Orthopedic Investigations Flashcards
(29 cards)
What is dactylitis suggestive of (3)
psoriatic arthritis
spondyloarthritis
gout
4 hand signs of rheumatoid arthritis
Boutonniere deformity of thumb
ulnar deviation of MCP
swan neck deformity of fingers
Hebenden and Bouchard’s nodes
subcutaneous tophi is a sign of what
gout
splinter haemorrhages and janeway lesions are a sign of what
subacute bacterial endocarditis
malar rash, alopecia and oro-nasal ulcers signs of what
SLE
4 (XRay) signs of osteoarthritis
joint space narrowing osteophytes subchondral cysts bony sclerosis (and loss of shape of femoral head from AVN)
4 options for operative management of osteoarthritis
- osteotomy (re-align the joint/limb)
- arthrodesis (make a stiff, painless joint)
- excision arthroplasty (remove arthritis)
- replacement arthroplasty (large joints mostly)
4 indications for joint replacement
- disabling pain (despite analgesia)
- functional restrictions (walking distance)
- quality of life (night pain)
- radiographic significant arthritis
3 complications of joint replacement
VTE
peri-prosthetic fracture
infection
1st stage of management of rheumatoid arthritis (3)
lifestyle:
MD - physio, OT, podiatry
NSAIDs
what makes COX-2 inhibitors preferable to NSAIDs for pain relief
less GI bleeding risk (less significant GI symptoms remain eg. dyspepsia)
what are DMARDs
long-term suppressive drug therapy - disease-modifying anti-rheumatic drugs
examples of DMARDs
methotrexate and sulfasalazine - good efficacy:toxicity ratio
monitoring with DMARDs
FBC LFTs U&Es BP Urinalysis
effects of blocking TNF alpha
immune: decreases rheumatoid factor, T cell function restored
inflammation: decreased cytokine production in joints (IL1, 6, TNF)
angiogenesis: decreased
joint destruction: decrease damage to bone/carti
haematology: decreased platelets, fibrinogen, restoration of Hb
do not initiate DMARDs in presence of what
serious active infection or high risk
what is the Salter Harris classification for?
paediatric physeal fractures S: separated growth plate A: above growth plate L: beLow growth plate T: through growth plate ER: erasure of growth plate
Treatment of a stable fracture
no surgery - hold in correct position until heals - cast/splint/traction
Treatment of an unstable fracture
surgical fixation with metalwork - usually allows quicker mbilisation of affected limb
what is acute compartment syndrome
intracompartmental pressure elevated (relative to end capillary-pressure) to a level and duration that causes compromised perfusion of intracompartmental structures
decompression is necessary to prevent muscle necrosis
why is decompression required in acute compartment syndrome
to prevent muscle necrosis
6 Ps of acute compartment syndrome
Pain Pain on passive stretch Paraesthesia Paralysis Pulses present Palpation
Most common cause of limp in child
transient synovitis
3 causes of a chronic limp in child
perthes disease
slipped upper femoral epiphysis SUFE
systemic illness (rheumatic disease or tumour)
