Flashcards in MSK & Rheum Deck (132)
Give general fracture and open fracture tx
1. Immobilise fracture including proximal and distal joints
2. Document neurovascular status before and after reduction and immobilisation
Ensure tetanus prophylaxis
1. IV broad spectrum abx
2. Tetanus prophylaxis
3. Thorough debridement and lavage
Tx for displaced and undisplaced NOF fracture. Extracapsular?
Pt v unwell intracapsular - hemiarthroplasty
Undisplaced - internal fixation
Displaced - below 70 internal fixation. Above 70 total hip
Extracapsular - dynamic hip screw
S&S of femur fracture?
• Shortened and externally rotated leg
Early S&S of compartment syndrome?
• EXTREME Pain or tenderness
○ Worse on passive movement
○ Worsening despite analgesia
Investigation for compartment syndrome. results?
• Measure intracompartmental pressure. >20mmHg is abnormal. >40mmHg is diagnostic.
RFs of compartment syndrome?
• Occurs following fractures. Typically suprachondylar and tibial shaft injuries.
Be wary also of tight casts or splints or DVTs
Tx for displaced and non displaced humeral fracture?
• Significantly displaced - ORIF
• Non displaced - Collar and cuff for 3 wks followed by physio
Assess neurovascular status
RFs for slipped upper femoral epiphysis?
• Age 11-15 most common
M 2:1 F
tx for slipped upper femoral epiphysis
• External fixation or Open reduction and pinning AS IS. Attempts to move it back could cause further damage.
Emergency as could lead to avascular necrosis of head of femur
Name the types of salter harris fractures
S - Slip
A - Above physis
L - Lower. Below physis in the epiphysis
TE - Through everything.
R - Rammed (crushed)
Flattened femoral head
S&S of perthes?
• Hip, knee or groin pain exacerbated by internal rotation
Leg length disparity
Tx of perthes
• Minimising damage while disease runs course
• Traction of leg using brace, physiotherapy.
Investigation of congenital hip dysplasia?
• Barlow maneuver (adduct hip and push knee) and Ortolani maneuver (abduct hip and push knee) - barlow dislocates and Ortolani relocates. Will hear clunking
Limb length inequality in 1 sided hip dysplasia.
Tx of Congenital hip dysplasia
Bloods - WCC
CT - cortical destruction with lytic centre
MRI - edema
ADR of methotrexate
ADR of sulfasalazine
ADR of leflunomide
ADR of infliximab
Reactivation of TB
• Oeseophageal ulcers
Osteonecrosis of jaw
OA S&S on hands
Bouchons nodes - proximal IPJ
Heberdens nodes - distal IPJ
Xray - LOSS
• L - Loss of joint space
• O - Osteophytes forming at joint margins
• S - Subchondral sclerosis
S - Subchondral cysts
OA tx analgesics
1st line Paracetemol + topical NSAIDs NSAIDs for Hand and knee OA only
2nd line Oral NSAIDs, opioids, capsaicin cream, intra-articular corticosteroids PPI co-prescribed with NSAIDs
3rd line Supports and braces, shock absorbing insoles
4th line Joint replacement
OA tx post operative
• LMWH for 4 weeks after hip
• Pts need physio and home exercises
• Crutches and walking sticks used for up to 6 wks
OA general advice
• Weight loss
Muscle strengthening + aerobic fitness
How to avoid dislocation in hip replacement?
• Avoid flexing hip >90 degrees
• Avoid low chairs
• Don’t cross legs
Sleep on back for first 6 wks
Indications for hip replacement in OA?
Conservative tried, pt still in pain.
• Swollen painful joints in hands and feet
• Morning stiffness improves with use
• Bilateral symptoms over a few months
• Systemic upset
Positive squeeze test - discomfort on squeezing across joint