TTHM 10.2 (3/18) Joints & Rheum Day
10a ~ Ankle (Laporte)
Ottowa Ankle Rules
Maissonneuve Frx ~ Distal Tibia, Proximal Head of Fibula, c injury of syndesmosis
Weber classifications (A, B, C) for ankle distal fibular frx
Tibia Pylon Frx
Achilles Tendon Rupture
Arthrocentesis of Ankle…
1030a ~ Septic Arthritis & Gout, MonoArticular Arthritis (Army)
Tap it! Beware alternate diagnoses, GC even in elderly population.
Podagra is 1st Toe Gout (negative biorefringence)… vs Pseudogout (Ca pyrophosphate disease, POS biorefringence)
Acute Gouty attacks treated c NSAIDs, possibly steroids… Diet recommendations…
Septic Joints mostly Staph, Strep, ~10% polymicrobial
Abx choice varies depending on joint & bacterial involvement
11a ~ Small Groups (Weidman, Rodriguez)
Extremity Trauma, splinting, cast removal exercises…
1230a ~ Jr/Sr Sessions (Lavoie, Weidman)
Metatarsal Fractures >3mm displacement or 10* Angulation might be reduced before immobilization, Lisfranc Injury can be ligamentous, or frx… Cuneiform & 2nd metatarsal alignment; up to 10% may get a foot compartment syndrome, pain with passive movement?…
Jones & PseudoJones 5th metatarsal frxs
Achilles avulsion or tear splinted in “Equinus” position 45* plantar felxed short leg splint.
Bohler’s Angle in Calcaneal fracture should be normal 20 to 40*.
Distal Fibular Fractures Weber A, B, C depend on position relative below, at, or above tibial mortise. A can be managed conservatively ~ sprain. B & C need more thorough splinting & likely surgical intervention, non weight bearing until SG followup.
TibFib frxs high risk for compartment syndrome. Likely SG & OBS…
Open Fractures ~ Gustilo Classification (I, II, III~abc) & Abx NOW, within 3 hrs!
Ancef still recommended, with potential broader spectrum, depending on exposure…
130p ~ Hip & Femur (MacConaghy)
Femoral Neck Frx, disruption of “Shenton’s line”
Allis Technique for Hip Reduction
Check big fractures for small punctures! Open needs Abx!
Femur Frx can bleed out! Avg blood loss 1L, can go to ~3L
2p ~ Knee (Knutsen)
Lachman > Drawer Test
McMurray & Apley tests for meniscal injury
Plan for internal derangements: knee immobilizer, Ortho followup for outpt MRI
Pain control, DC?…
crutches & advance weight bearing as tolerated after initial RICE…
Tibiofemoral joint dislocation is bad! reduce ASAP…
CTA needed after reduction dt high risk for vascular injury!
Patellar Frx & Patellar Tendon rupture need rapid repair for fxnl restoration…
Tibial plateau frxs can be occult but serious, talk to Ortho…
230p ~ Rheum Emergencies (Rossettie)
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3p ~ Foot (Prasad)
Lisfranc junction, Chopoff’s joint?, Torus fracture…
Jones frx, pseudojones…