Orthopedic Flashcards
Smith fx
- Distal radial fx with volar displacement and angulation
- Caused by falling onto dorsum of hand
- Uncommon fx
Coles fx
- Distal radial fx with dorsal displacement and angulation
- Caused by FOOSH
- Very common fx
Bennetts fx
-fx/dislocation of the base of the first metacarpal with disruption of the carpometacarpal joint
Boxer’s fx
- Fx of metacarpal neck(usually of the small finger)
- Treatment= ulnar gutter splint with closed reduction
Nightstick fx
-Ulnar fx of shaft with arm against blunt object
Monteggia fx
-fx of the proximal third of the ulna with dislocation of the radial head
Galeazzi fx
-fx of the radius at the junction of the middle and distal thirds accompanied by disruption of the distal radioulnar joint.
Shoulder dislocations
- 95% are anterior
- Axillary nerve and artery are at risk
- Sulcus sign, loss of deltoid bulge
- If anterior=slight abduction and external rotation
- Treatment: reduction, immobilize for 2-6 wks, hold in internal rotation if anterior
Osteosarcoma
- Malignant bone tumor
- sx= bone pain, pathologic fx, pain is worse at night
- 10-20yo, m>f
- mostly found in distal femur and proximal tibia
- 70% 5 year survival rate
- PE, labs, X-ray, CT, biopsy
- X-ray will show sunburst pattern
- Treatment: Resection with chemotherapy
- Can metastasize to the lungs
Compartment Syndrome
- Increased pressure in an osteofascial compartment that can lead to ischemic necrosis.
- Etiology: fx, vascular compromise, reperfusion injury, compressive dressings, musculoskeletal injury
- Most common site is the calf. High concern in tibial fxs.
- Need to be alert if: supracondylar elbow fx in kids, proximal/midshaft tibial fx, electrical burns, or arterial/venous disruption.
- Sx: Pain, paresthesias, paralysis
- Signs: Pain on passive movement, cyanosis or pallor, decreased sensation, firm compartment
- Dx: clinical, intracompartmental pressures
- Fasciotomy is indicated if pressure is >40mmHg. Perform within 4 hours. (6-8 hours max)
- Treatment: Bivalve and split casts, remove constricting clothes/dressings, place extremity at heart level.
- Complications: contractures, muscle necrosis, nerve damage, myoglobinuria.
Aseptic Necrosis
- Cell death to bone components due to lack of blood supply
- Most common in hip and shoulder
- Dx: x-ray, CT, MRI, bone scan
- Tx: surgery, bone graft, osteotomy, joint replacement
Herniated disc
- Most commonly found in lumbar region
- Sx: sudden onset of severe lower back pain (electricity like)-sciatica
- Etiology: Usually due to bending or heavy lifting
- Dx: x-ray, MRI is superior (need to r/o cauda equina)
- Tx: modified activity, NSAIDs, PT(core stabilization), corticosteroid injections, oral prednisone to reduce inflammation, Surgery
Bone cyst
- Benign
- Found in metaphysis of long bones
- Fluid filled
Bone tumors
- Most common is metastatic(from breast, lung, prostate, kidney, thyroid, and multiple myeloma)
- Presentation= bone pain, pathologic fx
- Benign= osteochondroma, enchondroma, unicameral/aneurysmal bone cysts, osteoid osteoma, chondroblastoma, fibroxanthoma, fibrous dysplasia, nonossifying fibroma.
- Malignant= multiple myeloma, osteosarcoma, chondrosarcoma, ewings sarcoma, giant cell tumor, malignant melanoma, metastatic
- Dx: PE/labs, x-ray, CT/technetium scan, biopsy
- Malignant findings= large size, poorly defined margins, aggressive bone destruction, extension into soft tissue.
- Benign findings= small, well circumscribed, sharp margins
- Treatment= Surgery (excision plus debridement), radiation and chemo.
Ganglion cysts
- Usually on dorsum of hand/wrist
- Presentation: swelling, pain, difficulty moving joint
- Tx: aspiration, excision
Soft tissue trauma
- NV assessment- check for pulses, motor activity, sensation
- nerve injury will require surgical repair
- Need early wound irrigation and tissue debridement!! Only use Abx after this if needed.
Humerus fx
- One of the most common bones broken
- Treatment: Sugar tong with sling for 4 weeks if not displaced. If displaced= ortho referral with possible surgery or PT. If open= prophylactic abx, debridement, irrigation, open reduction.
Most commonly fractured carpal?
- Scaphoid
- Tx: Thumb spica
- will have pain in the anatomical snuffbox
Elbow dislocation
- Mostly posterior due to FOOSH
- Brachial artery, ulnar nerve, and median nerve are at risk
- Reduce and splint for 7-10 days- long arm posterior splint in 90 degree flexion
Transcervical fx
-Fx through the neck of the femur
Tibial plateau fx
-Intra-articular fx of the proximal tibia
Pilon fx
-Fx of the distal tibia
Pott’s fx
-Fx of the distal fibula
Hip Dislocation
- Need to reduce immediately!! If not can have avascular necrosis
- Etiology= High velocity trauma
- Most are posterior
- Sciatic nerve at risk
- Tx= reduction (closed or open)
Most common cause of pathologic fx in adults?
-Osteoporosis
Hip fx
- Shortened and externally rotated leg
- Tx: ORIF
Femur fx
-Intermedullary rob placement in treatment of choice
Jones’ Fracture
-Fx at the base of the fifth metatarsal diaphysis
Ewings Sarcoma
- Lytic lesion with onion skinning pattern on x-ray
- Most commonly seen around the knee
- Tx: steroid injections
- Presentation: pain and swelling
