Emergencies, osteoporosis, thoracic outlet

Question 1

compartment syndrome tx

Answer 1

Remove all restrictive dressings, splints, and casts

Refer for emergent fasciotomy

Question 2

How do you treat septic arthritis

Answer 2

IV antibiotics after synovial fluid + blood cultures are obtained
→ IV ceftriaxone + vancomycin

Emergent surgical decompression + lavage of septic joint

Hospitalization

Prosthetic = may need removal and/or chronic suppression

Question 3

How do you tx knee dislocation

Answer 3

Ortho and Vascular consult for reduction, delayed ligament repair

Question 4

Treatment for osteoporosis is recommended in

Answer 4

women who have a T score <-2.5 who have already had a fracture
Women who have a T score -1.0 to -2.5 who have a high risk for fracture

Question 5

non-pharm osteoporosis treatment

Answer 5

maximize bone formation during youth w/ proper diet + exercise = avoid tobacco/alcohol, minimize steroids
Older patients → maintain body weight, minimize caffeine treat visual impairments, prevention w/ exercise

Question 6

pharm osteoporosis prevention

Answer 6

~ Vitamins → Vitamin D 600-800, calcium 1000-1200 (reserve for those with calcium-deficient diets)
~ Sex hormones → prevent, but do not treat, low dose transdermal estrogen, testosterone/estradiol (men)

Question 7

What are other osteoporosis treatments?

Answer 7

Bisphosphonates (alendronate, risedronate) inhibits resorption

Selective estrogen receptor modifiers (raloxifene) - increase bone in postmenopausal women only, only for prevention of osteoporosis

Denosumab - dec osteoclast formation, can be used in impaired renal function, effects wane after 6 mo

Calcitonin - last resort due to weak effects

Anabolic agents (teriparatide) - high fracture risk

Mixed agent (romosozumab) - for high fracture risk

Question 8

thoracic outlet syndrome tx

Answer 8

PT and activity modifications w/ shoulder girdle strengthening, proper posture, relaxation techniques

Neurological decompression and vascular reconstruction

Question 9

stinger’s tx

Answer 9

Non-operative = return to play with complete resolution of symptoms, normal strength + ROM

CIs to return to play: recurring symptoms, if cervical XRs have not come back

Try neck collars