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MSK Flashcards

1
Q

Ddx pathologic fracture - benign tumour

A

Aneurysmal bone cyst
Enchondroma
Eosinophilic granuloma
Fibrous dysplasia
Giant cell tumour
Nonossifying fibroma
Ostochondroma
Unicameral bone cyst

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2
Q

Ddx pathological fracture - malignant tumour

A

Chondrosarcoma
Ewing sarcoma
Neuroblastoma
Osteogenic sarcoma

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3
Q

Ddx pathological fracture - Hereditary diseases

A

Gaucher disease
Neurofibromatosis
Osteogenesis imperfecta
Osteopetrosis
Sickle cell disease

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4
Q

Ddx Pathologic fracture - metabolic disorders

A

Copper deficiency
Cushing syndrome
Hyperparathyroidism
Renal osteodystrophy
Rickets
Scurvy

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5
Q

What pathogens are most commonly responsible for septic arthritis?

A

** S. aureus
S. pneumoniae
GAS
Gonococcus (older)
Kingella kingae

Salmonella - kids with hemoglobinopathiesq

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6
Q

How is septic arthritis spread?

A

hematogenous usually

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7
Q

What is the imaging of choice for SCFE?

A

AP + frog-leg radiographs
MRI works too

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8
Q

What endocrinopathy is associated with SCFE outside the normal age range?

A

hypothyroidism

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9
Q

what is the most common hip disorder in adolescent patients?

A

SCFE

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10
Q

How much more common is SCFE in males than females?

A

2x more common

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11
Q

In what directio is slippage most common in SCFE?

A

posterior + inferior relative to the proximal femoral metaphysis

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12
Q

What is the cutoff between acute and chronic scfe?

A

3 weeks

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13
Q

What are risk factors for “atypical” SCFE?

A

endocrine disorder (esp hypothyroid)
renal failure
radiation therapy

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14
Q

What hip movements are limited/painful in SCFE?

A

full flexion’
internal rotation
abduction

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15
Q

What are the cardinal signs of tenosynovitis?

A

four cardinal Kanavel signs
- finger held in mild flexion
- fusiform swelling of the digit
- tenderness along the entire tendon sheath, especially at the palmar surface of the metacarpophalangeal (MCP) joint
- severe pain with passive extension

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16
Q

What is the maximum angulation acceptable for a fracture of the 4th or 5th metacarpals?

A

Up to 40 degrees is acceptable for the 4th and 5th metacarpals

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17
Q

What is the maximum angulation acceptable for a fracture of the 2nd or 3rd metacarpals?

A

10 to 20 degrees is acceptable for the 2nd and 3rd metacarpals

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18
Q

What are the signs and symptoms of compartment syndrome?

A

7 Ps
- pulseless
- pale
- paralysis
- hard on palpation
- painful
- poikilothermia
- paresthesia

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19
Q

What is the most common site of compartment syndrome?

A

anterior compartment of the leg

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20
Q

When does muscle necrosis become irreversible after start of tissue anoxia??

A

6-8 hrs

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21
Q

What causes the Volkmann’s contracture?

A

Displaced supracondylar fractures may injure the anterior interosseous artery and the flexor compartment of the forearm causing a compartment syndrome

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22
Q

What nerve is usually affected in compartment syndrome of the flexor aspect of the forearm?

A

Median nerve

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23
Q

how to test for axillary nerve damage?

A

o innervates deltoid and teres minor (motor) = abduction and external rotation
o sensation = lateral shoulder sensation

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24
Q

What are the classic findings on X-ray of a lisfranc fracture?

A

Widened space (diastasis) between base of 1st & 2nd metatarsals
Fleck fracture adjacent to base of 1st MT
Loss of alignment of medial edge of proximal second MT with medial edge of second cuneiform

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25
What is the classic mechanism of injury for a lisfranc fracture?
Axial load on plantar flexed foot
26
What are reasons to non urgently send patient to ortho for consult in MT fractures?
Displaced fracture of fifth metatarsal styloïde Shaft fracture near metatarsal head Unacceptable position needing reduction or unsuccessful reduction attempts Lisfranc injury or suspected Multiple Mt fractures
27
What is a jones fracture?
Fracture at the diaphyseal-metaphyseal junction at base of 5th MT
28
4 signs of SCFE on X-ray
Klein line (along superior edge of neck of femur) does not intersect epiphysis (AP view) Widened epiphysis Caudal displacement of femoral head Posterior displacement of the epiphysis A line along the inferior margin of the proximal femur should smoothly continue over the physis and epiphysis in an S shape. If there is discontinuity or abrupt bending of the line, SCFE should be strongly suspected
29
What endocrinopathy is most commonly associated with SCFE?
hypothyroidism
30
In what percentage of cases are SCFE bilateral?
25%
31
What are signs of SCFE on physical exam?
limited internal rotation pain with external rotation
32
What is the difference between a SH1 fracture and a SCFE?
in SCFE the perichondrium remains intact
33
Risk factors for SCFE
pre-pubertal/around puberty M>F African american Obesity Vertically inclined physeal angles Hypothyroidism Renal failure Radiation therapy
34
What is the time period for chronic vs acute SCFE?
Chronic > 3 weeks
35
Where does the chin point in a muscular torticollis?
chin points toward unaffected side
36
What pressure is diagnostic of compartment syndrome?
30mmHg
37
What is rotatory subluxation?
consider if head cannot be rotated past midline spontaneous or follows URTI or traumatic event Chin points to same side as SCM spasm (cock-robin position)
38
What xray finding could be indicative of rotary subluxation?
open-mouth radiograph with one of lateral masses of C1 appearing more forward and closer to midline vs other mass appears narrow and away from midline *CT scan is more useful
39
Possible traumatic causes of torticollis
cervical fracture atlanto-axial subluxation muscle spasm rotary dislocation SAH with extension into neck
40
Non-traumatic causes of torticollis
Spinal column infection (discitis, osteomyelitis, epidural abscess) RPA Cervical adenitis Myositis of SCM Rotary dislocation (Grisel's syndrome)
41
Complications of splinting of an MSK injury
Neurovascular compromise Pressure ulcers Contact dermatitis Contracture if prolonged splint or not in position of function
42
Volkmann's Contracture
Ischemic contracture resulting from unrecognized vascular compromise due to a supracondylar fracture, vessel injury during reduction or compartment syndrome - anterior interosseous artery
43
Most common pathogens of diskitis and vertebral osteomyelitis
Staph GAS E.Coli Kingella kingae (< 3 years)
44
What is the clinical appearance of a volkmann's contracture?
Decreased sensation Paleness of the skin Muscle weakness and loss (atrophy) Deformity of the wrist, hand, and fingers that causes the hand to have a claw-like appearance
45
Contraindications to knee aspiration
No absolute contraindications. Relative contraindications include: -overlying cellulitis - coagulopathy/bleeding disorders - a joint prosthesis - acute fracture - adjacent osteomyelitis - uncooperative patient.
46
What is a Jefferson fracture
bursting fracture of ring of C1 result of axial load
47
radiographic criterion for Jefferson fracture
lateral offset of lateral mass of C1 more than 1mm from vertebral body of C2
48
In what age grops can a "pseudo-jefferson fracture" be seen?
0-6 yrs
49
What is a hangman's fracture
traumatic spondylolisthesis of C2 resulting from hyperextension
50
sublixation associated with hangman's fracture
anterior subluxation C2 on C3
51
How can the distinction be made between a subtle hangman's fracture and pseudosubluxation
using Swischuk's posterior cervical line - > 1.5-2mm suggests occult fracture
52
Causes of ligament instability that can lead to atlantoaxial subluxation
tonsillitis cervical adenitis pharyngitis arthritis connective tissue disorders T21
53
Radiographic findings suggestive of atlantoaxial subluxation
widened predental space on lateral radiograph
54
4 types of atlantoaxial subluxation
Type 1 - no displacement of c1 Type 2 - 3-5mm C1 on C2 anterior displacement Type 3 - >5 mm C1 on C2 anterior displacement Type 4 - posterior displacement of C1 on C2
55
what is the most common cause of atlantoaxial subluxation in young children?
dens fracture
56
Cause of cervical distraction injures
rapid acceleration or deceleration incidents eg. MVC, pedestrian accident, infant abusive head trauma
57
Measurements for potential distraction injuries of cervical spine
atlantooccipital distance should not exceed 5mm C1-C2 interspinous distance should not exceed 10mm
58
What is sun's ratio
C1-C2:C2-C3 should be < 2.5 - if more, suggests potential ligamentous instability
59
most frequent cause of vertebral compression injuries
axial loading and hyperflexion
60
radiographic findings of vertebral compression injuries
isolated anterior wedging, teardrop fracture, burst vertebral bodies
61
What is SCIWORA?
spinal cord injury without radiographic abnormality mainly children < 8 y symptoms consistent with cervical cord injuries but no abnormal radiographs
62
How to distinguish between muscular torticollis vs SCM spasm
muscular = chin points toward unaffected side SCM - chin points toward affected side
63
when should rotary subluxation be considered in a patient with torticollis
when patients head cannot be rotated past midline chin pointed towards same side as SCM spasm
64
radiographic findings of rotary subluxation
openmouth radiograph - one of lateral C1 masses appears forward and lcoser to midline while opposite lateral mass appears narrow and away from midline (lateral offset)
65
MOst useful diagnostic tool in rotary subluxation
CT scan
66
treatment of mild rotary subluxation
cervical collar analgesia
67
What is anterior cord syndrome
loss of neurologic function in areas supplied by anterior spinal artery with loss of motor function below level of the lesion but normal touch and proprioceptive function
68
What is posterior cord syndrome?
loss of proprioceptive function,. deep pressure, pain, vibratory sense with preservation of temperature sensation and motor function
69
What is Brown-Sequard syndrome?
hemisection of the cord contralateral loss of pain and temperature sensation with ipsilateral motor findings below the lesion
70
What is central cord syndrome
injury most severe in center of the cord motor strength more severely depressed in arms than legs
71
Which lesions of the spinal cord are usually non-reversible?
anterior cord syndrome complete transection
72
What type of thoraco-lumbar spinal fracture requires immediate surgical consult?
any chance or burst fracture associated with 15+ degrees of kyphosis or any degree of neurologic impairment
73

PEM Lectures dirigées (28 decks)

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