Osteoblasts: build bone

Osteoclasts: destroy it

L3L4 disc:

  • L4 root compression (L4 think 4 quadriceps, weak knee jerk)

L4L5 disc:

  • L5 root compression (lift 5 toes, dorsiflexion; may see big toe hyperesthesia)

L5S1 disc:

  • S1 root compression (Stand on tiptoes, plantar flexion, weak ankle jerk, change in sensation to lateral foot/calf)

Biceps reflex: C5/6

Triceps: is C7

Anal wink: S2-S4

Ulnar nerve:

  • Intrinsic musculature of hand, finger abduction (for 'U' shape); wrist flexion; sensation to pinkie, ring fingers, back of hand

Median nerve:

Thumb apposition, sensation to most of palm, 1st 2 1/2 fingers (carpal tunnel)

Radial nerve:

  • No motor in hand; wrist extension, finger extension; sensation to back of lateral hand

Femur fx:

  • Early ORIF allows early mobilization, decrease fat embolization; decrease complications.

Pediatric femur fx: closed reduction, not ORIF (avoid interference with epiphyseal growth plate)

Salter-Harris fx: III, IV, V are intra-articular

  • Generally need open procedure

Hip dislocation:

  • 90% posterior, which present w/internal rotation, flexed and adducted thigh
  • Risk of sciatic n. injury, AVN of femoral head
  • Anterior hip dislocation: frog leg (external rotation, abduction)

Femoral neck fx: Shorted limb, external rotation, risk of non-union, AVN

Terrible Triad of O'Donaghue:

  • Lateral blow to knee è injury to:
  • Anterior Cruciate Ligament
  • Medial Collateral Ligament
  • Meniscus (medial or lateral)

Posterior knee dislocation:

  • Popliteal injury common, texts say arteriogram all

Calcaneous fx: Prone to compartment syndrome (as are tibia fx, supracondylar humerus fx)

Shoulder dislocation:

  • 90% anterior (risk axillary nerve injury)
  • Posterior seen with seizures, electrocution

Humerus fx:

  • May see radial nerve injury (weak wrist extension, sensation lateral-dorsal hand). Improves

Volkmann's contracture:

  • Supracondylar humerus fx è compromised anterior interosseous artery.
  • Deep forearm flexor compartment syndrome, need fasciotomy.
  • Pain in forearm w/extension. Median nerve.

Dupuytren's contracture of palmar fascia:

  • Tx with steroids, physical therapy; may need fasciotomy

Navicular fx: Tender snuffbox; even with negative XR, requires cast up to elbow Scaphoid fractures usually cause pain at the base of the thumb accompanied by swelling in the same area.Scaphoid fractures usually cause pain and sensitivity to palpation in the anatomic snuffbox at the base of the thumb accompanied by swelling in the same area. These are also called navicular fractures (the scaphoid also being called the carpal navicular) as navicular is the traditional name for the scaphoid bone, although this can be confused with the navicular in the foot.

Monteggia fx: Proximal ulnar fx w/radial head dislocation. ORIF.

Bone mets: Can fixate, XRT for pain relief. Only 65% symptomatic

Ewing's sarcoma:

  • 'onion layering'
  • Pseudorosettes on path.
  • Tx: is XRT; Average survival = 2 years

Osteogenic sarcoma: ‘Sunburst pattern’ on XRay

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