Primary Care Ortho Flashcards
(78 cards)
1
Q
Define physis
A
growth plate at each end of a long bone
2
Q
Define epiphysis
A
on joint side of physis
3
Q
Define metaphysis
A
on shaft side of physis
4
Q
Where do kids tend to fracture and why?
A
through the PHYSIS because it’s generally weaker than the shaft of the bone
5
Q
Salter Harris fractures involve the…
A
physis
6
Q
SH 1 fracture
A
through the physis only
7
Q
How should you treat any significant injury around the physis?
A
splint and re-x-ray in 10 to 21 days
8
Q
SH 2 fracture
A
through the physis and metaphysis
9
Q
SH 3 fracture
A
through the physis and epiphysis
10
Q
SH 4 fracture
A
through the metaphysis, physis and epiphysis
11
Q
Which SH fractures are the worst?
A
SH III and IV are worse that I and II because the joint is involved
12
Q
SH 5 fracture
A
d/t crush or burn injury of the growth plate - will get closure of growth plate
13
Q
Greenstick fracture
A
incomplete fracture- may have to complete the fracture to realign
14
Q
Torus fracture
A
bone is bent and fracture can be minimal buckle in cortex
15
Q
Peds fractures vs. fractures in adults
A
Children will heal and remodel a fracture much better and faster than an adult
16
Q
Hip dysplasia can be…
A
one or both hips dislocated or dislocatable
17
Q
Hip dysplasia is associated with…
A
oligohydramnios and large babies (Diabetic Mother?)
18
Q
Hip dysplasia tests (2)
A
- Ortolani (out or dislocated)- clunk as hip reduces.
2. Barlow- clunk as hip dislocates
19
Q
Hip dysplasia tx
A
Pavlic harness in newborns with frequent follow up exams.
20
Q
Fracture principles
A
- open fractures go to the OR (Most)
- always check neurologic status
- always check distal vascular status
21
Q
What are the 5 P’s of compartment syndrome?
A
Pain, Pallor, Paresthesias, Pulselessness, and Paralysis
22
Q
What is the MC site of fractures?
A
Tibial plateau
**medical emergency
23
Q
Fat emboli d/t fracture
A
- Fx of long bones,(femur, tibia and humerus, or pelvis)
- Pt presents with mental confusion, tachypnea, tachycardia and hypoxia.
24
Q
DVT s/p fracture
-how to dx?
A
- increased chance of clot with immobilization, bedrest.
- Dx with doppler venous studies or venogram
- CT Angio of chest for suspected PE
25
Tx of DVT
IV heparin bolus then drip, switch to Coumadin for several months
26
Tx of DVT or PE in fracture patients
- includes Factor X A inhibitors.
- Finn PA-C prefers apixaban - can use to bridge patients on Coumadin.
- should hold for 48 hours before surgery.
NEVER use in neurosurgery***
27
Shoulder impingement
| -involved anatomy
- tendonitis of rotator cuff muscles
| - usually involves the Supraspinatus muscle
28
S/sx of shoulder impingement
weakness, pain (night), minimum of injury
29
Exam of shoulder impingement
- (+) impingement test (neer, hawkin's, empty can)
| - get MRI to visualize? -discouraged, you should be able to diagnosis via simple tests
30
Adhesive capsulitis
AKA frozen shoulder
- decreased ROM
- pain often perceived as severe
31
Adhesive capsulitis cause
disuse of shoulder because of pain of injury.
32
Adhesive capsulitis tx
injection, ROM stretching exercises
33
Other shoulder problems
| -posterior dislocation
- associated with seizures and electrical shock
| - commonly missed on routine x-rays in OP setting
34
Epicondylitis of the elbow
| -lateral
"tennis elbow"
| -extensor tendonitis
35
Epicondylitis of the elbow
| -medial
"golfer's or pitcher's elbow"
| -flexor tendonitis
36
Epicondylitis of the elbow
| -tx
-both medial and lateral d/t overuse
TX:
-stretching exercises, NSAIDS, brace, steroid injections.
37
Wrist fractures
| -Colles
common with elderly and falls onto outstretched hand (FOOSH)
38
Wrist fractures
| -Scaphoid
fall onto outstretched wrist
| -pt c/o pain at snuff box
39
Tx of wrist fractures
any wrist with hx. of fall and snuff box tenderness is immobilized in splint including the thumb and then re-x-rayed in 10 to 21 days.
40
Wrist tendonitis
-can occur anywhere in wrist.
-Dequarvain’s- 1st extensor compartment. Extensor Pollicis Brevis and Abductor Pollicis Longus tendons.
(+ Finklestein test)
*EPL tendonitis/rupture common after Colles fracture.
41
Carpal Tunnel in the wrist
- sx
- causes
SX’s- numbness/tingling of thumb, index, long, and radial half of ring fingers.
Causes- synovitis, tendonitis or acutely with fracture.
**All reduce space in the carpal tunnel causing the compression of Median Nerve.
42
Carpal Tunnel exam & tx
Exam-
- (+) Tinel’s and Phelan’s, Thenar muscle atrophy.
- Adductor policis weakness
TX:
Rest, brace, NSAIDS, steroid injection, surgical release.
43
What joint is avascular necrosis commonly seen in?
the hip
44
Avascular necrosis
- cause
- s/sx
- bone dies d/t loss of blood supply
| - pain, antalgic gait, decreased ROM
45
What is Perthes disease?
- rare childhood condition where blood supply is cut off to the hip
- occurs in kids 3-8 y.o. primarily
- unknown etiology
- the older the child, the worse the prognosis
46
Avascular necrosis can be seen in patients who...
- have Sickle cell
- use steroids
- drink ETOH
- are scuba divers
**or can be idiopathic
47
Tx for avascular necrosis
- limit activities
- NSAIDs
- core decompression to bring more blood supply to joint
- total hip replacement
48
What imaging should you use for avascular necrosis?
MRI
49
Hip fracture etiology
- typically occur in femoral neck, intertrochanteric or sub-trochanteric
- females > males
- 35% die within a year after hip fracture
- osteoporosis is common
- pts often break their hip *before* they fall
50
Hip fracture tx
- stabilize or replace
- mobilize ASAP after surgery
- treat underlying osteoporosis
51
Slipped capital epiphysis etiology
- young males (10-15 y.o.)
- 25% occur bilateral
- commonly presents as knee pain
- xray shows slip but may need MRI
52
Slipped capital epiphysis tx
stabilize surgically
53
Knee - patellofemoral pain is commonly d/t
- chondromalacia (softening of the cartilage)
| - patellar tracking problems
54
Patellofemoral pain
- sx
- tx
Sx:
- pain
- gelling?
- increased pain arising from chair or using stairs
Tx:
- short arc quad sets (to realign the patella)
- arthroscopic debridement of patella
55
Knee - ACL tear etiology
- frequent injury from sudden deceleration
- effusion: rapid onset, grade III, and bloody
- (+) Lachman test, (+) pivot shift
*MCL and meniscus injury common
56
ACL tear tx
- immobilizer
- gradual return to normal activities
- 1/3 need reconstruction of ligament
57
Knee - meniscal tear etiology
- caused by extension and twisting motion of knee during weight bearing
- effusion: mild to moderate + or - blood; occurs slowly (> 1 - 2 hrs)
58
Meniscal tear sx
-joint margin tenderness
-locking
-popping
(+) or (-) McMurray test
59
Meniscal tear tx
arthroscopic resection
60
Foot and ankle sprain
- etiology
- sx
-tear of one or more lateral ankle ligaments
Sx:
-pain, ecchymosis, high amount of swelling
61
Foot and ankle sprain tx
- air or gel splint until asymptomatic
| - RICE: rest, ice, compression, elevation
62
Foot and ankle infection
- seen in patients who step on a nail with shoes on - the glue contains Pseudomonas
- start on anti-pseudomonal abx
63
Neck injury
- etiology
- imaging
- car wrecks, diving injuries, etc.
- must get lateral x-ray see all 7 cervical vertebrae to clear accident victim for battery of x-rays and removal of brace
64
Spine injury
| -sx
Clonus signifies upper motor neuron injury.
65
When do you see increased deep tendon reflexes in spine injuries?
with spinal cord lesion above that level
66
When do you see decreased deep tendon reflexes in spine injuries?
radiculopathy, lesion below the level
67
Imaging for spine injuries
CT, MRI, or Myelogram
68
Sprain of the lumbar spine
- sx
- tx
- back pain, but NO radiculopathy (no pain in the buttocks or legs)
- tx with rest, NSAIDs, non-narcotic analgesics, +/- lumbar support
- long-term tx: aerobic exercises, back strengthening, work hardening, and spine education
69
Lumbar spine herniated discs MC occur in level...
L4-L5
L3-L4 is 2nd MC
70
Lumbar spine herniated disc tx
- is the same as sprain early.
- PO or epidural steroids are added
- tx conservatively for at least 6 weeks
71
When should you consider surgery in lumbar spine herniated disc?
as last resort if it does not get better with conservative tx
72
Lumbar spinal stenosis
| -etiology
compression of nerve roots due to arthritic changes
73
Lumbar spinal stenosis
| -sx
1. neurogenic claudication- similar to vascular claudication with pain with ambulation, relieved with rest
2. must differentiate between +/- neuro changes
3. if minimal neuro. changes - most pt c/o back and leg pain (bilateral)
74
Lumbar spinal stenosis
| -tx
- same as for herniated disc
- epidural steroid injections
- PT for 6 weeks
- decompressive laminectomy
75
Nerve injuries
| -humerus
radial N located just behind the humerus and injured with a fracture
76
Nerve injuries
| -fibula
peroneal N located just behind the head of fibula
77
Nerve injuries
| -radius
median N located volar to distal radius
78
Nerve injuries
| -hip
sciatic N can be injured d/t fracture or dislocation (MC)
