Orthos Flashcards
SALTER HARRIS Classification
S - straight across
A - above
L - beLow
T - through
ER - erasure of growth plate
Type 1-2 can be conservative
Type 3-5 needs Orthos referral
Tillaux Fracture
Type of salter Harris Type 3
Anterolateral tibial epiphysis
Adolescents
Avulsion of Anterior inferior tibiofibular ligament
Supination and external rotation of foot
Low velocity
Sprain vs strain
Grading
Sprain - ligament
Strain - muscle tendon
Grade 1-3
3 - complete tear
MRI needed to Dx
Follow-up 2 weeks to do stress tests
Gastillo Anderson Classification
Open fractures
1 - Wound <1cm
Minimal ST damage
2 - Wound 1-10cm
Moderate ST damage
3a - Wound >10cm/ extensive ST damage/ comminuted/ contaminated
3b - plus periosteal stripping and bone exposure
3c - Vascular injury
Antibiotics based on GA classification?
Type 1 & 2 : Cefazolin
Type 3: Cefazolin plus gentamicin
Environments
Farm: c.diff - metronidazole
Seawater: vibrio - doxycycline
Compartment Syndrome
6 Ps
Number of compartments in limbs
Dx with what syringe
Pain - out of proportion
Pain with passive stress
Paresthesia
Paralysis
Pulseless
Arm: 2x
Forearm: 3x
Thigh: 3x
Leg: 4x
Buttocks
Hands
Striker syringe - measure pressure
>30mmHg
Delta P
Delta P - DBP - intracompartment P
> 30mmhg
Common compartment syndrome sites
Anterior leg
Volar forearm
Testing points of peripheral nerve of hand
Sensation
Motor
Ulna - tip of small finger / “scissors”
Median - index or middle “rock”
Radial - snuffbox “paper”
A OK - anterior interosseus nerve (median n)
Froment sign ?
Ulna nerve injury if positive
Compensate with median nerve (flexion of thumb)
Tendon testing
FDS - distal phalanx
FDP - proximal phalanx
Mallet finger
Extensor tendon injury
+~ avulsion
Splint 6-8weeks
Results in swan neck deformity - flexion DPJ and extension PPJ
Jersey finger
FDP tendon disruption
Forced extension MOA
+~ avulsion
Results in boutoniere deformity
Bennet vs Rolando #
1st MCP - proximal fracture
Bennet 1x fragment
Rolando multiple fragments
Boxers fracture and degrees of angulation of MC fractures ?
MC # of 5th finger
Degrees of angulation allowed
10 - index
20 - middle
30 - ring
40 - little finger
Fight bite bacteria concern
Eikenella corrodens
Paronychia
Felon
Herpetic Whitlow
Flexor tenosynovitis
And Kanavels signs
Usually Penetrating injury
Kanavels signs
- tender along flexor tendon sheath
- finger held in flexed position
- pain on passive extension at proximal end
- fusiform swelling of entire digit
Subungal haematoma
Trephination
Myotomes LL (ASIA)
L2 - hip flex
L3 - knee ext
L4 - dorsiflexion
L5 - big toe extension
S1 - plantaflexion
Myotomes UL (ASIA) vs other
C5 - elbow flex
C6 - wrist ext
C7 - elbow ext
C8 - finger flexion
T1 - finger abduction
Other
C1/C2 - neck flex /ext
C3 - lateral neck flexion
C4 - sh elevation
C5 - sh abduction
C6 - elbow flex / wrist ext
C7 - elbow ext/ wrist flexion
C8 - finger flexion
T1 - finger abduction
Spinal cord syndromes
Central cord - hypertension injury/ bilateral motor & sensory but UL>LL
Brown-Sequard - penetrating injury/ ipsilateral motor & proprioception/vibration; contralateral pain and temperature
Anterior cord - hyper flexion injury/
Posterior cord -
Procedural sedation
Ketamine
Propofol
Fentanyl
Cauda Equina symptoms and diagnosis
Post void residual volume > 200ml abnormal
US
Catheter post void
