ORTHOPEDICS NOTES

FOR MEDICAL STUDENTS

byJ.R. Phillip MD, PhD

LULU EDITION

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PUBLISHED BY:J.R. Phillip MD, PhD on Lulu

Orthopedics NotesFor Medical Students

Copyright © 2016 by J.R. Phillip MD, PhD

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CRANIUM

Facial Bone OsteomasAssn: Gardner’s Polyposis Syndrome

CLAVICLE

Clavicle FractureJunction of middle and distal thirdsTx: ‘figure of 8’ device for 4–6 wks

SHOULDER

Anterior Dislocation of ShoulderArm held close to bodyDx: AP & lateral XR viewsTx: reduction (risk of axillary nerve damage)

Posterior Dislocation of ShoulderCauses: high-voltage electric burns, severe muscle contraction (e.g. generalized seizure)Dx: axillary or scapular XR view

Frozen ShoulderJoint stiffness & restriction of movement (both active and passive) in all directions associated with inflammationTx: physical therapy, intra-articular Corticosteroid injections, referral to orthopedic surgeon if no improvement after 2-3 weeks

Rotator Cuff Tear or TendinitisSevere pain during mid arc abduction (passive movement is normal)D/D: Lidocaine injections → if movement improves → tendonitis - if movement doesn’t improve → tearDx: shoulder MRI

OsteochondromaMost common benign neoplasm of skeletonCartilage-capped osseous spur / outgrowth connected to surface of bone by stalkGenerally occur at end of growth plates of long bones, often at joints, most commonly shoulder or knee (but also radius and ulna)Mx: radiographic monitoringTx: surgical if symptomatic

Erb’s Palsy

Cause: Upper trunk (C5, C6) injury → axillary n. & musculocutaneous n. injury → muscles of shoulder & arm → arm medially rotated & adducted → forearm extended & pronated (“waiter’s tip” sign)Prognosis for obstetrical Erb’s palsy good (80% chance of full or near-full recovery)

HUMERUS

Humeral Fracture

Types:

-Upper humeral fractureTx: non-dislocated → conservative, displaced → internal fixationComplications: axillary nerve injury → deltoid weakness, frozen shoulder, avascular necrosis

-ShaftTx: closed fracture → conservative, open fracture → internal fixationComplications: brachial vessel, radial nerve injury (wrist, finger extensor, brachioradialis weakness, sensory loss over dorsum of hand)

Supracondylar FractureFracture of distal humerus just above epicondylesRelatively rare in adults, one of the most common fractures in childrenTx: non-displaced → splinting and casting, displaced fracture → internal fixationComplications: Volkmann’s ischemic contracture if Tx delayed, can present as tense and tender forearm after casting (requires immediate fasciotomy)

Giant Cell TumorEpiphyseal / metaphyseal region of long bones, commonly seen in females

Olecranon FractureDx: lateral XRTx: non-displaced fracture → long arm splint / cast with arm in mid flexion, displaced fracture → wired / plated

ELBOW

Golfer’s ElbowPain on medial side during lifting, with resisted wrist and finger flexionTx: NSAID, ice / rest

Tennis Elbow

Pain in lateral aspect of elbow with wrist motion and forceful gripping, decreased grip strength, pain with resisted wrist and finger extensionTx: NSAID, ice / rest

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