Orthopaedics Ver 3.9 Flashcards
SUFE
Slipped upper femoral epiphysis
- 11-15 years
- limping
- affecting leg shorter
-externally rotated hip with increased hip flexion
-painful knee/ hip /thigh/groin
Fall vertically, likely bone to be affected/#
Calcaneum
Spinal fractures
Stress #
Metatarsals
Long bone pain (femur/ tibia)
Unrelated to activity
In young people
Responds well to aspirin
Osteoid osteoma
Benign long bones tumor
Sensory loss responsible nerve roots
L12345 S1
L1 - groin and pelvis girdle
L2 - anterior thigh
L3 - medial and distal anterior thigh
L4 - inner/medial shin
L5 - outer/ lateral shin and dorsum foot
S1 - lateral foot
Cauda equina
Bundle of nerve roots at the lower end of spinal cord
Conus medullaris - an end T12
T12- L1- cauda equina
Cauda equina syndrome
1 Sciatica - pain along the nerve (back, buttock, hip, leg)
2 ** saddle paraestheisa** (anal, peri anal, groin numbness)
3 Urinary retention ( inability to void)
4 Fecal incontinence (involuntary soiling)
Causes of Cauda equina syndrome
Central disc prolapse
Postage cancer metastasis
It is * surgical emergency*
MRI spine / urgent referral to orthopedic surgeon
Lumbosacral Disc herniation/ prolapse
Leg raising test result?
Pain?
+ve straight leg raising test
- pain
Sitting from supine
Prong standing or walking
- Relieve by lying down
- sciatic nerve involve - electric shock like pain
Intervertebral disc prolapse
Not lambosacral (L5- S1, L4-L5)
Pain plus loss of sensation at affected area plus loss of deep tendon reflex at affected area
Shoulder weakness
Pain on raising arm above shoulder pain at night
Volleyball- tennis- badminton player- swimmer
Carrying heavy objects- recent move to a new house
Supraspinatous tendinitis
Shoulder weakness
Pain on raising arm above shoulder
Over head activities (volleyball, tennis, badminton, swimmer)
Supraspinatous tendinitis
Elderly + history of fall + painful hip + shortened, externally rotated leg
neck of femur (not head)
A Child girl limping
First born
Oligohydramnions
Birth weight > 5kg
Breech presentation
FHx
Painless leg
Shortened
Unequal skin folds
congenital calcaneovalgus foot deformity
DDH
Developmental Dysplasia of the Hip
Congenital dislocation of the Hip
One of the comment fracture
Secondary to falling on “outstretched hand”
Scaphoid fracture
Painful thumb base
Tender anatomical snuff-box
Pronation followed by ulnar deviation produces pain
Scaphoid #
Management of scaphoid#
X ray +ve
X ray -ve
+ve - scaphoid cast for 6weeks
-ve - 2 weeks and repeat X-ray in 2weeks
DDH
Sex and side preference
Diagnosis Invx
Female 6times more common, 80%
Left hip more common
USG to confirm Dx
DDH clinical examination
2tests
Barlow- attempts to dislocate the articulated femoral head
Ortilani- relocate the dislocated head
DDH Mx
- 3-6 weeks - spontaneously stabilize
- < 4-5 months - Pavlik harness (dynamic flexion-abduction orthosis)
Older children - Sx
Simmon’s triad
1) Abnormal angle of declination
2) feel for a gap in the tendon
3) gently squeeze the calf muscles (Thompson Test) - No/ Negative plantar flexion, remained dorsiflex
Sudden, audible pop in the ankle
Like someone has kicked my leg from behind
Sudden significant pain
Achilles Tendon Rupture
Acute (same day) referral to orthopaedics
Stiffness of a finger,
Snapping (click) sound when extending a flexed digit
Nodule is felt at the base of the finger
Common in thumb ring n middle fingers
Trigger finger
Stenosing tenosynovitis
Bouchard nodule/swelling
nodules at PIP in OA
Heberden nodule
Nodule/swelling at DIP in OA
Mx of OA
1) para
2) topical NSAID
3) oral NSAID
4) opioid (Corrine)
Distal radius posteriorly displaced
Collie’s #
Dinner fork deformity
Median nerve injury (osteoporosis)
Distal radius anteriorly displaced
Reverse Colle’s #
Smith’s #
Garden spade deformity
Finger bends at IP joint
Hit by a ball to his finger
Avulsion of extensor digitorum tendon
Mallet finger
Avulsion if flexor tendon at IP joint
Jersey finger
Pain when grasping things with thumb
Tenderness over MCP joints
Gamekeeper thumb
Skier’s thumb
Monteggia # (Man U)
Proximal Ulnar #
Dislocation of head of radius
Galeazzi’s # (Galacticos Rising)
Distal radius #
Distal radio-ulnar joint dislocation
1) Ca, PO4, ALP - normal
2) Ca, PO4 - normal, ALP ⬆️
3) ⬇️ Ca, PO4, ALP ⬆️
1) osteoporosis
2) Pager’s disease of bone
3) Osteomalacia
Bone manifestation
Heart failure
Hearing loss
⬆️ Ca ( even that)
⬆️ALP
Pager’s disease
X ray in paget
Coarse trabecular pattern
Cotton wool pattern - multi focal sclerotic patches
V shape pattern - blade of grass lesion
(Cortical) sclerotic lesions
Lyric (punch out) lesion on Xray
MM
Multiple myleoma
⬆️ALP causes (2Bs + P)
Bone
Biliary
Pregnancy
⬆️Ca
Polyadipsia
Polyuria
Bone pain
Constipation
Confusion
ECG- short QT interval
Bone metastasis (prostrate, breast)
SCC of lungs
Multiple myeloma
Primary hyper parathyroid
Bone pain
⬆️Ca
Anaemia
(Recurrent infection, renal failure)
MM
Multiple myeloma
(Plasma cell cancer, over growth of non- functioning Igs)
Absence of pulse
Neuro vascular compromise
Obvious deformity
Mx?
ABCD
Then urgent reduction under sedation or analgesia
IV midazolam
Femur # if patient is stable(SBP - >100), Mx?
Thomas splint
Acetabulum #
Nerve?
Sciatic nerve
Bone metastasis cases,
1) Initial test
2) The most appropriate test
1) serum Ca
2) MRI f/b bone scintigraphy
1) Osteoporosis
2) MM
Ix?
1) Dexa scan (Dural Energy Xray Absorptiometry)
2) skeletal survey , bone biopsy
Long term use of steroids
Osteoporosis
Cataract
Peptic ulcers
Hyper glycaemia
A young boy, painful knee, fixed mass over knee side, no systemic features
Osteosarcoma
(The Most common bone tumor in children)
A young boy, painful knee, tender fixed mass over knee side, systemic features such as fever, weight loss, tenderness
Ewing sarcoma
(2nd most common bone tumor in children)
Long bone fracture (femur)
Open surgery - 24 to 72 hours
O2⬇️
Consciousness ⬇️
Fat embolism
Carpal tunnel syndrome in pregnancy Mx?
Wrist splint until delivery
Fail- cut the transverse carpal ligament
Overstretched or trauma
Severe pain, rapid swelling, bruising, difficult to move
No # on X-ray
Sprain (torn ligament)
Mix of torn ligament (sprain)
PRICE
High arm sling for 3 days
Septic arthritis RFs
RA
DM
HIV
Steroids
Septic arthritis
1) Commoners organism
2) Dx
3) Tx
1) staph aureus/ young sexually active- gono
2) aspiration of synovial fluid, blood culture
3) flucloxacillin, clindamycin in pen allergic - 4wks to 6am a
If not staph or gono, cedotaxime /ceftrisone
If not okay, repeat percutaneous aspiration
IV 1 wk, if all resolves, oral 4 wks
Reactive arthritis
(Seronegative arthritis)
Cannot see
Cannot pee
Cannot climb a tree
No fever
Migratory oligo arthritis
Young adult after STI or GI infection
Reactive arthritis Tx
Analgesia, NSAID, intraarticular steroids
Sulfasalazine
Methotrexate
Symptoms rarely lasts more than 12 months
Toddler (1-3)years #
X-ray no deformity
Spiral
Child (4-10) year
Fall on outstretched hand,
Absent radial/brachial pulse
Supracondylar # of humerus (brachial artery injury)
If not given, green stick #
