Orthopedic Investigations Flashcards
What is dactylitis suggestive of (3)
psoriatic arthritis
spondyloarthritis
gout
4 hand signs of rheumatoid arthritis
Boutonniere deformity of thumb
ulnar deviation of MCP
swan neck deformity of fingers
Hebenden and Bouchard’s nodes
subcutaneous tophi is a sign of what
gout
splinter haemorrhages and janeway lesions are a sign of what
subacute bacterial endocarditis
malar rash, alopecia and oro-nasal ulcers signs of what
SLE
4 (XRay) signs of osteoarthritis
joint space narrowing osteophytes subchondral cysts bony sclerosis (and loss of shape of femoral head from AVN)
4 options for operative management of osteoarthritis
- osteotomy (re-align the joint/limb)
- arthrodesis (make a stiff, painless joint)
- excision arthroplasty (remove arthritis)
- replacement arthroplasty (large joints mostly)
4 indications for joint replacement
- disabling pain (despite analgesia)
- functional restrictions (walking distance)
- quality of life (night pain)
- radiographic significant arthritis
3 complications of joint replacement
VTE
peri-prosthetic fracture
infection
1st stage of management of rheumatoid arthritis (3)
lifestyle:
MD - physio, OT, podiatry
NSAIDs
what makes COX-2 inhibitors preferable to NSAIDs for pain relief
less GI bleeding risk (less significant GI symptoms remain eg. dyspepsia)
what are DMARDs
long-term suppressive drug therapy - disease-modifying anti-rheumatic drugs
examples of DMARDs
methotrexate and sulfasalazine - good efficacy:toxicity ratio
monitoring with DMARDs
FBC LFTs U&Es BP Urinalysis
effects of blocking TNF alpha
immune: decreases rheumatoid factor, T cell function restored
inflammation: decreased cytokine production in joints (IL1, 6, TNF)
angiogenesis: decreased
joint destruction: decrease damage to bone/carti
haematology: decreased platelets, fibrinogen, restoration of Hb
do not initiate DMARDs in presence of what
serious active infection or high risk
what is the Salter Harris classification for?
paediatric physeal fractures S: separated growth plate A: above growth plate L: beLow growth plate T: through growth plate ER: erasure of growth plate
Treatment of a stable fracture
no surgery - hold in correct position until heals - cast/splint/traction
Treatment of an unstable fracture
surgical fixation with metalwork - usually allows quicker mbilisation of affected limb
what is acute compartment syndrome
intracompartmental pressure elevated (relative to end capillary-pressure) to a level and duration that causes compromised perfusion of intracompartmental structures
decompression is necessary to prevent muscle necrosis
why is decompression required in acute compartment syndrome
to prevent muscle necrosis
6 Ps of acute compartment syndrome
Pain Pain on passive stretch Paraesthesia Paralysis Pulses present Palpation
Most common cause of limp in child
transient synovitis
3 causes of a chronic limp in child
perthes disease
slipped upper femoral epiphysis SUFE
systemic illness (rheumatic disease or tumour)
child with limp with:
hypothyroidism
panhypopiuitarism
hypogonadism
SUFE
4 causes of child with limp with fever
osteomyelitis
septic arthritis
transient synovitis
leukaemia
What does Galeazzi test for
posterior displacement in the developmentally dysplastic hip
child with antalgic gait keeping hip in abduction and external rotation (and low grade fever)
transient synovitis
typical patient of SUFE
Adolescent obese male 10-15 years
bilateral limp
limp and hip pain
positive trendelenburg test
