Orthopedics Flashcards
What are the different classifications of fractures?
- Closed or Open
- Transverse, oblique, spiral, comminuted, displaced, angulated, impacted rotated, distracted, Intra-articular
- Pathological, stress
How do you treat a closed fracture?
Reduction, immobilisation, protect until the fracture has consolidated, rehabilitation of the muscles and joints of the affected limb.
What is a Type One Open Fracture?
Type 1: Puncture of overlying skin or mucous membrane by a bony spike from within.
What is a Type Two Open Fracture?
Type 2: Lacerations less than 1cm overlying the fracture
What is a Type Three Open fracture?
Type 3: Laceration >1cm overlying fracture
What is a Type 3a Open fracture?
Type 3a open fracture: raising of the soft tissue flap around the fracture.
What is a Type 3b open fracture?
Type 3B: absolute skin loss around a fracture
What is a Type 3c fracture?
Deep and highly contaminated wound such as after a farm injury, gun shot injury, and fractures associated with neurovascular injury.
What is delayed union? What are its causes?
Delayed union is when a fracture has not united in a period of time that is at least 25% longer than the expected average time for fracture union at that site. Causes of delayed union include inadequate immobilisation, infection, avascular necrosis of the bone, and soft tissue interposition between fracture ends. Delayed union is assessed radiographically.
What is non union and what are its causes?
Non union is said to have occurred when there is no evidence of union that can be seen on sequential x-rays over a six month period of time. Non-union is associated clinically with movement or pain at the fracture site. If there is copious amounts of callus formation but without bridging of the fracture a state of hypertrophic non-union is said to exist and requires rigid internal fixation for cure. If there is no evidence of callus formation, then a state of hypotrophic non-union is said to exist and bone grafting and internal fixation is required for treatment.
What is malunion?
Malunion occurs when the fracture unites with a loss of anatomical alignment. Mal-union by shortening may be acceptable but angulation and rotation of the bone following union may not be acceptable and may interfere with normal function.
What are the typical features of a prolapsed disc?
A prolapsed disc produces clear dermatomal leg pain associated with neural deficits. The leg pain is often worse than the back pain, and the pain is worse upon sitting. Positive straight leg raise. Don’t order imaging as it doesn’t change treatment. Treat with analgesia, physiotherapy, and excercises.
What are the presenting features of chondromalacia patellae?
Chondromalacia patellae is a softening of the patella cartilage. It typically occurs in teenage girls. Chondromalacia patellae presents with pain that worsens on walking up and down stairs and upon sitting for long periods of time. Chondromalacia patellae responds well to physiotherapy.
What are the presenting features of Osgood-Schlatter disease?
Osgood-Schlatter disease (tibial apophysitis) is seen in sporty teenagers and is caused by overuse.. It presents with pain, tenderness, and swelling in the tibial tubercle. Treat conservatively with activity moderation. Use plain x rays to rule out other causes if other lesions of the proximal tibia if pain is unilateral and/or severe and persistent.
What is osteochondritis dissecans?
Osteochondritis dissecans is an acquired potentially reversible idiopathic lesion of subchondral bone resulting in delamination and sequestration with or without articular cartilage involvement and instability. It mainly involves the knee, ankle, and radiocapitellar joint of the elbow. Presents with pain after exercise, intermittent swelling and locking.
What are the presenting features of patellar subluxation?
Patellar subluxation presents with medial knee pain due to lateral subluxation of the patella. The knee may give way.
What are the red flags for lower back pain?
Red flags for lower back pain •age < 20 years or > 50 years •history of previous malignancy •night pain •history of trauma •systemically unwell e.g. weight loss, fever
What are the typical features of spinal stenosis?
Usually gradual onset
Unilateral or bilateral leg pain (with or without back pain), numbness, and weakness which is worse on walking. Resolves when sits down. Pain may be described as ‘aching’, ‘crawling’.
Relieved by sitting down, leaning forwards and crouching down
Clinical examination is often normal
Requires MRI to confirm diagnosis
What are the typical features of facet joint pain?
May be acute or chronic
Lower back pain worse in the morning and on standing
On examination there may be pain over the facets. The pain is typically worse on extension of the back.
What are the typical feature of lateral epicondylitis?
ain and tenderness localised to the lateral epicondyle
•pain worse on wrist extension against resistance with the elbow extended or supination of the forearm with the elbow extended
•episodes typically last between 6 months and 2 years. Patients tend to have acute pain for 6-12 weeks
What is trigger finger?
Trigger finger is a common condition associated with abnormal flexion of the digits. It is thought to be caused by a disparity between the size of the tendon and pulleys through which they pass. In simple terms the tendon becomes ‘stuck’ and cannot pass smoothly through the pulley. It is more common in women than men, and is associated with diabetes and RA. A nodule may be felt at the base of the finger, associated with difficulting extending a flexed digit. Manage with steroid injections, splint, or surgery,
What is talipes equinovarus?
Talipes equinovarus, or club foot, describes an inverted (inward turning) and plantar flexed foot. It is usually diagnosed on the newborn exam. Manage with the Ponseti method.
Describe the origin, and ennervations of the ulnar nerve.
•arises from medial cord of brachial plexus (C8, T1)
•sensory to medial 1 1/2 fingers (palmar and dorsal aspects)
- Finger abduction, thumb adduction, wasting of hypothenar eminence and intrinsic lumbricals”
-Can produce ‘claw hand’ - hyperextension of the metacarpophalangeal joints and flexion at the distal and proximal interphalangeal joints of the 4th and 5th digits
What is the typical presentation of medial epicondylitis?
- pain and tenderness localised to the medial epicondyle
- pain is aggravated by wrist flexion and pronation
- symptoms may be accompanied by numbness / tingling in the 4th and 5th finger due to ulnar nerve involvement
