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Fracture mx - bony injury -> # may arise from
- - trauma (excessive forces applied to bone)
- - stress related (repetitive low velocity injury)
- - pathological (abnormal bone, # during normal use / minimal trauma)
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# Mx - diagnosis involves
- - assessing fracture - site, type
- - associated injuries
- - distal NV deficit
- (so o/e +/- imaging)
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Most common classification system for open #
- Gustilo and Anderson classification
- - Grade 1: low energy wound <1cm
- - Grade 2: >1cm wound with moderate soft tissue damage
- - Grade 3: >10cm with extensive soft tissue damage
- + 3A: adequate soft tissue coverage
- + 3B: inadequate soft tissue coverage
- + 3C: associated artery injury
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Spinal disorders - dorsal column lesion
- Loss vibration and proprioception
- Tabes dorsalis, SACD
(Post-terrier picmonic, propeller + vibration fork, also pressure)
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Spinal disorders - Spinothalamic tract lesion
Loss of pain, temperature (lateral), crude touch and pressure (anterior)
- Contralateral anaesthesia
(Thor Picmonic - ladder temp thermometer, pain bolt, then anterior - ant-eater - touch crude oil, pressure)
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Spinal disorders - central cord lesion
Flaccid paralysis of the upper limbs
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Spinal disorders - infarction spinal cord
Dorsal column signs (loss of proprioception and fine discrimination) (jQuery112408195846008499672_1614906298310 not vibration, yes, just not written here) (fine discrimination - deep touch)
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Spinal disorders - cord compression
- UMN signs
- Malignancy
- Haematoma
- Fracture
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Spinal disorders - osteomyelitis progress, common microbes
- - Normally progressive
- - What
- + Staph aureus in IVDU, normally cervical region affected
- + Fungal infections in immunocompromised
- + Thoracic region affected in TB
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Spinal disorder - Brown-sequard syndrome
- Hemisection of the spinal cord
- Ipsilateral paralysis
- Ipsilateral loss of proprioception and fine discrimination
- Contralateral loss of pain and temperature
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Syringomyelia - what, most common variant
- - cystic cavity forms within spinal cord
- - commonest variant: Arnold - Chiari malformation (cavity connects with a congenital malformation affecting cerebellum)
- - acquired: from prev meningitis, surgery, tumours
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Syringomyelia - neurological manifestations - classical
- - spares dorsal columns and medial lemnicus
- - affecting only spinothalamic tract (loss of pain and temp sensation)
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