Orthopedics Flashcards
Developmental Dysplasia of Hips
Sonogram is diagnostic.
Tx: abduction splinting with Pavlik harness for about 6 months.
Legg Calve Perthes Disease (Avascular necrosis of the capital femoral epiphysis)
Occurs around age 6.
Insidious development of limping, decreased hip motion, and hip or knee pain.
Dx: AP and lateral hip xrays. Usually contain femoral head within acetabulum by casting and crutches.
Slipped Capital Femoral Epiphysis
Orthopedic Emergency
Chubby boy around age 13.
Affected side of foot points to other foot when sitting down.
Thigh cannot be rotated internally when hip is flexed.
X-rays are diagnostic and pins are needed to put femoral head back in place.
Septic Hip
Orthopedic emergency.
Febrile illness, and then refuses to move the hip.
Elevated sedimentation rate.
Dx: aspiration of hip under GA, and further open drainage is done if pus is obtained.
Acute Hematogenous Osteomyelitis
Kids who have febrile illness with no trauma to bone. X-rays will not show anything. MRI is best bet and tx with antibiotics.
Genu Varum (Bowlegs)
Normal up to age 3. Beyond that most likely Blount disease (a disturbance of the medial proximal tibial growth plate), for which surgery can be done.
Genu Valgus (Knock-Knee)
Normal between ages 4 and 8. No tx needed.
Osgood Schlatter Disease (Osteochondrosis of Tibial Tubercle)
Pain of tibial tubercle; aggravated by contraction of of quadriceps.
Tx: RICE (res, ice, compression, and elevation)
Club Foot (Talipes Equinovarus)
Feet turned inward, plantar flexion of ankle, inversion of foot, adduction of forefoot, and internal rotation of tibia.
-Tx: plaster casts, achilles tenotomy, and braces.
Typically done between ages 9 and 12 months if surgery.
Scoliosis
Adolescent girls with thoracic vertebra towards right.
Deformity will progress until skeletal maturity is reached.
Bracing is used to arrest progression.
Supracondylar fractures of of the humerus
Occur when hyperextension of elbow in child who fell. Vascular and nerve injuries can easily occur and could lead to Volkmann contracture.
Careful monitoring of vascular and nerve integrity and vigilance regarding development of compartment syndrome.
Fractures that Involve the Growth Plate
If displaced laterally, then closed reduction.
If in growth plate in two pieces, very precise alignment provided by open reduction and internal fixation will be required. Otherwise growth will occur unevenly, resulting in deformity of extremity.
Primary Malignant Bone Tumors
Disease of young people, complain of low persistent low-grade pain.
Present for several months.
Xray: Sunburst pattern and periosteal “onion skinning”.
Tx is highly specialized.
Osteogenic Sarcoma
Most common primary malignant bone tumor.
ages 10-25, usually around the knee.
Xray: typical sunburst pattern often described on xrays.
Ewing Sarcoma
5 to 15 years old and grows in diaphyses of long bones.
Xrays: onion skinning type pattern is often seen on xrays.
Soft Tissue Sarcoma
Relentless growth of soft tissue mass anywhere in the body.
Metastasize to lungs but not to lymph nodes.
MRIs and incisional biopsies.
X-rays for Suspected Fractures
Two views 90 degree to one another.
Xrays should be taken of bones that are in the line of force, which may also be broken.
Clavicular Fractures
Figure eight device to pull back on shoulders to align bones. Sling also works.
Anterior Dislocation of Shoulder
Arm close to body, but rotated outward. Numbness over deltoid.
Posterior dislocation from seizures would rotate inward. Need axillary or scapular lateral views.
Colles Fracture
From fall in old ladies with outstretched hand.
Deformed and painful wrist looks like dinner fork.
Main lesion is dorsally displaced and dorsally angulated.
Closed reduction and long arm cast.
Monteggia Fracture
Direct Blow to Ulna.
Diaphyseal fracture of proximal ulna with anterior dislocation of the radial head.
Galeazzi fracture
Distal radius gets direct blow. Dorsal dislocation of distal radioulnar joint.
Scaphoid Fracture
Young adult who falls on outstretched hands.
TTP on anatomic snuffbox.
Even if xrays are negative, thumb spica cast is still indicated.
Notorious for high rate of nonreunion.
Metacarpal Neck Fractures
Mild: closed reduction and ulnar gutter splint.
Bad: Kirschner wire or plate fixation.
Hip Fractures
Affected leg is shortened and externally rotated.
Specific treatment depends on specific location as shown by xrays.
Femoral neck fractures
Faster healing and earlier mobilization can be achieved by replacing the femoral head with a prosthesis.
Intertrochanteric Fractures
Open reduction and internal fixation.
Immobilization will pose high risk for deep venous thrombosis and pulmonary emboli.
Femoral Shaft Fractures
Intramedullary rod fixation.
Can cause shock if bilateral and communicated.
If open, OR emergency- must be cleaned and closed within 6 hours.
If multiple, may lead to fat embolism syndrome.
Knee Injuries
MRI is best highly recommended technological way of looking at knee.
Collateral Ligament Injuries
Isolated injuries are treated with hinged cast.
If several ligaments are torn, surgical repair is preferred.
Anterior Cruciate Ligament Injuries
MRI is diagnostic. Athletes require surgical reconstruction.
Meniscal Tears
Repair is done trying to save as much meniscus as possible.
Tibial Stress Fractures
Seen in young men subjected to forced marches.
Tx with cast and repeat xrays 2 weeks. Non-weight bearing (crutches) is another options.
Leg Fractures Involving Tibia and Fibula
Often seen when pedestrian is hit by car.
If cannot realign for closed reduction, then intramedullary nailing is needed.
Lower leg is one of most common sites for compartment syndrome.
Rupture of Achilles Tendon
Out of shape middle-aged men who subject themselves to to severe strain. Loud popping noise is heard and they fall clutching ankle.
Limited plantar flexion is still possible. Palpation will reveal a gap. Surgery will provide quicker care.
Fractures of the Ankle
AP, lateral, and mortise xrays are diagnostic.
Open reduction and internal fixation is needed.
Compartment Syndrome
Forearm or lower leg. Excruciating pain with passive extension.
Tx: emergency fasciotomy is required for treatment.
Pain under Cast
Always handled by removing cast and examining limb.
Open Fractures
Broken bone sticking out through a wound.
Require cleaning in OR and suitable reduction within 6 hours from time of injury.
Posterior Dislocation of Hip
Femur is driven backwards. Leg is shortened, adducted, and internally rotated. Because of tenous supply of femoral head, OR emergency to avoid avascular necrosis.
Gas Gangrene
Deep, penetrating dirty wounds. Site is tender, swollen, discolored and has gas crepitation.
Tx: Copious IV penicillin, extensive emergency surgical debridement and hyperbaric oxygen.
Radial Nerve Injury
Injured when oblique fractures of middle to distal thirds of the humerus.
No dorsiflexion.
Fracture is reduced and arm is placed in cast.
Popliteal Artery Injuries
Posterior dislocation of knee.
Attention to integrity of pulses, doppler studies, or CT angio.
Prompt reduction to minimize vascular compromise.
Facial fractures and closed head injuries
Always prompt evaluation of cervical spine.
Carpal Tunnel Syndrome
Initial treatment is splints and antiinflammatory agents.
If surgery is needed, electromyography should precede it. (Electro-diagnostic studies of nerve conduction).
Trigger Finger
Finger acutely flexed and unable to extend unless pull it with other hand. When they do so, painful snap.
Tx: Steroid injection is first line. Surgery is treatment of last resort.
De Quarvain Tenosynovitis
B/c of hand into wrist flexion and thumb extension.
Pain along radial side of wrist and first dorsal compartment.
Pain reproduce by asking her to hold thumb inside closed fist with ulnar deviation.
Splint, antiinflammatory agents, and steroid injection.
Dupuytren Contracture
Older men of Norwegian ancestry.
Contracture of palm of hand and palmar fascial nodules.
Surgery may be needed if hand cannot be placed flat on a table.
Felon
Abscess in pulp of a fingertip, caused by neglected penetrating injury.
Pressure can build up and lead to tissue necrosis; thus surgical drainage must be urgently done.
Gamekeeper Thumb
Injury of ulnar collateral ligament sustained by forced hyperextension of the thumb.
Casting otherwise dysfunctional, painful, and arthritis.
Jersey Finger
Injury to flexor tendon when flexed finger is forcefully extended.
When making a fist, distal phalanx of injured finger does not flex with others.
Mallet Finger
Extended finger forcefully flexed. Extensor tendon is ruptured.
Tip remains flexed when rest are extended.
Splinting usually first line tx.
Traumatically Amputated Digits
Surgically reattach when possible.
Amputated digit should be cleaned with sterile saline, wrapped in saline moistened gauze, placed in sealed plastic bag, and rested on top of ice. Should not be allowed to freeze.
Lumbar Disk Herniation
Occurs almost exclusively at L4-L5 or L5-S1. Peak age incidence is 45-46.
Vague aching pain before sudden onset neurogenic pain precipitated by event like attempting to lift object.
Tx: Body will reabsorb extruded disc. Require 3 week of bed rest.
Surgery if neurologic deficits are progressing and emergency intervention required if cauda equina syndrome.
Cauda Equina Syndrome
Distended bladder, flaccid rectal sphincter, perineal saddle anesthesia.
Surgery for immediate decompression.
Metastatic Malignancy
Suspected in elderly who may have progressive back pain that is worse at night and unrelieved by rest or positional changes.
Weight loss is also additional finding. MRI is best diagnostic tool.
Diabetic Ulcers
Start because of neuropathy and fail to heal because of microvascular disease.
Venous Stasis Ulcer
Chronically edematous, indurated, and hyperpigmented skin above medial malleolus.
Varicose veins and suffers from frequent bouts of cellulitis.
Tx: Stockings, vein stripping, grafting of ulcer, and endovascular ablation.
Marjolin Ulcer
SCC of skin developing in chronic leg ulcer.
Tx: Wide local excision and skin grafting are done.
Plantar Fasciitis
Common but poorly understood.
Spontaneous resolution can be expected in 12-18 months. Bony spur is not cause of pain.
Morton Neuroma
Inflammation of common digital nerve at third interspace, between third and fourth toes. Use of pointed, high-heeled shoes.
Analgesics, sensible shows, and surgical excisions.
Gout
Acute Attack: indomethicin and colchicine.
Chronic: allopurinol and probenicid are used for chronic control
