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1-KWPEM > KW ORTHO COMP > Flashcards

KW ORTHO COMP Flashcards

1
Q

COMMON INJURY PATTERNS: Outstretched hand? 4

A
  1. scaphoid
  2. radial head,
  3. wrist,
  4. proximal humerus
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2
Q

COMMON INJURY PATTERN: Fall off roof? 3

A
  1. os calcis,
  2. tibial plateau,
  3. TL compression Fx
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3
Q

FRACTURE DESCRIPTION…..get your book out before calling ortho 6

A
  1. Name of the injured bone
  2. Location (dorsal, volar – epiphysis, metaphysis, diaphysis)
    - Diaphyseal: proximal, middle, or distal third
  3. Orientation of the fracture (transverse, oblique, spiral)
  4. Also: angulated, comminuted, segmental, intra-articular, displaced, compression, and impaction
  5. Condition of overlying tissues (open or closed) 1 puncture; 2 laceration with mod ST injury 3 grossly contaminated
  6. Some fractures have unique names -Supracondylar, Colles, Boxer’s,
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4
Q

FACTORS THAT EFFECT TREATMENT 6

A
  1. Open or closed injury Nature and severity of the fracture
  2. Energy involved - Stable or unstable
  3. Is the position acceptable
  4. Is the joint involved
  5. Possible neuro-vascular injuries/complications -N/V issues and compartment syndromes
  6. Age, health, demands of the patient
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5
Q

COMPLICATIONS OF FRACTURES 6

A
  1. Pelvic and femoral fractures can have significant blood loss
  2. Injuries to other structures: Nerves/vessels, especially at knee & elbow
  3. Acute compartment syndromes
  4. Increased risk of venous thrombosis with major trauma
  5. Fat embolism syndrome
  6. Complex regional pain syndromes (sympathetic dystrophy)
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6
Q

COMPLICATIONS OF FRACTURES: Late signs? 3

A

Late:

  • osteomyelitis,
  • non/mal-union,
  • post-traumatic arthritis
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7
Q

PRINCIPLES OF TREATMENT Acute stabilization? 4

A

Acute stabilization

  1. Evaluate the patient
  2. Immobilize the Fx – usually splinting
  3. Provide analgesia: ice, elevation, immobilization, pain meds
  4. Decide on definitive treatment
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8
Q
  1. Casting is the tx of choice for what? 3
  2. What kinds? and what are their advantages?
  3. May splint initially: use what for forearm and wrist? What for ankle?
  4. What are diaphyseal Fxs?
  5. Complications? 5
A
  1. Rx of choice for undisplaced, stable, and some reduced Fx’s
  2. Plaster of Paris or fiberglass
    - Plaster easier to mold
    - Fiberglass more durable
  3. May splint initially – safer than a cast in acute setting
    - Volar splint forearm and wrist
    - Sugar tong splint for ankle
  4. Diaphyseal Fx’s: include joints above and below the fracture
  5. Complications include:
    - pressure sores,
    - N/V compromise,
    - compartment syndrome,
    - disuse atrophy,
    - joint stiffness
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9
Q

Clavicular fractures

  1. Most are where?
  2. What kind of splint?
  3. Which fractures may need surgery? 3
  4. In which ages are the majority of fractures displaced?
A
  1. Most (70%) are mid-shaft fractures
  2. Stable injuries… sling or figure of 8 splint

3.

  • Displaced,
  • angulated
  • over riding fracture may need surgery
    3. In children, 90% in the middle third
  • less than age 10, majority are non-displaced,
  • > age 10, majority are displaced
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10
Q

CLAVICULAR FRACTURES

  1. Distal third behave how?
  2. Tx for undisplaced?
  3. Otherwise?
  4. Proximal third beware of what?
  5. Commonly caused by?
A
  1. Distal third – behave like AC separations

2.

  • Undisplaced, conservative treatment
    3. Otherwise, may need surgical repair
    4. Proximal third – rare, beware internal injuries
    5. High energy injury
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11
Q

DISTAL FOREARM FRACTURES IN CHILDREN

  1. Need ortho referral if? 4
  2. Stable tx with?
A
  1. Need orthopedic referral if there is
    - N/V compromise,
    - open fracture,
    - gross deformity
    - displaced Salter Fx
  2. Stable Fx’s may be treated with casts or braces
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12
Q

Metacarpal fractures

  1. Usually due to?
  2. Tx depends on? 3
  3. Usually what is injured and how is it treated?
A
  1. Usually due to direct trauma (punching a wall)…..happens all the time!
  2. Treatment depends on
    - displacement,
    - angulation,
    - rotation
  3. Can accept significant angulation of 5th metacarpal (Boxer’s)
    - Can be treated with off the shelf brace or taping of fingers
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13
Q

For base of thumb fx what do you need to test?

A

Need to test stability – determines treatment

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14
Q

PELVIC FRACTURES

  1. Prognosis?
  2. Beware of what?
A
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15
Q

FOOT FRACTURES

  1. Need what Xrays? 3
  2. Beware of mid and hind foot fractures. Why?
  3. Palpate what? why?
  4. Most forefoot fractures can be treated conservatively. With? 4
A
  1. Need AP, lateral, and oblique x-rays
  2. Beware of mid and hind foot fractures: Severity of injury can be hard to see on x-rays
  3. Palpate tarsal-metatarsal joints, occult injuries
  4. Most forefoot fractures can be treated conservatively
    - Short leg walking cast or walking boot
    - First metatarsal Fx’s require extra vigilance
    - Stable toe Fx can be simply taped
    - Displaced, unstable toe Fx’s may need pinning
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16
Q

Stress Fractures

  1. Most respond to what?
  2. Beware stress fractures where? 3
  3. What in an endurance athlete must be fully evaluated?
A
  1. decreased activity and immobilization
  2. in
    - spine,
    - hip
    - tarsal navicular
  3. Aching groin pain
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17
Q

FRACTURES AND CHILD ABUSE

  1. Fracture patterns suggestive of inflicted trauma? 5
  2. What would you do to find occult lesions? 2
  3. What are you required to do?
A
  1. Fracture patterns suggestive of inflicted trauma
    - Metaphyseal corner fractures
    - Fractures of ribs, sternum, scapula, spinous processes
    - Multiple fractures in various stages of healing
    - Bilateral acute long-bone fractures
    - Skull fractures in children younger than 18 months
  2. Skeletal survey or bone scan to find occult lesions
  3. Legally required to notify child protective services
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18
Q

What is this?

What is it indicative of?

A

1.

METAPHSEAL CORNER FX’s

  1. Child abuse
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19
Q

What does this show?

A

FRESH CONDYLAR FX

OLD RADIAL FX’s

Child abuse

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20
Q

What are the Kocher criteria?
Hint = just a FEWw Kocher criteria

A

1) non-weight bearing status on the affected side
2) ESR >40
3) fever
4) WBC >12

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21
Q 
What are the probabilities of a septic joint with the following Kocher criteria?
1/4
2/4
3/4
4/4
A

1/4: 3%
2/4: 40%
3/4: 93%
4/4: 99%

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22
Q

What is Sever’s disease?

A

Calcaneus apophysitis

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23
Q

How do you treat kingella kingae osteomyelitis?

A

Clindamycin

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24
Q

In the symptomatic patient, classic history will include a child or adolescent athlete playing a sport that requires repetitive lumbar extension and rotation. The onset of pain may be either acute or insidious over several weeks. Patients will report their low back pain increases with strenuous activity or hyperextension and improves with relative rest. Pain typically remains located in the low back with occasional radiation to the buttock and/or proximal lower extremities, while neurologic symptoms such as numbness/tingling in the lower extremities are uncommon.

A

spondylolysis

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25
Q

What is spondylolysis?

A

Pars interarticularis defect

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26
Q

What is spondylolisthesis?

A

L5-S1 anterior displacement

27
Q

What should you consider with a limp, sub-acute non-focal back pain, refusal to walk, difficulty sitting upright and perhaps hip pain?

A

Discitis!

28
Q

What is the name of traction apophisitis at the inferior pole of the patella at the infrapatellar tendon?

A

Larsen-Johansson disease

29
Q

How do you diagnose developmental hip dysplasia?

A

U/S if <4 months, x-rays thereafter

abnormal abduction, abnormal skin folds, limb length discrepancy

30
Q

What is the first line antibiotic of choice for septic arthritis?
What are the top three bugs?

A

Cefazolin! In the US: clindamycin (MRSA)

S. aureus
Kingella kingae
S. pyogenes (GAS)

31
Q

What do you call an abscess in the deep space of the finger?

A

Felon

32
Q

What do you call an osteonecrosis of the subchondral bone secondary to overuse?
How do you manage it?

A

osteochondritis dissecans

start with restricted activity
then immobilization and non-WB
then laparascopic repair unstable joint or free floating bone

33
Q

How do you treat Lyme arthritis?

A

Doxycycline po x 1 month

34
Q

If you spot a bony tumour and cortical destruction, how should you manage?

A

Do not weight bear!

Refer to orthopedics

35
Q

What is the line to interpret a cervical pseudosubluxation?

A

the line of Swishuk!
used to distinguish between C2-C3 pseudosubluxation VS Hangman’s fracture
If the delta is >2mm then it is abnormal!

36
Q

What is a Monteggia injury?

A

ulnar fracture with radial head dislocation

37
Q

What is a Galeazzi fracture?

A

radial fracture with ulnar head dislocation

38
Q

What is the Ottawa ankle rule?

A

An ankle X-Ray series is only required if there is any pain in the malleolar zone and…
Bone tenderness at the posterior edge or tip of the lateral malleolus (A)
OR
Bone tenderness at the posterior edge or tip of the medial malleolus (B)
OR
An inability to bear weight both immediately and in the emergency department for four steps

39
Q

What is the Ottawa foot rule?

A

A foot X-Ray series is only required if there is any pain the midfoot zone and…
Bone tenderness at the base of the fifth metatarsal (C)
OR
Bone tenderness at the navicular (D)
OR
And inability to bear weight both immediately and in the emergency department for four steps

40
Q

What are two possible injury complications of a shoulder dislocation?

A

Hill Sachs deformity: compression fracture of the posterolateral humerus
Bankhart lesion: detached antero-inferior part of the labrum from the glenoid

41
Q

What are potential complications of an acute patellar dislocation?

A

osteochondral fracture of the femoral condyles or tibial plateau (best seen on MRI)

42
Q

What distinguishes a greenstick from a torus fracture?

A

greenstick: only one side of the cortex is broken
torus: buckle fracture, cortex intact

43
Q

What distinguishes a Tillaux fracture from a Triplane fracture?

A

The lack of a fracture component in the coronal plane (evaluated with lateral x-ray or CT) distinguishes a Tillaux fracture from a triplanar fracture.

44
Q

COMMON INJURY PATTERNS: Outstretched hand? 4

A
  1. scaphoid
  2. radial head,
  3. wrist,
  4. proximal humerus
45
Q

COMMON INJURY PATTERN: Fall off roof? 3

A
  1. os calcis,
  2. tibial plateau,
  3. TL compression Fx
46
Q

FRACTURE DESCRIPTION…..get your book out before calling ortho 6

A
  1. Name of the injured bone
  2. Location (dorsal, volar – epiphysis, metaphysis, diaphysis)
    - Diaphyseal: proximal, middle, or distal third
  3. Orientation of the fracture (transverse, oblique, spiral)
  4. Also: angulated, comminuted, segmental, intra-articular, displaced, compression, and impaction
  5. Condition of overlying tissues (open or closed) 1 puncture; 2 laceration with mod ST injury 3 grossly contaminated
  6. Some fractures have unique names -Supracondylar, Colles, Boxer’s,
47
Q

FACTORS THAT EFFECT TREATMENT 6

A
  1. Open or closed injury Nature and severity of the fracture
  2. Energy involved - Stable or unstable
  3. Is the position acceptable
  4. Is the joint involved
  5. Possible neuro-vascular injuries/complications -N/V issues and compartment syndromes
  6. Age, health, demands of the patient
48
Q

COMPLICATIONS OF FRACTURES 6

A
  1. Pelvic and femoral fractures can have significant blood loss
  2. Injuries to other structures: Nerves/vessels, especially at knee & elbow
  3. Acute compartment syndromes
  4. Increased risk of venous thrombosis with major trauma
  5. Fat embolism syndrome
  6. Complex regional pain syndromes (sympathetic dystrophy)
49
Q

COMPLICATIONS OF FRACTURES: Late signs? 3

A

Late:

  • osteomyelitis,
  • non/mal-union,
  • post-traumatic arthritis
50
Q

PRINCIPLES OF TREATMENT Acute stabilization? 4

A

Acute stabilization

  1. Evaluate the patient
  2. Immobilize the Fx – usually splinting
  3. Provide analgesia: ice, elevation, immobilization, pain meds
  4. Decide on definitive treatment
51
Q
  1. Casting is the tx of choice for what? 3
  2. What kinds? and what are their advantages?
  3. May splint initially: use what for forearm and wrist? What for ankle?
  4. What are diaphyseal Fxs?
  5. Complications? 5
A
  1. Rx of choice for undisplaced, stable, and some reduced Fx’s
  2. Plaster of Paris or fiberglass
    - Plaster easier to mold
    - Fiberglass more durable
  3. May splint initially – safer than a cast in acute setting
    - Volar splint forearm and wrist
    - Sugar tong splint for ankle
  4. Diaphyseal Fx’s: include joints above and below the fracture
  5. Complications include:
    - pressure sores,
    - N/V compromise,
    - compartment syndrome,
    - disuse atrophy,
    - joint stiffness
52
Q

Clavicular fractures

  1. Most are where?
  2. What kind of splint?
  3. Which fractures may need surgery? 3
  4. In which ages are the majority of fractures displaced?
A
  1. Most (70%) are mid-shaft fractures
  2. Stable injuries… sling or figure of 8 splint

3.

  • Displaced,
  • angulated
  • over riding fracture may need surgery
    3. In children, 90% in the middle third
  • less than age 10, majority are non-displaced,
  • > age 10, majority are displaced
53
Q

CLAVICULAR FRACTURES

  1. Distal third behave how?
  2. Tx for undisplaced?
  3. Otherwise?
  4. Proximal third beware of what?
  5. Commonly caused by?
A
  1. Distal third – behave like AC separations

2.

  • Undisplaced, conservative treatment
    3. Otherwise, may need surgical repair
    4. Proximal third – rare, beware internal injuries
    5. High energy injury
54
Q

DISTAL FOREARM FRACTURES IN CHILDREN

  1. Need ortho referral if? 4
  2. Stable tx with?
A
  1. Need orthopedic referral if there is
    - N/V compromise,
    - open fracture,
    - gross deformity
    - displaced Salter Fx
  2. Stable Fx’s may be treated with casts or braces
55
Q

COLLE’S FRACTURES

  1. Incidence increases with?
  2. Where is displacement and angulation?
  3. Injured how?
  4. Tx?
A
56
Q

Metacarpal fractures

  1. Usually due to?
  2. Tx depends on? 3
  3. Usually what is injured and how is it treated?
A
  1. Usually due to direct trauma (punching a wall)…..happens all the time!
  2. Treatment depends on
    - displacement,
    - angulation,
    - rotation
  3. Can accept significant angulation of 5th metacarpal (Boxer’s)
    - Can be treated with off the shelf brace or taping of fingers
57
Q

For base of thumb fx what do you need to test?

A

Need to test stability – determines treatment

58
Q

PELVIC FRACTURES

  1. Prognosis?
  2. Beware of what?
A
59
Q

FEMORAL NECK FRACTURES

  1. Positioning of the leg?
  2. Pain where?
  3. high complications rate why?
  4. Whats usually better: pinning or replacement?
A
  1. Shortening and external rotation of leg –
  2. groin pain
  3. Interrupt blood supply, high complication rate
  4. Replacement often better than pinning
60
Q

FOOT FRACTURES

  1. Need what Xrays? 3
  2. Beware of mid and hind foot fractures. Why?
  3. Palpate what? why?
  4. Most forefoot fractures can be treated conservatively. With? 4
A
  1. Need AP, lateral, and oblique x-rays
  2. Beware of mid and hind foot fractures: Severity of injury can be hard to see on x-rays
  3. Palpate tarsal-metatarsal joints, occult injuries
  4. Most forefoot fractures can be treated conservatively
    - Short leg walking cast or walking boot
    - First metatarsal Fx’s require extra vigilance
    - Stable toe Fx can be simply taped
    - Displaced, unstable toe Fx’s may need pinning
61
Q

Stress Fractures

  1. Most respond to what?
  2. Beware stress fractures where? 3
  3. What in an endurance athlete must be fully evaluated?
A
  1. decreased activity and immobilization
  2. in
    - spine,
    - hip
    - tarsal navicular
  3. Aching groin pain
62
Q

FRACTURES AND CHILD ABUSE

  1. Fracture patterns suggestive of inflicted trauma? 5
  2. What would you do to find occult lesions? 2
  3. What are you required to do?
A
  1. Fracture patterns suggestive of inflicted trauma
    - Metaphyseal corner fractures
    - Fractures of ribs, sternum, scapula, spinous processes
    - Multiple fractures in various stages of healing
    - Bilateral acute long-bone fractures
    - Skull fractures in children younger than 18 months
  2. Skeletal survey or bone scan to find occult lesions
  3. Legally required to notify child protective services
63
Q

What is this?

What is it indicative of?

A

1.

METAPHSEAL CORNER FX’s

  1. Child abuse
64
Q

What does this show?

A

FRESH CONDYLAR FX

OLD RADIAL FX’s

Child abuse

1-KWPEM (20 decks)

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