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Fiser's ABSITE Ryan > Chapter 42 - Ortho > Flashcards

Chapter 42 - Ortho Flashcards

1
Q

Function of osteoblasts?

A

Synthesize nonmineralized bone cortex

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2
Q

Function of osteoclasts?

A

Reabsorb bone

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3
Q

What are the stages of bone healing?

A

Inflammation, soft callus formation, mineralization of the callus, removal of the callus

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4
Q

Where does cartilage receive nutrients from?

A

Synovial fluid

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5
Q

What is shared by Salter-Harris fractures type II, IV, V? Treatment?

A

Cross the epiphyseal plate and can affect the growth plate of the bone
ORIF

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6
Q

What is the treatment for Salter-Harris type I and II?

A

Closed reduction

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7
Q

What are the fractures associated with AVN?

A

Scaphoid, femoral neck, talus

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8
Q

What are fractures associated with nonunion?

A

Clavicle, 5th metatarsal fracture (Jones’ fracture)

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9
Q

What are the fractures associated with compartment syndrome?

A

Supracondylar humerus and tibia

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10
Q

What is the biggest risk factor for nonunion?

A

Smoking

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11
Q

Obturator nerve does what?

A

Hip adduction

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12
Q

Superior gluteal nerve does what?

A

Hip abduction

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13
Q

Inferior gluteal nerve does what?

A

Hip extension

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14
Q

Femoral nerve does what?

A

Knee extension

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15
Q

What herniates with lumbar disc herniation?

A

Nucleus pulposus

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16
Q

What is the result of L3 nerve compression?

A

Weak hip flexion

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17
Q

What is the result of L4 nerve compression?

A

Weak knee extension; weak patellar reflex

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18
Q

What is the result of L5 nerve compression?

A

Weak dorsiflexion (foot drop), dec. sensation in big toe web space

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19
Q

What is the result of S1 nerve compression?

A

Weak plantar flexion, weak Achilles reflex; decreased sensation in lateral foot

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20
Q

Motor innervation from ulnar nerve? Sensory? Result of injury?

A

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

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21
Q

Motor innervation from median nerve? Sensory? Result of injury?

A

Motor: Thumb apposition, thumb abduction, finger flexors
Sensory: most of palm and 1st 3 1/2 fingers on palmar side
Injury: carpal tunnel syndrome

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22
Q

Motor innervation from radial nerve? Sensory?

A

Wrist extension, finger extension, thumb extension, triceps (no hand muscles)
Sensory: 1st 3 1/2 fingers on dorsal side

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23
Q

Motor innervation from musculocutaneous nerve?

A

Biceps, brachialis, coracobrachialis

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24
Q

Motor innervation from axillary nerve?

A

Deltoid (abduction)

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25
Q

C1-4 nerve compression causes what?

A

Neck and scalp pain

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26
Q

C5 nerve compression causes what?

A

Weak deltoid and biceps (weak bicep reflex)

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27
Q

C6 nerve compression causes what?

A

Weak deltoid and biceps, weak wrist extensors (weak biceps and brachioradialis reflex)

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28
Q

C7 nerve compression causes what?

A

Weak triceps

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29
Q

C8 nerve compression causes what?

A

Weak triceps, weak intrinsic muscles of hand and wrist flexion

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30
Q

Treatment of cervical fracture?

A

Sling

Risk of vascular impingement

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31
Q

What structure injury is associated with anterior shoulder dislocation? Posterior? Treatment?

A

Anterior: axillary nerve injury
Posterior (seizures, electrocution): axillary artery injury
Closed reduction for both

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32
Q

Treatment of acromioclavicular separation? Risk of injury to what?

A

Sling

Brachial plexus and subclavian vessel injury

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33
Q

Treatment for scapular fracture?

A

Sling unless glenoid fossa involvement, then need internal fixation

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34
Q

Treatment for midshaft humeral fracture?

A

Sling

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35
Q

Treatment for supracondylar humeral fracture?

A

Adults: internal fixation
Children: closed reduction, internal fixation if severe

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36
Q

What is Monteggia fracture? Treatment?

A

Proximal ulnar fracture and radial head dislocation

ORIF

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37
Q

What is Colles fracture? Treatment?

A

Fall on outstretched hand, distal radius

Closed reduction

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38
Q

What is Nursemaid’s elbow? Treatment?

A

Subluxation of the radius at the elbow caused by a pulling on an extended, pronated arm
Closed reduction

39
Q

Treatment for radial and ulnar fracture?

A

Adults: ORIF
Children: closed reduction

40
Q

Treatment for scaphoid fracture?

A

Cast to elbow, may need fixation

Risk of avascular necrosis

41
Q

What is Volkmann’s contracture?

A

Supracondylar humerus fracture, occluded anterior interosseous artery, closed reduction of humerus, artery opens up, reperfusion injury, edema, and forearm compartment syndrome (flexor compartment)

42
Q

Treatment for Volkmann’s contracture?

A

Fasciotomy

43
Q

What is Dupuytren’s contracture? Treatment?

A

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

44
Q

What is CTS? Treatment?

A

Median nerve compression by transverse carpal ligament

Splint, NSAIDs, steroid injections, transverse carpal ligament release

45
Q

What is trigger finger? Treatment?

A

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

46
Q

What is suppurative tenosynovitis? 4 classic signs?

A

Infection that spreads along the flexor tendon sheaths

Tendon sheath tenderness, pain with passive motion, swelling along sheath, semiflexed posture of the involved digit

47
Q

Treatment of suppurative tenosynovitis?

A

Elevation, splinting, abx; if no prompt improvement midaxial longitudinal incision and drainage

48
Q

What muscles make up the rotator cuff?

A

Supraspinatus, infraspinatus, teres minor, subscapularis

49
Q

Acute treatment of rotator cuff tears?

A

Sling and conservative treatment; surgical repair if pts needs to retain high level of activity or if ADL affected

50
Q

What is paronychia? Treatment?

A

Infection under nail bed

ABX, remove nail if purulent

51
Q

What is a felon? Treatment?

A

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

52
Q

Injury with posterior hip dislocation? Treatment?

A

Internal rotation and adduction of leg, risk of sciatic nerve injury
Closed reduction

53
Q

Injury with anterior hip dislocation? Treatment?

A

External rotation and abduction of leg, risk of injury to femoral artery
Closed reduction

54
Q

Treatment for femoral shaft fracture?

A

ORIF with intramedullary rod

55
Q

Femoral neck fracture treatment?

A

ORIF with risk of avascular necrosis if open reduction delayed

56
Q

ACL injury presentation? Treatment?

A

Positive anterior drawer test; knee effusion and pain with pivoting action
Surgery with knee instability, otherwise PT

57
Q

PCL injury presentation? Treatment?

A

Positive posterior drawer test, less common than ACL injury; knee pain, joint effusion
Conservative therapy initially, surgery for failure of medical management

58
Q

Posterior knee dislocation imaging?

A

All need angiogram to r/o popliteal artery injury

59
Q

Treatment for patellar fracture?

A

Long leg cast unless comminuted, then need internal fixation

60
Q

Treatment for tibial plateau fracture and tib-fib fracture?

A

ORIF unless open, then needs ex fix

61
Q

Presentation of plantaris muscle rupture?

A

Pain and mass below popliteal fossa (contracted plantaris) and ankle ecchymosis

62
Q

What ankle fractures need ORIF?

A

Bi and trimalleolar fractures

63
Q

Treatment for metatarsal fracture?

A

Cast immobilization or brace for 6 weeks

64
Q

Treatment for calcaneus fracture?

A

Cast and immobilization if nondisplaced; ORIF for displaced fractures

65
Q

Never most commonly injured with lower extremity fasciotomy?

A

Superficial peroneal nerve (foot eversion)

66
Q

What nerve is injured after lithotomy position or after crossing legs for long periods or fibula head fracture?

A

Common peroneal nerve; causes footdrop

67
Q

Components of anterior compartment?

A

Anterior tibial artery, deep peroneal nerve

Anterior tibialis, extensor hallucis longus, extensor digitorum longus, communis

68
Q

Components of lateral compartment?

A

Superficial peroneal nerve

Peroneal muscles

69
Q

Components of deep posterior compartment?

A

Posterior tibial artery, peroneal artery, tibial nerve

Flexor hallucis longus, flexor digitorum longus, posterior tibialis

70
Q

Components of superficial posterior compartment?

A

Sural nerve

Gastrocnemius, soleus, plantaris

71
Q

What is the most common compartment affected by compartment syndrome?

A

Anterior compartment of leg (footdrop) after vascular compromise

72
Q

What is the most common organism to cause osteomyelitis?

A

Staph

73
Q

What is idiopathic adolescent scoliosis?

A

In prepubertal females, right thoracic curve most common, usually asymptomtic

74
Q

Treatment for idiopathic adolescent scoliosis?

A

Curves >20-45 degrees: bracing to avoid progression with growth spurts
Curves >45 degrees: spinal fusion

75
Q

What is Osgood-Schlatter disease? Treatment?

A

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

76
Q

What is Legg-Calve-Perthes disease?

A

AVN of femoral head, children 2y and older

Can result from hypercoagulable state, bilateral 10%; present with painful gait limp

77
Q

Xray findings for LCP? Treatment?

A

Flattening of femoral head on xray

Maintain ROM with limited exercise; femoral head will remodel without sequelae

78
Q

What is Slipped capital femoral epiphysis? On imaging? Treatment?

A

Males 10-13y, increased risk of AVN of femoral head, painful gait
Widening and irregularity of epiphyseal plate
Surgical pinning

79
Q

Treatment for congenital dislocation of the hip?

A

Pavlik harness, keeps legs abducted and femoral head reduced in acetabulum

80
Q

Treatment for clubfoot?

A

Serial casting

81
Q

What is the most common bone tumor?

A

Mets (#1 breast, #2 prostate)

82
Q

Treatment for metastatic bone tumors?

A

Internal fixation with impending fracture followed by XRT

83
Q

What is the most common primary malignant tumor of bone?

A

MM

84
Q

Treatment for MM?

A

Chemo for systemic disease; internal fixation for impending fractures

85
Q

What is the most common primary bone sarcoma?

A

Osteogenic sarcoma

86
Q

Xray findings of Osteogenic sarcoma?

A

Codman’s triangle (periosteal retraction)

87
Q

Treatment for osteogenic sarcoma?

A

Limb-sparing resection, XRT and doxorubicin based chemo

88
Q

Treatment of benign bone tumors?

A

Curettage +/- bone graft

89
Q

Treatment for giant cell tumor of bone?

A

Total resection +/- XRT

90
Q

Recurrence risk with giant cell tumor?

A

30%

91
Q

What is spondylolisthesis? Treatment?

A

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

92
Q

What is torus fracture?

A

Buckling of the metaphyseal cortex seen in children (distal radius)

93
Q

Treatment for open fractures?

A

Incision and drainage, abx, fracture stabilization, soft tissue coverage

Fiser's ABSITE Ryan (50 decks)

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