Ortho Test 1 (Part 2 11-20)

Front 1

Nursemaids Elbow description

Back 1

Sublexation of the radial head MC elbow injury in children younger then 5 years old,
Associated with increased ligamentous laxity
-hurt it by elbow extended and forarm is pronated
-Child wont use arm, tenderness over the raidal head and resistatnce on attempted suptiation

Front 2

Nursemaids Dx and Tx

Back 2

Get an x-ray to rule out fracture -
To reduce - open a book
If that does not work flex the arm
-It should snap in but you wont hear the snap if its 1-2 days aft erht injruy (swelling0)
- If the elbow is in full flexion and supination then the radial head has been reducted.

Front 3

Dislocation of Elbows descirpition

Back 3

MC - posterior
-Happens with injury to the medial epicondyly
Closed recudion is usually successful
Neurovascular injuries can occur
Elbow is dislcated in childhood third after shoulder and finger.
-FOOS

Front 4

Dislocation PE and Sx

Back 4

extreme pain, swelling, inability oy bend elbow after FOOSH
CHECK neurovascular, motor and senory

Front 5

Dx Dislocaiton

Back 5

Ap and Lateral - lok for bony fragrament incarceratein in the joint

Front 6

Elbow dislocation Adverse outcomes and Tx

Back 6

- Loss extension, instability,
Hetertropic bone formation can cause arthritis.
Reduction - asap
check neuro
Make sure reduved with splint and x-ray
Make sure no loos bony or carilaginous intra-articular loos body
protect motion for 1 week and then progess 3-4 wekks
Want to block terminal extension,
Nsaids

Front 7

Fx of distal Humerus Discription

Back 7

uncommon, often comminuted with intra-articulare, - HIGH morbidiy

Front 8

humerus fx sxs

Back 8

swllling, ecchymosis, deformiy, pain aroudn the elbow,
Hurts more with FLEXIOn of arm

Front 9

humerus Fx PE

Back 9

Swellind defomiry is visible
palpate radial pulse and chekc cap refill
Chekc unlar work
Watch for brachial artery occlusion.

Front 10

Humerus Fx Dx test

Back 10

AP and laterak of elbow, humerus, and shoulder
-look for posterior fat pad (bleeding intot hte joint from occult fracture)

Front 11

Humerus Fx Adverse outcomes

Back 11

Pin, stiffness, nonunion, ulnar probles, ischmeia in forearm and cause COMPARTMENT syndrome

Front 12

Humerus Fx tx

Back 12

stable reduction that permits early motion
stable, nondispladed
Nerally all displaced fracture require open reudction with internal fixation

Front 13

Occult fx description

Back 13

posterior fat pad,
Elbow effusion - will elevate the anter and post fat bad
- If a kid has psot fat pad with no ohter fracutre or septic arthris should be assumed to have an aoocult, non-displaced fx and tx in a cast for 3-4 weeks.

Front 14

Olecranon Fracture desciption

Back 14

direct blow of fall on oustretched arm with elbow in flexed position
marked swellind ecchymosis
defomred elvbow
watch the ulnar nerve, - numbess

Front 15

Olecranon Adverse outomce and Tx

Back 15

- loss of motion or stability, triceps attach at the olecranon so elbow extension can be lost
Arthitis may develo
Non-displaced - posteriro splint/cast
To avoid excessive pull on the tripce - splint at 45 flesion
Follow up in 7-10 days to enure that the injury has not become displaced.

Front 16

Radial Head and neck fx description

Back 16

commonly due to FOOSH
paiwnt with ROm and tenderness over the later elbow
x-ray may be negative
CT and surgery may be required if its bad
Different types

Front 17

MUGR

Back 17

regurie open reduction with internal fixation

Front 18

Galezzia

Back 18

distal radial fx
distal radiulnar dislocation
Requires surgery

Front 19

Monteggia fx

Back 19

Proximal unla shaft
Dislocation of the readial head

Front 20

MC fracure in Primary care

Back 20

Distal radius
Tx by closed redcuiton, plater splint, (sugar tong)
If fracture is dorsal comminution or intra0articular fracutrew will likley need surgery.

Front 21

Synovitis/Tenosynovitis

Back 21

Stenosing tenosynovitis of the first dorsal compartment of the wrist
Golfers, racket sports, NEW MOTHERS.

Front 22

Which muscles does Synovitis effect?

Back 22

APL - adductor pollicis longue
EPB- estenosr pollicis brevis

Front 23

DeQuervians Dz

Back 23

localized pain, welling,
Posiitve finkelsteins test
Pain is reliebed after injeciton in the first dorsal compartment
Tx - thimb spica, NSAID, steroid injeciotn
Operative - surgical decompression

Front 24

Lateral Epicondylitis
Tennis Elbow desciption

Back 24

Pain and tendenress at the sige of origin of the extensor carpi radialis brevis mucsle

Front 25

Compression of the posterior interosseous Nerve

Back 25

Radial tunnel syndomre
Another lateral elbow pain,
fibrouw bands between the two heads of the supinarto
4-5cm distal and slighly anterior to the lateral epicondyle

Front 26

Sx of tennis elbow

Back 26

Laterl epicondylitis
35-50
Activity with wrist EXTENSION

Front 27

Tennis elbow Dx and Tx

Back 27

Dx: AP and lateral - to ro osteocondral loos bodies
-stop activity, strap, NSAIND, PT, coricosteroids injeciotn but no more then three, (may increase pain for 1-2 days)
If pain keeps on reuccring then do surgery

Front 28

Radial Tunnel syndrome Tx

Back 28

rest for actvity
NSAID
surgery for refractory pateints

Front 29

Medial Epicondylitis
Golfer elbow description

Back 29

tendinous origin of the flexor/pronator muscles just distal to the medial epi, cubital tunnel can also cause these sxs

Front 30

Golfer Elbow PE

Back 30

Localized tenderness over the flexor origin 1 cm distal the medial epicondyle
Tapping lightly on the medial epi may be painful
pain in the region aloso can be producew with resisted flexion.

Front 31

Golfer Elbow Tx

Back 31

PT, NSAIDS, tennis elbow brace,
AVOID injecitons bc to clos the ulnar nerve
Condiers cutital tunnel release or ulnar nerve transposition

Front 32

Colles fx

Back 32

distal radius - with dorsal displacemnt of the wrist and hand.
Falling onto an extended wrist

Front 33

Smiths fx

Back 33

Is reverse colle fracture,
fall onto flexed wrist
displaced wrist goes ventrally or anterior.

Front 34

Chauffer fracture

Back 34

fracture of the distal radial styloid process from compression of the scaphoid bone.

Front 35

Kienbocks Dz - description

Back 35

Osteonecoris of the lunate -form repetitive compressive forces on the wrist or truama
NEGATIVE ulnar varience

Front 36

Keinbocks Sx

Back 36

Negative ulnar varinec
pain with extension of the middle finger
Ulnar sided wrist pain

Front 37

Keinbocks Radio

Back 37

negative ulnar varinec
lunat is abnormal - sclerotic

Front 38

keinbocks Tx

Back 38

without fragmentation of the lung - splin or cast
w/ frag - operatate

Front 39

Scaphod Fx Descirption

Back 39

HX of foos
x-ray evidence is delayed for up to 2 weeks
SNUFF box pain
- alway think broke until otherwise
(4 different types of break)
Tx: long arm thumb spick cast, ORIF
takes 8-12 weeks to heal

Front 40

Doral Ganglion

Back 40

MC - dorsal, waxes and waine
Beware of the volar wrist ganglion cyst - send for sx/tx
Tx: osbserve, splint, rest, NSAID,d, bibble, aspiriate, compress, surgical but it will come back.

Front 41

Metacarpal Rule of thumb

Back 41

10 -2
20-3
30-4
40-5

Front 42

Thumb metacarpal Base fx

Back 42

Epibasal
Bennetss
Rolandos Y

Front 43

Boxers fracture

Back 43

MC fracture of the neck of the 5th metacarpal

Front 44

Boxer fracture TX

Back 44

less then 40 - SAC for 4 weeks
Over 40 - closed reduciton if that fails ORIF and SAV
Rotational malalignemnt is NOT acceptable and requires ORIF

Front 45

Tendon Injires

Back 45

Motor exam is how we dx,
Flexor - Operative
Extenisve - office or OR
Kessler sticht (nylone) used to stitch tendons back together (then spling) takes 6-8 weeks to heal

Front 46

Flexor digitorium Profundum Avulsion
Jerking finger

Back 46

Loss of flexion
avultion fracutre
lacerated FDP,or FDS
need surgery

Front 47

mallet finger

Back 47

Loss of extension
traumatic avulsion -jammed finger
Laceration of tendon
Sling in extenion 24/7 forr 6 weeks and then at night for another 6 weeks

Front 48

Boutonniere defomirty

Back 48

PIP flexed, IDP hyperextension

Front 49

Swank neck defmority

Back 49

DIP hyperflexed, PIP hyperextension

Front 50

Trigger Finger Discription

Back 50

Stenosing tenosynovitis of the flexor tenodn resulting in abnl gliding of the flexon tendon with the tendon sheath with catching of locking at the proximal edge of the A1 pully

Front 51

Trigger Finger Sxs

Back 51

catching during flexion/ext of finger
Tiggering is palpable proximal to the MCP (at A1 pully)

Front 52

Trigger Finger tx

Back 52

Injections work 50% of the time
Operative release of the A1 pully

Front 53

Duputryen's contractures Descrption

Back 53

cords and noldues in the subq palmar fasica (cannot estend hand - stay in flexion)
common in alcoholics, Dm, epilepsy, COPD, HIV< and celtics

Front 54

Duputryens Tx

Back 54

Surgical relase of contracture, if over 30 then consult a hand surgeon

Front 55

Lederhosen Dz

Back 55

Dupuytrens, Peyronies, Plantar fibromatosis