42. General Ortho principles

Question 1

5 identifiers for describing # and 4 modifiers

Answer 1

Identifier:

1. Open vs Closed
2. Exact location
3. Direction of # line
4. Simple/comminuted
5. Position

Modifiers

1. Complete/incomplete
2. Articular involvement
3. Avulsion
4. Impaction

Question 2

Describe Salter-Harris classification

Answer 2

1. Through epiphyseal plate, with displaced epiphysis
2. As 1 with triangle of metaphysis
3. # from joint surface to plate
4. As 3, but also through metaphysis
5. Crush of epiphysis

Question 3

When is bone most visible?

Answer 3

10-14 days

Question 4

When is callus visible?

Answer 4

2-4 weeks

Question 5

How to differentiate avulsions from ossicles and sesamoids

Answer 5

Avulsion: look for missing bone
Ossicles: Rounded cortex

Question 6

Grading system for open fractures:

Answer 6

1. Less than 1cm, punctured from below
2. 5cm long, no contamination or crush
3. Large laceration, with crush and contamination
   3a. Extensive soft tissue stripping
   3b. Periosteal stripping
   3c. Major vascular injury

Question 7

4 most common sites for compartment syndrome

Answer 7

1. Tibia
2. Forearm
3. Thigh
4. Hand/foot

Question 8

4 mechanisms of compartment syndrome, and examples

Answer 8

1. Increased Comp. Content

a. BLEED: anticoagulant/coagulopathic/traumatic
b. RE/increased PERFUSION: Post-op arterial bypass graft, embolectomy, lying on limb, #, convulsion
c. Exercise induced
d. Seizures
e. Eclampsia
f. Tetany
g. Post thermal/electrical burn
h. Snakebite
i. Intra-arterial drug injection
j. INCREASED CAPILLARY PRESS.
k. Intense muscle use
l. Venous obstruction (phlegmasia), venous ligation
m. Nephrotic syndrome – leading to diminished serum osmolality.

2. Dec. compartment volume

a. Postoperative closure of fascial defects
b. Excessive traction on limb

3. External pressure

a. Comatose drug user
b. Tight casts/dressings

4. Miscellaneous:

a. Interstitial infusion
b. Leaky dialysis cannula
c. Muscle hypertrophy
d. Popliteal cyst

Question 9

7 signs of compartment syndrome

Answer 9

1. POOP to PxF
2. Deep, burning, unrelenting, difficult to localize pain
3. Increasing need for analgesics
4. Pain on passive stretching of the muscle groups
5. Pain with active flexion of the muscle groups
6. Hypoesthesias or paresthesias in the distribution of nerves crossing the compartment
7. Tenderness / tenseness of the compartment

Question 10

5 bones susceptible to AVN

Answer 10

Femoral head
Talus
Scaphoid
Lunate
Capitate

Question 11

5 diagnsotic criteria for CRPS

Answer 11

Affects the DISTAL end of an extremity
Changes in blood flow to the extremity
Abnormal pseudo-motor activity in the region of pain
Hyperpathia (pain persisting or increasing after light or mild pressure)
There is no other evident diagnosis