- 3-6 weeks - spontaneously stabilize - < 4-5 months - Pavlik harness (dynamic flexion-abduction orthosis) Older children - Sx

Orthopaedics Ver 3.9 Flashcards by Saw Aar Kar Tun

SUFE
Slipped upper femoral epiphysis

11-15 years
limping
affecting leg shorter
-externally rotated hip with increased hip flexion
-painful knee/ hip /thigh/groin

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Fall vertically, likely bone to be affected/#

Calcaneum
Spinal fractures

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Stress #

Metatarsals

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Long bone pain (femur/ tibia)
Unrelated to activity
In young people
Responds well to aspirin

Osteoid osteoma
Benign long bones tumor

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Sensory loss responsible nerve roots
L12345 S1

L1 - groin and pelvis girdle
L2 - anterior thigh
L3 - medial and distal anterior thigh
L4 - inner/medial shin
L5 - outer/ lateral shin and dorsum foot
S1 - lateral foot

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Cauda equina

Bundle of nerve roots at the lower end of spinal cord
Conus medullaris - an end T12
T12- L1- cauda equina

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Cauda equina syndrome

1 Sciatica - pain along the nerve (back, buttock, hip, leg)
2 ** saddle paraestheisa** (anal, peri anal, groin numbness)
3 Urinary retention ( inability to void)
4 Fecal incontinence (involuntary soiling)

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Causes of Cauda equina syndrome

Central disc prolapse
Postage cancer metastasis
It is * surgical emergency*

MRI spine / urgent referral to orthopedic surgeon

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Lumbosacral Disc herniation/ prolapse
Leg raising test result?
Pain?

+ve straight leg raising test
- pain
Sitting from supine
Prong standing or walking
- Relieve by lying down
- sciatic nerve involve - electric shock like pain

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Intervertebral disc prolapse
Not lambosacral (L5- S1, L4-L5)

Pain plus loss of sensation at affected area plus loss of deep tendon reflex at affected area

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Shoulder weakness
Pain on raising arm above shoulder pain at night
Volleyball- tennis- badminton player- swimmer
Carrying heavy objects- recent move to a new house

Supraspinatous tendinitis

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Shoulder weakness
Pain on raising arm above shoulder
Over head activities (volleyball, tennis, badminton, swimmer)

Supraspinatous tendinitis

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Elderly + history of fall + painful hip + shortened, externally rotated leg

neck of femur (not head)

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A Child girl limping
First born
Oligohydramnions
Birth weight > 5kg
Breech presentation
FHx
Painless leg
Shortened
Unequal skin folds
congenital calcaneovalgus foot deformity

DDH
Developmental Dysplasia of the Hip
Congenital dislocation of the Hip

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One of the comment fracture
Secondary to falling on “outstretched hand”

Scaphoid fracture

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Painful thumb base
Tender anatomical snuff-box
Pronation followed by ulnar deviation produces pain

Scaphoid #

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Management of scaphoid#
X ray +ve
X ray -ve

+ve - scaphoid cast for 6weeks
-ve - 2 weeks and repeat X-ray in 2weeks

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DDH
Sex and side preference
Diagnosis Invx

Female 6times more common, 80%
Left hip more common
USG to confirm Dx

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DDH clinical examination
2tests

Barlow- attempts to dislocate the articulated femoral head
Ortilani- relocate the dislocated head

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DDH Mx

3-6 weeks - spontaneously stabilize
< 4-5 months - Pavlik harness (dynamic flexion-abduction orthosis)
Older children - Sx

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Simmon’s triad

1) Abnormal angle of declination
2) feel for a gap in the tendon
3) gently squeeze the calf muscles (Thompson Test) - No/ Negative plantar flexion, remained dorsiflex

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Sudden, audible pop in the ankle
Like someone has kicked my leg from behind
Sudden significant pain

Achilles Tendon Rupture
Acute (same day) referral to orthopaedics

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Stiffness of a finger,
Snapping (click) sound when extending a flexed digit
Nodule is felt at the base of the finger
Common in thumb ring n middle fingers

Trigger finger
Stenosing tenosynovitis

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Bouchard nodule/swelling

Study These Flashcards

nodules at PIP in OA

Heberden nodule

Nodule/swelling at **DIP** in OA

Mx of OA

1) para 2) topical NSAID 3) oral NSAID 4) opioid (Corrine)

Distal radius posteriorly displaced

Collie’s # Dinner fork deformity Median nerve injury (osteoporosis)

Distal radius anteriorly displaced

Reverse Colle’s # Smith’s # Garden spade deformity

Finger bends at IP joint Hit by a ball to his finger Avulsion of extensor digitorum tendon

Mallet finger

Avulsion if flexor tendon at IP joint

Jersey finger

Pain when grasping things with thumb Tenderness over MCP joints

Gamekeeper thumb Skier’s thumb

Monteggia # (Man U)

Proximal Ulnar # Dislocation of head of radius

Galeazzi’s # (Galacticos Rising)

Distal radius # Distal radio-ulnar joint dislocation

1) Ca, PO4, ALP - normal 2) Ca, PO4 - normal, ALP ⬆️ 3) ⬇️ Ca, PO4, ALP ⬆️

1) osteoporosis 2) Pager’s disease of bone 3) Osteomalacia

Bone manifestation Heart failure Hearing loss ⬆️ Ca ( even that) ⬆️ALP

Pager’s disease

X ray in paget

Coarse trabecular pattern Cotton wool pattern - multi focal sclerotic patches V shape pattern - blade of grass lesion (Cortical) **sclerotic lesions**

Lyric (punch out) lesion on Xray

MM Multiple myleoma

⬆️ALP causes (2Bs + P)

Bone Biliary Pregnancy

⬆️Ca Polyadipsia Polyuria Bone pain Constipation Confusion ECG- short QT interval

Bone metastasis (prostrate, breast) SCC of lungs Multiple myeloma Primary hyper parathyroid

Bone pain ⬆️Ca Anaemia (Recurrent infection, renal failure)

MM Multiple myeloma (Plasma cell cancer, over growth of non- functioning Igs)

Absence of pulse Neuro vascular compromise Obvious deformity Mx?

ABCD Then **urgent reduction under sedation or analgesia** IV midazolam

Femur # if patient is stable(SBP - >100), Mx?

Thomas splint

Acetabulum # Nerve?

Sciatic nerve

Bone metastasis cases, 1) Initial test 2) The most appropriate test

1) serum Ca 2) MRI f/b bone scintigraphy

1) Osteoporosis 2) MM Ix?

1) Dexa scan (Dural Energy Xray Absorptiometry) 2) skeletal survey , bone biopsy

Long term use of steroids

Osteoporosis Cataract Peptic ulcers Hyper glycaemia

A young boy, painful knee, fixed mass over knee side, no systemic features

Osteosarcoma (The Most common bone tumor in children)

A young boy, painful knee, tender fixed mass over knee side, systemic features such as fever, weight loss, tenderness

Ewing sarcoma (2nd most common bone tumor in children)

Long bone fracture (femur) Open surgery - 24 to 72 hours O2⬇️ Consciousness ⬇️

Fat embolism

Carpal tunnel syndrome in pregnancy Mx?

Wrist splint until delivery Fail- cut the transverse carpal ligament

Overstretched or trauma Severe pain, rapid swelling, bruising, difficult to move No # on X-ray

Sprain (torn ligament)

Mix of torn ligament (sprain)

PRICE High arm sling for 3 days

Septic arthritis RFs

RA DM HIV Steroids

Septic arthritis 1) Commoners organism 2) Dx 3) Tx

1) staph aureus/ young sexually active- gono 2) aspiration of synovial fluid, blood culture 3) flucloxacillin, clindamycin in pen allergic - 4wks to 6am a If not staph or gono, cedotaxime /ceftrisone If not okay, repeat percutaneous aspiration IV 1 wk, if all resolves, oral 4 wks

Reactive arthritis (Seronegative arthritis)

Cannot see Cannot pee Cannot climb a tree No fever Migratory oligo arthritis Young adult after STI or GI infection

Reactive arthritis Tx

Analgesia, NSAID, intraarticular steroids Sulfasalazine Methotrexate Symptoms rarely lasts more than 12 months

Toddler (1-3)years # X-ray no deformity

Spiral

Child (4-10) year Fall on outstretched hand, Absent radial/brachial pulse

Supracondylar # of humerus (brachial artery injury) If not given, green stick #

Orthopaedics Ver 3.9 Flashcards

(58 cards)