T&O Flashcards
Which sites are most commonly affected by compartment syndrome?
Leg
Thigh
Forearm
Foot
Hand
Buttock
Features of compartment syndrome
Severe pain - worse on stretching
Paraesthesia
Tense
Diagnostic test for compartment syndrome
Intra-compartmental pressure monitor
Management of compartment syndrome
Urgent fasciotomy
Monitor for rhabdomyolysis & reperfusion injury
Causes of compartment syndrome
High energy trauma
Crush injury
Iatrogenic vascular injury
Tight casts
DVT
Burns
Classification system for clavicle fractures
Allman Classification
Type 1 clavicle fracture
Fracture of middle 1/3 clavicle
Generally stable
Type II clavicle fracture
Lateral 1/3 clavicle
Unstable
Type III clavicle fracture
Medial 1/3 clavicle
Rarest
Neurovascular compromise, pneumothorax
Management of clavicle fracture
Conservatively with sling
Early shoulder movement encouraged
Surgical ORIF if open
Major complication of clavicle fracture
Non-union
Muscles in the rotator cuff
Supraspinatous - abduction
Infraspinatous - external rotation
Teres minor - External rotation
Subscapularis - Internal rotation
Cause of rotator cuff injury
Degenerative microtears
High force
Risk factors for rotator cuff injury
Age
Trauma
Overuse
Repetitive overhead shoulder motions
Obesity
Smoking
Specific tests for rotator cuff injury
Jobe’s test - supraspinatous
Gerber’s lift-off test - subscapularis
Posterior cuff test - infraspinatous & teres minor
Investigations in suspected rotator cuff injury
Plain film radiograph
Ultrasonography
MRI
Management of rotator cuff injury
Analgesia
Physiotherapy
surgical repair in large tears
Complication of rotator cuff injury
Adhesive capsulitis
Which nerve is at highest risk in humeral shaft fractures
Radial nerve
Signs of radial nerve injury
Reduced sensation over dorsal 1st webspace
Weakness of wrist extension
Management of humeral shaft fracture
Re-alignment of limb
Functional humeral brace
ORIF
Intramedullary nail if pathological
Pathophysiology of adhesive capsulitis
Glenohumeral joint capsule becomes contracted & adherent to humeral head
Causes of secondary adhesive capsulitis
Rotator cuff tendinopathy
Subacromial impingement syndrome
Biceps tendinopathy
Previous shoulder surgery
Joint arthropathy
Features of adhesive capsulitis
Deep & constant pain
Pain disturbs sleep
Joint stiffness
Deltoid atrophy
Loss of arm swing
Limited external rotation and flexion
Management of adhesive capsulitis
Self limiting over months/years
Education
Analgesia
Glenohumeral joint steroid injections
Characteristic MRI finding in adhesive capsulitis
Thickening of the glenohumeral joint capsule
Peak age of incidence for supracondylar humeral fracture
5-7 years
Most common mechanism of injury in supracondylar fracture
FOOSH
Which nerves are at risk in supracondylar fracture
Median nerve
Anterior interosseous nerve
Radial nerve
Ulnar nerve
Xray signs for supracondylar fracture
Posterior fat pad sign
Displacement of anterior humeral line
Classification system for supracondylar fractures
Gartland classification
Gartland type 1 fracture
Undisplaced supracondylar fracture
Gartland type II fracture
Displaced supracondylar fracture with intact posterior cortex
Gartland type III fracture
Supracondylar fracture that is displaced in 2 or 3 planes
Gartland type IV fracture
Supracondylar fracture that is displaced with complete periosteal disruption
Management of supracondylar fracture with neurovascular compromise
Immediate closed reduction with K wire fixation
Management of type 1 supracondylar fracture
Above elbow cast at 90 degrees flexion
Management of displaced supracondylar fractures
Closed reduction with percutaneous K wire fixation
Complications of supracondylar fracture
Anterior interosseous nerve palsy
Ulnar nerve palsy
Malunion
Volkmann’s contracture
Which muscle inserts at the olecranon
Triceps muscle
Common mechanism of olecranon fracture
FOOSH
When would you surgically manage an olecranon fracture
Displacement >2mm
What is the most common elbow fracture
Radial head fracture
What does the radial head articulate with at the elbow
Capitulum of the humerus
Proximal ulna
What classification system for radial head fractures
Mason classification
Mason type 1 fracture
Non-displaced/minimally displaced fracture of the radial head
Mason type 2 fracture
Partial articular fracture of the radial head with displacement >2mm
Mason type 3 fracture
Comminuted fracture of the radial head with displacement
Management of radial head fracture
Type 1 - Sling <1 week with early mobilisation
Type 2&3 - ORIF
Types of distal radius fractures
Colles’
Smith’s
Barton’s
What is the most common type of wrist fracture
Colles’
Colles’ fracture
Extra articular fracture of distal radius with dorsal angulation and displacement.
Forward fall with forced wrist supination
Smith’s fracture
Extra articular fracture of distal radius with volar angulation and displacement
Backward fall with forced wrist pronation
Barton’s fracture
Intra articular fracture of distal radius with dislocation of radiocarpal joint
Risk factors for distal radius fractures
Increasing age
Female gender
Early menopause
Smoking
Alcohol excess
Prolonged steroid use
Assessing median nerve
Abduction of the thumb
Sensation of radial surface of distal 2nd digit
Assessing ulnar nerve
Adduction of the thumb
Sensation of ulnar surface of distal 5th digit
Assessing radial nerve
Extension of IPJ of thumb
Sensation of dorsal 1st webspace
Management of distal radius fracture
Closed reduction
Below elbow backslab cast
ORIF if unstable
Complications of distal radius fracture
Malunion
Median nerve compression
Osteoarthritis
