Fracture management

4Rs

Resuscitation

Reduction

Restriction

Rehabilitation

Open fracture requirements

6As

Analgesia

Assess neurovascular status, soft tissues, photograph

Antisepsis: wound swab, copious irrigation, cover with soaked dressing

Alignment: align fracture and splint

Anti-tetanus

Abx

Problems with non-union - causes

5Is

Ischaemia

Infection

Increased interfragmentary strain

Interposition of tissue between fragments

Intercurrent disease eg malignancy or malnutrition

Galeazzi and Monteggia fracture-dislocations

GRUesome MURder assists remembering which bone is firstly fractured and then secondly which is dislocated:

G: Galeazzi R: radius fracture U: ulna dislocation

M: Monteggia U: ulna fracture R: radial head dislocation

Arm Fractures + nerves affected:

ARM fracture:

• Axillary = Head of Humerus

• Radial = mid shaft

• Median = Supracondylar

Colle’s vs Smith’s Fracture:

Colle’s fracture makes a C shape in fall position

Smith’s fracture makes an S shape in fall position

Osteoporosis risk factors

Age + SHATTERED

Steroids

Hyper-para/thyroidism

Alcohol and cigarettes

Thin (BMI<22)

Testosterone low

Early menopause

Renal/liver failure

Erosive/ inflammatory bone disease eg RA, myeloma

Dietary Ca low/ malabsorption, DM

​

Osteoarthritis

LOSS

Loss of joint space

Osteophytes

Sub-chondral sclerosis

Sub-chondral cysts

Bouchard’s and Heberden’s Nodes

B comes before H, so bouchards is in proximal IP joint

Holding a Bat you use more of proximal IPJ – B for Bat

Holding a Hair you use more of your distal IPJ – H for Hair (Heberden’s)

Seronegative Spondylarthropathies

P[P]EAR –

• Psoriatic Arthropathy

• Pseudogout

• Enteropathic Arthritis

• Ankylosing Spondylitis

• Reiter's

Cranial Bones:

PEST OF 6

Parietal

Ethmoid

Sphenoid

Temporal

Occipital

Frontal

Muscles of the Neck

TOSS My Gravy Spoon, Darling

Infrahyoid muscles (TOSS) – the strap muscles of the neck

• Thyrohyoid

• Omohyoid

• Sternothyroid

• Sternohyoid

Suprahyoid (My Gravy Spoon, Darling)

• Mylohyoid

• Geniohyoid

• Stylohyoid

• Digastric

Rotator Cuff Muscles

SITS (clockwise from top)

Supraspinatus

Infraspinatus

Teres Minor

Subscapularis

Brachial Plexus Nerves

Aunty Iris Made My Uncle Really Mad!

• Axillary

• Intercostobrachial

• Medial cutaneous

• Musculocutaneous

• Ulnar

• Radial (posterior cutaneous and superficial branches)

• Median

Brachial plexus nerves and how to remember their spinal roots:

3 musketeers (musc N top 3)

2 assassins (axil N top 2)

5 men (median N all 5)

5 rats (radial N all 5)

2 unicorns (ulnar N bottom 2)

Randy Travis Drinks Cold Beer (brachial plexus subunits)

Roots

Trunks

Divisions

Cords

Branches

Radial Nerve: muscles innervated

BEST muscles

Brachioradialis

Extensors

Supinator

Triceps

Anterior forearm muscles: superficial group

"Pimps F*** P********** For Fun"

(let’s say Pimps Feed People For Fun!)

Pronator teres

Flexor carpi radialis

Palmaris longous

Flexor carpi ulnaris

Flexor digitorum superficialis

Muscles that flex the Elbow

3 Bs flex the ElBow

Brachialis

Biceps

Brachioradialis

Brachioradialis

Beer Raising muscle (flexor)

Breaks Rules, it’s a flexor muscle But Radial (radial nerve usually innervates extensors)

Hand Muscles innervated by the median nerve

Meat-LOAF

• Meat – reminder that the median nerve supplies these muscles

• Lateral two lumbricals

• Opponens pollicis

• Abductor pollicis brevis

• Flexor pollicis brevis

Causes of carpal tunnel syndrome

MEDIAN TRAP

M: myxoedema

E: (o)edema

D: diabetes mellitus

I: idiopathic

A: acromegaly

N: neoplasm

T: trauma

R: rheumatoid arthritis

A: amyloidosis

P: pregnancy

Dupuytren's contracture associations

B.A.D F.I.B.E.R.S

Bent penis: Peyronies

AIDS

DM

FH

Idiopathic (most common)

Booze: ALD

Epilepsy and epilepsy meds

Reidel's thyroiditis

Smoking

Carpal Bones

Some Lovers Try Positions That They Can’t Handle

• Scaphoid

• Lunate

• Triquetrum

• Pisiform

• Trapezium

• Trapezoid

• Capitate

• Hamate

Interossei Muscles

Pad and DAb

The Palmar Adduct and the Dorsal abduct

• Use your hand to dab with a pad

Intrinsic Muscles of Hand

A OF A OF A

Thenar, lateral to medial

Abductor pollicis longus

Opponens pollicis

Flexor pollicis brevis

Adductor pollicis. ­

Hypothenar, lateral to medial

Opponens digiti minimi

Flexor digiti minimi

Abductor digiti minimi

Serratus Anterior

SALT (innervation)

Serratus Anterior = Long Thoracic

‘C5,6,7, raise your arms up to heaven’ (the roots)

Abdominal muscles

"Spare TIRE around their abdomen"

Transversus abdominis

Internal oblique

Rectus abdominis

External oblique

How to remember direction of obliques:

When you put your hands in your pockets, your fingers lie on top of the external obliques and fingers point their direction of fibres.

Lumbar Plexus roots

I twice Get Laid On Fridays

• Iliohypogastric (T12, L1)

• Ilioinguinal (L1)

• Genitofemoral (L1, L2)

• Lateral femoral cutaneous (L2, L3)

• Obturator (L2-L4)

• Femoral (L2-L4)

2 nerves from 1 root (L1): Ilioinguinal, iliohypogastric

2 nerves from 2 roots: Genitofemoral (L1.L2), Lateral Femoral (L2,L3)

2 nerves from 3 roots: Obturator (L2,3,4), Femoral (L2,3,4)

Safest part of buttock for needle insertion:

Shut Up and Butt Out

The Upper and Outer quadrant of the buttock avoids needle hitting the sciatic nerve.

Thigh – Innervation by Compartment:

MAP of Sciatic

Medial compartment: Obturator

Anterior compartment: Femoral

Posterior compartment: Sciatic

Femoral triangle boundaries

SAIL

• Sartorius muscle (lateral border)

• Adductor longus muscle (medial border)

• Inguinal Ligament (superior border)

Popliteal Muscle Arrangements

2 semis go together (membranosus + tendinosus) Tendinosus is on Top (superficial).

Membranosus is Medial so Biceps Femoris is lateral.

Inversion + Eversion muscles of Leg

Eversion muscles

pErineus longus

pErineus brevis

pErineus terius

Inversion muscles

tIbialis anterior

tIbialis posterior

Soleus vs Gastrocnemius Function:

Stand on your soles. Explosive Gas

Soleus for standing (posture)

Gastrocnemius is for explosive movement!

Deep tendon reflexes:

One, two-- buckle my shoe. Three, four-- kick the door. Five, six-- pick up sticks. Seven, eight-- shut the gate.

S1,2 = ankle jerk

L3,4 = knee jerk

C5,6 = biceps and brachioradialis

C7,8 = triceps

Body position

Supine = on your spine

Prone = the other one

Lordosis + Kyphosis

Lumbar = Lordosis

Ky is high up the spine!