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Emergency Medicine > LE Surgery > Flashcards

LE Surgery Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

50% of pelvic fx are a/w _____

A

internal injury

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2
Q

what is a low-energy MOI and population for pelvic fx?

A

falls in elderly

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3
Q

What must be included in H & P with pelvic fx?

A

rectal/genital

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4
Q

Gold standard imaging for pelvic fx

A

CT

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5
Q

Bedside US can be helpful in what pelvic fx patients?

A

blunt trauma

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6
Q

What 4 views on X-Ray for pelvic fx

A

AP, Judet, Inlet, Outlet

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7
Q

MC pattern of pelvic fx…

A

posterior wall fx w/ femoral head dislocation

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8
Q

avulsion fx of pelvis is more common in what population?

A

skeletally immature athletes

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9
Q

Pelvic ring is unstable with how many fx?

A

2

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10
Q

pelvic fx intervention if hemodynamically unstable…

A

pelvic wrapping/binder

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11
Q

conservative tx of pelvic cx…

A

restricted weight bearing

ice

rest

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12
Q

surgical intervention for pelvic fx

A

ORIF/external fixation

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13
Q

major complication of hip dislocation

A

femoral head death

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14
Q

maintain survival of femoral head, reduction of hip dislocation must be performed w/in…

A

6-8 hours

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15
Q

what percent of hip dislocations also have other injuries

A

80-90%

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16
Q

MOI of hip dislocation

A

high energy trauma

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17
Q

90% of hip dislocations are…

A

posterior

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18
Q

complex dislocation means…

A

dislocation + fx

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19
Q

Pt. presents with:

pain
nwb
one leg shorter
fixed in adduction and internal rotation

A

hip dislocation

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20
Q

NV check on hip dislocation should be focused on…

A

sciatic nerve

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21
Q

MC hip dislocation reduction technique…

A

Allis maneuver

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22
Q

Pain in groin, radiates to inner thigh

difficulty with flexion, internal rotation

leg held in external rotation/abduction

A

proximal femoral fx

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23
Q

why CT in proximal femoral fx?

A

evaluate displacement

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24
Q

2 views of x-ray for proximal femoral fx?

A

AP/Lat, Full femur (incl knee joint)

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25
Q

4 complications of proximal femoral fx…

A

AVN
infx
DVT/PE
nonunion

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26
Q

proximal femoral fx requires prophylaxis for…

A

DVT

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27
Q

2 populations for femoral shaft fx and mechanisms…

A

young men = severe trauma

elderly women = falls

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28
Q

Pt. p/w:

obvious femoral deformity

nwb

lost of ROM

A

femoral shaft fx

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29
Q

2 x-ray views for femoral shaft fx…

A

AP/Lat

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30
Q

what can be life threatening in femoral shaft fx?

A

blood loss

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31
Q

3 complications of femoral shaft fx…

A

malunion/nonunion
infx
hardware pain

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32
Q

______ is a surgical emergency with high incidence of neurovascular injury…

A

knee dislocation

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33
Q

MC MOI for posterior knee dislocation

A

dashboard injury

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34
Q

What knee dislocation?

MC
MOI = hyperextension

A

anterior

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35
Q

what nerve is MC associated with knee dislocation?

artery?

A

peroneal n.

popliteal a.

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36
Q

x-rays for knee dislocation

A

pre-post reduction AP/lat

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37
Q

CT can better define _____ following knee dislocation reduction

A

fx

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38
Q

_____ is needed following hardware placement to assess for soft tissue involvement

A

MRI

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39
Q

knee dislocation often requires..

A

ortho fixation

40
Q

splinting of knee location at ____ degrees of flexion

A

20 degrees

41
Q

important facet of knee dislocation mgmt…

A

serial NV assessments

42
Q

patellar dislocations are typically which direction?

A

lateral

43
Q

MOI for patellar dislocation

A

twist on flexed knee

44
Q

pt. p/w:

knee “gives way” + severe pain

knee fixed in 20-30 degrees of flexion

A

patellar dislocation

45
Q

reduction technique for patellar dislocation…

A

supine w/ hip flexion

gradually increase knee extension w/ medial pressure on patella

46
Q

radiographs (3) for patellar dislocation…

A

AP/Lat, sunrise

47
Q

post-reduction mgmt of patellar dislocation

A

RICE, NSAIDs +/- muscle relaxant/narcotics

48
Q

what fx?

MOI = direct force in knee flexion

indirect force with extreme contraction of quads

A

patellar fx

49
Q

Patient p/w:

knee effusion
hemarthrosis
inability to extend knee

A

clinical presentation

50
Q

imaging for patellar fx

A

AP/Lat, sunrise view

51
Q

splinting for patellar fx

A

full extension, nwb

52
Q

non-surgical mgmt of patellar fx

A

extension cylinder casting

locked extension brace

53
Q

when is surgery indicated for patellar fx…

A

displaced or complex fx

54
Q

concominant injuries w/ tibial plateau fx (2)

A

meniscus, ligament

55
Q

pt. p/w:

localized pain and swelling to LE

knee effusion

restricted ROM, pain w. WB

A

tibial plateau fx

56
Q

3 radiograph views for tibial plateau fx

A

AP, Lat, intercondylar notch

57
Q

if x-ray inconclusive but still suscpicious of fx, what imaging?

A

CT

58
Q

what position to splint tibial plateau fx?

A

full extension

59
Q

how long nwb with tibial plateau fx?

A

6 weeks

60
Q

which 2 are unstable malleolar fx?

A

bimalleolar, trimaleolar

61
Q

Ottawa Ankle Rules:

if malleolar tenderness and 1 of the below, what is indicated?

  • posterior fibular pain
  • posterior distal tibia pain
  • nwb
A

ankle films

62
Q

Include foot films if midfoot pain and 1 of what 3?

A

navicular pain
5th MT base pain
nwb

63
Q

ankle series x-ray

A

AP/Lat, mortise

64
Q

3 immobilization options for ankle fx

A

splinting, brace, CAM boot

65
Q

MC MT fx in adults…

A

5th MT

66
Q

metaphyseal-diaphyseal junction fx of 5th MT…

A

jones fx

67
Q

jones fx has risk of…

A

nonunion

68
Q

proximal tubercle of 5th MT fx

A

pseudo-jones/avulsion

69
Q

3 x-rays for MT fx

A

AP, lateral, oblique

70
Q

2 conservative tx of MT fx

A

rigid shoe, CAM boot

71
Q

jones fx, delayed union or unstable fx treatment options

A

casting/surgery

72
Q

A fx or dislocation of 1st and 2nd TMT…

A

lisfranc fx

73
Q

low energy mechanism of lisfranc fx

A

stepping off curb into hole

74
Q

high energy moi for lisfranc fx

A

MVA, fall from height

75
Q

lisfranc fx present with pain where?

A

midfoot

76
Q

x-ray views for lisfranc fx

A

AP weight bearing bilateral feet, lateral, oblique

77
Q

which x-ray view for lisfranc fx?

-medial margin 2nd MT and middle cuneiform alignment

A

AP

78
Q

which x-ray view for lisfranc fx?

dorsal margin 1st and 2nd metatarsal and cuneiform alignment

A

lateral

79
Q

which view for liscranc fx

base of 4th metatarsal and cuboid alignment

A

oblique view

80
Q

lisfranc requires surgery if > ___mm

A

2mm

81
Q

most helpful view for calcaneal fx

A

lateral

82
Q

tx for calcaneal fx is typically casting and nwb… surgery is needed if…

A

displacement

83
Q

MC region of compartment syndrome

A

lower leg, anterior compartment

84
Q

high energy trauma and crush injuries are at high risk of…

A

compartment syndrome

85
Q

6 Ps of compartment syndrome

A 
paresthesia
pallor
pulseless
poikilothermia
paralysis
86
Q

intra-compartmental pressue isn’t always necessary, but > ___ mmHg is concerning and warrants fasciotomy

A

30 mmHg

87
Q

Tx for compartment syndrome if dx within 8 hours…

A

dermato-fasciotomy

88
Q

tx for late finding compartment syndrome…

A

amputation or fasciotomy (high risk infx)

89
Q

4 complications of acute compartment syndrome

A

infx
amputation
volkmann’s contracture
rhabdo

90
Q

MC agent of septic arthritis

A

staph aureaus

91
Q

MC peds septic arthritis

A

knee/hip

92
Q

a pediatric patient in the FABER position is concerning for…

A

septic arthritis of hip

93
Q

gold standard diagnostic for septic arthritis

A

arthrocentesis

94
Q

radiographs show:

increased joint space or narrowing

A

septic arthritis

95
Q

use of US in septic arthritis…

A

detect effusion/guide aspiration

Emergency Medicine (12 decks)

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