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Flashcards in MSK & Rheum Deck (132)
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1

Give general fracture and open fracture tx

General:
1. Immobilise fracture including proximal and distal joints
2. Document neurovascular status before and after reduction and immobilisation
Ensure tetanus prophylaxis

Open:
1. IV broad spectrum abx
2. Tetanus prophylaxis
3. Thorough debridement and lavage

2

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

3

S&S of femur fracture?

• Pain
• Shortened and externally rotated leg

4

Early S&S of compartment syndrome?

• EXTREME Pain or tenderness
○ Worse on passive movement
○ Worsening despite analgesia
• Swelling
Parasthesia

5

Investigation for compartment syndrome. results?

• Measure intracompartmental pressure. >20mmHg is abnormal. >40mmHg is diagnostic.

6

RFs of compartment syndrome?

• Occurs following fractures. Typically suprachondylar and tibial shaft injuries.
Be wary also of tight casts or splints or DVTs

7

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

8

RFs for slipped upper femoral epiphysis?

• Obesity
• Age 11-15 most common
M 2:1 F

9

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

10

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)

11

Perthes xray?

Flattened femoral head

12

S&S of perthes?

• Hip, knee or groin pain exacerbated by internal rotation
• Limp
Leg length disparity

13

Tx of perthes

• Minimising damage while disease runs course
• Traction of leg using brace, physiotherapy.

14

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.

15

Tx of Congenital hip dysplasia

pavlik harness

16

Osteomyelitis investigation

Bloods - WCC
CT - cortical destruction with lytic centre
MRI - edema
Bone biopsy

17

ADR of methotrexate

• Myelosuppression
• Hepatotoxic
PULMONARY FIBROSIS

18

ADR of sulfasalazine

• Rashes
• Oligospermia
ILD

19

ADR of leflunomide

• ILD
• HTN
Hepatotoxic

20

ADR of infliximab

Reactivation of TB

21

Bisphosphonate ADRs

• Oeseophageal ulcers
Osteonecrosis of jaw

22

OA S&S on hands

Bouchons nodes - proximal IPJ
Heberdens nodes - distal IPJ

23

OA investigations

Xray - LOSS
• L - Loss of joint space
• O - Osteophytes forming at joint margins
• S - Subchondral sclerosis
S - Subchondral cysts

24

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

25

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

26

OA general advice

• Weight loss
Muscle strengthening + aerobic fitness

27

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

28

Indications for hip replacement in OA?

Conservative tried, pt still in pain.

29

RA S&S

• 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

30

RA blood tests

• Rheumatoid Factor (RF) detected by Rose-Waaler test. RF not specific to RA.
Anti-CCP antibody