Trauma and Orthopaedics

Dr Chris Simpson

Topics covered
Act conditions
Septic arthritis, temporal arteritis

Orthopaedics + rheumatology
OA, RA, gout, AS, polymyalgia rheumatica, reactive arthritis, osteoporosis

Trauma
Sprained ankle, long bone fracture, colles fracture, hip fracture, multisystem/head trauma

Orthopaedics and Rheumatology

Septic arthritis
S/S erythematous, hot swollen joint, decreased ROM, cant weight bear, fever, systemic sepsis Ix Bloods, joint aspirate MC+S

Tx IV fluclox. and ben.pen. Prior to sensitivities, surgical drainage and irrigation

Presentation
Headache Scalp hurts when I brush my hair Now my jaw has started hurting when I eat

Temporal arteritis
S/S as above, progresses to visual disturbances Ix temporal artery biopsy Tx 30mg Prednisolone, decreasing by 5mg every 1/12

Rheumatoid arthritis
Female 30-50 S/S EMS>1h, progressive symmetrical symptoms Ix Rheumatoid factor, CCP, XR
Soft Tissue swelling Periarticular erosions Absent osteophytes Deformities Erosions Subluxation

Tx exercise, NSAIDs, DMARDs, steroids, biologics

Osteoarthritis
S/S Pain, stiffness, worse with use, asymetrical Ix XR
Loss of joint space Osteophytes Subchondral sclerosis Subchondral cysts

Tx weight loss and exercise, analgesics, NSAIDs, arthroscopic washout, arthroplasty

Gout
Increased serum uric acid level leads to monosodium urate crystals forming within joint S/S painful swollen joint, usually small joints of extremeties, erythema, warmth Ix Bloods including uric acid level, aspirate birefringent ve needle shaped crystals Tx acute NSAIDs or Colchicine, Allopurinol 2/52 later

Pseudogout
Inflammatory arthropathy caused by calcium pyrophosphate crystals S/S same as gout except normally larger joints knees most common Ix XR chondrocalcinosis mineralisation within fibrocartilage, Aspirate birefringent +ve rhomboid shaped crystals Tx NSAIDs and analgesics

Presentation
R knee pain Over 2 days Red, swollen, hot PMH D+V 2/52 ago after a takeaway

Reactive arthritis
Sterile arthritis typically affecting the lower limb 1-4 weeks following urethritis or dysentery Ix CRP and ESR raised, stool culture, sexual health Tx rest and splint affected joints, NSAIDs, local steroid injections

Reiters syndrome I cant see, I cant pee and I have a pain in my knee

Ankylosing spondylitis
Chronic inflammatory disease of spine and SI joints of unknown cause S/S lower back pain worse at night, EMS relieved by exercise, progressive loss of spinal movement in all directions, ? Posture Ix clinical diagnosis, XR bamboo spine Tx intense exercise regimen, NSAIDs, steroids

Polymyalgia rheumatica
Rare <60, females 2:1 males S/S gradual onset symetrical aching tenderness and EMS, shoulders and proximal limb muscles Ix raised CRP and ESR Tx 15mg pred. dose decreased slowly over 2 years osteoporosis prevention

Osteoporosis
Quantitative reduction in bone mass RFs female, smoker, low BMI, steroids

S/S insufficiency fractures esp spine, NOF and distal radius following low energy falls Ix DEXA bone scan Tx - Bisphosphonates

OSCE
Joint Disease
OA RA Crystal arthropathies + septic arthritis Seronegative spondyloarthropathies

Presenting complaint: 1. Pain in thumb 2. Pain in R knee

Trauma

Ankle Injury
Hx mechanism, inversion/eversion Ex - Look, feel, passive movement, active movement Ottowa ankle rules: XR if pain in

Maleolar zone + tip of lat. Maleolus or tip of

med. Maleolus or unable to weight bear

Midfoot zone + 5th metatarsal or navicular or

unable to weight bear

Long bone fracture

1. hairline vs simple vs comminuted (>3 pieces) vs compound 2. linear vs transverse vs oblique vs spiral

Wrist fractures
Colles distal segment posterior

 Smiths distal segment volar

NOF
S/S pain, unabale to weight bear, shortened, externally rotated Intra vs extra capsular blood supply from femoral neck therefore AVN risk (intertrochanteric line) Garden classification (1-4):
1 and 2 use a screw (DHS) 3 and 4 Austin Moore (hemi)

Major Trauma
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