Orthopedics

Compartment Syndrome

Compartment Syndrome Etiology ↑ Pressure → Compression of nerve, vessel, muscle inside a closed space Can happen within a cast Presentation Early Pain → First symptom Pallor Paresthesia → Pins and needles Late Poikilothermia → Cold to touch Paralysis Pulselessness → Worst finding Diagnosis Clinical Complications Necrosis Treatment Medical emergency → Immediate fasciotomy

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Fat Embolism

Fat Embolism Etiology Long bone fracture Most common → Femur Presentation Within 5d of fracture Dyspnea Confusion Petechial rash → Arm, trunk Diagnosis ABG → PO2 <60% CXR → First normal → Then infiltrates U/A → Fat droplets Treatment Oxygen → Keep PO2 >95% Severe hypoxia → Intubation and mechanical ventilation

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Lower Limb Injuries

Knee Injuries ACL is most common injury Mechanism of injury is important Unhappy triad of knee in sports trauma ACL (anterior cruciate ligament) MCL (medial collateral ligament) Meniscus (medial/lateral) Injury Etiology Presentation Diagnosis Treatment MCL Lateral trauma Pain MRI Surgical repair LCL Medial trauma Pain MRI Surgical repair ACL...

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Upper Limb Injuries

Upper Limb Injuries Anterior Shoulder Dislocation Etiology Strain of glenohumeral ligaments >95% of shoulder dislocations Presentation Arm held to side Forearm externally rotated Severe pain Diagnosis Best initial → X-ray Most accurate → MRI Complications Axillary artery injury Axillary nerve injury Treatment Shoulder relocation Immobilization Weak pulse/sensation → Surgery Posterior...

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Fractures

Fractures Presentation Pain Swelling Deformity Diagnosis → X-ray Treatment rules Closed reduction Mild fracture No displacement Open reduction + internal fixation Severe fracture Displacement or misalignment Surgery and debridement Open fracture Types Comminuted fracture Bone broken into multiple pieces Cause → Crush injuries Stress fracture Cause → Repetitive insult to bone Most...

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Bone Cancer

Ewing Sarcoma Classic presentation 10-20y Multilayered onion-skinning on X-ray of Femur diaphysis 11, 22 translocation Mid shaft Systemic symptoms → Fever, Anorexia, Fatigue Onion skin on X-ray Eat Wings and Onion Rings Osteosarcoma Rb gene (Retinoblastoma) Metaphysis Distal femur Proximal tibia Proximal humerus Metastasis to lungs ↑ Alk. P...

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