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Flashcards in Random Ortho Deck (24):
1

What is a SLAP tear? How do you test for it?

A SLAP tear is an injury to the labrum of the shoulder, which is the ring of cartilage that surrounds the socket of the shoulder joint.

The term SLAP stands for Superior Labrum Anterior and Posterior. In a SLAP injury, the top (superior) part of the labrum is injured. This top area is also where the biceps tendon attaches to the labrum. A SLAP tear occurs both in front (anterior) and back (posterior) of this attachment point. The biceps tendon can be involved in the injury, as well.

2

What else is medial epicondylitis called? What is the pathology? What are the key clinical findings of medial epicondylitis?

Medial epicondylitis = "Golfer's Elbow"

Pathology:
Inflammation to the FLEXOR muscles and tendons of the forearm that attach to the medial epicondyle

- An overuse syndrome of the flexor-pronator mass origin
- more difficult to treat than lateral epicondylitis
- less well-studied than lateral epicondylitis

sports that require repetitive wrist flexion/forearm pronation during ball release:
- common in golfers, baseball pitchers, javelin throwers, bowlers, weight lifters, racquet sports

Muscles/Tendons Involved:
- Common flexor tendon
- Flexor/Pronator mass (includes pronator teres, flexor carpi radialis, FDS, palmaris longus, flexor carpi ulnaris)

Provocative tests:
- pain with resisted forearm pronation and wrist flexion

3

What else is lateral epicondylitis called? What is the pathology? What are the key clinical findings of lateral epicondylitis?

Lateral epicondylitis = "Tennis Elbow"

Pathology:
Involves the extensor muscles and tendons of the forearm (responsible for extending wrist and fingers) that attach to the lateral epicondyle
The tendon usually involved in tennis elbow is called the Extensor Carpi Radialis Brevis (ECRB).
Usually caused by over-use or repetitive strain

Clinical Features:
- Symptoms develop gradually, slowly worsens over weeks or months
- Usually no specific injury
- pain or burning on outer part of elbow
- weak grip strength
- Symptoms can be exacerbated by movements such as holding a racquet, turning a wrench or shaking hands

4

What are the most common FOOSH injuries?


Colles fracture
Scaphoid fracture
Monteggia fracture-dislocation
Galeazzi fracture-dislocation

5

What are the most common causes of a limping child?

Dependent on age!

Toddler (1-4yo):
DDH
Toddler's #
Transient Synovitis (Irritable Hip)
Child Abuse

Child (4-10yo):
Transient Synovitis
Perthes Disease

Adolescent (>10yo):
SUFE (slipped upper femoral epiphysis)
Overuse Syndromes/Stress #s

6

What is the treatment of lateral epicondylitis?

"Tennis Elbow"
- inflammation to extensor compartment of forearm. Esp ECRB

Tx:
1. Non-Surgical:
- ~80% to 95% of patients have success with nonsurgical treatment.
- Rest. Proper rest. Stop participation in sports or heavy work activities for several weeks.
- NSAIDs
- Wrist stretching exercise
- Physio: strengthening regime. They may also perform ultrasound, ice massage, or muscle-stimulating techniques to improve muscle healing.
- Brace
- Steroid injections
- Extracorporeal shock wave therapy. Shock wave therapy sends sound waves to the elbow. These sound waves create "microtrauma" that promote the body's natural healing processes
- PRP
- Equipment check.

2. Surgical:

7

What is the treatment of medial epicondylitis?

"Golfer's Elbow"
- inflammation to flexor muscles/tendons of forearm

Tx:
1. Non-Surgical:
- ~ Physio:
** Squeeze a tennis ball
** Wrist curls
** Reverse wrist curls.

Eccentric exercise, specifically using bodyweight to achieve tendon lengthening under load has a long history of effective clinical use in treating tendon injury, especially chronic tendinopathy. The exercise must be specific to the tendon involved and should involve mainly the eccentric component with minimal concentric component

2. Surgical:

8

What is a Colles fracture?

Colles fractures are very common extra-articular fractures of the distal radius that occur as the result of a fall onto an outstretched hand. They consist of a fracture of the distal radial metaphyseal region with dorsal angulation and impaction, but without the involvement of the articular surface

The vast majority of Colles fractures can be treated with closed reduction and cast immobilisation. The cast extends from below the elbow to the metacarpal heads and holds the wrist somewhat flexed and in ulnar deviation 4 - for those of you familiar with Australian rules football; this position is reminiscent of the position adopted when holding a ball in preparation for a kick. This cast is known as a Colles cast

Open reduction and internal fixation (ORIF) is considered when the fracture is unstable, and/or unsatisfactory closed reduction is achieved (i.e. >10 degrees dorsal angulation; >5 mm shortening; significant comminution)

9

What is a Galeazzi fracture?

Galeazzi fracture. A displaced fracture in the radius and a dislocation of the ulna at the wrist

Galeazzi fracture-dislocations consist of fracture of the distal part of the radius with dislocation of distal radioulnar joint and an intact ulna. A Galeazzi-equivalent fracture is a distal radial fracture with a distal ulnar physeal fracture 2.
Epidemiology

Galeazzi fractures are primarily encountered in children, with a peak incidence at age 9-12 years 3. In adults, it is estimated to account for ~7% of forearm fractures 3.
Mechanism

Typically, Galeazzi fracture-dislocations occur due to a fall on an outstretched hand (FOOSH) with the elbow in flexion.

10

What is a Monteggia fracture?

Monteggia fracture. A fracture in the ulna and the head of the radius is dislocated at the wrist. This is a very severe injury and requires urgent care

Monteggia fracture-dislocations consist of a fracture of the ulnar shaft with concomitant dislocation of the radial head. The ulnar fracture is usually obvious, whereas the radial head dislocation can be overlooked, with potentially serious functional and medico-legal ramifications.

Mechanism
Typically, Monteggia fracture-dislocations occur as the result of a fall onto an outstretched hand (FOOSH)

11

What are the key features of a scaphoid fracture?

Scaphoid fractures are common, in some instances can be difficult to diagnose, and can result in significant functional impairment.

Scaphoid fractures account for 70-80% of all carpal bone fractures. Adolescents and young adults are most commonly affected

Clinical presentation
Classically there can be pain in anatomical snuffbox which is thought to have a sensitivity of ~90% and a specificity ~40%

Management:
Management options can broadly be divided into:
1. immobilisation with cast application
2. internal fixation for displaced fragments, usually with a headless self-compressing screw
3. non-union can be managed with internal fixation and bone grafting

Non-union occurs in 5-10% of cases

12

How do you describe fractures through the growth plate?

SALTER HARRIS Fractures:
Type I Straight: straight across the growth plate, no bone involved
Type II Above: Most common! ~75%. Fracture passes across most of the growth plate and up through the metaphysis
Type III Lower: Along the growth plate and down through the metaphysis
Type IV Through: Through the metaphysis, growth plate and down through the epiphysis
Type V Rammed/Ruined: Uncommon. <1%. Crush/compression. Worst prognosis

13

What are the distal radial fractures?

Colle's #
Smith's #
Chaffeaur # (radial styloid fracture- distal)
Barton #
Reverse Barton #

14

What is a Smith's Fracture?

Smith fractures are fractures of the distal radius with associated volar angulation of the distal fracture fragment(s). Classically, these fractures are extra-articular transverse fractures and can be thought of as a reverse Colles fracture.

Smith fractures account for less than 3% of all fractures of the radius and ulna and have a bimodal distribution: young males (most common) and elderly females.

Pathology
Smith fractures usually occur in one of two ways:
- a fall onto a flexed wrist
- direct blow to the back of the wrist

15

What is Oshgood-Schlatter disease?

Osgood-Schlatter disease results from stress on the epiphyseal plate in the tibia, leading to excess bone growth and a painful lump at the knee.

16

What is lateral epicondylitis?

T's!!!
Tennis elbow
Inflammation of the exTensor muscles of the forearm

17

What is medial epicondylitis?

NOT THE T's!
Golfer's Elbow
Inflammation of the flexor muscles of the forearm

18

What is a Monteggia #?

Displaced # of the proximal ulna, associated with dislocation of the radial head
URGENT referr to Ortho!!

19

How do scaphoid #'s normally occur? What are they at high risk for? What is the standard management?

FOOSH, with an extended and radially deviated wrist
High risk for non-union and AVN due to limited blood supply
Standard mx = immobilisation in thumb abduction case for 10 days and repeat xray

20

What is the sail sign on xray?

Elevation of the anterior fat pad of the elbow. When the joint space fills with fluid or blood it becomes elevated like a boat sail.

Indicates fracture until proven otherwise!

21

What are the indications for imaging in cervical spine trauma (NEXUS criteria)?

Midline cervical tenderness on palpation
Focal neurological deficit (paraesthesia, central cord syndrome, radiculopathy)
Intoxication
Painful distracting injury (long bone fracture, considerable burns, visceral injury)
Altered mental status ie GCS < 15

22

What important features of examination will help you assess the severity of a wound?

Presence of FBs
Assess joint ROM
Determine penetration of bone or joint
Assess NV damage/involvement

23

What management steps would you institute for a wound?

Clean + irrigate the wound
Remove FBs if prsent
Elevate and immobilise injured estremeity for first 48-72 hrs
Prophylatic Abx if required
Instruct carer to check wound daily
Advise review if signs of infection

24

What wounds need prophylactic Abx coverage?

Bites and clenched fist injuries with a high risk of infection:
- Wound with delayed presentation (8 hrs or more)
- Puncture wounds that cannot be debrided adequately
- Wounds on the hand, feet or face
- Wounds involving deeper tissues (bones joints tendons)
- Wounds in immunocompromised patients