Surgical Clerkship- Orthopaedics lectureOrtho-Lite Notes:
Review of all typical study guides was made: we do not recommend Appleton and Lange
Surgery (ortho section) or the First Aid Surgery (ortho chapters).
Ortho Radiology• Plain Films= Bone
• CT= articular cartilage, complicated fracture patterns
• MRI= ligaments, soft tissue
Principles of AO (Arbeitsgemeinschaft für Osteosynthesefragen)
• fracture reduction and fixation to restore anatomical relationships
• fracture fixation providing absolute or relative stability as the “personality” of the
fracture, the patient, and the injury requires
• preservation of the blood supply to soft tissues and bone by gentle reduction
techniques and careful handling
• early and safe mobilization and rehabilitation of the injured part and the patient as
a whole
Pelvic Ring injury
• Increase in pelvic volume is mechanism ((4/3)pi(r^3))!!
• Emergency!
• Binder, ex-fix, sheet, something!, reduce the potential volume.
Compartment Syndrome
The 5 “P”s
• Pain out of proportion
• Pain with Passive Stretch
• Paresthesia
• Pulselessness
• Pallor
• Never have more than 2 “P”s
• Pain out of proportion to the injury
• Beware of the patient requiring INCREASING analgesics
• Pain with Passive stretch
• Stabilize the leg
• Stretch toes up and down
• Pain will increase dramatically
Clinical Exam: Absolutely sufficient to make diagnosis
• Irreversible Nerve and muscle injury at 6 hours
• On ward neuro and pulse checks q2h
• True OR Emergency
• Fasciotomies in ICU, if you can’t to OR fast enough
• Don’t elevate the leg (same height as heart)
• Keep BP up (think of this like a head injury…keep up the perfusion pressure)
Septic JointsUsually not able to bear weight on joint
Attempts at aspiration must be diligent about not contaminating joint
Brief TumorMOST bone tumors are NOT primary. Bone Tumors need Systemic Evaluation for
Malignancy.
primary tumors likely to be on your test:
Ewing Sarcoma= onion skin
Giant cell tumor= soap bubble appearance
Avascular NecrosisSeen usually in femoral head
Sequela from Sickle Cell, steroids, post-traumatic
Common Pediatric Ortho topics
Slipped cap (femoral epiphysis)
Legg calve perthes
Scoliosis
Club foot