Sprain vs strain
Sprain = ligament. Strain = muscle
Ortho emergency! Irrigate wound, remove debris, stabilize with splint, start ABx/tetanus ppx -> surgery
What is a pathologic fracture?
A fracture that would not have occurred due to the force alone if not for predisposing condition, such as osteoporosis
Most common site for stress fracture?
Metatarsals. Also common are calcaneus and tibia
Salter-Harris classification of fractures involving the epiphysiseal (or growth) plate
I and II have good prognosis for healing. III and IV require surgery. V has poor prognosis with high risk of growth plate arrest
More common in kids, who have "softer" bone than adults
Buckling of cortex due to compression. Typically in kids in metaphyseal areas. Heals in 2-3 weeks with simple immobilization
Parts of bone
see attached image
Fat embolism syndrome
ARDS syndrome. Confusion, dyspnea, petechial rash on chest/axilla/neck/conjunctiva. Hallmark: arterial hypoxemia with PO2
Anterior shoulder dislocation
Most common type; younger patients, high risk of recurrence. Caused by abduction/external rotation. Presents with inability to adduct/internally rotate, loss of normal rounded shoulder contour. Complications: rotator cuff tear, labral lesions, coracoid fx, Hill-Sachs deformity
What is a Hill-Sachs deformity?
Compression fx of humeral head
Posterior shoulder dislocation
Often precipitated by convulsion, seizure, fall. Caused by internal rotation/adduction. Presents with inability to abduct/externally rotate, prominant coracoid process, flattened anterior aspect of shoulder.
Inferior shoulder dislocation
Complications that occur from any type of shoulder dislocation
Axillary artery injury, venous injury, injury to nerves of brachial plexus, most commonly axillary nerve
How to assess axillary nerve
Deltoid strength. Sensation over lateral upper arm
What pressure in a compartment is indication for fasciotomy (aside from other clinical signs)?
> 30 mm Hg
Volkmann's ischemic contracture
Consequence of failure to fully treat compartment syndrome. Fibrous replacement of necrotic muscle.
Most often seen in LE of diabetic patients. Acute osteo -> walled-off cavity; polymicrobial. Tx options: open drainage of abscess vs. sequestrectomy vs amputation vs debridement + reconstruction; can use depot abx beads in wound as adjunct
Infection of superficial bursa, often affecting bunion, olecranon, and prepatellar bursa. Most often Staph aureus. Tx: aspirate bursa + culture. Broad spectrum Abx right away
Benign bone tumor arising from osteoblasts, usu age 5-25 yo. Most commonly proximal femur. Local tenderness + dull aching pain at site, relieved by NSAIDs. Dx: xray shows localized area of sclerosis with central radiolucent nidus. Tx: symptomatically with NSAIDs. Surgery to remove nidus if med mgmt fails. Excellent prognosis.
Rare benign bone tumor, similar to osteoid osteoma but larger. Most commonly on axial skeleton. Non specific xray. Tx: curettement of lesion, can recur if not adequately excised. Have potential to undergo malignant transformation.
Outgrowth of bone capped by cartilage. Most common benign tumor of bone, usually at metaphysis of long bones of extremities. Xray shows mushroom-like bony prominence. Surgical excision if sx. Very rarely undergo malignant transformation to chondrosarcoma.
Chondroma (mature hyaline cartilage tumor) that grows within bone and expands it. Presentation: asx until pathologic fracture brings attention to it (e.g. Alex's hand fracture). Tx: none if asx. If pathologic fx, allow to heal and then simple excision + bone grafting procedure
Giant cell tumor
Arises from mesenchymal stromal cells supporting the bone marrow; benign tumor. Most commonly around the knee, distal radius, sacrum. Xray: radiolucent lesion, with asymmetric bone destruction; occasional "soap bubble appearance" of thin subperiosteal shell. Tx: curettage + bone grafting, add adjuvant liquid nitrogen to reduce recurrence. Afterwards, monitor CXR q 6 mo for 2-3 years
4 types of malignant primary bone tumors
Osteosarcoma, chondrosarcoma, Ewing's sarcoma, multiple myeloma (most common)
Arises from malignant spindle cell stroma that produces osteoid. Most commonly around knee, prox humerus, rarely mandible. Presentation: pain + tender mass +/- B sx. Xray: poorly defined lesion with bone destruction/formation, may have *sunburst* pattern. Tx: surgery + chemo. Prognosis: 5 year 60%
Low-grade malignant tumor that presents with pain/swelling over months to years. Tx: surgery, do NOT respond to chemo/rads. Better prognosis than osteosarcoma b/c it is slow-growing and metastasizes late.
Can occur anywhere in body. Xray: lytic lesions, "onion skin" pattern of periosteum. Tx: surgery + chemo. Most lethal bone tumor.
Most likely site of origin for bone mets
BLT with Kosher Pickle: Breast, Lung, Thyroid, Kidney, Prostate
Most common site of origin for bone mets, peds