Partial or full patellar tendon tears F/U
Knee immobilizer and given urgent orthopedics follow-up
Tendon pathology, including rupture, which antibiotic class?
Fluoroquinolones
Rhabdo fluid replacement
Goal UOP of 3 cc/kg/hour or 200 to 300 cc/hr to prevent acute renal failure
Normal ABI
> 0.9
Humeral shaft fractures most common nerve affected
Radial nerve (wrist drop)
Primate bite treatment and why?
- Monkeys carry Cercopithecine herpesvirus 1, also called Herpesvirus simiae or more simply, B virus
- Fatal to humans if not treated early.
- Treatment is with acyclovir
- Pain with overhead movement.
- Pain with arm in 180 degrees forward flexion, followed by internal rotation
- Pain with arm in 90 degrees abduction, elbow flexed at 90 degrees, followed by internal rotation
Subacromial bursitis 2/2 overuse causing impingement
Weakly positively birefringent and rhomboid shaped crystals
Calcium pyrophosphate crystals = pseudogout
Needle like and negative birefringent crystals
Uric acid crystals = gout
Most common cause of septic arthritis
Staph Aureus
In a patient with sickle cell disease presenting with septic arthritis, what additional organism must be considered?
- Salmonella.
- Patients with sickle cell anemia require vancomycin and ciprofloxacin for better coverage for salmonella.
What nerve is most commonly injured in a perilunate dislocation?
Median nerve.
Fracture of the distal radius paired with a dislocation of the distal radioulnar joint.
Galeazzi fracture
Fracture of the proximal ulna, paired with dislocation of the radial head
Monteggia fracture
Flexor tenosynovitis treatment
IV ampicillin-sulbactam (Unasyn) and vancomycin
- Symmetrical swelling of the involved finger
- Finger held in flexion at rest
- Tenderness along the flexor tendon sheath
- Pain with passive extension
Flexor tenosynovitis
- Loss of motor, pain, and temperature below injury
- Proprioception and vibration intact
Anterior Cord Syndrome
Fluoroquinolone S/E
- Prolongation of the QTc
- Spontaneous tendon rupture
Clay-shoveler fracture
- Avulsion of the spinous process of C6 or C7
- Stable fracture
Unstable cervical spine fractures
Jefferson bit off a hangman’s thumb
- Jefferson burst fracture
- Bilateral facet dislocation
- Odontoid type II and type III fractures, any fracture with a dislocation
- Hangman fracture
- Teardrop fracture
Septic joint ESR and CRP
ESR is normal in up to 30% of patients and CRP is normal in up to 12% of patients.
Finkelstein test
- Flexion of the thumb across the palm and then ulnar deviation of the wrist.
- Sharp pain at the dorsal compartment suggests a positive test and a diagnosis of de Quervain’s tenosynovitis.
Hawkins-Kennedy test
- Shoulder flexed to 90° and their elbow flexed to 90°.
- Clinician grasps proximal to the wrist and elbow and then quickly rotates the arm internally.
- Positive test suggests subacromial impingement syndrome.
Felon treatment
- S.aureus is the most common bacterial pathogen
- Most effective treatment is incision and drainage and trimethoprim-sulfamethoxazole
