Ortho I Fractures, Joint Pain, Spinal Injuries

SUGGESTED READINGS ORTHO I

Bernstein, J., Musculoskeletal Medicine, 2003.

OBJECTIVES ORTHO I

1. Describe fractures with regard to angulation, displacement, shortening, rotation, and comminution.

2. Discuss the usual clinic presentation and management of the following fractures: a. Colles’ b. Shaft of radius and ulnar c. Femur/femoral neck d. Tibia e. Clavicle f. Ankle Discuss the pathophysiology of fracture healing.

3. Describe the vascular and neurologic injuries that may occur with supracondylar fractures of the humerus and femur.

4. Discuss the clinical presentation and management of compartment syndrome. Discuss fractures which are more commonly associated with this.

5. Recognize the indicators and the valve of appropriate splinting of musculoskeletal injuries.

6. Recognize the complications associated with the use of splints.

7. Identify pelvic instability associated with pelvic fracture.

8. Recognize the value of the AP pelvic x-ray to identify the potential for massive blood loss and the maneuvers that may be used to reduce pelvic volume and control bleeding.

9. Discuss the Salter-Harris classification and the prognostic significance.

10. Discuss the neurological findings associated with spinal cord injury syndromes (central cord, anterior cord, Brown-Sequard). Discuss the pathophysiology of spinal cord injury.

11. Describe the common clinical presentation and management of patients with acute low back pain versus herniated nucleus pulposus. Know when radiographic studies are appropriate.

12. Discuss the clinical presentation, radiographic findings, and non-operative management of adolescent idiopathic scoliosis.

CASE HISTORIES ORTHO I

1. A 50-year-old female tripped on her dog’s leash while taking her dog for a walk. She had immediate pain, swelling, and deformity at her right wrist. She also noticed some blood on her hand. She presents to the emergency room for an evaluation where you are the emergency room physician. • What do you expect to see on physical exam? • What initial treatment do you provide? • What diagnostic studies do you request? • What is your working diagnosis?

2. An 18-year-old male was running through the park when he slipped on some wet leaves, twisted his leg, and fell to the ground. When he tried to get up he could not bear weight because of pain. There was significant swelling but no deformity. His friend helped him to his car and took him to his home where he applied ice to his leg, propped his leg on come pillows, and played some video games. Several hours later he became concerned when the pain did not subside, swelling became worse, and he experienced tingling in his foot, which was also very painful to move. He comes to your emergency room where you are to evaluate him.

• What do you expect to see on physical exam?
• What initial treatment do you provide?
• What diagnostic studies do you request?
• What is your working diagnosis?

3. A 24-year-old female was working out at the gym when she flexed her knee and felt something pop when she tried to stand from the squatting position. Her knee felt a little sore but she continued her workout. The next day her knee was swollen and she was unable to fully extend it. She went to work where the knee became more uncomfortable throughout the day. She took some Motrin and felt a little better. A few days later she still could not fully extend her knee and presents to your clinic for an evaluation.

• What questions should you ask her?
• What is your working diagnosis?
• What diagnostic studies do you request – and why?
• What is your treatment plan?

4. A 45-year-old man was helping his friend move some furniture when the friend slipped and fell while they were carrying a sofa bed. After a couple of beers, the friend was fine but the man who did not fall noticed some discomfort in his shoulder. In addition to the pain, he could not lift his arm above his head without the assistance of the uninjured arm. The next day he was unable to do his regular job of installing ceilings. He now is in your office for an examination.

• What do you expect to find on physical examination?
• What’s your differential diagnosis?
• What diagnostic studies would be helpful?
• What would be your initial treatment?

5. A 68-year-old woman is in your office with complaints of decreased motion in her knee and recurrent swelling of that knee. She denies any injury. She has problems walking on uneven ground. Pain and stiffness limit her activity for a few hours each morning.

• What questions would be important in her history?
• What would you expect to fine on physical exam?
• What diagnostic studies would be helpful?
• What would be some suggestions for her treatment?

6. A 40-year-old male asthmatic has noted a progressive onset of pain in his thigh and groin. He denies any injury. He has aching at night that sometimes keeps him awake. He does not notice any loss of motion in his hip or knee. Swimming or cycling does not seem to affect his condition one way or another. • What questions regarding his history would help you make a diagnosis?

• What diagnostic studies would be important in his treatment plan?
• What would be your differential diagnosis?
• What could you tell him regarding his prognosis?

7. A 50-year-old is in your office with complaints of hip pain. She denies any injury. She tells you that her pain goes from her hip to her foot, and sometimes she has tingling in her toes.

• Your physical exam shows completely normal motion in her hip and knee.
• What other portions of the physical exam would be helpful?
• What further history would you like to know?
• What diagnostic studies should be arranged?

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