Please enable JavaScript.

Coggle requires JavaScript to display documents.

Ortho Surgery - Coggle Diagram

- - - - Most common: second metatarsal
      - Proximal tibia: very common
    - - Runners
      - Jumpers
      - Anorexia nervosa
    - - Pain increases with activity
      - Pain decreases with rest
      - Localized tenderness
    - - X ray usually normal
    - - Rest and analgesics main treatment
      - Cast helps rapid healing
      - Surgery rarely needed
  - - - Adolescence
    - - Marathon running
      - Jumping
    - - Traction on immature tibial tubercle by patellar tendon
    - - Pain at knee joint or patella
    - - Tenderness at tibial tubercle
    - - Self limited
      - Resolves within 12 to 18 months
    - - Rest
      - Activity restriction
      - NSAIDs
  - - - Locking of knee
      - Cannot fully straighten knee
      - Giving way
    - - Conservative treatment possible especially in less active patients
  - - - Twisting injury
      - Audible pop
      - Inability to continue activity
      - Severe swelling
    - - MRI is investigation of choice
    - - ACL: anterior drawer, Lachman, pivot shift
      - PCL: posterior drawer
      - Collateral ligaments: varus and valgus stress
      - Meniscus: McMurray
    - - MCL and PCL: conservative
      - ACL and LCL: surgical
  - - - Running or jumping
    - - Sudden severe pain at back of ankle
    - - Calf squeeze test
      - No ankle movement
    - - Emergency surgery if less than 3 hours
    - - Quinolones eg ciprofloxacin increase risk
  - - - Vessel injury
      - Acute limb ischemia
    - - First step: reduction
      - If still no pulse: exploration
    - - First: reduction
      - Second: debridement
  - - - Bleeding
    - - Tie and bind pelvis
      - Analgesia
      - Early mobilization
    - - Never advise rest due to DVT risk
  - - - Pain
      - Swelling
      - Bleeding
      - Deformity
    - - Closed reduction main treatment
      - Rhinoplasty if deformity persists
  - - - Low dose LMWH
    - - Start before surgery
      - Continue after surgery
    - - Up to 6 weeks
    - - Early mobilization
    - - DEXA scan for osteoporosis
  - - - Increased alkaline phosphatase
      - Lytic lesions on X ray
    - - Bisphosphonates
  - - - Teenagers
    - - Painful movement
      - Swelling after trauma
    - - Periosteal elevation
      - Subcortical new bone formation
    - - Metaphysis of femur
  - - - Soap bubble appearance
  - - - Adducted foot
      - Bean shaped sole
    - - Heel can go flat on surface
    - - Resolves by 3 years
    - - Serial casting
      - Surgery if persists after 3 years
  - - - Often none
      - Corrective shoes
      - Serial casting
  - - - Observe and reassure
      - Resolves by age 3 to 4
  - - - Reassurance
      - Observation
    - - Usually by age 8 to 9 years
- - - - Glenohumeral joint
    - - Inability to raise arm above head
      - Flattening of the deltoid
    - - Axillary nerve
    - - Over the shoulder region
    - - Closed reduction followed by sling
    - - Intranasal fentanyl
      - IV midazolam
  - - - Axillary nerve
  - - - Radial nerve
    - - Cast
    - - Spiral humeral fracture in children raises suspicion of abuse
  - - - Brachial artery
    - - Ischemia
    - - Immediate reduction if signs of ischemia
  - - - Brachial artery
    - - Ischemia
    - - Immediate reduction if ischemia present
    - - Severe pain or ischemic signs require immediate cast removal
    - - Volkmann contracture
      - Ischemic deformity of hand, fingers, and wrist due to forearm muscle damage
  - - - Compartment syndrome
    - - Fasciotomy
  - - - Elderly females
    - - Osteoporosis
    - - Fall on outstretched hand
    - - Posterolateral displacement
      - Impaction and angulation
    - - Closed reduction followed by cast
    - - Disimpaction
      - Traction
      - Hand flexed with ulnar deviation
    - - Below elbow
      - Pronated, semi flexed hand with ulnar deviation
    - - X-ray after 2 weeks
    - - Malunion
      - Stiff fingers
    - - Analgesia
      - Physical therapy
  - - - Fall on outstretched hand
    - - Tenderness in anatomical snuff box
    - - X-ray may be normal initially
      - Radiological changes appear after 2 weeks
      - Repeat X-ray after 2 weeks or MRI
    - - Nonunion
      - Avascular necrosis of proximal fragment
    - - Thumb spica cast or splint
      - If unstable: ORIF
  - - - Fall on outstretched hand
    - - Middle third
  - - - No reduction
      - Broad arm sling for 2 weeks
    - - Undisplaced: no reduction
      - Displaced: refer to orthopedics
      - Broad arm sling for 2 weeks or until comfortable
    - - Undisplaced: no reduction
      - Displaced: urgent referral
      - Broad arm sling
    - - Malunion
    - - Broad arm sling
    - - If vessel injury suspected
      - Marked displacement
    - - Clinical picture:
        
        Deformity
        
        Fullness
        
        Crepitation
      - Treatment:
        
        No treatment required
  - - - Trauma to extended finger
    - - Hyperextension of DIP joint for 6 weeks
      - Keep DIP extended using adhesive tape
  - - - Inflammation of extensor muscle attachment
    - - Repeated bending and twisting
    - - Tennis players
      - Carpenters
      - Violinists
      - Excessive computer use
    - - Pain at lateral elbow
    - - First line: NSAIDs
      - Second line: brace under elbow and physiotherapy
  - - - Flexor muscles
  - - - Car accidents
    - - Shortened limb
      - Internal rotation
    - - Sciatic nerve
    - - Closed reduction
  - - - Shortened limb
      - External rotation
    - - Fat embolism
    - - Intramedullary nail fixation
  - - - Direct trauma
    - - Compartment syndrome
  - - - Common peroneal nerve
- - - - Numbness or pain over outer thigh
    - - Lateral cutaneous nerve of thigh
    - - Osteoarthritis
      - Compression from underwear
      - Tight outer clothing
      - Belts
    - - X ray hip
  - - - Positive when hip abductors are weak or paralyzed
    - - Gluteus medius
      - Gluteus minimus
    - - Weight bearing exercises to strengthen hip muscles
  - - - Orthopantomogram
  - - - Inability to abduct arm more than 40 degrees
      - Deltoid muscle still actively contracting
  - - - Malignancy of plasma cells
    - - Old age
      - More common in men
    - - Bone pain especially back
      - Anemia
      - Weight loss
      - Hypercalcemia symptoms
        
        Constipation
        
        Polyuria
        
        Excessive thirst
        
        Nausea
      - Renal failure due to Bence Jones proteins
      - Recurrent infections
        
        Pneumonia
        
        Sinusitis
        
        Kidney infections
        
        Skin infections
        
        Shingles
    - - Calcium level increased
      - Plasma cells more than 10 percent
      - M protein increased
      - Rouleaux formation on blood film
      - X ray shows osteolytic lesions
      - MRI if back pain present
    - - Bone marrow biopsy
    - - Chemotherapy eg thalidomide
    - - Old male with chronic back pain and anemia equals multiple myeloma until proven otherwise
      - Normal calcium does not rule out multiple myeloma
      - Young male with chronic back pain suggests ankylosing spondylitis
  - - - Monoclonal paraprotein less than 3 g per dL
      - Plasma cells less than 10 percent
      - No bone lesions
      - No anemia
      - No hypercalcemia
      - No renal insufficiency
      - No other B cell proliferative disorder
    - - May progress to multiple myeloma
    - - Annual serum protein electrophoresis
    - - Multiple myeloma plasma cells more than 10 percent
      - MGUS plasma cells less than 10 percent
  - - - Compression of median nerve
    - - Middle aged women
    - - Rheumatoid arthritis
      - Hypothyroidism
      - Pregnancy
    - - Pain and numbness in thumb
      - Index finger
      - Middle finger
    - - Worse at night
    - - Permanent weakness
      - Persistent numbness
    - - Nerve conduction velocity
      - EMG
    - - Phalen test
    - - First line: splint and analgesics
      - Second line: corticosteroid injection
      - Last line: surgery in severe cases
  - - - Foot pain worse at start of walking
      - Improves after walking
    - - X ray shows bony spur
    - - NSAIDs
    - - Resolves within 12 to 18 months
  - - - Obstruction of superior vena cava
      - Most commonly lung cancer
    - - Facial congestion
      - Neck congestion
      - Worsens with arm elevation
      - Positive Pemberton sign
    - - CT chest
    - - First step: corticosteroids
      - Second: radiotherapy to shrink tumor
  - - - Metastatic cancer eg breast
    - - Back pain
      - History of malignancy
      - UMN signs below level of compression
    - - Immediate MRI spine
    - - First step: dexamethasone
      - Second step: radiotherapy