Ross - General Ortho Flashcards
name 7 components of ortho ER hx
- numbness/weakness
- MOI
- snap/crackle/pop?
- r or l handed
- previous injury
- tetanus
- last meal (if acute)
what 3 components should you base “neurovascular intact (NVI)” on
- pulses
- color of extremity
- sensory and motor peripheral nerve fxn
in acute ortho injury, what is the 2nd step after ABCs
assess neurovascular status
when should you document neurovascular status
before AND after any manipulation → ex even just a sling
what are 4 pe signs of bone fx
- crepitus
- false motion
- exposed fragments
- pain
- locked joints
what does blood on clothing suggest
open fx
what does pain out of proportion suggest
compartment syndrome
what does an elderly pt w. hip pain and a neg film suggest
occult hip fx
what imaging should you order for previous pt
MRI
what injury does a jump from a height suggest
calcaneous fx w. vertebral body compression
what does an elderly pt w. hx malignancy and mechanism that doesn’t fit suggest
pathologic fx
what does a grossly deformed extremity in field, now normal suggest
dislocation reduced in field
what is a do not miss in the previous pt
vascular injury!
what is a major concern in this fx
femoral fx → concern for severing of popliteal artery
bones heal by
callus formation
what are the 3 stages of callus formation
- inflammatory
- ossification
- remodeling
in acute ortho injury __ first
then order __
examine
xray
what is the second most common reason for medical law suit
missed fracture
tx for open fractures is always
operating room
what type of fx is this and what pt population does it affect
greenstick
peds
what type of fx
spiral
what type of fx
comminuted
what type of fx
transverse
what type of fx
compound
how many hours until a limb is dead in vascular injury
6 hours
where should you check the pulse for an acute fx
distal to fx
what are the peripheral nerves of upper extremity
MARMU → median, axillary, radial, musculocutaneous, ulnar
what are the peripheral nerves of the lower extremity
I2GOLF
what is the only nerve that goes to the distal end of the phalanges
flexor digitorum profundus
what type of fx
supracondylar
what nerve is damaged
median
what nerve is injured
ulnar n
signs of a median n injury (3)
- weak pronation of forearm
- weak flexion and radial deviation of wrist
- thenar atrophy and inability to oppose or flex thumb
is it ok to give narcotics to a fx pt?
yes
what do you need to do before ordering xray in female
pregnancy test
what does tdt stand for
tetanus diptheria
does this need immediate ortho consult
yes! still an open fx
what is abx of choice for open fx
- cefazolin 1-2 g IV q8 → wt based dosing
- pen allergy: clindamycin 600 mg IV
where do splint in hand fx
one joint above fx
closed and angulated fx needs
reduction
you should splint a pt in what position
anatomical
what are 4 post fx complications
- non-healing
- neurological dysfxn → sympathetic dysreflexia
- loss of fxn
- avascular necrosis
what 2 bones are highest risk for avascular necrosis
scaphoid
femur
what are 3 causes for compartment syndrome
- overuse w. edema
- crush
- fracture
what is mc location for compartment syndrome
ant leg
what part of leg is often missed in compartment syndrome
deep posterior
where is flexor compartment syndrome
volar forearm
volkmann’s contracture
what pediatric fx is prone to compartment syndrome
supracondylar
for compartment syndrome raise extremity, but not
above the heart
tx for compartment syndrome w. pressure btw 10-20
admit → watch
tx for compartment syndrome btw 10-20
emergent fasciotomy
painful joint, swelling + fever makes you think
septic joint until proven otherwise!
what should you do if you see blood in joint aspirate
advanced imaging
reactive arthritis
RA
SLE
are
monoarticular
lyme dz and gonococcal dz are
migratory
septic arthritis and crystal induced arthritis are
monoarticular
usually w. septic joint there is a hx of
penetrating trauma (may be minor)
what should you do BEFORE you tap a joint
xray! → then aspirate
what is gold standard to r.o septic joint
arthrocentesis
is a peripheral cbc helpful in a painful joint
no!
what labs may helpful in painful joint
CRP
sed rate
→ but limitied → no parameters for values for septic joint
-
what will arthrocentesis look like for OA
yellow
clear
WCC: 700
PMN: 15%
crystals: none
bacteria: none
what does arthrocentesis report look like for traumatic arthritis
color: straw
clarity: cloudy
WCC: 100
PMN: 25%
crystals: none
bacteria: none
septic joint clues (5)
pain out of proportion
pain w. passive/active ROM
limited ROM
pain at rest
elevated WBC in aspirate
at risk for septic joint (4)
- elderly
- DM
- IVDU
- prosthetic joint
mc locations for septic joint (3)
knee
wrist
ankles
mc organisms in septic joint
s. aureus
streptococci
early abx for septic joint
vancomycin
OR
cefazolin
mc cause of septic arthritis in young sexually active adults
gonococcal arthritis
mc locations for gonococcal arthritis
large joints:
knee
wrist
ankle
what are these called
what condition
what tx
gun metal gray lesions
disseminated gonorrhea
ceftriaxone 250 mg im + single dose arythromycin 1 gm po
when would you xray a pt w. bursitis
if trauma is involved
no pain w. radiation means this is unlikely
septic joint
are serum uric aid levels useful for ACUTE attacks of gout
no!
just for chronic
how do you confirm dx of acute gout attack
joint aspiration
what is podagra
mc location for acute gout attack → great toe
what med is preventive and abortive for gout
colchicine
does allopurinol help w. acute gout attack
no!
prophylactic only
mc pathogen in osteomyelitis in pt w. scc
salmonella
mc cause of osteomyelitis in ivdu pt
pseudomonas
mc cause of osteomyelitis overall
s. aureus
what is gs to diagnose osteomyelitis
MRI → said in lecture
bone bx → on slide
initial abx tx for osteomyelitis
3rd gen cephalosporin
the lower the number in a likelihood ratio,
the more helpful
