TNO common presentations Flashcards
Shoulder dislocation can be
anterior, posterior or inferior
cause and presentation of anterior shoulder dislocation
Cause: arm forced backwards whilst abducted and extended at the shoulder e.g. someone reaching up and out to try and acth a heavy rock travelling towards
Presentation:
- arm held to body
- deltoid flattened
- humerus will cause a bulge
cause of posterior dislocation
electric shocks and seizures
damage associated with shoulder dislocation
- Bankart lesion
- Hill-sachs lesion
- Axillary nerve damage
bankart lesion
tears to the anterior portion of the labrum
These occur with repeated anterior subluxations or dislocations of the shoulder.
Hill-sachs lesion
are compression fractures of the posterolateral part of the head of the humerus. As the shoulder dislocates anteriorly, the posterolateral part of the humeral head impacts with the anterior rim of the glenoid cavity. Part of the humeral head is damaged, making the shoulder less stable and at risk of further dislocations.
investigation for shoulder dislocation
- X-ray (AP, lateral, axillary view)
- Confirm dislocation
- exclude fracture
- MRI
- look for Hill-sachs and Bankart lesions
- prep for surgery
- Arthroscopy
acute management of shoulder dislocation
Relocate ASAP- heres the step
Shoulder muscles goes into spasm making it harder to relocate as time goes on
- Analgesia, muscle relaxant and sedation as appropriate
- Gas and air (Entonox)
- Broad arm sling
- Reduce
- if associated fracture- surgery
- Post reduction x-ray
- immobilisation after relocation of shoulder
Ongoing management after shoulder disloation
to help reduce recurrent dislocations
- physiotherapy
- shoulder stabilisation therapy
Wrist fractures
-
Distal radial fracture
- Colles
- Smiths
- Bartons
- Scaphoid
Colles fracture summary
- Extra, articular transverse distal radius fracture
- may not mention but will include avulsion fracture of ulnar styloid
- Cause
- forward FOOSH
- fragility fracture e.g. think osteoporosis RF
- Presentation
- Dinner fork deformity
- Distal radius is dorsally displacement
Smith fracture
- Extra, articular transverse distal radius fracture
- less common
- think of as reverse of colles
- Cause
- Backwards FOOSH
- Presentation
- Palmar/volar angulation of distal radial fragment, with or without palmar displacement
Bartons fracture
This is an intra-articular fracture of the distal radius with associated dislocation of the radio-carpal joint.
A Barton fracture can be described as volar (more common) or dorsal (less common), depending on whether the volar or dorsal rim of the radius is involved.
The main risk factors for distal radius fractures are related to osteoporosis:
- Increasing age
- Female gender
- Early menopause
- Smoking or alcohol excess
- Prolonged steroid use
Investigation for distal radius fracture
- Neurovascular examination before and after any procedure
- Investigations
- X-ray (AP and lateral)
- Radial height <11mm
- Radial inclination <22 degrees
- Radial (volar) tilt >11 degrees
- CT or MRI more complex fractures
- X-ray (AP and lateral)
management of distal radius fractures: undisplaced
- ATLS
- Closed reduction
- Haematoma block (lidocaine)
- Traction and manipulation
- Below-elbow backslap
- allows for swelling
- Radiography repeated after 1 week to check for displacement
- Physio
management of distal radius fractures: displaced
Surgical management if
- displaced
- intra-articular
Options
- :open reduction and internal fixation with
- plating or
- K-wire fixation
- Back-slab cast to ensure immobility
mortality rate of hip fracture
5-10%
Hip Fracture Presentation
The typical scenario is an older patient (over 60) who has fallen, presenting with:
- Pain in the groin or hip, which may radiate to the knee
- Not able to weight bear
- Shortened, abducted and externally rotated leg
Hip fractures can be categorised into:
*
- Intra-capsular fractures
- Extra-capsular fractures
blood supply to the femoral head
- retrograde
- Deep femoral artery: medial and lateral circumflex supply the femoral head
- branches of circumflex arteries supply the top of the head
- If intracapsular fracture the neck of the of the femur can damage these blood vessels- removing blood supply to the femoral head→ Avascular necrosis
Intra-capsular fractures
- Break in femoral neck
- Classification : Garden
- displaced
- non- displaced
investigations for hip fracture
- X-ray (AP and lateral)
- look for Shentons line
- MRI or CT if x-ray negative, but fracture still investigated
Non-displaced intra-capsular fracture management
internal fixation (with screws)
Displaced intra-capsular fracture management
Total hip replacement (head and socket): if patient walk independently
Hemiarthroplasty (head): limited mobility or significant co-morbidities
why replacement for displaced intra-capsular and not non-displaced
Intra-capsular fractures may have an intact blood supply to the femoral head, meaning it may be possible to preserve the femoral health without avascular necrosis occurring.
extra-capsular fractures can be split up into
Intertrochanteric fractures- between greater and lesser trochanter
Subtrochanteric fractures- occurs distal to lesser trochanter (within 5cm)
Weber classification for lateral malleolus fractures
- Type A = below the syndesmosis
- Type B = at the level of the syndesmosis
- Type C = above the level of the syndesmosis
surgical management fo ankle fracture
Open reduction and internal fixation (ORIF) is often required in ankle fractures to achieve stable anatomical reduction of the talus within the ankle mortise. Ankle fractures that require an ORIF include:
- Displaced bimalleolar or trimalleolar fractures
- Weber C fractures
- Weber B fractures with talar shift
- Open fractures
The type of operative procedure performed depends on the specific type of ankle fracture sustained.
