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Ortho Tx 1


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
Created by: Adam Barnard Adam Barnard