Ortho Review

NSAID side effects

1. GI: ulcers

2. Kidney probs

cant take if on anticoagulants

arthroscopy vs arthroplasty

Scopy: holes made to clean out debris/do surgery/look into the joint

Plasty: replacement

Planks are an example of what type of exercise

Isometric (contraction without movement)o

Bench press and squats are and example of what type of exercise

Isotonic (mechanical resistance applied as muscle moves through ROM)

Muscle contraction at a constant rate of speed

Isokinetic

DVT risk

Virchows triad

-stasis

-hypercoaguable

-endothelial injury

DVT presentation

-unilateral leg swelling

-leg pain

-low grade fever

-positive homans sign

MRI vs CT uses

MRI: soft tissue

CT: bone

General anesthesia vs nerve block

general anesthesia: major surgeries, prolonged sedation and recovery

Nerve block: UE and LE, just blocks the sensory nerve pain

Aspiration: Clear to pale yellow with <200 WBC

Normal

Aspiration: deeper yellow, transparent with <2000 WBC

OA

Aspiration: dark yellow, cloudy with <80,000 WBC

Inflammatory

Aspiration: purulent, dense, opaque, with >50,000 WBC

Septic

Aspiratoin: red, blood tinged, opaque

Hemarthrosis

Most common bone affected in child abuse

Long bone shaft

(Then metaphysis)

Child abuse fracture presentation

-long bones

-posterior/lateral ribs

-vertebral compression fx

-multiple sites

What type of Fx:

A: comminuted

B: transverse

C: oblique

D: spiral

E: segmental

Fracture through physis plate

Salter Harris I

Fracture through physis and metaphysis

Salter Harris II

Fracture through physis and epiphysis

Salter Harris III

Fracture through distal metaphysis, physis, and epiphysis

Salter Harris IV

Crush injury involving the physis

Salter Harris V

Reduction of a fracture with instrumentation through the skin

Open reduction external fixation

Reduction of a fracture reinforced with instrumentation inside the patient

ORIF

Closed reduction

Manual reduction of a fracture

3 most common primary bone tumors

Osteosarcoma (sunburst)

Ewings (onion)

Chondrosarcoma (cartilage)

where do enchondromas occur? What age group?

-hands/fingers and metaphysis of long bones

-15-40 yr old

Most common primary bone tumor

Osteosarcoma

How does an enchondroma appear on XR

Ground glass appearance

Where does osteosarcomas typically occur? In who?

Femur, tibia and humerus in teenagers (adolescents)

Appearance os osteosarcoma on XR

Sunburst

"Pain out of proportion"

CRPS/RDS

Where does CRPS occur

Distal to injury/trauma

pencil in cup deformity on XR

psoriatic arthritis

How is psoriatic arthritis differentiated from RA

DIP joint involvement, absence of nodules

How to treat psoriatic arthritis

Methotrexate

Benign bone tumor that presents in 10-30 y/o on long bones and posterior spine

Osteoid Osteoma

Osteoid Osteoma presentation

Pain at night relieved by NSAIDs

How does osteoid osteoma appears on XR

Sclerotic with small lucent nidus

Most common site of osteomyelitis

Metaphyseal end of a long bone near knee joint

Gold standard to diagnose osteomyelitis

Open biopsy and aspiration

(Need positive patho and bx)

MC pathogen causing osteomyelitis

Staph

How to treat osteomyelitis

Abx: cefazolin, clinda, vanco

MC type of arthritis

OA

MC joints affected by OA

Knees, then hips

How does OA present on XR

-Loss of joint space

-sclerosis

-subchondral cysts

-osteophytes at joint

Autoimmune disorder with inflammation of synovium causing proliferative and erosive joint changes

RA

What joints does RA affect?

-hands, wrists, knees, feet, ankles

Presentation of RA

-pain, stiffness, swelling

-DIP joints are spared

-nodules

How to diagnose RA

-Lab tests: anti-CCP, RF factor

-XR: bone erosion

Know how to differentiate OA and RA

:)

Reiter Syndrome Triad

Conjunctivitis, urethritis, arthritis

-cant see, cant pee, cant climb a tree

What is reactive arthritis triggered by?

-GI/GU infection, STD

-common in young males

Gout vs Pseudogout diagnostic features

Gout: hyperuricemia, negative birefringent urate crystals

Pseudogout: positive birefringent rhomboid crystals

Gout treatment

Indomethacin

Colchicine

Allopurinol

Types of osteoporosis

Type 1: postmenopausal

Type 2: senile (age)

What type of injury is more common in type 2 osteoporosis

Hip/Pelvic fractures

What needs to be present in a cervical XR

All 7 vertebrae

Pt presents post MVA c/o neck pain...how to differentiate herniation vs cervical sprain/strain

Herniation: neck pain with radiculopathy/paresthesias

Sprain/strain: non radicular, non focal neck pain

How to diagnose an odontoid fracture (C2)

XR: open mouth Fuchs view

How does an odontoid fracture present

Injury from forceful flexion, extension, or rotational injury

How does torticollis present?

-Tilting of head with chin rotated to opposite side

-SCM contracture causes pain/dizziness

-may or may not lump in the neck

Cervical spondylosis

DJD of cervical spine causing cervical stenosis

Caused by: bone spurs, herniations, protruding ligaments

Where are cervical degenerative changes most commonly seen

C5-6 and C6-7 disc spacing

How to manage a cervical trauma

-immobilization

-cross table lateral XR

saddle anesthesia is seen with

Cause equina syndrome

Where does the cauda equina begin?

L1-L2

How does cauda equina syndrome present?

-low back pain

-bowel/bladder incontinence

-LE weakness

-gait probs

-saddle anesthesia

How does Scheuremanns kyphosis present?

-kyphosis >40 degrees

-schmorls nodes

At what degree do you need to brace with scoliosis? Kyphosis?

Scoliosis:

25-45: brace and PT

>45: surgery

Kyphosis:

50-70 degrees: Milwaukee brace

>70: surgery

Slipping of vertebrae

Spondylolisthesis

Loosening of vertebrae

Spondylolysis

Degenerative disease of vertebrae and discs

Spondylosis

Lumbar herniated disc vs sprain stain

Same as cervical :)

Brown sequard syndrome

Hemisection of the spinal cord d/t trauma that causes:

-Loss of Ipsilateral motor function, proprioception, and light touch sensation

-loss of contralateral pain and temp

Anterior hip dislocation presentation

abducted, externally rotated, flexed

XR: femur head is larger

Posterior hip dislocation presentation

adducted, internal rotation, flexed

XR: femoral head is smaller

MOST COMMON

Know these hip fractures:

intracapsular vs extracapsular hip fractures

Intracapsular = femoral neck

Extracapsular = intertrochanteric

Causes of avascular necrosis

-trauma/fracture

-etoh

-steroids

Progressive displacement of upper femur in relation to capital femoral epiphysis

Slipped capital femoral epiphysis (SCFE)

How does SCFE present on XR

"Ice cream fall of cone"

Klines lines (no epiphyseal intersection)

Pistol grip (chronic)

How does SCFE present?

-groin pain

-Dec internal rotation

- POS trendelenburg

-antalgic gait

Legg calve perthes disease involves a complete block of what?

Capital femoral epiphysis blood supply

How does legg calve perthes disease present?

-limp

-POS trendelenburg

-atrophy of thigh, calf, butt

-leg length inequality

Diagnostic testing for legg calve perthes disease

XR: frog view

MRI