Ortho continued Flashcards
if you suspect fracture, what types of X-rays should you get
two views at 90 degrees to one another. include joints above and below the broken bone. also include bones in the line of force (feet-> lumbar spine)
when can you do closed reduction
bones that are not badly displaced or angulated and can be satisfactorily alligned by external manipulation in a cast
when do you do open reduction and fixation
broken bones that are severely displaced or angulated and cannot be easily aligned. need surgical intervention to reduce and fix the fracture
tx for clavicular fractures
usually at junction of distal and middle thirds. tx: place arm in sling. young women might get surgery for cosmetic reasons
pt holds arm close to body but rotated outward as if about to shake hands. numbness over small area in deltoid.
anterior dislocation of shoulder. MC shoulder dislocation. numbness from stretching of axially nerve. dx: AP and lateral X-rays. some people develop recurrent dislocations with minimal trauma.
pt s/p seizure or electrical burn with arm close to body and internally rotated.
posterior shoulder dislocations. regular X-rays can miss it, axillary or scapular lateral views are needed.
tx for developmental dysplasia of the hip
pavlik harness for 6 months. sono is dx- X-rays don’t work
6 year old with insidious development of limp, decreased hip motion, and hip or knee pain. antalgic gait.
legg-calve-perthe dz. dx by AP and lateral hip X-rays. tx controversial- contain femoral head within the acetabulum by casting and crutches
chubby 13 year old boy with groin or knee pain and limping. sit- sole of affected leg inverts. limited hip internal hip rotation.
Slipped capital femoral epiphysis. dx: X-ray. tx: emergency! surgical tx to pin femoral head back into place.
toddler with febrile illness who refuses to move his hip. hip flexed in slight abduction and external rotation.
septic hip. surg emergency! elevated ESR. dx: aspirate hip under general anesthesia. do further open drainage if pus is obtained.
little kid with hx of febrile illness. shows up with severe localized pain in a bone and no hx of trauma to that bone.
acute hematogenous osteomyelitis. dx: MRI (X-rays don’t show anything for a couple of weeks). tx: antibiotics
legs that bow outwards
genu varum. normal up to age 3- no tx needed. after age 3 it is called blount dz- disturbance of medial proximal growth plate- surgery must be done
knock knees
genu valgus. normal between age 4-8- no tx needed.
baby born with both feet turned inward with plantar flexion of ankle, inversion of foot, adduction of forefoot , and internal rotation of tibia.
clubfoot (talipes equinovarus). tx: serial plantar csts. often achilles tenotomy and part time long term use of braces. non responders get surgery 9-12 months.
old osteoporotic woman falls on hand and has deformed and painful wrist that looks like “dinner fork”
colles fracture. main lesion is dorsally displaced dorsally angulated fracture of distal radius. treat with close reduction and long arm cast
direct blow to ulna fracture. pt has a raised protective arm against a nightstick.
monteggia fracture. diaphyseal fracture of proximal ulna with anterior dislocation of radial head. broken bone needs ORIF while dislocated one needs closed reduction.
galeazzi fracture
mirror image of monteggia fracture. distal third of radius gets direct blow and has the fracture and there is direct dislocaition of distal radioulnar joint.
young adult falls on an outstretched hand and complains of wrist pain.
fracture of the scaphoid (carpal navicular). physical exam shows localized tenderness to palpation over the anatomical snuff box. X-rays negative in undisplayed fx, will show in three weeks. thumb spica cast is indicated with just h&p. if original X-rays show displaced and angulated fx, ORIF needed. scaphoid fx notorious for a high rate of nonunion.
pt hits a hard surface like a wall with fist. the hand is swollen and tender. dx? tx?
metacarpal neck fractures- usually fourth or fifth or both. X-rays are diagnostic. tx depends on degree of angulation, displacement, or rotary malalignment. closed reduction and ulnar gutter splint for mild. kirscHner wire or plate fixation for bad ones.
old pt had a fall- laying on stretcher with and shortened and externally rotated leg
hip fracture! get X-ray. treatment depends on specific location.
femoral neck fracture issues and treatment
compromise blood supply of femoral head! faster healing and earlier mobilization can be achieved by replacing the femoral head with a prosthesis.
intertrochanteric fracture issues and treatment
less likely to lead to avascular necrosis than femoral neck fractures. treat with ORIF. unavoidable immobilization that ensues gives a very high risk of DVT and PE, so post op anticoagulation is recommended
femoral shaft fracture issues and tx.
tx: usually intramedullary rod fixation. if b/l and comminuted, may produce enough internal bleeding -> shock, so need external fixation while pt is stabilized. if open, it is an ortho emergency with OR cleaning and closure within 6 hours. if multiple-> fat embolization.
knee pain w/o swelling
unlikely to be serious knee injury
best way to evaluate knee injury
MRI. swelling is “poor man’s MRI”
sideways blow to knee.
collateral ligament injury. medial blow will affect lateral ligament and vice versa. knee will be swollen and show localized pain on affected side.
physical exam maneuvers for collateral ligament injury.
flex knee 30 degrees. passsive abduction (valgus stress test shows medial injury) or adduction (varus stress test shows lateral injury) will produce pain on torn ligaments and allow further displacement that normal leg.
tx for collateral ligament injury
isolated injuries treated with hinged cast. when several ligaments are torn, surgical repair is preferred.
Pt has severe knee swelling and pain. Anterior drawer test positive and Lachlan test positive.
Anterior cruciate ligament injury. More common than posterior. MRIS are diagnostic. Tx: immobilization and rehab for sedentary patients but athletes need arthroscopic reconstruction
Pt has a knee injury- protracted pain and swelling- catching and locking that limits motion
Meniscal tears- difficult to dx clinically and on X-rays but show up beautifully on MRIS. Tx: repair, trying to save as much meniscus as possible. Complete meniscotomy leads to late development of degenerative arthritis. USMLE answer is open repair.
Young men subjected to forced marches. Tenderness to palpating over a specific part of bone. X-rays are normal.
Tibial stress fx. Treat with a cast and repeat X-ray in 2 weeks. Non weight bearing crutches is another option.
Out of shape middle aged man who subjects himself to severe strain. Plant foot, change direction, large popping noise is heard and they fall clutching the ankle. Limited plantarflexion is possible but pain swelling and limping.
Rupture of the Achilles’ tendon. Palpating tendon leaves a gap. Tx: casting in equinus position allows healing in several months- surgery achieves quicker cure
