX incision over the tip ans along medial and lateral aspects to prevent necrosis of tip of finger
posterior hip dislocation
internal rotation and adduction of leg; risk of sciatic nerve injury
TX closed reduction
anterior hip dislocation
external rotation and abduction of leg; risk of injury to femoral artery
TX closed reduction
posterior knee dislocation
all patients need angiogram to rule out popliteal artery injury
footdrop after lithotomy positoin
common peroneal nerver
anterior leg compartment
anterior tibial artery, deep peroneal nerve
anterior tibilains, extensor hallucis longus, extensor digitorum longus, and communis
lateral
superficial peroneal nerve
deep posterior
posterior tibial artery, peroneal artery and tibial nerve
flexor hallucis longus, flexor digitorum longus and posterior tibialis
superficial posterior
sural nerve
gastrocnemius, soleus, plantaris
compartment syndrom of leg
most likely to occur in the anterior compartment of leg (get foot drop) after vascular compromise
compartment syndrom
distal pulses last thing to go
pain with passive motion
pressure > 20-30 HG abdnormal
osteomyelitis
most common - STAPH
sxs: pain, decreased use of extremity
idiopathic adolescent scolisosis
prepubertal females, right thoracic curve most common
Curves> 20-45 need brace
curves > 45 spinal fusion
osgood-schlatter disease
tibial tubercle apophysitis (pain in front of knee)
traction injury from quadriceps.
TX: rest vs cast
legg - calve perthes disease
AVN of femoral head
painful gait with limp
XRay flattening of the femoral head
slipped capital femoral epiphysis
males, fat, increased risk of AVN
TX pin
congenital dislocation of the hip
TX pavlik harness, keep legs abducted and the femoral head reduced in the acteabulum
multiple myeloma
most common primary malignant tumor of bone
TX chemotherapy
osteogenic sarcoma
most common primary bone sarcoma
80% in pts < 20 yro
XRAY: codmans triangle –> periosteal rxn
giant cell tumor of bone
total resection + XRT
spondylolisthesis
formed by subluxation or slip of one vertebral body over another
most common occurs in lumbar region
