Orthopedic Procedures Flashcards
What should be done prior to obtaining an XR for an injury?
Complete history and physical. Not all injuries need imaging
Sprain vs. Strain
Sprains= Ligamentous stretch that causes tearing. Can result in bruising and patients hear a characteristic “pop”
Strains= Muscle/soft tissue injury, usually does not have any observable signs. Patients report a “grabbing sensation”
Steps to PE for an MSK injury
Inspection
Palpation- use back of hand for temperature, check OxI’s of muscles, fractures tend to have point tenderness
ROM- watch for signs of pain
Neuromuscular exam
Always compare bilaterally
Ottawa Ankle Rules for an XR
- Bone tenderness along distal tibia OR medial malleolus
- Bone tenderness along posterior fibular OR Lateral Malleolus
- Inability to bear weight for 4 steps after injury and in ED
Ottawa “foot” XR rules
- Tenderness at 5th metatarsal base
- Navicular tenderness
- Inability to walk 4 steps
Treatment for sprains
RICE- Rest, Ice (48-72h), Compression, Elevation
Referral to ortho
What is buddy taping?
Used for finger/toe injuries to stabilize non displaced fractures (hairline fx)
recommended for 2-3w
Types of fractures (SAC COST)
Simple- 2 pieces Comminuted- crushed into pebbles Avulsion- fx at site of ligament origin/insertion Compound- opens the skin Spiral- twisting caused by torque Oblique- caused by long axis force Transverse- perpendicular blow to bone
“SAC COST”
What type of splint could be used for a distal radial & Ulnar fracture?
Sugar Tong
What type of cast can be used for a navicular fx, Radius/Ulna shaft fx, or a colles fx?
Long-Arm Cast
What is an ulnar gutter cast used for?
Fx of neck, shaft, & base of 4/5 metacarpals
What infection is a common cause of septic arthritis?
Neisseria Gonorrhea
Indications for Joint Arthrocentesis
- Relief of pain from effusion/hemarthroses
- Steroid Administration
- Intraarticular fibrosis
- Establish diagnosis of infection
Contraindications for Arthrocentesis
- Don’t pass needle through infected skin, subQ tissue
- Caution in anticoaged patients
- Bacteremia is relative contraindication
Common causes of joint pain
Gout Pseudogout Infections OA RA
Landmarks for shoulder arthrocentesis
Needle goes inferolateral to coracoid process and directed posteriorly toward joint space
Landmarks for knee arthrocentesis
Needle enters 1cm medial or lateral to superior third of patella
A patient has elevated uric acid levels. is this indicative of gout?
NO! Serum levels serve no purpose in diagnosis of gouty arthritis
