PAEA Orthopedics EOR
ACL injury - ✔️✔️-MC ligament injury in the knee
-pivoting injury
-pop and swelling, hemarthrosis
lachman's, anterior drawer - ✔️✔️special tests for ACL
segond fracture - ✔️✔️-avulsion of lateral tibial condyle
-pathognomonic for ACL tear
injury to: ACL, MCL and medial meniscus - ✔️✔️what does donoghue's triad (unhappy)
consist of (3)
MCL/LCL injuries - ✔️✔️pain, swelling, ecchymosis, stiffness
dx: varus/valgus testing
grade I & II: conservative (RICE, NSAIDS
grade III: +/-surgery - ✔️✔️tx for MCL/LCL injury (diff tx depending on grade)
meniscal tears - ✔️✔️-MOI: squatting, twisting
-locking, popping, "giving way", effusion
mcmurray, apley grind - ✔️✔️special tests for meniscal tear
patellar fracture - ✔️✔️MC direct blow to knee cap, young pt
sunrise view (X-ray) - ✔️✔️dx of patellar fracture (special view)
-nondisplaced: knee immobilizer, leg cast x 6 weeks
-displaced:surgery - ✔️✔️tx of patellar fracture (displaced vs nondisplaced)
patellar and quadriceps tendon rupture - ✔️✔️-forceful quad contraction (fall on flexed
knee)
-MC males, systemic ds (DM, gout)
-sharp knee pain, inability to extend knee/SLR
-tx: surgery
patella baja - ✔️✔️deformity seen on X-ray with quadriceps tendon rupture
patella alta - ✔️✔️deformity seen on X-ray with patellar tendon rupture
,patellar dislocation - ✔️✔️valgus stress after twisting injury
-apprehension sign (push laterally)
closed reduction (anterior medially), knee immobilizer - ✔️✔️tx of patellar dislocation
Knee (tibiofemoral dislocations) - ✔️✔️-high velocity injury
-severe limb threatening EMERGENCY (popliteal artery rupture)
gross deformity, may reduce by itself
-get arteriography
ortho consult/longitudinal traction - ✔️✔️tx of knee dislocation (tibiofemoral)
femoral condyle fractures - ✔️✔️-MOI: axial loading/fall from height
-peroneal nerve injuries (check first dorsal web space)
-cannot bear weight
-usually heals poorly
1st dorsal web space - ✔️✔️where do you check for injury to the peroneal nerve?
ortho consult/ORIF - ✔️✔️tx for femoral condyle fractures
tibial plateau fractures - ✔️✔️-MC kids in motor vehicle accidents
-complication=degenerative arthritis
-tx: non displaced: conservative (non-weightbearing cast 6-8 weeks); displaced: surgery
osgood schlatter disease - ✔️✔️-MC cause of knee pain in young active adolescents
-overuse/repetitive stress before finished growing
-pain with activity, tender anterior tibial tubercle
-lump below knee
x ray (prominence, ossification of tibial tuberosity) - ✔️✔️dx study for osgood schlatter
disease
patellofemoral syndrome (chondromalacia) - ✔️✔️softening of the patellar articular
cartilage
-most common in runners
-anterior knee pain behind or around patella
-+ apprehension sign
NSAIDs, rest, rehab (strengthen quads) - ✔️✔️tx of patellofemoral syndrome
(chondromalacia)
baker's cyst - ✔️✔️-MOI: synovial fluid effusion- displaced with cyst formation
, -popliteal mass, clicking, buckling, not usually painful
-if ruptured: pseudothrombophlebitis (mimics DVT!)
conservative: NSAIDs, ice - ✔️✔️tx for baker's cyst
ITB syndrome - ✔️✔️-most common cause of knee pain in runners
-inflammation of the iliotibial band, lack of flexibility
-lateral knee pain worse with climbing downhill/running
ober test (pain/resistance to adduction, lateral knee tenderness), NSAIDS, steroids -
✔️✔️dx and tx of ITB syndrome
osteomyelitis - ✔️✔️-inflammation/infection of bone by pyogenic organism
-MC <20 y/o
-acute (MC kids) vs chronic, usually staph aureus
-gradual onset of bacteremia, inflammation over involved bone
-MRI: most sensitive in early disease ( periosteal reaction), areas of cortical destruction,
advanced disease: sequetrum
salmonella - ✔️✔️what type of bacteria causes osteomyelitis in a patient with sickle cell
disease?
bone aspiration - ✔️✔️what is the gold standard dx of osteomyelitis?
abx 4-6 weeks (IV) followed by 1-2weeks oral)
-<4 months: nafcillin or oxacillin + 3rd gen cephalosporin
->4 mo: MSSA (nafcillin or oxacillin or cefazolin), MRSA (vancomycin or linezolid)
-sickle cell: 3rd gen ceph or fluroquinolone
-puncture wound-ciprofloxacin
-chronic: surgical debridement + abx dependent on cultures - ✔️✔️tx for osteomyelitis
-<4 months
->4 mo
-sickle cell
-puncture wound
-chronic
septic arthritis - ✔️✔️-infection in joint cavity
-most dangerous form of acute arthritis: MEDICAL EMERGENCY
-hematogenous, direct, or contiguous spread
-staph MC, gonorrhea, GB strep in neonates
-single swollen, warm painful joint (MC knee)
arthrocentesis (3 cs and a G), WBC >50,000, can be turbid whiteish/yellow tinged -
✔️✔️dx of septic arthritis
ACL injury - ✔️✔️-MC ligament injury in the knee
-pivoting injury
-pop and swelling, hemarthrosis
lachman's, anterior drawer - ✔️✔️special tests for ACL
segond fracture - ✔️✔️-avulsion of lateral tibial condyle
-pathognomonic for ACL tear
injury to: ACL, MCL and medial meniscus - ✔️✔️what does donoghue's triad (unhappy)
consist of (3)
MCL/LCL injuries - ✔️✔️pain, swelling, ecchymosis, stiffness
dx: varus/valgus testing
grade I & II: conservative (RICE, NSAIDS
grade III: +/-surgery - ✔️✔️tx for MCL/LCL injury (diff tx depending on grade)
meniscal tears - ✔️✔️-MOI: squatting, twisting
-locking, popping, "giving way", effusion
mcmurray, apley grind - ✔️✔️special tests for meniscal tear
patellar fracture - ✔️✔️MC direct blow to knee cap, young pt
sunrise view (X-ray) - ✔️✔️dx of patellar fracture (special view)
-nondisplaced: knee immobilizer, leg cast x 6 weeks
-displaced:surgery - ✔️✔️tx of patellar fracture (displaced vs nondisplaced)
patellar and quadriceps tendon rupture - ✔️✔️-forceful quad contraction (fall on flexed
knee)
-MC males, systemic ds (DM, gout)
-sharp knee pain, inability to extend knee/SLR
-tx: surgery
patella baja - ✔️✔️deformity seen on X-ray with quadriceps tendon rupture
patella alta - ✔️✔️deformity seen on X-ray with patellar tendon rupture
,patellar dislocation - ✔️✔️valgus stress after twisting injury
-apprehension sign (push laterally)
closed reduction (anterior medially), knee immobilizer - ✔️✔️tx of patellar dislocation
Knee (tibiofemoral dislocations) - ✔️✔️-high velocity injury
-severe limb threatening EMERGENCY (popliteal artery rupture)
gross deformity, may reduce by itself
-get arteriography
ortho consult/longitudinal traction - ✔️✔️tx of knee dislocation (tibiofemoral)
femoral condyle fractures - ✔️✔️-MOI: axial loading/fall from height
-peroneal nerve injuries (check first dorsal web space)
-cannot bear weight
-usually heals poorly
1st dorsal web space - ✔️✔️where do you check for injury to the peroneal nerve?
ortho consult/ORIF - ✔️✔️tx for femoral condyle fractures
tibial plateau fractures - ✔️✔️-MC kids in motor vehicle accidents
-complication=degenerative arthritis
-tx: non displaced: conservative (non-weightbearing cast 6-8 weeks); displaced: surgery
osgood schlatter disease - ✔️✔️-MC cause of knee pain in young active adolescents
-overuse/repetitive stress before finished growing
-pain with activity, tender anterior tibial tubercle
-lump below knee
x ray (prominence, ossification of tibial tuberosity) - ✔️✔️dx study for osgood schlatter
disease
patellofemoral syndrome (chondromalacia) - ✔️✔️softening of the patellar articular
cartilage
-most common in runners
-anterior knee pain behind or around patella
-+ apprehension sign
NSAIDs, rest, rehab (strengthen quads) - ✔️✔️tx of patellofemoral syndrome
(chondromalacia)
baker's cyst - ✔️✔️-MOI: synovial fluid effusion- displaced with cyst formation
, -popliteal mass, clicking, buckling, not usually painful
-if ruptured: pseudothrombophlebitis (mimics DVT!)
conservative: NSAIDs, ice - ✔️✔️tx for baker's cyst
ITB syndrome - ✔️✔️-most common cause of knee pain in runners
-inflammation of the iliotibial band, lack of flexibility
-lateral knee pain worse with climbing downhill/running
ober test (pain/resistance to adduction, lateral knee tenderness), NSAIDS, steroids -
✔️✔️dx and tx of ITB syndrome
osteomyelitis - ✔️✔️-inflammation/infection of bone by pyogenic organism
-MC <20 y/o
-acute (MC kids) vs chronic, usually staph aureus
-gradual onset of bacteremia, inflammation over involved bone
-MRI: most sensitive in early disease ( periosteal reaction), areas of cortical destruction,
advanced disease: sequetrum
salmonella - ✔️✔️what type of bacteria causes osteomyelitis in a patient with sickle cell
disease?
bone aspiration - ✔️✔️what is the gold standard dx of osteomyelitis?
abx 4-6 weeks (IV) followed by 1-2weeks oral)
-<4 months: nafcillin or oxacillin + 3rd gen cephalosporin
->4 mo: MSSA (nafcillin or oxacillin or cefazolin), MRSA (vancomycin or linezolid)
-sickle cell: 3rd gen ceph or fluroquinolone
-puncture wound-ciprofloxacin
-chronic: surgical debridement + abx dependent on cultures - ✔️✔️tx for osteomyelitis
-<4 months
->4 mo
-sickle cell
-puncture wound
-chronic
septic arthritis - ✔️✔️-infection in joint cavity
-most dangerous form of acute arthritis: MEDICAL EMERGENCY
-hematogenous, direct, or contiguous spread
-staph MC, gonorrhea, GB strep in neonates
-single swollen, warm painful joint (MC knee)
arthrocentesis (3 cs and a G), WBC >50,000, can be turbid whiteish/yellow tinged -
✔️✔️dx of septic arthritis
