ORTHOPEDICS NOTES

FOR MEDICAL STUDENTS

by

J.R. Phillip MD, PhD

LULU EDITION

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PUBLISHED BY:

J.R. Phillip MD, PhD on Lulu

Orthopedics Notes

For Medical Students

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

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CRANIUM

Facial Bone Osteomas

Assn: Gardner’s Polyposis Syndrome

CLAVICLE

Clavicle Fracture

Junction of middle and distal thirds

Tx: ‘figure of 8’ device for 4–6 wks

SHOULDER

Anterior Dislocation of Shoulder

Arm held close to body

Dx: AP & lateral XR views

Tx: reduction (risk of axillary nerve damage)

Posterior Dislocation of Shoulder

Causes: high-voltage electric burns, severe muscle contraction (e.g. generalized seizure)

Dx: axillary or scapular XR view

Frozen Shoulder

Joint stiffness & restriction of movement (both active and passive) in all directions associated with inflammation

Tx: physical therapy, intra-articular Corticosteroid injections, referral to orthopedic surgeon if no improvement after 2-3 weeks

Rotator Cuff Tear or Tendinitis

Severe pain during mid arc abduction (passive movement is normal)

D/D: Lidocaine injections → if movement improves → tendonitis - if movement doesn’t improve → tear

Dx: shoulder MRI

Osteochondroma

Most common benign neoplasm of skeleton

Cartilage-capped osseous spur / outgrowth connected to surface of bone by stalk

Generally occur at end of growth plates of long bones, often at joints, most commonly shoulder or knee (but also radius and ulna)

Mx: radiographic monitoring

Tx: 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 fracture

Tx: non-dislocated → conservative, displaced → internal fixation

Complications: axillary nerve injury → deltoid weakness, frozen shoulder, avascular necrosis

-Shaft

Tx: closed fracture → conservative, open fracture → internal fixation

Complications: brachial vessel, radial nerve injury (wrist, finger extensor, brachioradialis weakness, sensory loss over dorsum of hand)

Supracondylar Fracture

Fracture of distal humerus just above epicondyles

Relatively rare in adults, one of the most common fractures in children

Tx: non-displaced → splinting and casting, displaced fracture → internal fixation

Complications: Volkmann’s ischemic contracture if Tx delayed, can present as tense and tender forearm after casting (requires immediate fasciotomy)

Giant Cell Tumor

Epiphyseal / metaphyseal region of long bones, commonly seen in females

Olecranon Fracture

Dx: lateral XR

Tx: non-displaced fracture → long arm splint / cast with arm in mid flexion, displaced fracture → wired / plated

ELBOW

Golfer’s Elbow

Pain on medial side during lifting, with resisted wrist and finger flexion

Tx: 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 extension

Tx: NSAID, ice / rest

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