Step 2 Ck Musculoskeletal

Front 1

Name all 8 Common Adult Orthopedic Injuries:

Back 1

shoulder dislocation, hip dislocation, colle's fracture, boxer's fracture, humerus fracture, "Night stick" fracture, monteggia's fracture

Front 2

Common Adult Orthopedic Injuries: what are the two types of Shoulder dislocation?

Back 2

Anterior Shoulder dislocation and posterior dislocation

Front 3

what is the most common shoulder dislocation?

Back 3

anterior dislocation

Front 4

Common Adult Orthopedic Injuries: Anterior shoulder dislocation presentation and what nerve and artery are involved?

Back 4

the axilliary nerve and artery are involved. Patient comes in holding the arm slightly abducted and externally rotated.

Front 5

Common Adult Orthopedic Injuries: Shoulder dislocation Tx. acute and recurrent dislocations

Back 5

reduction followed by a sling swath. Recurrent dislocations may need surgical repair

Front 6

Common Adult Orthopedic Injuries: Posterior dislocation of the shoulder is associated with what?

Back 6

seizure and electrocution

Front 7

Common Adult Orthopedic Injuries: Posterior shoulder dislocation injury: what artery and describe the presentation

Back 7

will injure the radial artery. Patients hold the arm in an adduction and internal rotation.

Front 8

Common Adult Orthopedic Injuries: 2 type of Hip dislocations

Back 8

anterior and posterior hip dislocations

Front 9

Common Adult Orthopedic Injuries: anterior hip dislocation can injure what nerve

Back 9

obturator nerve

Front 10

What is the most common hip dislocation?

Back 10

posterior hip dislocation

Front 11

Common Adult Orthopedic Injuries: Posterior hip dislocations is associated with what?

Back 11

sciatic nerve injury and avascular necrosis

Front 12

Common Adult Orthopedic Injuries: Posterior hip dislocations are common cause of what?

Back 12

It occurs via a "dash board injury". a posteriorly direct force on an internally rotated, flexed, adducted hip.

Front 13

Common Adult Orthopedic Injuries: Posterior hip dislocations Tx:

Back 13

closed reduction followed by abduction pillow/bracing. Evaluated with CT scan after reduction

Front 14

Common Adult Orthopedic Injuries: Colle's fracture association.

Back 14

commonly seen in the elderly (osteoporosis) and children

Front 15

Common Adult Orthopedic Injuries: Colle's fracture presentation

Back 15

It involves the distal radius. Often results from a fall onto an outstreched hand, leading to a dorsally displaced, dorsally angulated fracture

Front 16

Common adult orthopedic Injuries: Colle's fracture Tx:

Back 16

closed reduction followed by a long arm cast; open reduction if fracture is intrarticular.

Front 17

Common adult orthopedic Injuries: what is the most commonly injured carpal bone?

Back 17

scaphoid fracture

Front 18

Common adult orthopedic Injuries: how is Scaphoid fracture diagnosed?

Back 18

assume there is a fracture if there is tenderness on the anatomical snuff box. It may take 2 weeks for a radiograph to show the fracture.

Front 19

Common adult orthopedic Injuries: Scaphoid fracture Tx:

Back 19

thumb spica cast. If displacement or navicular or non-union is present do an open reduction.

Front 20

Common adult orthopedic Injuries: proximal third scaphoid bone fracture complication.

Back 20

AVN may result to disruption of blood flow

Front 21

Common adult orthopedic Injuries: Boxer's fracture presentation

Back 21

fracture of the fifth metacarpal neck due to a forward trauma of a closed fist (ie. punching a wall)

Front 22

Common adult orthopedic Injuries: Boxer's fracture Tx:

Back 22

close reduction and ulnar gutter splint. If fracture is excessively angulated: percutaneous pinning.
If skin is broken, assume infection: treat with surgical irrigation, debridment and IV antibiotics (covering eikenella)

Front 23

what are the 6P's of compartment syndrome

Back 23

Pain
Pallor
Paresthesias
Poikilothermia
Paralysis
Pulselessness

Front 24

complications of supracondylar fractures due to compartment syndrome

Back 24

Volkmann’s contracture of the
wrist and fingers.

Front 25

what is compartment syndrome

Back 25

↑ pressure within a confined space that compromises nerve, muscle, and soft tissue perfusion.

Front 26

where is the most common location of compartment syndrome

Back 26

anterior compartment of the
lower leg and forearm.

Front 27

presentation of compartment syndrome

Back 27

pain with passive motion
of the fingers and toes; paresthesias, pallor, poikilothermia, pulselessness,
and paralysis.

Front 28

how is compartment syndrome diagnosed?

Back 28

Measure compartment pressures (usually ≥ 30 mmHg); measure delta
pressures (diastolic pressure − compartment pressure).

Front 29

treatment for compartment syndrome?

Back 29

Immediate fasciotomy to ↓ pressures and ↑ tissue perfusion.

Front 30

Risk factors for malignancy in lower back pain (6)

Back 30

1. age > 50,
2. a previous history of cancer,
3. pain not relieved by lying down
4. symptoms > 1 month,
5. pain that worsens at night
6. constitutional symptoms.

Front 31

contraindicated in lower back pain

Back 31

Prolonged bed rest is contraindicated

Front 32

causes of herniated disk

Back 32

degenerative changes, trauma, or neck/back strain or sprain

Front 33

Most common area of herniated disk

Back 33

lumbar region, especially at L4–L5 and L5–S1.

Front 34

Dx and treatment: Bowel or bladder dysfunction, impotence, and saddle-area anesthesia

Back 34

cauda equina syndrome,
which is a surgical emergency

Front 35

Hx and PE of herniated disk

Back 35

Sudden onset of severe, electricity-like LBP, usually preceded by several
months of aching, “discogenic” pain.
■ Common among middle aged and older men.
■ Exacerbated by straining (e.g., coughing).
■ Associated with sciatica, paresthesias, muscle weakness, atrophy, contractions, or spasms.
■ Passive straight leg raise ↑ pain (highly sensitive but not specific).
■ Large midline herniations can cause cauda equina syndrome.

Front 36

what should be ordered is other lower back pain is suspected (ie. infection)

Back 36

plain radiograph if other causes of back pain are suspected

Front 37

what should be ordered if after conservative management of lower back pain, it would not resolve?

Back 37

MRI if symptoms are refractory to conservative management

Front 38

lower back pain treatment

Back 38

NSAIDs, physical therapy, and local heat → resolution within four weeks

Front 39

Tx: lower back pain with neurological symptom such a cauda equina.

Back 39

indications for discectomy.

Front 40

what is spinal stenosis?

Back 40

A narrowing of the lumbar or cervical spinal canal that can → compression of the nerve roots. usually due to degenerative joint disease in in middle-aged or elderly patients.

Front 41

spinal stenosis Hx/PE

Back 41

Neck pain; back pain that radiates to the buttocks and legs; leg numbness
and weakness.
■ Leg cramping is worse at rest, with standing, and with walking (pseudoor
neurogenic claudication).
■ Symptoms improve with flexion at the hips

Front 42

how is spinal stenosis diaganosed?

Back 42

Radiographs show degenerative changes and a narrowed spinal canal.
■ MRI or CT shows spinal stenosis.

Front 43

Treatment of spinal stenosis:
mild to moderate

Back 43

Mild to moderate: NSAIDs and abdominal muscle strengthening.

Front 44

treatment of lumbar spinal stenosis: Advanced stage

Back 44

■ Advanced: Epidural steroid injections can provide relief.

Front 45

treatment of lumbar spinal stenosis: refractory stage

Back 45

■ Refractory: Surgical laminectomy may achieve significant short-term success,
but many patients will have a recurrence of symptoms

Front 46

what is ankylosing spondylitis?

Back 46

A chronic inflammatory disease of the spine and pelvis that causes sacroiliitis
and, eventually, fusion of the affected joints.
Strongly associated with HLAB27.
Risk factors include male gender and a
family history.

Front 47

ankylosing spondylitis Hx/PE?

Back 47

Typical onset is in the late teens and early 20s
intermittent
hip pain and LBP that worsen with inactivity and in the mornings but improve with activity.

Front 48

ankylosing spondylitis Hx/PE II?

Back 48

↓ spine flexion (
+Schober test), loss of lumbar lordosis, hip pain and stiffness,
and ↓ chest expansion are seen as the disease progresses.
■ Anterior uveitis and third-degree heart block may occur.

Front 49

what other diagnosis must be rule out in ankylosing spondylitis?

Back 49

Other seronegative spondyloarthropathies must be ruled out such as Reactive arthritis (aka Reiter’s syndrome) and Psoriatic arthritis

Front 50

Reiter’s syndrome

Back 50

disease of young men
arthritis, uveitis, conjunctivitis, and urethritis usually
follow an infection with Campylobacter, Shigella, Salmonella, Chlamydia,
or Ureaplasma

Front 51

Psoriatic arthritis

Back 51

An oligoarthritis of the DIP joints. Associated with psoriatic skin changes and sausage-shaped digits.

Front 52

how is ankylosing spondylitis diagnosed

Back 52

+ HLA-B27.
Radiographs show bamboo spine and fused sacroiliac joints.
■ ESR ↑.
■  - RF;  - ANA

Front 53

treatment for ankylosing spondylitis: for pain, for improvement of posture and refractory cases

Back 53

NSAIDs (e.g., indomethacin) for pain; exercise to improve posture and breathing.
■ Tumor necrosis factor (TNF) inhibitors are used in refractory cases.

Front 54

what is duchenne Muscular dystrophy and onset

Back 54

X-linked recessive disorder resulting from a deficiency of dystrophin, a cytoskeletal protein.
Onset is usually at 3–5 years of age.

Front 55

Hx/PE: duchenne muscular dystrophy

Back 55

Affects axial and proximal muscles
progressive clumsiness, fatigability, difficulty standing
or walking, difficulty walking on toes (gastrocnemius shortening), Gowers’
maneuver
Pseudohypertrophy of the gastrocnemius muscles is also seen.
■ Mental retardation is common.

Front 56

Dx of duchenne muscular dystrophy

Back 56

 (-) dystrophin immunostain
↑ CK.
■ EMG shows polyphasic potentials and ↑ recruitment.
Dystrophin mutation is sometimes seen.
■ Muscle biopsy

Front 57

treatment of duchenne muscular dystrophy

Back 57

Physical therapy
Perform Achilles tendon release if necessary.

Front 58

what would be the motor, sensory and reflex deficit if the nerve L4 is affected on a lower back pain?

Back 58

L4:
Motor: Foot dorsiflexion (tibialis anterior).
reflex: Patellar
sensory: Medial aspect of the lower leg.

Front 59

what would be the motor, sensory and reflex deficiency if L5 nerve is involved in a lower back pain?

Back 59

L5
Motor: Big toe dorsiflexion (extensor hallucis longus), foot eversion
Reflex: None
Sensory: Dorsum of the foot and lateral aspect
(peroneus muscles). of the lower leg.

Front 60

what would be the motor, sensory and reflex deficit if S1 nerve is involved in a lower back pain?

Back 60

S1
Motor: Plantar flexion (gastrocnemius/soleus), gluteus maximus
Reflex: Achilles
Sensory: Plantar and lateral aspects of the foot. (hip extension).

Front 61

what is fibromyalgia?

Back 61

>>A connective tissue disorder characterized by myalgias, weakness, and fatigability.
>>Inflammation is notably absent

Front 62

Hx/PE of fibromyalgia?

Back 62

>>women 30–50 years of age; >>associated with depression,
anxiety, sleep disorders, and IBS.

Front 63

Dx of fibromyalgia?

Back 63

Multiple (≥ 11 of 18), diffuse tender points are seen

Front 64

what if there is <11 tender points or or non-fibromyalgia-associated
tender points, what is the diagnosis?

Back 64

myofascial pain syndrome

Front 65

Rx of fibromyalgia

Back 65

ANTIDEPRESSANT, stretching, heat application, hydrotherapy, transcutaneous
electrical nerve stimulation (TENS).

Front 66

what are the causes of hyperurecemia?

Back 66

>>↑ cell turnover (hemolysis, blast crisis, tumor lysis)
>>Cyclosporine
>>Diabetes insipidus
>>Diet (e.g., ↑ red meat,
alcohol)
>>Diuretics
>>Lead poisoning
>>Lesch-Nyhan syndrome
>>Salicylates

Front 67

what is the most effective medication for gout during a flare?

Back 67

COLCHICINE, inhibits chemotaxis and is most effective when used early, during a gout flare.

Front 68

Hx/PE of gout

Back 68

>>excruciating joint pain of sudden onset that awakens the patient from sleep.
>>affects the first MTP joint (podagra) and the midfoot, others are spared.
>>Tophi (urate crystals deposits → deformed joints) maybe seen in chronic disease

Front 69

what is gout?

Back 69

acute monoarticular arthritis resulting from intra-articular
deposition of monosodium urate crystals.
>>most common in the male gender

Front 70

In gout, what would be shown in the aspirate?

Back 70

>>needle-shaped
>>negatively birefringent crystals
>>Elevated WBC count during flares
>>uric acid may or may not be up

Front 71

gout: what would be seen on an x-ray?

Back 71

>>x-ray: Punched-out erosions with overhanging cortical bone (“rat-bite” erosions)

Front 72

treatment of gout: acute attacks

Back 72

Acute attacks: High-dose NSAIDs (e.g., indomethacin), colchicine, and/or steroids.

Front 73

treatment of gout: maintenance therapy

Back 73

>>Weight loss and avoidance of triggers of hyperuricemia will prevent recurrent
attacks in many patients.
>>Maintenance therapy: Allopurinol for overproducers and refractory cases;
probenecid for undersecretors.

Front 74

gout and pseudogout:
shape and crystal bifringence:

Back 74

Gout: Needle shaped with negative bifingence
Pseudogout: Rhomboid
shaped with positive bifingence.

Front 75

what is osteoarthritis?

Back 75

>>chronic, noninflammatory arthritis of movable joints (e.g., DIP joints).
>>deterioration of the articular cartilage and osteophyte
formation at joint surfaces.

Front 76

risk factors of osteroarthritis?

Back 76

family history, obesity, and a history of joint trauma.

Front 77

Hx/PE: of osteoarthritis

Back 77

>>Crepitus
>>pain that worsens with activity
and weight bearing but improves with rest.
>>decrease ROM

Front 78

Dx of osteoarthritis

Back 78

>>Radiographs show joint space narrowing, osteophytes, subchondral sclerosis, and subchondral bone cysts.
>>Synovial fluid shows straw-colored fluid, normal viscosity, and a WBC count < 3000 cells/μL.

Front 79

Rx: osteoarthritis:

Back 79

>>Physical therapy, weight reduction, NSAIDs.
>>Intra-articular corticosteroid
injections may provide temporary relief.
>>Consider joint replacement
(e.g., total hip/knee arthroplasty) in advanced cases.

Front 80

polymyositis vs. dermatomyosistis

Back 80

>>Polymyositis is a progressive, systemic connective tissue disease characterized by striated muscle inflammation.
>>Dermatomyositis presents with symptoms of polymyositis plus cutaneous involvement

Front 81

risk factors for polymyositis and dermatomyositis

Back 81

>>patients 50–70 years of age >>the male-to-female ratio is
1:2.
>>African-Americans are affected more often than Caucasians

Front 82

how does polymyositis presents?

Back 82

Presents with symmetric, progressive proximal muscle
weakness; pain; and difficulty breathing or swallowing (advanced disease).

Front 83

how does dermatomyositis presents?

Back 83

>>Patients may have heliotrope rash (a violaceous periorbital rash),
>>“shawl sign” (a rash involving the shoulders, upper chest, and back),
>>Gottron’s papules (a papular rash with scales located on the dorsa of the hands, over bony prominences).

Front 84

what are polymyositis and dermatomyositis increase risk of?

Back 84

>>myocarditis
>>cardiac conduction deficits
>>malignancy

Front 85

Dx: of polymyositis and dermatomyositis

Back 85

>>↑ serum CK, aldolase, and CPK.
>>EMG shows fibrillations.
>>Muscle biopsy reveals inflammation and muscle fibers in varying stages of
necrosis and regeneration.

Front 86

Tx: polymyositis and dermatomyositis

Back 86

>>High-dose corticosteroids with taper after 4–6 weeks to ↓ the maintenance
dose.
>>Azathioprine and/or methotrexate can be used as an adjunct.

Front 87

what is rheumatoid arthritis?

Back 87

Systemic inflammatory disease of symmetric
involvement of both large and small joints that → synovial hypertrophy and pannus formation → erosion of adjacent cartilage, bone, and tendons

Front 88

RF or rheumatoid arthritis (3)?

Back 88

>>female gender
>>age 35–50
>>HLA-DR4.

Front 89

presentation of RA

Back 89

>>Insidious onset of morning stiffness for > 1 hour w/ pain of the MCP and PIP joints for > 6 weeks.
>>Ulnar deviation of the fingers is seen with MCP joint hypertrophy
>>may also present swan-neck and
boutonnière deformities), Baker’s cysts, vasculitis, atlantoaxial subluxation,
carpal tunnel syndrome, and Felty’s syndrome.

Front 90

what is felty's syndrome

Back 90

RA + neutropenia and splenomegally

Front 91

what would one see in the labs of RA? RF, ESR, synovial fluid, WBC count.

Back 91

Labs:
■ ↑ RF (anti-Fc IgG antibody) in > 75% of cases.
■ ↑ ESR may also be seen.
■ Synovial fluid aspirate shows turbid fluid, ↓ viscosity, and an ↑ WBC count (3000–50,000 cells/μL).

Front 92

what would one see in the radiography of RA?
early and late

Back 92

>>Early: Soft tissue swelling and juxta-articular demineralization.
>>Late: Joint space narrowing and erosions.

Front 93

Tx of RA

Back 93

NSAIDs.
■ (DMARDs) should be started
early.
First-line: methotrexate, hydroxychloroquine, and TNF inhibitors.
Second-line: penicillamine and cyclosporine.

Front 94

describe JRA

Back 94

A nonmigratory, non-suppurative mono- and polyarthropathy with bony destruction that occurs in patients ≤ 16 years of age and lasts > 6 weeks

Front 95

what are its 3 types?

Back 95

>>puciarticular
>>polyarticular
>>acute febrile

Front 96

pauciarticular

Back 96

>>fever, nodules, erythematous rashes, pericarditis, and fatigue.
>>An asymmetric arthritis that involves weight-bearing
joints. Associated with an ↑ risk of iridocyclitis that → blindness if left untreated.

Front 97

Polyarticular

Back 97

Resembles RA with symmetric involvement of multiple (≥ 5) small joints. Systemic features are less prominent; carries a ↓ risk
of iridocyclitis.

Front 98

acute febrile

Back 98

>>manifests as arthritis with
daily high, spiking fevers and an evanescent, salmon-colored rash.
>>Hepatosplenomegaly and serositis may also be seen.
>>No iridocyclitis is present; >>remission occurs within one year.

Front 99

how is JRA diagnosed?

Back 99

There is no diagnostic test for JRA.

Front 100

what would one see in the labs of JRA?

Back 100

Labs:
■
RF in 15% of cases.
■ ANA may be
, especially in the pauciarticular subtype.
■ ↑ ESR, WBC count, and platelets.

Front 101

what would one see in the imaging of JRA?

Back 101

Soft tissue swelling and osteoporosis may be seen

Front 102

treatment of JRA?

Back 102

>>NSAIDs or corticosteroids; >>methotrexate is second-line therapy.
>>ROM and strengthening exercises

Front 103

what is scleroderma?

Back 103

>>excessive deposition of collagen.
>>Commonly manifests as CREST syndrome but can also occur in a diffuse form.
>>RF: female gender and age 35–50.

Front 104

hX/PE: of scleroderma

Back 104

>>symmetric thickening of the skin
>>CREST syndrome involves Calcinosis, Raynaud’s phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasias.
>>The diffuse form can → PULMONARY FIBROSIS, cor pulmonale, acute renal
failure, and malignant hypertension

Front 105

labs of scleroderma:

Back 105

RF and ANA may be +
.
■ Anticentromere antibodies are specific for CREST syndrome.
■ Anti-Scl-70 (antitopoisomerase 1) antibodies: a poor prognosis.
■ Eosinophilia may be seen.

Front 106

tx of scleroderma:
>>acute flares
>>skin changes
>>raynaud's
>>renal disease and malignant HTN

Back 106

Steroids for acute flares; penicillamine can be used for skin changes.
■ Calcium channel blockers for Raynaud’s.
■ ACEIs for renal disease and malignant hypertension.

Front 107

SLE:

Back 107

A multisystem autoimmune disorder related to antibody-mediated cellular attack
and deposition of antigen-antibody complexes.

Front 108

RF of SLE

Back 108

AA women

Front 109

Hx/PE of SLE

Back 109

"DOPAMIN RASH" >5
discoid rash, oral ulcers, photosensitivity, arthritis, malar rash, immunologic (anti-dsDNA, anti-smith, anti-cardiolipin ab), neurologic (psychosi), renal failure (MCC of death),ANA +, serositis and hemolytic anemia

Front 110

SLE diagnosis most sensitive screening test

Back 110

ANA is highly sensitive.

Front 111

SLE: most specific

Back 111

■ Anti-dsDNA and anti-Sm antibodies are highly specific but not as sensitive.

Front 112

SLE: drug induced

Back 112

■ Drug-induced SLE:
antihistone antibodies are seen in 100% of cases
but are nonspecific.

Front 113

SLE: neonatal

Back 113

■ Neonatal SLE:
anti-Ro antibodies.

Front 114

SLE: what else can also be seen

Back 114

■ The following may also be seen:
■ Antiphospholipid antibodies.
■ Anemia, leukopenia, and/or thrombocytopenia.
■ Proteinuria and/or casts.

Front 115

Tx: mild joint symptoms of SLE

Back 115

Treat with NSAIDs for mild joint symptoms.

Front 116

Tx: acute exacerbation of SLE

Back 116

■ Steroids for acute exacerbations.

Front 117

Tx: of progressive or refractory cases of SLE

Back 117

■ Steroids, hydroxychloroquine, cyclophosphamide, and azathioprine for progressive or refractory cases

Front 118

most feared complication of temporal arteritis

Back 118

blindness 2° to occlusion of the central retinal artery (a branch of the internal carotid artery).

Front 119

what is temporal arteritis?

Back 119

giant cell arteritis: subacute granulomatous inflammation of the large vessels, including the aorta, external carotid (especially the temporal
branch), and vertebral arteries.

Front 120

RF of temporal arteritis?

Back 120

>>polymyalgia rheumatica
>>age > 50
>>female gender.

Front 121

Hx/PE: temporal arteritis?

Back 121

>>New headache (unilateral or bilateral); scalp pain and temporal tenderness; jaw claudication.
■ Fever; transient or permanent monocular >>BLINDNESS; weight loss; myalgias/ arthralgias (especially of the shoulders and hips).

Front 122

Dx: temporal arteritis?

Back 122

ESR > 50 (usually > 100).
■ Ophthalmologic evaluation.
■ Temporal artery biopsy: Look for thrombosis; necrosis of the media; and lymphocytes, plasma cells, and giant cells.

Front 123

treatment of temporal arteritis?

Back 123

>>High-dose prednisone for 1–2 months before tapering.
>>Obtain a biopsy, but do not delay treatment
>>follow-up eye exam.

Front 124

PMR: RF

Back 124

RF: female gender and age > 50.

Front 125

PMR: Hx/PE

Back 125

Hx/PE:
>> Pain and stiffness of the shoulder and pelvic girdle areas with difficulty
getting out of a chair or lifting the arms above the head.
>>Other symptoms include fever

Front 126

PMR: Dx

Back 126

Markedly ↑ ESR, often associated with anemia.

Front 127

PMR: Rx

Back 127

Low-dose prednisone (10–20 mg/day).

Front 128

what is developmental dysplasia of the hip?

Back 128

>>congenital hip dislocation; can result in subluxed, dislocatable, or dislocated femoral heads
>>poor development of acetebelum due to excessive uterine packing in the flexed and adducted position (e.g., breech presentation) → excessive stretching of the posterior hip capsule and adductor muscle contracture.

Front 129

presentaion of DDH:

Back 129

first-born females born in the breech position.
Barlow’s maneuver
Ortolani’s maneuver
Allis’ (Galeazzi’s) sign
Asymmetric skin folds

Front 130

Barlow’s maneuver

Back 130

Pressure is placed on the inner aspect of the abducted thigh, and the hip is then adducted → posterior dislocation.

Front 131

Ortolani’s maneuver

Back 131

The thighs are gently abducted from the midline with anterior pressure on the greater trochanter. A soft click signifies reduction
of the femoral head into the acetabulum.

Front 132

Allis’ (Galeazzi’s) sign

Back 132

The knees are at unequal heights when the hips and knees are flexed (the dislocated side is lower).

Front 133

Dx: of DDH

Back 133

EARLY DETECTION IS CRIITICAL to allow for proper hip development.
>>Ultrasound may be helpful, especially after 10 weeks of age.

Front 134

Treatment of DDH at ff.
<6 months
6-15 months
15–24 months

Back 134

Begin treatment early.
■ < 6 months: Splint with a Pavlik harness (maintains hip flexed and abducted).
■ 6–15 months: Spica cast.
■ 15–24 months: Open reduction.

Front 135

complications of DDH

Back 135

>>Joint contractures and AVN of the femoral head.
>>Without treatment, a significant defect patients < 2 years of age.

Front 136

what are the DDx of a limp:

Back 136

"STARTSS HOTT"
Septic joint
Tumor
Avascular necrosis
(Legg-Calvé-Perthes)
Rheumatoid
arthritis/JRA
Tuberculosis
Sickle cell disease
SCFE
Henoch-Schönlein
purpura
Osteomyelitis
Trauma
Toxic synovitis

Front 137

what is Legg-Calvé-Perthes Disease?

Back 137

>>AVN of the femoral head of unknown etiology
>>Most commonly found in boys 4–10 years of age.
>>self-limited disease, with symptoms lasting < 18 months.

Front 138

Legg-Calvé-Perthes Disease Hx/PE?

Back 138

>>asymptomatic at first, but patients can develop a painless limp.
>>If pain is present, it can be referred to the knee.
>>Limited abduction and internal rotation;
>>atrophy of the affected leg.
>> Usually unilateral

Front 139

Tx:Legg-Calvé-Perthes disease. when ithere is limited femoral head involvement or if full ROM is present.

Back 139

Observation

Front 140

Tx:Legg-Calvé-Perthes disease. when extensive or if there is ↓ ROM

Back 140

consider bracing, hip abduction with a Petrie cast, or an osteotomy.

Front 141

what is the good prognosis of Legg-Calvé-Perthes disease?

Back 141

>>if the patient is < 5 years of age
>has full ROM
>>↓ femoral head involvement, and a stable joint.

Front 142

what is Slipped Capital Femoral Epiphysis (SCFE)

Back 142

Separation of the proximal femoral epiphysis through the growth plate → medial
and posterior displacement of the femoral head.

Front 143

what is posterior displacement of the femoral head in SCFE due to?

Back 143

due to an imbalance between growth hormone and sex hormones.

Front 144

RF of SCFE

Back 144

obesity
age 11–13
male gender
AA

Front 145

what is SCFE associated with?

Back 145

hypothyroidism and other endocrinopathies.

Front 146

Hx/PE: Slipped Capital Femoral Epiphysis (SCFE)

Back 146

>>acute or insidious thigh or knee pain and a painful limp
>>in acute cases inability to
bear weight.
>>Bilateral 30%
>>Limited internal rotation and abduction of the hip.

Front 147

Dx: of SCFE

Back 147

>>Radiographs of both hips in AP and frog-leg lateral views reveal posterior and medial displacement of the femoral head
>>Rule out hypothyroidism with TSH.

Front 148

Tx: of SCFE

Back 148

>> progressive, so treatment should begin promptly
>>No weight bearing should be allowed until the defect is surgically stabilized.
>>Gentle closed reduction only in acute slips

Front 149

complications of SCFE (3)

Back 149

>>Chondrolysis
>>AVN of the femoral head >>premature hip osteoarthritis →
hip arthroplasty.

Front 150

osteosarcoma

Back 150

usually occurs at the >>metaphyseal regions of the distal femur, proximal tibia, and proximal humerus
>>often metastasizes to the lung

Front 151

osteosarcoma risk factors

Back 151

male gender and age 20–30.

Front 152

osteosarcoma: Hx/PE

Back 152

>>progressive then intractable PAIN THAT IS WORSE AT NIGHT.
>>fever, weight loss, and night sweats may
>>Erythema and enlargement over the site of the tumor maybe seen
be present.

Front 153

Dx: osteosarcoma

Back 153

>>CODMAN'S TRIANGLE (periosteal new bone formation at the diaphyseal end of the lesion)
>>SUNBURST PATTERN
>>ONION SKINNING (classic for ewing sarcoma)

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once osteosarcoma is diaganosed what is the next best step of management?

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MRI and CT for staging (soft tissue and bony invasion) and to plan for surgery.

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Tx osteosarcoma

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>>Limb-sparing surgical procedures and pre- and postoperative chemotherapy
(e.g., methotrexate, doxorubicin, cisplatin, ifosfamide).
>> Amputation may be necessary

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Common Adult Orthopedic Injuries: Humerus fracture

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Direct trauma. May have radial nerve palsy → wrist drop and loss of thumb abduction

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Common Adult Orthopedic Injuries :Humerus fracture

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Hanging-arm cast vs. coaptation splint and sling.

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Common Adult Orthopedic Injuries: “Nightstick fracture”

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Ulnar shaft fracture resulting from self-defense with the arm against a blunt object.

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Common Adult Orthopedic Injuries: “Nightstick fracture” treatment

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Open reduction and internal fixation (ORIF) if significantly displaced.

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Common Adult Orthopedic Injuries: Monteggia’s fracture

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Diaphyseal fracture of the proximal ulna with subluxation of the radial head

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Common Adult Orthopedic Injuries: Monteggia’s fracture treatment

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ORIF of the shaft fracture (due to poor fracture diaphyseal blood supply) and closed reduction
of the radial head.

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Common Adult Orthopedic Injuries:Galeazzi’s fracture

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Diaphyseal fracture of the radius with dislocation of the distal radioulnar joint. Results from a direct blow to the radius. radioulnar joint.

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Common Adult Orthopedic Injuries: Galeazzi’s fracture treatment

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ORIF of the radius and casting of the forearm in supination to reduce the distal fracture.

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Common Adult Orthopedic Injuries: Tibial fracture

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Direct trauma. Watch for compartment syndrome.

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Common Adult Orthopedic Injuries:Tibial fracture treatment

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Casting vs. intramedullary nailing.

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Common Adult Orthopedic Injuries: Hip fracture

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↑ risk with osteoporosis. Presents with a shortened and externally rotated leg.may Displaced femoral neck fractures: Associated with an ↑ risk of AVN, nonunion, and DVTs.

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Common Adult Orthopedic Injuries: Hip fracture treatment

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>>ORIF with parallel pinning of the femoral neck.
>>Displaced fractures in elderly patients require a hip hemiarthroplasty.
>>Anticoagulate to ↓ the likelihood of DVTs.

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Common Adult Orthopedic Injuries: Femoral fracture

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Direct trauma. Beware of fat emboli, which present with fever, change in mental status, dyspnea, hypoxia, petechiae, and ↓ platelets.

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Common Adult Orthopedic Injuries: Femoral fracture treatment

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Intramedullary nailing of the femur. Irrigate and debride open fractures.

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Common Adult Orthopedic Injuries: Open fractures

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An orthopedic emergency; patients must be taken to the OR in < 6 hours owing to ↑ infection risk.

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Common Adult Orthopedic Injuries:Open fractures treatment

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OR emergently to repair fracture. Treat with antibiotics.

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Common Adult Orthopedic Injuries: Achilles tendon rupture

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Presents with a sudden “pop” like a rifle shot. More likely with ↓ physical conditioning.
Exam shows limited plantar flexion and a
Thompson’s test (pressure on the gastrocnemius → absent foot plantar flexion).

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Common Adult Orthopedic Injuries: Achilles tendon rupture treatment

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Treat surgically followed by long leg cast for six weeks.

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Common Adult Orthopedic Injuries: Knee injuries (3 types)

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ACL
PCL
meniscal tears

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Common Adult Orthopedic Injuries: Knee injury ACL

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Present with knee instability, edema, and hematoma.
ACL:
■ Results from forced hyperflexion or impact to
an extended knee. tendons.
■
positive anterior drawer and Lachman’s tests.
■ Rule out a meniscal or MCL injury.

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Common Adult Orthopedic Injuries: Knee injury ACL treatment

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Treatment of ACL injuries is generally surgical with graft from the patellar or hamstring an extended knee. tendons.

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Common Adult Orthopedic Injuries: Knee injury PCL

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PCL:
■ Results from forced hyperextension.
■
posterior drawer test.

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Common Adult Orthopedic Injuries: Knee injury PCL treatment

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Operative PCL repair is reserved for highly competitive athletes

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Common Adult Orthopedic Injuries: Knee injury medial meniscus

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■ Clicking or locking may be present.
■ Exam shows joint line tenderness and a

McMurray’s test.

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Common Adult Orthopedic Injuries: Knee injury medial meniscus/LCL

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Treatment of MCL/LCL and meniscal tears is usually conservative.