Orthopaedics PDF

Preview

Summary

Orthopedics INFECTION............................................................................................................................................. - SEPTIC ARTHRITIS..........................................................................................................................

Description

ORTHOPAEDICS

CONDITIONS Orthopedics

INFECTION.............................................................................................................................................2 SEPTIC ARTHRITIS............................................................................................................................................................. 2 PROSTHETIC JOINT INFECTION......................................................................................................................................... 4 OSTEOMYELITIS................................................................................................................................................................ 5

INJURIES................................................................................................................................................7 DISLOCATION.................................................................................................................................................................... 7 IMPINGEMENT................................................................................................................................................................. 9 SPRAIN  ANKLE + WRIST............................................................................................................................................... 9

INJURIES OF: THE SHOULDER.........................................................................................................11 ROTATOR CUFF TEAR  SHOULDER...............................................................................................................................11 FROZEN SHOULDER........................................................................................................................................................ 12

INJURIES OF: THE KNEE...................................................................................................................13 ANTERIOR CRUCIATE LIGAMENT TEAR........................................................................................................................... 13 POSTERIOR CRUCIATE LIGAMENT TEAR..........................................................................................................................13 MEDIAL COLLATERAL LIGAMENT TEAR...........................................................................................................................14 LATERAL COLLATERAL LIGAMENT TEAR..........................................................................................................................15 MEDIAL MENISCUS......................................................................................................................................................... 15 LATERAL MENISCUS........................................................................................................................................................16 PATELLOFEMORAL PAIN SYNDROME..............................................................................................................................17 ILIOTIBIAL BAND SYNDROME..........................................................................................................................................18

INFLAMMATORY DISORDERS...........................................................................................................18 BURSITIS......................................................................................................................................................................... 18 TENDONITIS.................................................................................................................................................................... 20 ACHILLES TENDONITIS....................................................................................................................................................21 TENNIS + GOLFER’S ELBOW............................................................................................................................................22 TRIGGER FINGER.............................................................................................................................................................23 DEQUERVAINS TENOSYNOVITIS......................................................................................................................................23 PLANTAR FASCIITIS......................................................................................................................................................... 24

OTHER DISORDERS...........................................................................................................................25 BUNIONS........................................................................................................................................................................ 25 COMPARTMENT SYNDROME..........................................................................................................................................25 DUPUYTREN’S CONTRACTURE........................................................................................................................................ 26

DISORDERS OF: THE SPINE.............................................................................................................27 SPINE STUFF................................................................................................................................................................... 27 CERVICAL SPONDYLOSIS.................................................................................................................................................29

FRACTURES THE BASICS.................................................................................................................30 BONE HEALING............................................................................................................................................................... 31 TYPES OF FRACTURES.....................................................................................................................................................32 FRACTURE FIXING........................................................................................................................................................... 33

FRACTURES OF: UPPER LIMB.........................................................................................................34 SCAPHOID....................................................................................................................................................................... 34 METACARPAL / PHALANGEAL.........................................................................................................................................35 WRIST: DISTAL RADIAL....................................................................................................................................................36 ELBOW: OLECRANON.....................................................................................................................................................37 ELBOW: CORONOID........................................................................................................................................................ 38 ELBOW: RADIAL HEAD....................................................................................................................................................39 HUMERAL NECK.............................................................................................................................................................. 40

FRACTURES OF: CENRAL / TRUNK.................................................................................................42

ORTHOPAEDICS

CONDITIONS

CLAVICLE......................................................................................................................................................................... 42 SCAPULA......................................................................................................................................................................... 43 RIB.................................................................................................................................................................................. 43 SPINE.............................................................................................................................................................................. 44

FRACTURES OF: LOWER LIMB........................................................................................................45 HIP: NECK OF FEMUR..................................................................................................................................................... 45 PELVIS............................................................................................................................................................................. 48 PATELLA.......................................................................................................................................................................... 50 TIBIAL PLATEAU.............................................................................................................................................................. 50 ANKLE: MALLEOLUS FRACTURE......................................................................................................................................51 CALCANEAL..................................................................................................................................................................... 53 METATARSAL................................................................................................................................................................... 53 AVASCULAR NECROSIS....................................................................................................................................................54

NERVE STUFF.....................................................................................................................................54 PERIPHERAL NERVE INJURY............................................................................................................................................54 CARPAL TUNNEL SYNDROME.......................................................................................................................................... 57 MORTON’S NEUROMA................................................................................................................................................... 58 OTHER STUFF.................................................................................................................................................................. 59

BONE CANCER...................................................................................................................................60 OSTEOSARCOMA............................................................................................................................................................ 60 EWING’S SARCOMA........................................................................................................................................................ 61 CHONDROSARCOMA...................................................................................................................................................... 62

PROCEDURES.....................................................................................................................................64 ATHROPLASTY................................................................................................................................................................. 64 AMPUTATION.................................................................................................................................................................. 64 ARTHROSCOPY............................................................................................................................................................... 65

INFECTION SEPTIC ARTHRITIS Define Joint inflammation resulting from intra-articular infection, usually monoarthritic (affecting large joint) Also known as infective arthritis  it is a medical emergency Aetiology/risk factors  May be idiopathic  In most cases there is systemic infection allowing for haematogenous spread o Infection has spread to the joint from elsewhere in the body via the blood  But can be due to direct inoculation  originating from a focus of infection adjacent to joint  The most common joint affected is the knee o Hip, shoulder, wrist and elbow joints are less commonly affected  Medical emergency because the articular cartilage can be destroyed within 24hours of symptoms by the immunological response to bacteria in the joint Common causative organisms:  Acute monoarticular o Bacteria  S. aureus, streptococci, Neisseria gonorrhoeae, E. coli, TB  Neonates  GBS and E. coli  Children  haemophilus influenzas, Kingella kingae  16-40  N. gonorrhoea

ORTHOPAEDICS

CONDITIONS

 Elderly  S. aureus o Viruses  Rubella, Mumps, Hepatitis B, Parvovirus B19 o Fungi  Candida  Chronic monoarticular  mycobacteria, Brucella sp., Nocardia sp., Candida  Polyarticular  Occurs in the immunosuppressed o N. gonorrhoea, B. burgdorferi, rheumatic fever, Parvovirus B19, Hepatitis B, endocarditis Risk Factors  Infection or infected wound  Joint disease  Osteomyelitis, gout, RA, osteoarthritis,  Recent orthopaedic procedures, open fracture or trauma  Joint prostheses  Immunosuppression, DM  IV drug user + poor hygiene + alcoholism Epidemiology Most common in children (40years of European descent  FHx  Smoking  Alcoholic liver disease, liver cirrhosis, DM  Drugs  Phenytoin, carbamazepine Signs and Symptoms  Difficulties with manual activities  Bilateral firm thickened palmar nodules  Palmar skin changes  skin thickening, tethering, puckering, pitting  Progresses to contracture of the fingers  MCP and PIP joints Management  Before contractures develop  intralesional corticosteroids injections  30° MCP joint contractures +/- PIP contractors: o Open partial fasciectomy  all fascia forming pathological cords is excised  Post-op fingers are splinted in full extension

COMPARTMENT SYNDROME Define Pathological conditions characterised by elevated interstitial pressure in a closed osseofascial compartment that results in microvascular comprise  restriction of capillary blood flow and decrease in perfusion Aetiology/risk factors  The compartments most commonly involved are those with relatively non-compliant osseous or fascial structures, such as: o Anterior and deep posterior compartments of the leg o Volar compartment of the forearm  Something causes an increase in pressure to above the capillary level o This restricts capillary flow  results in tissue necrosis secondary to oxygen deprivation  Significant muscle damage / necrosis can occur with intra-compartmental pressures >3040mmHg or within 20-30mmHg of diastolic BP Risk factors  Trauma  fracture, compartment haemorrhage, soft tissue injury, muscular injury  Thermal injury  burns (as skin becomes tight)  Compression support  cast, bandage  Intense muscular activity  e.g. long-distance running

ORTHOPAEDICS

CONDITIONS

 Bleeding disorder  haemophilia Epidemiology Common when associated with risk factors Signs and Symptoms  6 Ps o Pain o Pulselessness o Pallor o Pressure  muscle tightness o Paraesthesia o Paralysis  Loss of muscle function Investigation  Compartment pressure measurement o Differential pressure = difference between diastolic BP and measured compartment pressure  Diastolic BP – compartment pressure o Differential pressure within 20-30mmHg of diastolic BP suggests compartment syndrome  Elevated urine myoglobin + serum creatine kinase  muscle cell lysis and muscle necrosis Management 1. Emergency Fasciotomy of the relevant compartments of the limb  cutting of fascia to relieve the pressure and swelling within the compartment  Analgesia  morphine sulphate  Elevate limb  If have rhabdomyolysis  hydration therapy + urinary alkalinisation (sodium bicarbonate) +/haemodialysis 2. Amputation  if long duration (>8 hours) with no muscle function amputation is best or if fasciotomy doesn’t work and has been done too late Complications  Limb loss, phantom pain, wound infection  Acute renal failure  Sensory + motor deficit  Of fasciotomy  excessive bleeding, infection, scarring, chronic pain, nerve + muscle damage, rhabdomyolysis

DISORDERS OF: THE SPINE SPINE STUFF Discitis  Inflammation of the intervertebral disc within the spine  Most commonly caused by bacterial infection o Can also be due to viral infection o Can be spontaneous or a result of medical intervention in the spine  Relatively uncommon  o Risk factors ...