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Ortho Tx 1
Orthopedics
Question | Answer |
---|---|
Nonspecific NSAIDs: appropriate for: | impingement & inflammatory disorders |
Nonspecific NSAIDs: not appropriate for: | chronic tendonitis |
Nonspecific NSAIDs: Topical: | Flector patch, Voltaren gel |
COX-2 Inhibitors: Not indicated for: | soft tissue injury |
COX-2 Inhibitors: Concern about: | cardiovascular effects |
Low dose Celebrex for: | RA and OA |
Tylenol: effective as pain relief for: | soft tissue injuries & as opioid sparing combination |
Joint & Soft Tissue Injections: should be limited to: | 4 per year, per site |
Do not inject corticosteroids into: | a septic joint or thru cellulitic skin |
Glucosamine indications | Analgesic effect & cartilage repair for OA; no support for soft tissue injury |
Osteoarthritis: Tx: | APAP?, NSAIDs, ROM, Glucosamine |
Splinting | Plaster or ready to use (Orthoglass); acutely, 10 thick, use padding |
Casting | Fiberglass; after swelling subsides, check NV status |
Closed reduction | Hematoma block, digital block, exaggeration of Fx & reduction with traction |
CRPP/ORPP = | (open/closed reduction percutaneous pinning) |
ORIF | Screws, plates |
Bone Grafts: MOA | act as framework for new bone growth |
Autograft | from same patient |
Xenograft (heterograft) | from another species |
Allograft | from cadaveric bone bank |
Bone Grafts: Types | Autograft; Xenograft; Allograft; Ceramics |
Estrogen prevents: | bone loss |
Rhabdomyolysis: Tx | Fluids; Correct imbalances; tx underlying cause |
Myositis Ossificans: tx | Ice, compression; excision for impairment after stabilization in 6-8 months |
Fat Embolism Syndrome: Tx: | Maintain perfusion with O2, inotropics, maintain hematocrit, correct metabolic acidosis; mechanical ventilation may be required. |
Reflex Sympathetic Dystrophy: Tx | Early referral to a pain specialist; neuroleptic pain meds (Neurontin, Lyrica); Regional sympathetic nerve blocks; PT |
Venus Thromboembolism: Tx: | Anticoagulation; prophylactic anticoagulation in trauma admissions & certain ortho surgeries |
Tendonitis: tx | Conservative therapy: Relative rest, stretch, ice, NSAIDs, correct biomechanics; PT/ OT; ROM, Iontophoresis; Corticosteroid Injection |
Joint & Soft Tissue Injections/ Aspirations: Indications | Obtaining dx samples; assess pain relief as a dx tool; administer meds for pain/ inflammation |
Joint & Soft Tissue Injections/ Aspirations: Technique: | Ethyl chloride spray, Marcaine/Lidocaine, Kenalog |
PRICEMMM | Protect/ prevent damage; Rest 24-48 hr; Ice 20 min q 1-4 hr ASAP & for 2-3 d; compression/ prevent more swelling; elevation to drain fluid; motion early/ speed recovery; meds; modalities: Iontophoresis, US, etc |
Iontophoresis | Application of electric current to skin to transport anti-inflammatory drugs across skin to affected tendon |
Phonophoresis | Application of ultrasound to skin to create pores for transport of anti-inflammatory drugs across skin to affected tendon |
Sonorex | Extracorporeal shock wave tx; provides local anesthesia & promotes neovascularization (Plantar Fasciitis) |
Prolotherapy | Injection of sclerosant (phenol of hypertonic glucose); no support for soft tissue injuries; low level support for back pain and OA |
Botulism Toxin | Inhibits neurotransmitters & mx contraction; low level evidence for chronic lateral epicondylitis |
Osteoarthritis: Injections: | Corticosteroids, Visco-supplementation (Synvisc : 3 weekly injection, Hyalgan (hyaluronate): 5) |
Time from amputation to replantation | Warm ischemia: 6 hrs; Cold ischemia: 12 hrs; up to 30 hrs for digits |
Septic joint/ Osteomyelitis Tx: | Parenteral Abx, I&D |
Hand lac: close within: | 8 hrs |
Hip dislocation tx | Allis maneuver |
Femur fx tx | usually ORIF; femoral fx = closed reduction & Nail; femoral neck fx: Garden III & IV need prosthetic |
best non-surgical treatment for osteoarthritis | wt loss |
initial treatment for rotator cuff tendonitis | physical therapy and NSAIDS |