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ABSITE 2019-RM > chapter 42: orthopedics > Flashcards

chapter 42: orthopedics Flashcards

1
Q

synthesize non mineralized bone cortex

A

osteoblasts

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2
Q

reabsorb bone

A

osteoclasts

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3
Q

stages of healing

A

1) inflammation
2) soft callus formation
3) mineralization of the callus
4) remodeling of the callus

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4
Q

receives nutrients from synovial fluid (osmotic)

A

cartilage

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5
Q

fractures: cross the epiphyseal plate and can affect the growth plate of the bone; need ORIF

A

Salter-Harris fractures 3, 4, and 5

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6
Q

fractures: closed reduction

A

Salter-Harris fractures 1 and 2

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7
Q

epiphysiolysis of the involved growth plate without associated fracture

A

salter-harris type 1 fracture

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8
Q

epiphysiolysis of the involved growth plate without associated fracture; additional metaphysical fracture fragment

A

salter-harris type 2 fracture

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9
Q

salter harris fracture: good prognosis and are usually treated with closed reduction and casting

A

type 1 and 2 fractures

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10
Q

injury results in a fracture through the growth plate and epiphysis

A

type 3 fracture

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11
Q

fracture cross the epiphysis, growth plate (physis), and metaphysis

A

type 4 fracture

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12
Q

injuries require careful ORIF if displaced

A

type 3 and 4 fractures

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13
Q

involves a crush of the growth plate without a fracture and is usually detected late by asymmetric or premature closure of the growth plate

A

type 5 injury

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14
Q

fractures associated with avascular necrosis (AVN)

A

scaphoid, femoral neck, talus

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15
Q

fractures associated with nonunion

A

clavicle, 5th metatarsal fracture (Jones’ fracture)

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16
Q

fractures associated with compartment syndrome

A

supracondylar humerus, tibia

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17
Q

biggest risk factor for nonunion

A

smoking

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18
Q

LE nerve: hip adduction

A

obturator nerve

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19
Q

LE nerve: hip abduction

A

superior gluteal nerve

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20
Q

LE nerve: hip extension

A

inferior gluteal nerve

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21
Q

LE nerve: knee extension

A

femoral nerve

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22
Q

presents with back pain, sciatica
herniated nucleous pulposus
nerve root compression affects 1 nerve root below disc

A

lumbar disc herniation

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23
Q

Lumbar disc herniation: weak hip flexion

A

L3 nerve compression (L2-3 disc)

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24
Q

Lumbar disc herniation: weak knee extension (quadriceps), weak patellar reflex

A

L4 nerve compression (L3-4 disc)

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25
Q

Lumbar disc herniation: weak dorsiflexion (foot drop), decreased sensation in big toe web space

A

L5 nerve compression (L4-5 disc)

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26
Q

Lumbar disc herniation: weak plantar flexion, weak Achilles reflex, decreased sensation in lateral foot

A

S1 nerve compression (L5-S1 disc)

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27
Q

dx: lumbar disc herniation

A

patients with neurologic findings need MRI

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28
Q

tx: lumbar disc herniation

A

NSAIDs, heat, and rest; surgery for substantial / progressive neurologic deficit, refractory cases, severe sciatica, or disc fragments that have herniated into the cord

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29
Q

motor: intrinsic musculature of hand (palmar interpose, palmar brevis, adductor pollicis, and hypothenar eminence); finger abduction (spread fingers); wrist flexion
sensory: all of 5th and 1/2 4th fingers, back of hand

A

ulnar nerve

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30
Q

injury results in claw hand

A

ulnar nerve

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31
Q
  • motor: thumb apposition (anterior interosseous muscle, OK sign); finger flexors
  • sensory: most of palm and 1st 3 and 1/2 4th fingers on palmar side
A

median nerve

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32
Q

nerve involved in carpal tunnel syndrome

A

median nerve

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33
Q
  • motor: wrist extension, finger extension, thumb extension, and triceps; no hand muscles
  • sensory: 1st 3 and 1/2 4th fingers on dorsal side
A

radial nerve

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34
Q

motor to deltoid (abduction)

A

axillary enrve

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35
Q

motor to biceps, brachialis, and coracobrachialis

A

musculocutaneous nerve

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36
Q

cervical radiculopathy: neck and scalp pain

A

C1, C2, C3 and C4 nerve compression (C1-2, C2-3, C3-4 discs)

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37
Q

cervical radiculopathy: weak deltoid and biceps

- weak biceps reflex

A

C5 nerve compression (C4-5 disc)

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38
Q

cervical radiculopathy: weak deltoid and biceps, weak wrist extensors
- weak biceps reflex and brachioradialis reflex

A

C6 nerve compression (C5-6 disc)

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39
Q

cervical radiculopathy: weak triceps

- weak triceps reflex

A

C7 nerve compression (most common, C6-7 disc)

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40
Q

cervical radiculopathy: weak triceps, weak intrinsic muscles of hand and wrist flexion
- weak triceps reflex

A

C8 nerve compression (C7-T1 disc)

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41
Q

radial nerve

A

C5-8

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42
Q

median nerve

A

C6-T1

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43
Q

ulnar nerve

A

C8-T1

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44
Q

musculocutaneous nerve

A

C5-7

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45
Q

axillary nerve

A

C5-6

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46
Q

on the superior portion of the brachial plexus

A

radial nerve roots

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47
Q

on the inferior portion of the brachial plexus

A

ulnar nerve roots

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48
Q

tx: clavicle fracture

A

usually just treated with sling (risk of vascular impingement)

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49
Q

shoulder dislocation: risk of axillary nerve injury

- tx?

A

anterior (90%) - tx: closed reduction

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50
Q

should dislocation: risk of axillary artery injury

- tx?

A

posterior (seizures, electrocution)

- tx: closed reduction

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51
Q

tx: acromioclavicular separation

A

sling (risk of brachial plexus and subclavian vessel injury)

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52
Q

tx: scapula fracture

A

sling unless gleaned fossa involved, then need internal fixation

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53
Q

tx: midshaft humeral fracture

A

sling for almost all

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54
Q

tx: adults - supracondylar humeral fracture

A

ORIF

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55
Q

tx: children - supracondylar humeral fracture

A

nondisplaced -> closed reduction; displaced -> ORIF

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56
Q

proximal ulnar fracture and radial head dislocation

- tx: ORIF

A

monteggia fracture

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57
Q

fall on outstretched hand, distal radius

- tx: closed reduction

A

colles fracture

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58
Q

subluxation of the radius at the elbow caused by pulling on an extended, pronated arm
- tx: closed reduction

A

nursemaid’s elbow

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59
Q

adults: combined radial and ulnar fracture

A

ORIF

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60
Q

children: combined radial and ulnar fracture

A

closed reduction

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61
Q

snuffbox tenderness; can have negative XR

A

scaphoid fracture

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62
Q

tx: scaphoid fracture

A

all patients require cast to elbow, may need fixation; risk of avascular necrosis

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63
Q

supracondylar humerus fracture -> occluded anterior interosseous artery -> closed reduction of humerus -> artery opens up -> reperfusion injury, edema, and forearm compartment syndrome (flexor compartment most affected)

A

volkmann’s contracture

64
Q

symptoms: forearm pain with passive extension; weakness, tense forearm, hypesthesia

A

volkmann’s contracture

65
Q

what nerve is most affect by swelling in volkmann’s contracture?

A

median nerve

66
Q

tx: volkmann’s contracture

A

forearm fasciotomies

67
Q

management: forearm fasciotomies

A

need to open volar and dorsal compartments

68
Q
  • associated with diabetes, ETOH
  • progressive proliferation of the palmar fascia of hand results in contractures that usually affect the 4th and 5th digits (cannot extend fingers)
A

dupuytren’s contracture

69
Q

tx: dupuytren’s contracture

A

NSAIDs, steroid injections; excision of involved fascia for significant contraction

70
Q

median nerve compression by transverse carpal ligament

A

carpal tunnel syndrome

71
Q

tx: carpal tunnel syndrome

A

splint, NSAIDs, and steroid injection; transverse carpal ligament release if that fails

72
Q

tenosynovitis of the flexor tendon that catches at the MCP joint when trying to extend finger

A

trigger finger

73
Q

tx: trigger finger

A

splint, tendon sheath steroid injections (not the tendon itself); if that fails, can release the pulley system at the MCP joint

74
Q

infection that spreads along flexor tendon sheaths of digits (can destroy sheath)

A

suppurative tenosynovitis

75
Q

tendon sheath tenderness
pain with passive motion
swelling along sheet
semi-flexed posture of the involved digit

A

4 classic signs of suppurative tenosynovitis

76
Q

tx: suppurative tenosynovitis

A

midaxial longitudinal incision and drainage

77
Q

rotator cuff tears: what are the muscles?

A

supraspinatus
infraspinatus
teres minor
subscapularis

78
Q

tx: acutely for rotator cuff tears

A

sling and conservative treatment

79
Q

when do you consider surgical repair for rotator cuff tears?

A

surgical repair if the patient needs to retain a high level of activity or if ADL affected

80
Q

infection under nail bed; painful

- tx: antibiotics; remove nail if purulent

A

paronychia

81
Q

infection in the terminal joint space of the finger
- tx: incision over the tip of the finger and along the medial and lateral aspects to prevent necrosis of the tip of the finger

82
Q

patients have internal rotation and adduction of leg;

  • risk of sciatic nerve injury
  • tx?
A

posterior hip dislocation (90%)

- tx: closed reduction

83
Q

patients have external rotation and abduction of leg; risk of injury to femoral artery
- tx?

A

anterior hip dislocation

- tx: closed reduction

84
Q

tx: isolated anterior ring with minimal ischial displacement

A

weight bearing as tolerated

85
Q

tx: femoral shaft fracture

A

ORIF with intramedullary rod

86
Q

tx: femoral neck fracture

A

ORIF -> risk of avascular necrosis if open reduction delayed

87
Q

what structures are at risk in lateral knee trauma?

A

can result in injury to ACL, PCL, and medial meniscus

88
Q

positive anterior drawer test

- present with knee effusion and pain with pivoting action; MRI confirms diagnosis

A

anterior cruciate ligament injury

89
Q

tx: anterior cruciate ligament injury

A

surgery with knee instability (reconstruction with patellar tendon or hamstring tendon); otherwise physical therapy with leg-strengthening exercise

90
Q

positive posterior drawer test

- much less common than ACL injury; present with knee pain and joint effusion

A

posterior cruciate ligament injury

91
Q

tx: posterior cruciate ligament injury

A

conservative therapy initially; surgery for failure of medical management

92
Q

collateral ligament: lateral blow to knee

A

medical collateral ligament injury

93
Q

collateral ligament: medial blow to knee

A

lateral collateral ligament injury

94
Q

tx: collateral ligament

A

tx -
small tear: brace
large tear: surgery

95
Q

what are collateral ligaments associated with?

A

these injuries are associated with injuries to the corresponding meniscus

96
Q

joint line tenderness; can treat with arthroscopic repair or debridement

A

meniscus tears

97
Q

what do you need to rule out in posterior knee dislocation?

A

all patients need angiogram to rule out popliteal artery injury

98
Q

tx: patellar fracture

A

long leg cast unless comminuted, then need internal fixation

99
Q

tx: tibial plateau fracture and tibia-fibula fracture

A

ORIF fixation unless open, then need external fixator until tissue heals

100
Q

pain and mass below popliteal fossa (contracted planters) and ankle ecchymosis

A

plantaris muscle rupture

101
Q

tx: ankle fracture

A

most treated with cast and immobilization; bimalleolar or trimalleolar fractures need ORGI

102
Q

tx: metatarsal fracture

A

cast immobilization or brace for 6 weeks

103
Q

tx: calcaneus fracture

A

cast and immobilization if non displaced; ORIF for displacement

104
Q

tx: talus fracture

A

closed reduction for most; ORIF for severe displacement

105
Q

nerve most commonly injured with lower extremity fasciotomy

A

superficial peroneal nerve (foot eversion)

106
Q

nerve: foot drop after lithotomy position or after crossing legs for long periods or fibula head fracture

A

common perennial nerve (foot-drop)

107
Q

components of anterior leg compartment

A

anterior tibilal artery, deep peroneal nerve

- muscles: anterior tibialis, extensor hallucis longus, extensor digitorum longus, and communis

108
Q

components of lateral leg compartment

A

superficial peroneal nerve

- muscles: peroneal muscles

109
Q

components of deep posterior leg compartment

A

posterior tibial artery, peroneal artery, and tibial nerve

- muscles: flexor hallucis longus, flexor digitorum longus, posterior tibilais

110
Q

components of superficial leg compartment

A

sural nerve

- muscles: gastrocnemius, soleus, plantaris

111
Q

what are the four compartments of the leg?

A

anterior, lateral, deep posterior, superficial posterior

112
Q

most likely to occur in the anterior compartment of the leg (get foot drop) after vascular compromise, restoration of blood flow, and subsequent repercussion injury with swelling of the leg compartment

A

compartment syndrome

113
Q

can occur from crush injuries

- symptoms: pain with passive motion; swollen extremity

A

compartment syndrome

114
Q

what is the last thing to go in compartment syndrome

A

distal pusles can be present with compartment syndrome -> last thing to go

115
Q

abnormal pressures in compartment syndrome

A

pressure > 20-30mmHg

116
Q

dx: compartment syndrome

A

based on clinical suspicion

117
Q

tx: compartment syndrome

A

fasciotomy

118
Q

can occur in metaphysis of long bones in children; most commonly staph
- symptoms: pain, decreased use of extremity

A

osteomyelitis

119
Q

dx: osteomyelitis

A

MRI, bone biopsy

120
Q

tx: osteomyelitis

A

incision and drainage; antibiotics

121
Q

prepubertal females, right thoracic curve most common, usually asymptomatic

A

idiopathic adolescent scoliosis

122
Q

tx: idiopathic adolescent scoliosis - curves 20-45 degrees

A

need bracing to slow progression, which can occur with growth spurt

123
Q

tx: idiopathic adolescent scoliosis - curves > 45 degrees or those likely to progress

A

spinal fusion

124
Q

tibial tubercle apophysitis; caused by traction injury from the quadriceps in adolescents aged 13-15; most commonly have pain in front of the knee

A

Osgood-Schlatter disease

125
Q

xr: osgood-schlatter disease

A

irregular shape or fragmenting of the tibial tubercle

126
Q

tx: osgood-schlatter disease

A

mild symptoms -> activity limitation, severe symptoms -> cast 6 weeks followed by activity limitation

127
Q

AVN of the femoral head; children 2 years and older

  • can result form a hyper coagulable state; bilateral in 10%
  • symptoms: painful gait limp
A

Legg-Calve-Perthes disease

128
Q

xr: legg-calve-perthes disease

A

flattening of the femoral head

129
Q

tx: legg-calve-perthes disease

A

maintain range of motion with limited exercise; femoral head will remodel without sequelae

130
Q

when do you consider surgery for legg-calve-perthes disease?

A

surgery if femoral head is not covered by the acetabulum

131
Q

males aged 10-13 ; increased risk of AVN of the femoral head; painful gait

A

slipped capital femoral epiphysis

132
Q

xr: slipped capital femoral epiphysis

A

widening and irregularity of the epiphyseal plate

133
Q

tx: slipped capital femoral epiphysis

A

surgical pinning

134
Q
  • more common in females

- tx: pavlik harness, which keeps the legs abducted and the femoral head reduced in the acetabulum

A

congenital dislocation of the hip

135
Q

tx: clubfoot

A

serial casting

136
Q

MCC bone tumors

A 
most common is metastatic disease
#1 breast
#2 prostate
137
Q

tx: bone tumors secondary to metastatic disease

A

internal fixation with impending fracture (> 50% cortical involvement); followed by XRT

138
Q

most common primary malignant tumor of bone

A

multiple myeloma

139
Q

tx: multiple myeloma

A

chemotherapy for systemic disease; internal fixation for impending fractures

140
Q

tx: pathologic fracture from bone tumors

A

treat with internal fixation

141
Q

management: pathologic fractures from bone tumors

A

XRT can be used for pain relief in patients with painful bony metastases

142
Q

most common primary bone sarcoma, usually around the knee

A

osteogenic sarcoma

143
Q

demographic of osteogenic sarcoma

A

80% in patients

144
Q

xr: osteogenic sarcoma

A

codman’s triangle -> periosteal reaction

145
Q

tx: osteogenic sarcoma

A

limb-sparing resection; XRT and doxorubicin-based chemotherapy can be used preoperatively to increase chance of limb-sparing resection

146
Q

benign bone tumors treated with curettage +/- bone graft

A

osteoid osteoma, endochondroma (may be able to observe), osteochondroma (resection only if cosmetic defect or causing symptoms), chrondoblastoma, non ossifying fibroma (may be observed) and fibrodysplasia

147
Q

tx: giant cell tumor of bone

A

total resection +/- XRT (Benign but 30% risk of recurrence; also has malignant degeneration risk)

148
Q

formed by subluxation or slip of one vertebral body over another

A

spondylolisthesis

149
Q

where does spondylolisthesis most commonly occur?

A

lumbar region

150
Q

most common cause of lumbar pain in adolescents (gymnasts)

A

spondylolisthesis

151
Q

tx: spondylolisthesis

A

depends on degree of subluxation and symptoms - ranges from conservative treatment to surgical fusion

152
Q

tx: cervical stenosis

A

surgical decompression if significant myelopathy present

153
Q

tx: surgical decompression for cases refractory to medical treatment

A

lumbar stenosis

154
Q

tx: torus fracture

A

buckling of the metaphyseal cortex seen in children (i.e. distal radius)

155
Q

tx: open fractures

A

need incision and drainage, antibiotics, fracture stabilization, and soft tissue coverage.

ABSITE 2019-RM (33 decks)

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