MSK4 Flashcards
(51 cards)
How would common peroneal nerve entrapment present? What is the mechanism of injury? What is the differential diagnosis? What is the management approach?
Pain and sensory loss in the lateral shin and dorsum of foot.
Weakness of ankle on DORSIFLEXION (Foot drop) and eversion.
Entrapment usually occurs when there’s trauma or pressure at the neck of the fibula.
DDx - L5 nerve root compression
Management - wedging or orthotics to maintain eversion.
Neurolysis is most effective treatment (targeted degeneration of nerve)
How would you assess and manage an AC joint dislocation?
They are assessed in regards to the position of the clavicle with respect to a) the acromion and b) coracoid process of the scapula.
Initial management comprises: Rest, Ice, Protect in a sling.
Severe injuries require urgent orthopaedic reduction
Xray Shoulder and Transfer all for Orthopaedic review
What is a buckle fracture? How does it present? What is your management?
A buckle fracture is a fracture seen in children where there is an axial loading force on trabecular bone.
This causes one side of the cortext of bone to buckle at the site of injury without a cortical break.
Order AP and Lateral Xrays (Best seen on lateral)
ALL CORTICES ARE IN TACT (if not - greenstick - not buckle)
Buckle fracture of distal radius -
Management: Below elbow back slab (or fibreglass cast or wrist splint) for three weeks.
Provide patient information (Royal childrens hospital hand out on buckle injury)
No follow up Xray is required
How would you manage a greenstick fracture of radial diaphysis?
This should be referred to the nearest emergency department with appropriate services for closed reduction and Local anaesthetic and manipulation plaster. (LAMP)
They will need six weeks in a well moulded above elbow cast.( with elbow in 90 degrees flexion)
How would you manage a minimally displaced complete metaphysial fracture of the radius?
These fractures are unstable and need to be managed in a well moulded below elbow (for lower down fractures) above elbow (for higher up )cast for six weeks.
Review in fracture clinic within 7 days with an Xray
What is a supracondylar humerus fracture?
A fracture above the distal humerus just above the elbow joint. It is the commonest elbow fracture in children (rare in adults)
What is the mechanism of injury in a suprcondylar humeral fracture?
Usually fall onto outstretched and hyperextended upper extremity
(Direct trauma to elbow is less common but can occur)
What are clinical signs that indicate urgent orthopaedic review in emergency dept of a supracondylar humeral fracture?
Open injury
Neurological injury
Absence of radial pulse
ischaemia of hand - pale/cool
severe swelling in forearm and/or elbow
skin puckering and or anterior bruising
REFER ALL OF THESE TO ED anyway
What examination findings would you look for when considering a supracondylar fracture in a child?
Patient will present with SWOLLEN, TENDER elbow, with PAINFUL ROM
Inspect for S- Shaped deformity - occurs when fracture is completely displaced at the distal humerus
Inspect for pucker sign - puckering, dimpling or eccymoses of the skin anterior to distal humerus
- indicates proximal fragment has penetrated the brachialis muscle
Perform a thorough neurovascular examination
Check for neuropraxia in the following nerves:
Anterior interosseus branch of median nerve - can’t make ‘ok sign - can’t flex interphalangeal joint of thumb and distal phalangeal joint of index finger. (in anterior interosseus syndrome)
Radial nerve neuropraxia - can not extend wrist or digits
Ulnar nerve neuropraxia - can not adduct or abduct fingers
Inspect the hand for signs of ischaemia
Examine for vascular injury - Feel the brachial and radial pulse for character, volume and rate.
- (Volkamans contracture is a permanent flexion contracture of the hand at the wrist secondary to brachial artery obstruction)*
- Ant on Ossie is ok*
Rex’s wrist
Ulster adds abs
What Investigations would you order in a suspected supracondylar fracture? What would you see in an occult fracture?
AP and lateral radiographs of elbow joint
Occult fracture may show - posterior fat pad sign (Always pathological)
ELEVATION of the anterior fat pad sign (Sail sign) - sign of a joint effusion
What is an osteoporotic fracture? What is the most common type?
Fracture from a fall of standing height or less without major trauma.
Most common is a vertebral compression fracture - often occur in mid thoracic spine (T7-T8) or at Thoracolumbar junction (T12-L1).
Fractures - can cause pain/decreased ADLs/affect mood AND are an important risk factor for further fractures
What are the types of vertebral osteoporotic fracture?
Wedge, Biconcave, compression fracture
How do vertebral osteoporotic fractures present?
Can be occult and seen incidentally on imaging
Can present acutely with pain
Can present with kyphosis and height loss
What is Dowagers hump?
Progressive rounding of back caused by thoracic kyposis secondary to osteoporosis/osteoporotic fractures
How should osteoporotic fractures be treated?
- Acute managment with analgesia
- Activity modification
- Patient education
- Treatment of underlying osteoporosis
What is a pathological fracture?
results when normal stress is placed on abnormal bone.
Look for lytic lesions in myeloma.
What is the anatomical snuff box and what are its borders?
A triangular depression in the lateral/radial side of the wrist.
Medial Boundary - Tendon of EPL
Lateral boundary - ABPL and EPB
MEPL
LABPL EPBl
If there is pain in the anatomical snuffbox and no scaphoid fracture on Xray?
IF still high suspicion - at 14 days repeat Xray or perform a CT of the wrist.
What is a monteggia fracture?What do you need to think about?
It refers to ANTERIOR displacement of the RADIAL HEAD (proximal radioulnar joint)
with an ulnar fracture.
If you see an ulnar fracture -always look at whether the radial head is displaced.
Most common complication is delayed diagnosis/missed diagnosis.
Other complication is radial nerve injury (most common) or posterior interosseus nerve injury.
TEST - radial nerve function by extending hand and digits.
How would you treat a non displaced patellar fracture?
Walking plaster cylinder for four weeks
How would manage a displaced single transverse fracture of patella
surgical reduction with Kirschner wires
How would you manage a comminuted patellar fracture?
REfer for patellectomy
What are benign nocturnal limb pains?
Chidren between 3-12
Normal examination
Well.
Diffuse bilateral pain around knees and lower limbs
At night.
No fever, limp, joint stiffness, skin discolouration or other symptoms
Management is reasurrance, warm baths and gentle massage.
