Ortho Mixed Bag Flashcards
What are the Ottawa Ankle Rules for getting ankle films?
How about for getting foot films?
-Ankle Films
–Pain along lateral malleolus
–Pain along medial malleolus
–Unable to walk > 4 steps in ER
-Foot Films
–Navicular (mid foot) pain
–5th metatarsal pain
–Unable to walk > 4 steps in ER
Weber Ankle Fracture Classification
-What is a Weber A
-What is a Weber B
-What is a Weber C
-Weber A: fibular fracture BELOW syndesmosis. All ligaments intact. Stable.
-Weber B: fibular fracture AT LEVEL of syndesmosis. Can be stable or unstable. Tibiofibular ligament and deltoid ligament may be intact or mild tear.
-Weber C: fibular fracture ABOVE mortise. Tibiofibular ligament torn, widening of talofibular joint, deltoid ligament damage, medial malleolar fracture. Requires ORIF due to instability.
Septic Arthritis
-MC organism overall
-MC in neonates and infants < 3 months
-MC in sexually active young adults
Staph A MC overall
Strep Pneumo, Group B Strep in neonates
Neisseria Gonorrhea in sexually active young adults
What is the best initial and most accurate test for septic arthritis?
What is seen?
Arthrocentesis: WBC > 50,000 and primarily neutrophils
Septic Arthritis Treatments
-Empiric
-Gram Positive Cocci (Staph A)
-Gram Neg Cocci (Gonorrhea)
-Gram Neg Rods (Pseudomonas)
-Empiric: Ceftriaxone + Vanco
-Staph A: Vanco
-Gonorrhea: Ceftriaxone
-Pseudomonas: Ceftazidime + Gentamicin (Cipro for PCN allergy)
SALTER-HARRIS classification for growth (epiphyseal) plate fractures
-Explain SALTR in relation to the fractures
-Type I: Same (at growth plate only)
-Type II (MC): growth plate + fracture of metaphysis
-Type III: growth plate + fracture of epiphysis
-Type IV: fracture extending across teh metaphysis, growth plate, and epiphysis (NEEDS REDUCTION)
-Type V: growth plate compression injury.
MC location for a herniated disc and why?
Symptoms of a herniated disc
Best diagnostic test
-L5-S1 (this is the junction between mobile and non-mobile spine)
Radicular back pain, unilateral radiating down the leg in a dermatomal pattern.
-Positive Straight Leg Raise, crossover test
MRI is best imaging study
Herniated Disc Facts
-Location - Sensory - Weakness - Reflex Diminished
L4 (think A)
-Anterior thigh pain and sensory loss to medial ankle
-Ankle dorsiflexion weakness
-loss of knee jerk
L5 (think L)
-Lateral thigh/hip/groin pain and dorsum of foot
-Big toe extension/dorsiflexion weakness
-reflexes usually normal
S1 (think P)
-Posterior leg/calf pain and plantar surface of foot
-Plantar flexion weakness
-Loss of ankle jerk
