T&O Flashcards
Gustillo’s classification of open fractures
1 wound <1cm
2 wound >1cm with minimal soft tissue damage
3 extensive soft tissue damage
3a adequate coverage
3b inadequate coverage
3c neurovascular compromise
Most dangerous complication of open fracture
Clostridium perfringes - wound infection leading to gas gangrene, shock, renal failure
Rx of clostridium perfringes infection
Debride
Abx - benpen + clindamycin
Immediate, early and late complications of fractures
Immediate - neurovascular compromise
Early - infection, compartment syndrome, fat embolism
Late - malunion, AVN, post traumatic OA, complex regional pain syndromes
What palsy can result from anterior shoulder dislocation and signs
Axillary nerve damage
Regimental patch numbness
Impaired abduction
Palsy as a result of a humeral shaft fracture and signs
Radial nerve - wrist drop (unopposed flexion), sensory loss to dorsal surface of lateral 3 and a half digits
which fractures are most commonly associated with compartment syndrome
tibial fractures
supracondylar fractures
displacement of the lateral and medial fragments in a clavicular fracture and why
medial fragment displaces superiorly bc of SCM pulling and lateral goes inferior with the weight of the arm
1 which 3rd of the clavicle is most commonly fractured
2 Which 3rd of the clavicle if fractured is most unstable
1middle third
2 lateral third
Which nerves are at risk in a clavicular fracture
brachial plexus
Rx of a clavicular fracture. How long to heal
medical - sling immobilisation, analgesia, physio.
Surgery
4-6 week healing time
Risk factors for fracture non union or malunion
comminuted
displaced
older people
smoker
overweight
RF for rotator cuff tears
older
repetitive overhead shoulder motions
overuse
DM
Smokers
Trauma
What muscles make up the rotator cuffs
Supraspinatous
Infraspinatous
Subscapularis
Teres minor
Examination findings in rotator cuff tears
Unable to do empty can test - (supraspinatous)
Pain on resistance when externally rotate arm 90 degrees (infraspinatous)
Tenderness
what is adhesive capsulitis and risk factors for it
Frozen shoulder. inflammation of joint causing thickening, fibrosis and adherence of capsule
DM
Thyroid
examination findings in adhesive capsulitis
symmetric loss of active and passive ROM
pain throughout movement
Might get stuck with pain radiating down biceps
Blood investigations that might be done for adhesive capsulitis. Think associated conditions
HbA1C
TSH
Rx of adhesive capsulitis
PT, NSAIDs, Intra articular steroid injections
Surgery if doesn’t help
Who is subacromial impingement common in
Sx
What is the treatment
U25s - active individuals or in manual labour
Pain anterolaterally
Conservative +/- steroid injections
RF for humeral shaft fractures
High energy trauma
Osteoporosis and older age
Smoking
Main complication to be aware of for humeral fracture and the sx/signs of this
Radial nerve injury
- Weakness in wrist extension
- reduced sensation of dorsal 1st webspace
Typically no loss of elbow extension as this part of the nerve comes off before the radial groove
Cause of an anterior shoulder dislocation ie what position is the arm in when force is applied
extended, abducted and externally rotated humerus
What usually causes a posterior shoulder dislocation
seizures or electrocution
Which nerves may become compromised in shoulder dislocations
axillary
suprascapular
Other injuries that may be concurrent with a shoulder dislocation
Hill sachs - impaction on humeral head
Bankarts - impaction on glenoid
Rotator cuff injuries
What sign on X-ray indicates a posterior dislocation. And which view is this visible in
light bulb sign
Y view
what is a common cause of b/l carpal tunnel syndrome
RA
Surgical rx of NOFs:
Extracapsular (subtrochanteric and intertrochanteric)
Intracapsular (displaced and undisplaced)
Extracapsular subtrochanteric - inter medullary nail
Extracapsular intertrochanteric - DHS
Intracapsular displaced - Total or semi arthroplasty. Total preferred if person independent and fit
Intracapsular undisplaced - internal fixation
Examination sign of a NOF
Externally rotated shortened leg
SALTER Harris classification of pads fractures
1 Straight - through the physics only
2 Above - through physics and metaphysics
3 Lower - through physics and epiphysis
4 Through - physis, epiphysis and metaphysis
5 ER - Erasure or cRush injury
OA vs RA on xray
OA - LOSS
loss of joint space
osteophytes
subchondral sclerosis
subchondral cysts
RA LESS
Loss of joint space
Erosions
Subluxation
Soft bones (osteopenia)
imaging modality of choice for osteomyelitis
MRI
what movements of the wrist is medial epicondylitis (golfers elbow) exacerbated by
wrist flexion and pronation
what meds are first line for lower back pain
NSAIDs
signs of compartment syndrome
parasthesia
pain - worse when doing passive movements
trauma to the limb
normal x ray findings
imaging for supraspinatous tendinitis
none - clinical diagnosis
imaging choice for suspected c spine fracture
ct neck
how long is abx course for septic arthritis usually
2 weeks IV followed by another 4 weeks oral
Tends to be fluclox or clindamycin if pen allergy
kocher criteria for septic arthritis
unable to weightbear
raised ESR
raised WCC
fever >38.5
most common organism causing septic arthritis in adults and in children
staph aureus
haem influenzae in children
most common organism causing septic arthritis in adults and in children
staph aureus
haem influenzae in children
causes of septic arthritis
haematogonous spread - accesses, wounds disseminated infection eg gonorrhoea
direct - joint injections, joint surgery, penetrating injuries
rf for septic arthritis
RA, SLE, prosthetic joints, IVDU, diabetes, immunosuppression
why are people with RA/SLE more at risk of septic arthritis (pathophys)
inflammation - neovascularisation - bacteria spread from distant sites - reduced joint defence leads to rapid colonisation
synovial fluid appearance in septic arthritis
yellow/green, turbid
complications of septic arthritis
joint damage
osteomyelitis
sepsis
Ix of choice for osteomyelitis
MRI
commonest causes of rotator cuff tears
chronic overuse
acute trauma
degeneration
presentation of subacromial impingement syndrome
what group of people
<25 - active
anterior shoulder pain, painful at 60-120 degrees
worse at night and at rest
presentation of rotator cuff tears
what group of people
40-70 yrs
lateral pain, particularly over greater tubercle
Can not lift arm above 90 degrees
what examination tests
- supraspinatous
- infraspinatous
- subscapularis
s - empty can test
i - weakness or pain on resisted external rotation
su - weakness when lifting hand against resistance from small of back
ix that can be done for rotator issues, when would they be done
USS or MRI - if other treatment hasn’t worked first
ddx of rotator cuff tear
SAIS, adhesive capsulitis, inflammatory arthritis, acromioclavicular OA
