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