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Ortho > Intro > Flashcards

Intro Flashcards

1
Q

Types of fractures

A
  1. Oblique
  2. comminuted- shattered into 2+ pieces
  3. spiral/torsion
  4. compounded- breaks through skin
  5. Greenstick (incomplete)- one side of bone breaks and the other is bent
  6. transverse- horizontal
  7. simple (n)o surrounding damage
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2
Q

How do you stabilize a long bone fracture

A
  • plate and screws outside the bone

- rod inside in bone

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3
Q

describe the healing of a fracture

A

hematoma and granulation tissue–> cartilaginous callus–> bony callus and cartilaginous remnants (about 6 weeks)–> re-modeling (about 3 months)

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4
Q

Dead bone and fibrous tissue in a nonunion fracture, that prevents new bone formation from occurring

A

Non-union

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5
Q

When can a mal-union fracture be called a non-union fx

A

6 months

*can be seen at 3 months though

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6
Q

Treatment of a non-union tx

A
  • if asymptomatic– nothing
  • if symptomatic- open it up, scrap the bad stuff out, put in bone graph, and secure with nail and the healing process starts over again
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7
Q

Types of fracture displacement include -

A
  1. angulation,
  2. rotation,
  3. change of bone length, and
  4. loss of alignment
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8
Q

For fingers and forearm, directional displacement is described as __ or __, for all other bones __ or __

A

radial or ulnar

medial or lateral

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9
Q

Most displaced fractures result in more than one type of displacement. Displacement combinations:

A
  1. Oblique fracture
  2. Lateral displacement
  3. Shortening
  4. Valgus angulation
  5. Internal rotation
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10
Q

Degrees of angulation can be measured using

A
  1. Appex volar or dorsal angulation, or
  2. medial angulation can be termed ‘varus’, (much worse)
  3. lateral angulation can be termed ‘valgus’.
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11
Q

What should you do with an open fracture/dislocation

A

Orthopaedic emergency!!
1st- check pulse
2nd- check nerve function
3rd- reduce it

*Always document the neurovascular status before AND after reduction!!!!

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12
Q

What type of fracture in a kid should worry you for abuse?

A

femur fracture in kids less than 1 y/o

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13
Q

What do you need to be worry about with compound fractures?

A
  1. Neurovascular injury

2. compartment syndrome (always document if there is a sign of compartment syndrome- in femur and tibia fx especially)

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14
Q

When do you get CTs

A
  1. Good for bone details,
    Ex. Comminuted (tells you how many fragments, how big they are, where are they going)
  2. always get for calcaneus fx
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15
Q

When do you get MRIs

A

primarily for soft tissue, stress fractures, and bone infection

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16
Q

What do T2 and T1 MRIs highlight?

A

T2= H20, is white= get for herniation

T1= bone is white= get for osteomylitis

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17
Q

When are bone scans helpful?

A

*abnormalities in bone which are triggering the bone’s attempts to heal

  1. CA
  2. stress fracture
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18
Q

When do you order a PET

A
  1. CA
  2. check blood flow
  3. see how organs are working

-takes glucose as your tracer bc all cells need sugar to survive

**NEVER ORDER A PET SCAN FOR SCREENING

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19
Q

When are U/s order

A

tendon ruptures

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20
Q

When is a DEXA scan ordered

A

(bone density scan)

osteoporosis

21
Q

describe the HPI for an orho injury

A

PQRST

  1. Location and if possible “pin-point location”
  2. Pain: palliative, provocative (What makes the pain worse or better)
  3. Q: quality (sharp, dull, stabbing pain)
  4. R: radiation
  5. S: severity (1-10, or mild. Mod etc.)
  6. T: Time of injury, duration of symptoms, etc.
  7. What, when, where…
22
Q

How do you perform/document a knee injection

A
  1. Knee prepped in usual sterile fashion with betadine
  2. Use A mixture of 5cc of 1% Xylocaine without epinephrine and 4cc of 0.25 % Marcaine without epinephrine, with 1cc of Kenalog 40mg/cc injected intra-articularly using the superior-lateral approach.
  3. bandaid placed
  4. give handout about signs/sx of allergic rxn, infection and complications
  5. use ice, rest, NSAIDS prn for comfort

*always document consent as well

23
Q

How do you perform/document a knee aspiration

A
  1. Skin prepped with Betadine
  2. injected with 1% Lidocaine without epinephrine subcutaneously followed by joint aspiration using the superior-lateral approach. Aspiration of ___cc of clear, yellowish fluid with a positive string test.
  3. Plan to send synovial fluid for Gram Stain with cultures / sensitivities, WBC cell count (purple top tube) and crystals.

*always document consent as well

24
Q

Treatment of open fractures

A
  1. Decreased infection rate if diagnosed accurately and with formal Incision and Drainage surgery as soon as possible.
  2. Broad spectrum IV antibiotics ASAP
  3. Skeletal stabilization with splints or with external fixation.
  4. Wound vac for large soft tissue defect if indicated.
25
Q

Clues to an open fracture

A
  1. non-weight baring
  2. a lot of pain
  3. looks deformed
  4. blood out of a small opening with shiny stuff on blood = bone marrow

*open fracture until proven otherwise–> need Abx, wash out

26
Q

Describe the different classes of open fractures according to the Gustilo, Mendoza and Williams Classification

A 
I: wound less than 1cm, low energy
II: wound less than 10cm, moderate energy
III: wound over 10cm, high energy
IIIA: adequate tissue coverage
IIIB: massive contamination
IIIC: vascular injury
27
Q

Tx of Grade I, II and III open fractures

A

I: IV 1st generation cephalosporins
II: IV 1st generation ceph and Gentamycin
III: above and consider anaerobic antibotics (pcn, clindamycin, flagyl) AND 3+ needs surgery right away w/in 6 hrs

*Unless you have had a tetanus booster within 5 years of the injury, you will also be given a tetanus shot

28
Q

External fixation of an open fracture is often initial tx secondary to

A

soft tissue injury or possible infection

**Keep it nice and tight so you can fix it later (allow soft tissue to go down)

29
Q

When do you use a wound vacuum?

A
  1. Wound is not bleeding but is oozing–> put a wound vacuum on a LOW pressure so it doesn’t suck up granulation or clot
  2. Good for deep infections and transport
30
Q

How do you dx compartment syndrome

A

Pressure 30 or greater mm Hg(intra-compartment pressure) or 20 units of Hg discrepancy in diastolic BP between the two extremities.

*Use a Stryker needle into the compartment to measure the compartment pressure

31
Q

Compartment syndrome commonly follows major traumas such as:

A
  1. gun shot wounds (GSW)
  2. crush injuries (foot, leg, hand)
  3. long bone fractures (tibia, femur, forearm)
  4. dislocations (foot, knee, wrist)
  5. bites (animal or human)
  6. pediatric distal humerus fracture
  7. Third degree burns
32
Q

5 P’s of compartment syndrome

A

signs and sx

  1. PAIN out of proportion
  2. Pallor
  3. paralysis
  4. Paresthesias
  5. Pulseless (big trouble if this)
33
Q

tx of compartment syndrome

A

The only effective treatment is fasciotomy

34
Q

Signs/Sx of Cauda Equina Syndrome

A
  1. Pain and Weakness
  2. Saddle parasthesias (usually early)
  3. Paralysis
  4. Bowel/Bladder dysfunction (overflow bladder incontinence and loss of bowel control)–no anal tone w/ rectal exam
  5. Absence or diminished Deep Tendon Reflexes
35
Q

tx of Cauda Equina Syndrome

A
  1. emergent MRI

2. emergent surgical decompression

36
Q

How do you dx septic arthritis

A
  1. joint aspiration w/ synovial fluid labs w/ WBC (usually infected if over 50K and over over 100K), gram stain, cultures, and crystals
  2. Young adults rule out N. gonorrhea
37
Q

Presents: pt holding extremity in position of comfort and with severe pain with range of motion.

A

septic arthritis

38
Q

adverse outcome of septic arthritis

A
  1. cartilage damage w/ possible length discrepancy (physeal arrest) in children
  2. sepsis
  3. death
39
Q

tx of septic arthritis

A
  1. Incision and drainage
  2. irrigation
  3. Abx
40
Q

Morning stiffness and pain, joint effusion and hypertrophy of DIPJs (Heberden’s nodes) are common

A

OA

41
Q

Bouchard’s nodes of PIPJs and ulnar deviation of MCPJs

A

RA

42
Q

how do you dx RA

A

Labs:

  1. RF (+ in 80% of cases)
  2. Anti-citrulline Ab ANA
  3. HLA
  4. ESR, CRP
43
Q

What are the following nodules associated with?

  1. Heberden’s Nodules
  2. Bouchard’s ndoules of PIPJs
  3. Gouty nodules
A
  1. Heberden’s Nodules: OA
  2. Bouchard’s ndoules of PIPJs: RA
  3. Gouty nodules: gout
44
Q

Crystalline Deposition Diseases

A
  1. Gout
  2. Pseudo-gout
  3. Calcium Pyrophosphate Deposition Dz
45
Q
  • Crystals in the synovium and other tissues with subsequent inflammatory response.
  • Abrupt episodes of severe joint pain with usually a single joint involvement
A

Crystalline Deposition Diseases (Gout / Pseudo-gout / Calcium Pyrophosphate Deposition Dz.)

46
Q

A definitive diagnosis of gout is based upon the identification of

A

monosodium urate (MSU) crystals in synovial fluid or a tophus

47
Q

great toe erythema and swelling with severe pain even to light touch.

A

Podagra

*it is the first presentation of gout in 50% of new cases

48
Q

Calcium pyrophosphate deposition disease (CPPD), aka pseudogout, consists of the deposition of ___ crystals into soft tissue

A

calcium pyrophosphate crystals

Ortho (6 decks)

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