ORTEM Flashcards
Ruptured anterior cruciate ligament summary
Sports injury
Mechanism: High twisting force applied tto bent knee
Typical presentation: Loud crack, pain ane RAPID joint swelling (haemoarthrosis)
Poor healing
Manage: Intense Physio or surgery
Ruptured posterior cruciate ligament
Mefh: Hyperextension injuries
Tibia lies back om femur
Paradoxical anterior draw test
Rupture of medial collateral ligament
Mech: Leg forced into valgus via force outside the leg
Knee unstable when put into valgus position
Meniscal tear
Rotational sporting injury
Delayed knee swelling
Joint locking (patient may develop skills to inlock)
Recurrent episodes of pain and effusions are common, often following minor trauma
Chondromalacia patellae
Teenage girls following an injury to knee eg dislocation of patella
Typically history of pain on going downstairs or at rest
Tenderness, quadriceps wasting
Dislocation of the patella
Most commonly as traumatic primary event, either through direct traume or severe contraction of quads with knee stretched in valgus and external rotation
Genu valgum, tibial torsion and high riding patella are risk factors
Skyline xrays of patella may be obvious
Osteochondral fracture present in 5%
Recurrence rate: 20%
Fractured patella types
Direct blow to patella cuasing undisplaced fragments
Avulsion fracture
Tibial plateau fractures
Occur in elderly (or signif trauma in yougn)
Mech: Knee locked into valgus or varus, but knee fractures before the ligament ruptures
Varus injury affects medial plateau, valgus injury then lateral plateau depressed fracture
Classify using Schtzker system
Adhesive capsulitis also known as…
Frozen shoulder
Adhesive capsulitis associated with
Diabetes mellitus. 20% of diabetics may have an episode
Features of adhesive capsulotis
Tend to develop over days
External rotation affected more than internal or abduction
Passive and active movement affected
Typically painful freezing phase, an adhesive phase and recovery phase
Bilateral in up to 20% patients
Episode lasts 6 months. To 2 years
Management of adhesive capsulitis
diagnose clinically
NSAIDs, Physio, oral corticosteroids, intra articular corticosteroids
No single intervention has been shown to I,prove outcome in long term
What is an iliopsoas abscess
collection of pus in iliopsoas compartment
Either from haematogenous spread of bacteria (commonly staph aureus), or secondary to:
Crohns, dicerticulitis, UTI, Gu Cancer, vertebral osteomyelitis, femoral catheter, endocarditis IVDU
Features of iliopsoas abscess
fever
Back/flank pain
Limp
Weight loss
with patient supine with knee flexed and hip slightly externally rotated, ask to lift thing against hand ->pain, or huperextend affected hip with parient on their side
Management of iliopsoas abscess
antibiotics
Percutaneois drainage
Surgery if failed to drain or other need for intra ah’dominal
Paeds complete fracture
Both sides of cortex are breached
Toddlers fracture
oblique tibial fracture in infanrs
Ttpically from falling off sofa onto straight leg
Not NAI concern particularly
Paeds plastic deformity
stress on bone resulting in deformity without cortical disruption
Paeds greenstick fractire
unilateral cortical breach only
Paeds buckle ‘torus’ fracture
incomplete cortical disruption resulting in periosteal hematoma only
Salter Harris system
Classification of paeds fractures with involvement of the growth plate.
From I: Through physis only
To IV: Involving physis, metaphysis and epiphysis
V: Crush injury
NAI red flafs
Delayed presentation
Delay in attaining milestones
Lack of concordance between proposed and actual mechanism of injury
Multiple injuries
Injury at site not normally exposed to trauma
Children on at risk register
Pathological fractures caused by…
underlying bone issues eg osteogenesis imperfecta
Or osteoporosis
acetabular labral tear
may occur following trauma in Young, or as result of degenerative change in older
Feat: Hip/groin pain
Snapping sensation around hip
Occasional sensation of locking
Leriche syndrome
atheromatous disease involving the iliac vessels
Blood flow to pelvic viscera is compromised
Classic triad of symtpoms:
1. Claudication of buttocks and thighs
2, atrophy of the musculature of legs
3. Impotence (due to paralysis of L1)
Diagnose with angiography, and if poss treat with endovascular angioplasty and stent insertion
Fearures of discitis
=an infection in intervertebral disc space
Back pain
Pyrexia + rigors + sepsis
Neuro fearures: Changing lower limb neurology if epidural abscess develops (=basically Progressing to cauda equina)
Diagnosis and treatment of discitis
MRI has highest sensitivty, CT guided biopsy may be useful for guiding antimicrobuals
Treatment: 6-8 weeks IV abx. Choice dependent on organism cultured
Assess for endocarditis
What is avascular necrosis of the hip
death of bone tissue secondary to loss of the blood supply
Leads to bone destruction and loss of joint function
Commonly epiphysis of long bones eg the femur
Causes of avascular necrosis
long term steroid use
Chemotherapy
Alcohol excess
Trauma
Diagnosing avascular necrosis
initially asymptomatic but then pain in affected joint and stiffness. In the hip, pain is typically in the anterior groin region
Xray may see osteopenia and microfractures early on, MRI is investigation of choice
Injury resulting in a scaphoid fracture
typically following fall onto outstretched hand causing axial compression of scaphoid with wrist hyperextended and radially deviated
In contact sports but also RTA the person holding the wheel
Importance of recognizing a scaphoid fracture
80% of blood supply is from dorsal carpal branch of the radial artery in a retrograde manner. Interruption of blood supply -> poss avascular necrosis. Often initially inconclusive radiography, so need further imaging 7-10 days later.
Symptoms and signs of a scaphoid fracture
Pain along radial aspect of wrist and at base of thumb
Loss of grip/pinch strength
Point of max tenderness over the anatomical snuff box
wrist joint effusion
Pain elicited by telescoping of the thumb
Tenderness of the scaphoid tubercle
Pain on ulnar deviation of the wrist
Management of scaphoid fracture
immobilize with futuro splint or below elbow backslab
Refer to orthopaedics
- if undisplaced to cast for 6-8 weeks, should unite well
- displaced scaphoid fractures require surgical fixation
- proximal scaphoid pole fractures also need surgery
What is lumbar spinal stenosis
condition in which central canal is narrowed by a tumour, a disc prolapse or other degenerative change
Degenerative disease in most common underlying cause
Lumbar spinal stenosis presentation
back pain
Neuropathic pain
Symptoms mimicking claudication (severe low extremity pain, or weakness with ambulation- due to incr metabolic demands of compressed nerve roots)
Sitting better than standing, may be easier to walk uphill than downhill
Absence of pain when spine is in flexed position
Differentiating lumbar spinal stenosis from peripheral arterial disease
pain improving on sitting down or croucdhing
Weakness of leg
Lack of smoking history
Lack of cardiovascular history
Features of L3 nerve root compression
sensory loss over anterior thigh
Weak hip flexion, knee extension and hip addiction
Reduced knee reflex
Positive femoral stretch test
Features of L4 nerve root compression
sensory loss anterior aspect of knee and medial malleolus
Weak knee extension and hip addiction
Reduced knee reflex
Positive femoral stretch test
L5 nerve root compression features
sensory loss dorsum of food
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test
S1 nerve root compression features
sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test
Intracapsular hip fractures locations
subcapital (below femoral head)
Transcervical (across mid femoral neck)
Basocervical (across the base of the femoral neck)
Extracapsular hip fractire lpcations
Intertrochanteric - fracture line between the two trochanters, separation of lesser trochanter
Subtrochanteric - femoral neck remains intact
Garden classification system
traditional way or assessing severity of neck of femur fractures
I incomplete or impacted bone injury with valgus angulation of the distal component
II complete (across whole nexk) undisplacsd
III complete -partially displaced
IV - complete - totally displaced
Posterior hip dislocation
90% of dislocations
Affected leg is shortened, adducted and internally rotated
Anterior hip dislocation
affected lef is usually abducted and externally rotated, no leg shortening
Colles’ fracture
Fall onto extended outstretched hands
Described as dinner fork type deformity
Classically: Transverse fracture of the radius
- 1 inch proximal to radio carpal joint
- dorsal displacement and angulation
Smiths fracture (reverse Colles’ fracture)
volar angulation of distal radius fragment (garden Spade deformity)
Caused by falling backwards onto palm of an outstretched hand or falling with wrists flexed
Bennett’s fracture
intra articular fracture at base of thumb metacarpal
Impact on flexed metacarpal, caused by fist fights
Xray: Triangular fragment at base of metacarpal
