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LL Ox > Q3: RA, Tarsal/MT Fx, Fusions > Flashcards

Q3: RA, Tarsal/MT Fx, Fusions Flashcards

1
Q

Definition

RA

A

chronic, autoimmune disorder affecting synovium of joints

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2
Q

How RA affects the joints

RA

A
  1. Immune system attcks synovium
  2. incresed inflammation
  3. symptoms
  4. thickening damages joints
  5. joint is no longer functional
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3
Q

Etiology

RA

A

Idiopathic

Risks include age, genetics, smoking, and obesity

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4
Q

Clinical Presentation

RA

A
  • small joints affected first
  • bilateral
  • warm and swollen joints
  • metatarsalgia
  • heel pain
  • nodules
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5
Q

Toe Deformities

RA

A

Hammer - flexed PIP, extended DIP
Claw - flexed PIP & DIP
Bunion
Nodule

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6
Q

Clinical Significance

RA

A

Tender areas (callus and ulcer)
Shoe wear
loss of function (hand)
Other implications: fatigue, fever, and loss of apetite

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7
Q

Diagnostic Techniques

RA

A
  • Blood Test
  • X-Ray - track deformity progression
  • MRI, Ultrasound - inflammation
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8
Q

Diagnostic Qualifications

RA

A

4 out of 7 of the chart criteria for at least 3 months

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9
Q

Non-Ox Intervention

RA

A

Surgery
* synovectomy - remove inflamed lining
* tendon repair
* joint fusion or replacment
* ORIF

Pharmaceuticals, PT/OT, and Assistive devices

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10
Q

Ox Intervention

RA

A
  • Extra D+W shoe wear
  • Accommodative FOs
  • Compression Therapy

Velcro/Adaptive closure may be helpul for these patients

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11
Q

Etiology

Tarsal & MT Fx

A

10% of fractures occur in the foot, usually from:
* overuse
* sports/activity
* trauma
* change in activity level

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12
Q

Calcaneus Fx

Tarsal & MT Fx

A

Usually from trauma/fall;
rare;
can possibly be from avulsion too

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13
Q

Talus Fx

Tarsal & MT Fx

A

Trauma, MVA, fall; neck more common than body
Snowboarders Fx - lateral process of talus from being “locked in”

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14
Q

Hawkins classification

Tarsal & MT Fx

A

Measures talus fx; based on amount of displacement and disruption of blood supply

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15
Q

Navicular Fx

Tarsal & MT Fx

A
  • running
  • repitition/overuse
  • hard to see on imaging
  • avulsion is common too

can be associated with ligament injury (tibialis posterior)

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16
Q

Cuboid Fx

Tarsal & MT Fx

A

AKA Nutcracker Fx; from compression between calcaneus and MTs

17
Q

Cuneiform Fx

Tarsal & MT Fx

A

Less common, usually not alone
* axial loading

18
Q

Metatarsal Fx

Tarsal & MT Fx

A

Stress Fx’s common; usually 5th MT
* Jones - through base
* Shaft - through shaft
* Dancers - spiral/oblique (art. with cuboid)

Can be avulsion (insertion of fib. brevis)

19
Q

Diagnostic Techniques - Observation

Tarsal & MT Fx

A
  • Redness
  • Hot
  • Swollen
  • Painful
  • Blisters
20
Q

Diagnostic Techniques - Radiology

Tarsal & MT Fx

A
  • Radiographs - all views and B/L for comparison
  • CT - boney details
  • MRI - soft tissue
21
Q

Fx Classification

Tarsal & MT Fx

A

AO/OTA Classification
based on bone, fx type, and location

22
Q

Non-Ox Intervention

Tarsal & MT Fx

A

ORIF if displaced, compound, or comminuted (alignment issues)

External Fixation

Pharmaceuticals

Casting/Splinting

23
Q

Weightbearing Status

Tarsal & MT Fx

A

NWB - non weight bearing
TTWB - Toe Touch Weight bearing
PWB - Partial weight bearing
FWB - Full weight bearing

24
Q

Ox Intervention

Tarsal & MT Fx

A

Goals - reduce force and motion through joint or bone

FO
Carbon footplate
Post-Op shoe
CAM Walker (short)
PTB or Unloading Ox

25
Q

Surgical Indications

Fusions

A
  • Painful arthritis
  • cancer
  • osteomyelitis
  • failed Sx
  • nuero- arthropathy
  • fx malunion
  • deformity
26
Q

Clinical Significance

Fusions

A
  • Loss of ROM
  • hardware for modifications
  • arthrodesis

Complications: nonunion, infection, nerve damage, OA

27
Q

Sx: 1st MTP

Fusion

A

Hallux valgus; bunion
can also fuse 1st ray to reduce hypermobility (Lapidus procedure)

28
Q

Sx: Midfoot

Fusions

A

Includes the navicular, cuboid, cuneiform

Min. loss of motion but reduces collapse

29
Q

Sx: Calcaneocuboid

Fusions

A

Calcaneus and cuboid

30
Q

Sx: Talonavicular

Fusions

A

Talus and navicular to realign pes planus

31
Q

Sx: Subtalar

Fusions

A

Talus and calcaneus
loss of inversion/eversion

lack of safety on uneven surfaces

32
Q

Sx: Triple Athrodesis

Fusions

A
  1. Talocalcaneal
  2. Talonavicular
  3. Calcaneocuboid
33
Q

Sx: Pantalar

Fusions

A

Triple arthrodesis + tibiotalar fusion

2 stage Sx:
first tibiotalar, second triple arthrodesis

LL Ox (24 decks)

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