Category: Orthopedics
Keywords: Lisfranc Fracture (PubMed Search)
Posted: 6/2/2008 by Michael Bond, MD
(Updated: 10/15/2024)
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Lisfranc Fracture:
Typically consists of a fracture of the base of the second metatarsal and dislocation, though it can also be associated with fractures of a cuboid. Common current mechanism is when a person steps into a hole and twists the foot.Originally described when a horseman would fall of their horse with their foot still trapped in a stirrup.
Diagnosis should be considered if patient has difficult weight bearing with pain on palpation over the 2nd and 3rd metacarpal head with an appropriate mechanism.
Pearls:
Category: Orthopedics
Keywords: Clavicle, fracture, surgery (PubMed Search)
Posted: 5/25/2008 by Michael Bond, MD
(Updated: 10/15/2024)
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I remember being taught as a medical student that clavicle fractures could be treated conservatively. A direct quote was "if both ends of the clavicle are in the same room it will heal".
Though conservative treatment with a sling for 6 weeks with early pendulum ROM exercises for the shoulder is appropriate for the vast majority of clavicle fractures surgery should be considered for those that have:
Category: Orthopedics
Keywords: Mallet finger, Extensor Injury (PubMed Search)
Posted: 5/18/2008 by Michael Bond, MD
(Updated: 10/15/2024)
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Extensor Tendon Injuries [Mallet Finger]
Category: Orthopedics
Keywords: Posterior Interosseous Nerve, Compression, Radial Tunnel (PubMed Search)
Posted: 5/11/2008 by Michael Bond, MD
(Updated: 10/15/2024)
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Posterior Interosseous Nerve Compression Syndrome
As eluded to last week Posterior Interosseous Nerve (PIN) Compression Syndrome, a deep branch of the radial nerve, is felt to be radial tunnel syndrome with paralysis.
Category: Orthopedics
Keywords: Radial Tunnel Syndrome (PubMed Search)
Posted: 5/3/2008 by Michael Bond, MD
(Updated: 10/15/2024)
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For those at the University of Maryland that got the chance to hear my lecture this week, you learned about Cubital tunnel syndrome [ulnar neuropathy], the second most common compressive neuropathy. Carpal Tunnel syndrome remains the number one compressive neuropathy, and this pearl, for the sake of completeness, will address Radial tunnel syndrome.
Stay tuned for next week for Posterior Interosseous Nerve syndrome.
Category: Orthopedics
Keywords: Turf Toe (PubMed Search)
Posted: 4/27/2008 by Michael Bond, MD
(Updated: 10/15/2024)
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Turf Toe:
Most commonly seen in atheletes who compete on artificial turf. Presents as pain over the 1st Metatarsalphalangeal (MTP) joint.
Category: Orthopedics
Keywords: Achilles Tendon Rupture (PubMed Search)
Posted: 4/19/2008 by Michael Bond, MD
(Updated: 10/15/2024)
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Achilles Tendon Rupture
This addition was sent in my Dr. Andrew Milstein:
Thanks for the Orthopedics update. A few pearls for Achilles Tendon Rupture --> often these patients may present like a typical ankle sprain patient and are placed in a hallway chair. You can't do an adequate Thompson Test while someone is sitting in a chair. If you're concerned, lay them down on a stretcher to do the test.
Category: Orthopedics
Keywords: DeQuervain, Intersection, Tenosynovitis (PubMed Search)
Posted: 3/30/2008 by Michael Bond, MD
(Updated: 10/15/2024)
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DeQuervain and Intersection Syndromes:
Category: Orthopedics
Keywords: Sternoclavicular, Dislocation, Posterior (PubMed Search)
Posted: 3/24/2008 by Michael Bond, MD
(Updated: 10/15/2024)
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Sternoclavicular Dislocation:
Sorry this is being delivered to you late.
Category: Orthopedics
Keywords: Metacarpal, Fracture, Boxer's Fracture (PubMed Search)
Posted: 2/2/2008 by Michael Bond, MD
(Updated: 10/15/2024)
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Metacarpal Neck Fractures (i.e.: Boxer’s Fracture if 5th Metacarpal)
Depending on the MCP joint involved a certain amount of angulation is permissible before it adversely affects normal function.
Category: Orthopedics
Keywords: Knee Injury, ACL, dislocation (PubMed Search)
Posted: 1/5/2008 by Michael Bond, MD
(Updated: 10/15/2024)
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Some quick facts about Knee Injuries:
Category: Orthopedics
Keywords: Salter Harris, Fracture, Strain, pediatric (PubMed Search)
Posted: 10/13/2007 by Michael Bond, MD
(Updated: 10/15/2024)
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Pediatric Strain versus Fracture
Review of Salter Harris Fractures
Please click here for a pictorial of Salter Harris Fractures from FP Notebook.
Category: Orthopedics
Keywords: Back Pain, Guideline, Treatment (PubMed Search)
Posted: 10/7/2007 by Michael Bond, MD
(Updated: 10/15/2024)
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Low Back is one of the most common complaints that we see in the Emergency Department. Our first priority is to rule out those causes that can lead to paralysis or death (i.e.: epidural abscess, pathological fracture, cauda equina syndrome, etc…). However, most of the back pain that we will see is musculoskeletal in origin.
Links to the Clinical Guidelines are listed below:
Category: Orthopedics
Keywords: Supracondylar, Fracture, Pediatric, Ossification (PubMed Search)
Posted: 7/12/2007 by Michael Bond, MD
(Emailed: 7/8/2007)
(Updated: 10/15/2024)
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Category: Orthopedics
Keywords: Sports Hernia, groin pain (PubMed Search)
Posted: 4/6/2014 by Brian Corwell, MD
(Emailed: 10/15/2024)
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Sports Hernia/Athletic pubalgia
Hx: Gradually increasing lower abdominal/proximal adductor pain. Usually activity related, resolves with rest. Frequent return despite rest when sports activity resumes.
Most common in athletes who perform cutting/maneuvers in addition to frequent acceleration/deceleration. Think ice hockey and soccer.
Bilateral symptoms not uncommon.
PE: Resisted sit up with palpation of the inferolateral edge of the distal rectus may recreate symptoms. Similarly, resisted hip adduction may elicit symptoms.
If for no other reason than to make the diagnosis harder to make, valsalva induced pain may also occur.
Fluoroscopic guided injections can be helpful to isolate the site of pain generation.
First line therapy is rest, non-narcotic analgesia and physical therapy.
With surgery, >80% return to pre injury level of play.
http://atlantasportsmedicine.com/orthopedic-surgeon/wp-content/uploads/2009/11/groin-injuries.jpg
Sports Hernia/Athletic Pubalgia: Evaluation and Management. Christopher Larson. Sports Health.
Category: Orthopedics
Posted: 10/1/2017 by Brian Corwell, MD
(Emailed: 10/15/2024)
(Updated: 10/15/2024)
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Category: Orthopedics
Posted: 10/1/2017 by Brian Corwell, MD
(Emailed: 10/15/2024)
(Updated: 10/15/2024)
Click here to contact Brian Corwell, MD
Category: Orthopedics
Keywords: tendon, antibiotics, tendonitis (PubMed Search)
Posted: 5/22/2021 by Brian Corwell, MD
(Emailed: 10/15/2024)
(Updated: 10/15/2024)
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A recent article in Pediatrics attempted to estimate the association between fluoroquinolone use and tendon injury in an adolescent population.
Fluoroquinolones are thought to negatively impact tendons and cartilage in the load-bearing joints of the lower limbs through collagen degradation, necrosis, and disruption of the extracellular matrix.
Population: 4.4 million adolescents aged 12–18 years with filled outpatient fluoroquinolone prescription vs. an oral broad-spectrum antibiotic for comparison.
Fluoroquinolones included ciprofloxacin, levofloxacin, moxifloxacin, and gatifloxacin
Comparator antibiotics included amoxicillin-clavulanate, azithromycin, cefalexin, cefixime, cefdinir, nitrofurantoin, and bactrim.
Outcomes: Primary outcome was 90-day tendon rupture (Achilles, patellar, quadricep, patellar, tibial) identified by diagnosis and procedure codes. Secondary outcome was tendinitis.
Results: The weighted 90-day tendon rupture risk was 13.6 per 100 000 fluoroquinolone-treated adolescents and 11.6 per 100 000 comparator-treated adolescents.
Fluoroquinolone-associated excess risk: 1.9 per 100 000 adolescents; the corresponding number needed to treat to harm was 52 632.
The weighted 90-day tendinitis risk was 200.8 per 100 000 fluoroquinolone-treated adolescents and 178.1 per 100 000 comparator-treated adolescents
Fluoroquinolone-associated excess risk excess risk: 22.7 per 100 000 adolescents; the corresponding number needed to treat to harm was 4405.
Conclusion:
The excess risk of tendon rupture associated with fluoroquinolone treatment was extremely small, and these events were rare. On average, 50,000 adolescents would need to be treated with a fluoroquinolone for 1 additional tendon rupture to occur
The excess risk of tendinitis associated with fluoroquinolone treatment though larger was also small.
Besides tendon rupture, other more common potential adverse drug effects may be more important to consider for treatment decision-making, in adolescents without other risk factors for tendon injury.
Ross RK, Kinlaw AC, Herzog MM, Jonsson Funk M, Gerber JS. Fluoroquinolone Antibiotics and Tendon Injury in Adolescents. Pediatrics. 2021 May 14:e2020033316.