Orthopedic

General Principles

Narrowing of joint space w/ bony erosions radiologically indicates advanced infection & poorer prognosis
Surgical neck junction between the humeral head & the tuberosities
Intramedullary aspirate best part to get an aspirate for bacterial diagnosis

Anthropometrics

True leg length ASIS to medial malleolus

Goniometer instrument used to measure ROM
25 to 29.9 - BMI for overweight px

TB of Spine

Vasculitis of blood vessels supplying the cord causes paraplegia in TB of spine w/ good prognosis
Kyphosis in TB of spine
- thoracolumbar commonly affected
- multiform deformity
- massive bone destruction
- NOT : posterior parts affected first
Potts disease
- fusiform shadow if it affects the thoracic spine
- birds nest appearance if it ruptures in the mediastinum
- loss of psoas shadow if it involves the lumbar spine
- NOT: sinus formation at the base of nect if it affects the cervical spine

Shoulder

Sternocleidomastoid midshaft clavicular fracture is pulled by this muscle superiorly & posteriorly

Arm

Triceps muscle that pulls proximal olecranon posteriorly during fracture

Forearm

Transradial level at which most upper limb amputations occur

Hip

Posterior hip dislocation clinical presentation: shortened, internally rotated, adducted

Thigh

Intramedullary nailing treatment of choice for transverse midshaft femoral fracture which results to
predictable alignment & early mineralization
Conical ideal shape for transfemoral residual limb

Leg
 Cylindrical ideal shape for transtibial residual limb

Foot

Tarsometatarsal level of Lisfranc amputation

Arthritis

Arthritis of Rheumatic fever polymigratory

Ankle joint not involved in osteoarthritis
Big toe most commonly affected joint in gout

Septic Arthritis

Hematogenous most common route of infection for septic arthritis

Staphylococcus aureus most commonly encountered bacteria in septic arthritis
Knee most common joint involved

TB Arthritis

TB arthritis characterized by single weight bearing joint affected

TB arthritis pannus formation, large abscess formation, granuloma formation
TB arthritis doughy joint consistency, ballotable patella, limited joint rotation
Mostly affects diaphysis NOT true of the pathology of TB arthritis
Marked inflammatory response NOT true of PE in a px w/ TB arthritis of the knee
Bony ankylosis natural course of severe joint TB after treatment
PCR confirmatory test that would give early result in TB arthritis

Diabetes Mellitus

Neuropathy most important contributing factor in the development of unrecognized injury in DM px

Pain in the presence of ulcer signifies that blood distribution to the limb is compromised
DM Foot leading cause of amputation in diabetic patients
DM Foot polymicrobial
Total protein metabolic factor indicating potential wound healing in diabetic px

Wagner Classification

Grade IV diabetic ulceration w/ local gangrene of foot

Bone Tumors

Ewings sarcoma bone lesion: diaphysis

Ewings sarcoma 2nd decade
Periosteal sarcoma bone lesion: diaphysis
Axial skeleton pedicles in vertebra, commonly affected in metastaic lesions
Fribrous dysplasia ground glass matrix
Chondrosarcoma punctuate lesions, cartilaginous lesions
Fibrosarcoma moth eaten pattern
Osteosarcoma

Osteosarcoma bone lesion: metaphysis

Osteosarcoma codmans triangle, onion peel, sunburst pattern
Codmans triangle triangular shadow between cortex & raised ends of periosteum
Codmans triangle - characteristic but not diagnostic of osteosarcoma

Other Diseases

Borrelia burgdorferi causative agent of Lyme disease

Escherichia coli not associated w/ Reiters syndrome (Salmonella, Campylobacter, Shigella)

Rehabilitation

Chairback used to support lumbosacral flexion & extension

Swing through non-weight bearing crutch ambulation
Milwaukee bridge used to treat scoliosis
MMT Grade I palpable contraction
Age of px factor that affects MMT results
Williams brace lumbosacral spine orthoses
Syme type of BKA prosthesis w/ removable medial window