Adult Orthopedics

Question 0

Patient presents with fatigue, anemia, localized bone pain – suspect? Other tests/characteristic findings?

Treatment?

Answer 0

Multiple myeloma

#X-ray – punched-out lytic lesions
#Urinalysis – Bence-Jones protein
#Immunoelectrophoresis – abnormal immunoglobulins

1. Chemotherapy
2. If fails, thalidomide

Question 1

Most common malignant bone tumor in adults? Specific names of lesions?

Answer 1

Metastasis from breast or prostate

Lytic lesions (breast) or blastic lesions (prostate)

Question 2

Soft tissue sarcoma – physical exam findings? Typical areas of metastasis? Does not metastasize to? Treatment?

Answer 2

Firm, fixed mass to surrounding tissues

To lungs; avoids lymph nodes

Incisional biopsy, radiation + chemotherapy

Question 3

Closed versus open reduction?

Answer 3

External manipulation and immobilized in a cast

Versus

Surgical intervention to reduce and fix fracture

Question 4

Typical location of clavicular fracture? Treatment?

Answer 4

Junction of middle and distal birds

Place arm in sling

Question 5

Most common shoulder dislocation? How does patient hold their arms? Associated symptoms?

Answer 5

Anterior dislocation of the shoulder

Hold on close to body, rotated outward (like going to shake hands)

Numbness over deltoid from stretching of axillary nerve

Question 6

Colles’ fracture – mechanism of injury? What is fractured? Management?

Answer 6

Fall on outstretched hand; angulated fracture of distal radius

Closed reduction and cast

Question 7

Posterior shoulder dislocation – typical inciting cause? Patient holds arm how? Diagnosis?

Answer 7

Massive uncoordinated muscle contractions (epileptic shock or electrical)

Arm close to body and internally rotated

Axillary/scapular x-rays

Question 8

Monteggia fracture – mechanism of injury? Location of fracture? Associated finding?

Mirror image of what other fracture?

Answer 8

Direct blow to ulna

Fracture of diaphysis of the ulna with anterior dislocation of radial head

Open reduction, internal fixation

Galeazzi fracture

Question 9

Galeazzi fracture? Management?

Mirror Image of what other fracture?

Answer 9

Fracture of distal radius with dorsal dislocation of radioulnar joint

Open reduction, internal fixation

Monteggia

Question 10

Scaphoid fracture – a.k.a.? Mechanism? Physical exam findings? Imaging? Management? Post fracture management difficulty?

Answer 10

Carpal navicular; patient falls on outstretched hand

Localized tenderness over snuff box

X-rays usually negative, may show fracture on the weeks later

If x-rays do show angulated fracture, open reduction and internal fixation

Nonunion

Question 11

Patient punches a wall – type of fracture? Diagnosis? Management if mild? If severe?

Answer 11

Metacarpal neck fracture; x-rays diagnostic

Closed reduction and ulnar gutter splint

Wire or plate fixation

Question 12

Advantages of prosthesis in femoral neck fracture?

Answer 12

Faster healing and earlier mobilization

Question 13

Treatment of intertrochanteric fracture? Additional management? Unlike femoral neck fractures, less likely to cause?

Answer 13

Open reduction and pinning with immobilization

Postop anticoagulation to prevent DVT

Less likely to cause avascular necrosis

Question 14

Treatment of femoral shaft fracture? Alternate treatment if? Important complications?

Answer 14

Intramedullary rod fixation

If open, orthopedic emergency requiring closure within six hours

#Shock
#If multiple fractures, fat embolism

Question 15

Knee injury – be wary of serious injury if accompanied with?

Answer 15

Knee swelling

Question 16

Collateral ligament injury – usual mechanism? Management if isolated injury? If several ligaments torn?

Answer 16

Blow to knee from side

Hinged cast versus surgical repair

Question 17

Which is more common - ACL or PCL tears? Test? Imaging? Treatment?

Answer 17

ACL

Anterior/posterior drawer test

MRI

#Sedentary patient – immobilization and rehabilitation
#athlete – arthroscopic reconstruction

Question 18

Patient presents with a click when knee is extended – diagnosis? Imaging study? Management?

Answer 18

Meniscal tears; MRI; arthroscopic repair

Question 19

Tibial stress fracture – mechanism of injury? Physical exam findings? Imaging results? Management?

Answer 19

Forced marches

Tenderness to palpation over very specific point

X-rays initially normal, show findings within two weeks

Cast or crutches