Speciality: Orthopaedics Flashcards
Compartment Syndrome
- Causes
- Presentation
- Ix
- Rx
- Complication occurring following ### or reperfusion in vascular patients.
- Raised pressure within a closed anatomical space.
- Compromises tissue perfusion - necrosis.
- ### = supracondylar fractures and tibial shaft. - Pain (worse on movement, even passive).
- Parasthesiae
- Pallor
- Arterial pulsation
- Paralysis of the muscle group. - Intracompartmental pressure measurement; >20mmHg is abnormal and >40mmHg is diagnostic.
- Clinical.
- Increased CK - Prompt and extensive Fasciotomy.
- Analgesia
- Aggressive fluid resus due to myoglobinuria –> Renal failure.
- Debride and amputate necrotic muscle.
- No anticoagulation - worsens Sx.
Risk factors for DDH
- Female gender
- Breech
- FHx
- Firstborn
- Oligohydramnios.
DDH tests
- Barlow and Ortolani at NIPE
Psoas abscess
- Causes
- Presentation
- Ix
- Rx
- Often seen in IVDU.
- Collection of pus in the psoas muscle.
- Psoas stretches from T12-L5.
- Primary origin or secondary infection to pyelonephritis or IBD, UTI.
- Commonly due to Staph.aureus or strep and related to immunosuppression and IVDU. - Pain
- Fever
- Psoas irritation - hip extension.
- Patients often adopt a lying position w/ slightly flexed knees + hip externally rotated. - Identify infection
- Septic screen
- MRI/CT is gold standard. - ABx + drainage
- Manage RF’s
Management of Hip ## in older adults.
1) Undisplaced intracapsular # w/ no co-morbs.
2) Undisplaced intracapsular # w/ co-morbs
3) Displaced intracapsular # w/ no co-morbs
4) Displaced intracapsular # w/ co-morbs or older.
5) Extracapsular #
6) Extracapsular # subtrochanteric.
1) Internal fixation
2) Hemiarthroplasty
3) Internal fixation
4) Total hip replacement
5) Dynamic hip screw
6) Intramedullary device.
Nerve most commonly affected in TK replacement
- Common peroneal
- Foot dorsiflexion
Knee injury
1) Ruptured anterior cruciate
2) Ruptured posterior cruciate
3) Ruptured medial collateral
4) Meniscal tear
5) Dislocation of patella.
1) Sport injury.
- Twisting force w/ bent knee.
- Loud crack, pain and haemarthrosis
- Rx w/ physio and surgery
2) Hyperextension injury
- Paradoxical anterior draw test
3) Leg forced into valgus
- Knee unstable in valgus.
4) Rotational sport injury
- Delayed swelling
- Joint locking
- Pain and effusion following minor subsequent trauma
- Positive McMurray’s test
- worse on straightening
5) Trauma
- XR required skyline view
Back pain red flags
- age <20 or >50yo
- Hx of malignancy
- night pain
- Hx of trauma
- Systemically unwell
Back pain; Facet joint pain
- Younger pt.
- Acute or chronic
- Worse on morning and standing.
- Pain worse on extension.
Back pain; spinal stenosis
- Gradual onset
- Unilateral or BL leg pain, numbness, weakness worse on walking.
- Relieved on sitting, leaning forward or crouching.
- MRI for Dx
Baker’s cyst.
- Causes
- Presentation
- Ix
- Rx
- Distention of the gastrocnemius-semimembranosus bursa.
- Primary = no pathology, kids.
- Secondary = Hx of OA and seen in adults. - Swelling in popliteal fossa. soft and fluctuant.
- Clinical
- Rule out other pathology if required. - In kids none is required as they resolve
- Surgical repair and aspiration.
- Rupture requires elevation and rest.
Sarcoma
- Causes
- Presentation
- Ix
- Rx
- Malignant tumours of mesenchymal origin.
- Bony = osteosarcoma, Ewing’s (femoral diaphysis), chondrosarcoma.
- Soft tissue = Rhabdomyosarcoma, Leiomyosarcoma. - Mass or swelling
- Large >5cm soft tissue swelling.
- Deep tissue location or intramuscular
- Rapid growth
- Painful - XR/MRI/CT/USS
- Biopsy - Surgery
- Chemo/radio.
Carpal Tunnel Syndrome
- Causes
- Presentation
- Ix
- Rx
- Idiopathic.
- median nerve neuropathy
- Tightness of the flexor retinaculum etc.
- More common in females
- Associated w/ RA - Sx at night
- Pins and needles in fingers
- Loss of sensation of the palmar aspect of lateral 3 fingers
- Wasting thenar eminence - Clinical
- Tinels and Phalens
- Formal Dx w/ electrophysiological study. - Splinting
- Surgical decompression of the flexor retinaculum.
FRAX Screening
- Assess in all women >65 all men >75 and younger people w/ RF’s
1) Age
2) Sex
3) Weight
4) Height
5) Previous #
6) Parent hip #
7) Current smoking
8) Steroids
9) RA
10) Secondary osteoporosis
11) Alcohol >3 unit/day 12)
12) Femoral neck bone density. (optional)
Low risk = reassure + lifestyle advice
Med risk = DEXA
High = Bone protection
Adhesive capsulitis
- Causes
- Presentation
- Ix
- Rx
- Frozen shoulder
- UK
- Associated w/ DM, MI and lung disease. - Features develop over days
- External rotation affected more than internal rotation or abduction.
- Both active and passive movement affected.
- Painful freezing phase, frozen phase and thawing phase.
- Often self resolving. - Clinical
- Shoulder exam
- Arthroscopy? - Analgesia w/ NSAIDs
- Physio
- Steroid injections.
Trigger finger
- Causes
- Presentation
- Ix
- Rx
- Abnormal digit flexion and catching.
- Associated w/ RA and DM. - More common in thumb, middle or ring finger.
- Stiffness and snapping.
- Catching
- Nodule at base. - Clinical
- Steroid injection
- Finger splinting
- Surgery in those who don’t respond.
Charcot joint
- Causes
- Presentation
- Ix
- Rx
- Neuropathic joint.
- Badly disrupted and damaged due to lack of sensation.
- Most commonly seen in diabetics and alcoholics. - Painful but less than expected given deformity level.
- Joint is swollen, red and warm often w/ intact skin.
- Insidious onset. - Plain XR can show joint dislocation and disruption and osteolysis.
- Ix for the neuropathy cause. - Educate
- Rx underlying condition.
- Podiatry care
- Special shoes.
- Bisphosphonates can help in an acute phase and prevent bone resorption.
- Surgical fixation.
Chondromalacia Patellae
- Teen girls
- Follows a knee injury; dislocation patella
- Pain on going downstairs and at rest.
- Tenderness and quads wasting.
Osgood Schlatters disease
- Athletic boys and girls
- Micro fractures at the point of insertion of the tendon into the tibial tuberosity.
- Swelling and tenderness over the tibial tuberosity
- Settles w/ physio and rest.
Osteomyelitis
- Causes
- Presentation
- Ix
- Rx
- Bone infection
- S.aureus.
- Sickle cell anaemia - salmonella.
- RF’s - DM, sickle cell, IVDU, alcoholic, HIV - Bone pain
- Fever
- Systemic upset - MRI is best.
- Flucloxacillin 4 weeks
- Clindamycin if penicillin allergic.
L3 compression
- sensory loss anterior thigh
- Weak quads
- Reduced knee reflex
- Positive femoral stretch test
L4 compression
- Sensory loss of the anterior aspect of the knee
- Weak quads
- reduced knee reflex
- postive femoral stretch test
L5 compression
- Sensory loss dorsum of the foot.
- Weakness in foot and big toe dorsiflexion
- Reflexes preserves
- Positive sciatic nerve stretch test.
S1 compression
- Sensory loss of the posterolateral aspect of the leg and food.
- Weakness in plantar flexion of the foot
- Reduced ankle reflex
