Chapter 42 - Ortho Flashcards
Function of osteoblasts?
Synthesize nonmineralized bone cortex
Function of osteoclasts?
Reabsorb bone
What are the stages of bone healing?
Inflammation, soft callus formation, mineralization of the callus, removal of the callus
Where does cartilage receive nutrients from?
Synovial fluid
What is shared by Salter-Harris fractures type II, IV, V? Treatment?
Cross the epiphyseal plate and can affect the growth plate of the bone
ORIF
What is the treatment for Salter-Harris type I and II?
Closed reduction
What are the fractures associated with AVN?
Scaphoid, femoral neck, talus
What are fractures associated with nonunion?
Clavicle, 5th metatarsal fracture (Jones’ fracture)
What are the fractures associated with compartment syndrome?
Supracondylar humerus and tibia
What is the biggest risk factor for nonunion?
Smoking
Obturator nerve does what?
Hip adduction
Superior gluteal nerve does what?
Hip abduction
Inferior gluteal nerve does what?
Hip extension
Femoral nerve does what?
Knee extension
What herniates with lumbar disc herniation?
Nucleus pulposus
What is the result of L3 nerve compression?
Weak hip flexion
What is the result of L4 nerve compression?
Weak knee extension; weak patellar reflex
What is the result of L5 nerve compression?
Weak dorsiflexion (foot drop), dec. sensation in big toe web space
What is the result of S1 nerve compression?
Weak plantar flexion, weak Achilles reflex; decreased sensation in lateral foot
Motor innervation from ulnar nerve? Sensory? Result of injury?
Motor: intrinsic musculature of hand, finger abduction, wrist flexion
Sensory: all of 5th and 1/2 of 4th fingers, back of hand
Injury: Claw hand
Motor innervation from median nerve? Sensory? Result of injury?
Motor: Thumb apposition, thumb abduction, finger flexors
Sensory: most of palm and 1st 3 1/2 fingers on palmar side
Injury: carpal tunnel syndrome
Motor innervation from radial nerve? Sensory?
Wrist extension, finger extension, thumb extension, triceps (no hand muscles)
Sensory: 1st 3 1/2 fingers on dorsal side
Motor innervation from musculocutaneous nerve?
Biceps, brachialis, coracobrachialis
Motor innervation from axillary nerve?
Deltoid (abduction)
C1-4 nerve compression causes what?
Neck and scalp pain
C5 nerve compression causes what?
Weak deltoid and biceps (weak bicep reflex)
C6 nerve compression causes what?
Weak deltoid and biceps, weak wrist extensors (weak biceps and brachioradialis reflex)
C7 nerve compression causes what?
Weak triceps
C8 nerve compression causes what?
Weak triceps, weak intrinsic muscles of hand and wrist flexion
Treatment of cervical fracture?
Sling
Risk of vascular impingement
What structure injury is associated with anterior shoulder dislocation? Posterior? Treatment?
Anterior: axillary nerve injury
Posterior (seizures, electrocution): axillary artery injury
Closed reduction for both
Treatment of acromioclavicular separation? Risk of injury to what?
Sling
Brachial plexus and subclavian vessel injury
Treatment for scapular fracture?
Sling unless glenoid fossa involvement, then need internal fixation
Treatment for midshaft humeral fracture?
Sling
Treatment for supracondylar humeral fracture?
Adults: internal fixation
Children: closed reduction, internal fixation if severe
What is Monteggia fracture? Treatment?
Proximal ulnar fracture and radial head dislocation
ORIF
What is Colles fracture? Treatment?
Fall on outstretched hand, distal radius
Closed reduction
What is Nursemaid’s elbow? Treatment?
Subluxation of the radius at the elbow caused by a pulling on an extended, pronated arm
Closed reduction
Treatment for radial and ulnar fracture?
Adults: ORIF
Children: closed reduction
Treatment for scaphoid fracture?
Cast to elbow, may need fixation
Risk of avascular necrosis
What is Volkmann’s contracture?
Supracondylar humerus fracture, occluded anterior interosseous artery, closed reduction of humerus, artery opens up, reperfusion injury, edema, and forearm compartment syndrome (flexor compartment)
Treatment for Volkmann’s contracture?
Fasciotomy
What is Dupuytren’s contracture? Treatment?
Associated with DM, ETOH
Progressive proliferation of the palmar fascia of hand resulting in contractures that usually affect the 4/5th digits
NSAIDs, steroid injections, excision of involved fascia
What is CTS? Treatment?
Median nerve compression by transverse carpal ligament
Splint, NSAIDs, steroid injections, transverse carpal ligament release
What is trigger finger? Treatment?
Tenosynovitis of the flexor tendon that catches at the MCP joint when trying to extend finger
Splint, tendon sheath steroid injections, release pulley system at MCP joint
What is suppurative tenosynovitis? 4 classic signs?
Infection that spreads along the flexor tendon sheaths
Tendon sheath tenderness, pain with passive motion, swelling along sheath, semiflexed posture of the involved digit
Treatment of suppurative tenosynovitis?
Elevation, splinting, abx; if no prompt improvement midaxial longitudinal incision and drainage
What muscles make up the rotator cuff?
Supraspinatus, infraspinatus, teres minor, subscapularis
Acute treatment of rotator cuff tears?
Sling and conservative treatment; surgical repair if pts needs to retain high level of activity or if ADL affected
What is paronychia? Treatment?
Infection under nail bed
ABX, remove nail if purulent
What is a felon? Treatment?
IInfection in the terminal joint space of the finger
Incision over tip of finger and along medial and lateral aspects to prevent necrosis of tip of finger
Injury with posterior hip dislocation? Treatment?
Internal rotation and adduction of leg, risk of sciatic nerve injury
Closed reduction
Injury with anterior hip dislocation? Treatment?
External rotation and abduction of leg, risk of injury to femoral artery
Closed reduction
Treatment for femoral shaft fracture?
ORIF with intramedullary rod
Femoral neck fracture treatment?
ORIF with risk of avascular necrosis if open reduction delayed
ACL injury presentation? Treatment?
Positive anterior drawer test; knee effusion and pain with pivoting action
Surgery with knee instability, otherwise PT
PCL injury presentation? Treatment?
Positive posterior drawer test, less common than ACL injury; knee pain, joint effusion
Conservative therapy initially, surgery for failure of medical management
Posterior knee dislocation imaging?
All need angiogram to r/o popliteal artery injury
Treatment for patellar fracture?
Long leg cast unless comminuted, then need internal fixation
Treatment for tibial plateau fracture and tib-fib fracture?
ORIF unless open, then needs ex fix
Presentation of plantaris muscle rupture?
Pain and mass below popliteal fossa (contracted plantaris) and ankle ecchymosis
What ankle fractures need ORIF?
Bi and trimalleolar fractures
Treatment for metatarsal fracture?
Cast immobilization or brace for 6 weeks
Treatment for calcaneus fracture?
Cast and immobilization if nondisplaced; ORIF for displaced fractures
Never most commonly injured with lower extremity fasciotomy?
Superficial peroneal nerve (foot eversion)
What nerve is injured after lithotomy position or after crossing legs for long periods or fibula head fracture?
Common peroneal nerve; causes footdrop
Components of anterior compartment?
Anterior tibial artery, deep peroneal nerve
Anterior tibialis, extensor hallucis longus, extensor digitorum longus, communis
Components of lateral compartment?
Superficial peroneal nerve
Peroneal muscles
Components of deep posterior compartment?
Posterior tibial artery, peroneal artery, tibial nerve
Flexor hallucis longus, flexor digitorum longus, posterior tibialis
Components of superficial posterior compartment?
Sural nerve
Gastrocnemius, soleus, plantaris
What is the most common compartment affected by compartment syndrome?
Anterior compartment of leg (footdrop) after vascular compromise
What is the most common organism to cause osteomyelitis?
Staph
What is idiopathic adolescent scoliosis?
In prepubertal females, right thoracic curve most common, usually asymptomtic
Treatment for idiopathic adolescent scoliosis?
Curves >20-45 degrees: bracing to avoid progression with growth spurts
Curves >45 degrees: spinal fusion
What is Osgood-Schlatter disease? Treatment?
Tibial tubercle apophysitis, caused by traction injury from quads in adolescents aged 13-15; pain in front of knee
Mild symptoms: activity limitation
Severe: cast 6 wks followed by activity limitation
What is Legg-Calve-Perthes disease?
AVN of femoral head, children 2y and older
Can result from hypercoagulable state, bilateral 10%; present with painful gait limp
Xray findings for LCP? Treatment?
Flattening of femoral head on xray
Maintain ROM with limited exercise; femoral head will remodel without sequelae
What is Slipped capital femoral epiphysis? On imaging? Treatment?
Males 10-13y, increased risk of AVN of femoral head, painful gait
Widening and irregularity of epiphyseal plate
Surgical pinning
Treatment for congenital dislocation of the hip?
Pavlik harness, keeps legs abducted and femoral head reduced in acetabulum
Treatment for clubfoot?
Serial casting
What is the most common bone tumor?
Mets (#1 breast, #2 prostate)
Treatment for metastatic bone tumors?
Internal fixation with impending fracture followed by XRT
What is the most common primary malignant tumor of bone?
MM
Treatment for MM?
Chemo for systemic disease; internal fixation for impending fractures
What is the most common primary bone sarcoma?
Osteogenic sarcoma
Xray findings of Osteogenic sarcoma?
Codman’s triangle (periosteal retraction)
Treatment for osteogenic sarcoma?
Limb-sparing resection, XRT and doxorubicin based chemo
Treatment of benign bone tumors?
Curettage +/- bone graft
Treatment for giant cell tumor of bone?
Total resection +/- XRT
Recurrence risk with giant cell tumor?
30%
What is spondylolisthesis? Treatment?
Formed by subluxation or slip of one vertebral body over another, most commonly in lumbar region
Depends on degree of subluxation and symptoms, conservative treatment to surgical fusion
What is torus fracture?
Buckling of the metaphyseal cortex seen in children (distal radius)
Treatment for open fractures?
Incision and drainage, abx, fracture stabilization, soft tissue coverage
