Soft Tissue & Ortho Misc Flashcards
What are the 3 paediatric-specific fracture patterns? How does their Mx differ?
Plastic deformity
- Bend
Buckle (torus)
- *Only reduce these if significant deformity.
- Removeable splint 3 weeks
Greenstick
- One cortex is broken, other not
Tx these as per normal #- plaster
_______
*Bucket-handle (AKA metaphyseal corner #)
What are the potential complications of fractures:
EARLY
Pain
Instability
–> Associated dislocation, malunion in future, NV risk
Compartment syndrome
Fat embolism
DVT
DELAYED
Non-union
Malunion
–> Deformity, functional
Post-traumatic arthritis
Heterotrophic ossification
Vasc
–> Avascular necrosis
–> Ischaemic contractures
CRPS
What are the special tests of the knee, and what do they test for?
Anterior and Posterior Drawer
- ACL and PCL, respectively
- More accurate for PCL
Lachman’s
- Better test for ACL
Lateral laxity
- Med and lat collateral ligaments
McMurray
- Meniscal
Apley
- Meniscal
ACL injury:
- Stops tibia moving ant and stabilises in twist/turn
-
More commonly injured
–> Planted twist
–> ant force on tibia, post force on femur - Mainly sport injury
- Often audible pop and haemarthrosis
- Common to have concurrent med collat and med meniscus inj.
+- Segond #
If suspected:
- Ant drawer
- Lachman’s
- Assess for MCL/med meniscus
–> MRI
Operative
–> arthroscopy or open recon.
PCL injury
- Stops tibia moving post
- Essential for downhill as it is only stabiliser in weightbearing, flexed knee
- Blow to bent knee
- Mainly dashboard injury
If suspected:
- Posterior drawer
- Assess for co-injury
–> MRI
- Conservative, unless co-injury.
Risk factors for patellar/ quadriceps tendon rupture:
Steroids
Previous patellar tendonitis
Renal failure, diabetes, SLE, rheumatoid
Assessment for patellar tendon rupture:
Forceful quadriceps contraction with knee at 60 deg flexion
ie. landing a jump
Usually ruptures off inferior patella. Less commonly, off tibial tubercle.
CLINICAL:
- Loss of knee extension
- Palpable deficit below patella
- XR:
–> High-riding patella (above condyles)
–> +/- patella or tubercle avulsion
- USS
IF SUSPECTED
- Immobilise in extension (eg. zimmer)
- MRI
Partial= immob 6 weeks. Complete = OT
‘Patella alta’
High-riding patella (above condyles)
Sign of patella tendon rupture.
Clinical signs of quadriceps tendon rupture:
*More common**
- Palpable defect superior to patella
- Loss of extensor mechanism
- Low-riding patella (patella baja)
Management same as patellar tendon rupture:
- Partial = immob in ext 6 weeks
- Complete = OT
- Send home from ED in zimmer for MRI and ortho.
Meniscal injury
Almost never occur in isolation- often collateral/ cruciate damage.
- Lateral is mobile, more commonly injured
- Usually twisting whilst loadbearing
- +-locked knee
- McMurrays/ Apleys
- MRI or arthroscopy
Which bursae communicate with their joint?
SUPRApatella bursa of knee
(+ Baker’s cyst)
Management of septic bursitis:
Aspirate for diagnosis (+therapeutic)
As per cellulitis:
- PO vs IV depending on individual case
- 14-day initial course
Failure to respond –> bursectomy (ortho)
Steroid injection contraindicated in SEPTIC bursitis
What are the clinical signs of Achilles tendon rupture?
Palpable defect
Weakened plantarflexion
–> Not absent. Long toe/ankle flexors still intact
Thompson’s test +
Initial management of Achilles tendon rupture:
Below- knee slab in full plantarflexion
Refer ortho
(Conservative Mx = progressive casting with gradually less flexion)
Management of Paronychia:
Nail fold infection +/- abscess +/- surrounding cellulitis
- Soak in warm water for 10 mins (soften)
- Lift nail fold away from nail with small, flat object (18G needle, splinter forceps)
- Express pus
- +/- gauze ‘wick’ to hold open
- CONSIDER antibiotics only if significant cellulitis/ systemically unwell
Discharge advice:
- Repeat at home PRN 2-3x per day
Refractory:
- I&D
- Nail removal
‘Knavel signs’ of pyogenic tenosynovitis:
- Flexed posture
- Pain ++ with passive extension
- Tendor over flexor sheath
- ‘Sausage’ digit (fusiform swelling)
–> Admit for OT
–> (Skin +/- MRSA) IV Ceftriaxone +/- Vanc. (MRSA)
High pressure injection injuries
Eg. Paint gun, water, grease, diesel… Usually non-dom hand.
Benign entry wound but MASSIVE risk of amputation.
Surgical Emergency
–> Direct trauma
–> Ischaemia
–> Compartment syndrome
–> Chemical necrosis
–> Closed space infection
–> Systemic absorption/toxicity
40-80% ultimately require amputation. Those that don’t, have significant functional impairment.
ED Mx is supportive: optimise perfusion, Antis/ADT, analgesia –> OT.
