orthopaedics Flashcards
ix for achilles tendon rupture
ultrasound
quinolones risk factor for injury
adhesive capsulitis
Features typically develop over days
external rotation is affected more than internal rotation or abduction
both active and passive movement are affected
patients typically have a painful freezing phase, an adhesive phase and a recovery phase
bilateral in up to 20% of patients
the episode typically lasts between 6 months and 2 years
associated with DMT2
meralgia paraesthetica
burning anterolateral thigh
lateral cutaneous nerve of thigh compression
salter harris classification
I Fracture through the physis only (x-ray often normal)
II Fracture through the physis and metaphysis
III Fracture through the physis and epiphyisis to include the joint
IV Fracture involving the physis, metaphysis and epiphysis
V Crush injury involving the physis (x-ray may resemble type I, and appear normal)
Kanavel’s signs of flexor tendon sheath infection
fixed flexion, fusiform swelling, tenderness and pain on passive extension
frax score for dexa
A FRAX score of 10% or greater warrants a DEXA scan
radiculopathies and sciatica
L4 radiculopathy would cause reduced knee jerk, whilst S1 would affect the ankle jerk.
L5 radiculopathy presents with weakness of hip abduction and foot drop, as seen in this patient. It is typically due to a slipped disc compressing the nerve root. It presents with a positive SLR test and as L5 does not provide any reflex loop, reflexes remain intact.
Sciatic neuropathy which is commonly confused with this would cause a loss of the ankle jerk and plantar response and loss of knee flexion and power below the knee
acromioclavicular joint management
Grade I and II injuries are very common and are typically managed conservatively including resting the joint using a sling.
Grade IV, V and VI are rare and require surgical intervention.
types of shoulder dislocation
Posterior shoulder dislocation is more likely associated with seizures and electric shock. It presents with unilateral shoulder deformity.
Anterior shoulder dislocation is associated with a fall onto an outstretched hand (FOOSH). It presents with unilateral shoulder deformity.
Finkelstein test positive
De Quervain’s tenosynovitis as she is Finkelstein test positive ie. she has pain over her radial styloid on forced abduction/flexion of the thumb.
mx of #nof
Intracapsular fracture, displaced Independently mobile, does not use more than a stick Total hip replacement
Intracapsular fracture, displaced Not independently mobile Hemiarthroplasty, cemented implants preferred
Trochanteric fracture Mobility not a factor Sliding hip screw
Subtrochanteric fracture Mobility not a factor Intramedullary nail
Monteggia fracture and Galeazzi
a fracture of the proximal ulna in association with a dislocation of the proximal head of the radius. It is most commonly seen in children aged between 4 and 10 years.
A Galeazzi (4) fracture is a fracture of the distal radius with an associated dislocation of the distal radioulnar joint.
A method to remember the difference between the two of these is by combining the name of the fracture with the bone that is broken:
Monteggia ulna (Manchester United), Galeazzi radius (Galaxy rangers)
herbedens
vs
bouchards
DIPs
PIPs
both seen in OA
fat embolism fx
Respiratory
Early persistent tachycardia
Tachypnoea, dyspnoea, hypoxia usually 72 hours following injury
Pyrexia
Dermatological
Red/ brown impalpable petechial rash (usually only in 25-50%)
Subconjunctival and oral haemorrhage/ petechiae
CNS
Confusion and agitation
Retinal haemorrhages and intra-arterial fat globules on fundoscopy
red flags for back pain
Thoracic pain Age <20 or >55 years Non-mechanical pain Pain worse when supine Night pain Weight loss Pain associated with systemic illness Presence of neurological signs Past medical history of cancer or HIV Immunosuppression or steroid use IV drug use Structural deformity
l3 radiculopathy
Sensory loss over anterior thigh
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test
l4
Sensory loss anterior aspect of knee
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test
l5
Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test
s1
Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test
causes of AVN of hip
long-term steroid use
chemotherapy
alcohol excess
trauma
mx of plantar fasciitis
Initially, plantar fasciitis should be managed conservatively with rest and the management of any precipitating factors, including weight loss. Stretching exercises are also recommended as first line therapy in combination with rest. These exercises should be conducted three times per day and are aimed at the plantar fascia and the Achilles tendon.
Orthotics and NSAIDs are appropriate in the management of plantar fasciitis, however should not be called upon before the measures listed in the paragraph above. Additionally, the patient has asthma
Femoral nerve
m:Knee extension, thigh flexion
s:Anterior and medial aspect of the thigh and lower leg Hip and pelvic fractures
Stab/gunshot wounds
Obturator nerve
Thigh adduction Medial thigh Anterior hip dislocation
Lateral cutaneous nerve of the thigh
None Lateral and posterior surfaces of the thigh Compression of the nerve near the ASIS → meralgia paraesthetica, a condition characterised by pain, tingling and numbness in the distribution of the lateral cutaneous nerve