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PEM Lectures dirigées > MSK > Flashcards

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
Q

What is the classic mechanism of injury for a lisfranc fracture?

A

Axial load on plantar flexed foot

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26
Q

What are reasons to non urgently send patient to ortho for consult in MT fractures?

A

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

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27
Q

What is a jones fracture?

A

Fracture at the diaphyseal-metaphyseal junction at base of 5th MT

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28
Q

4 signs of SCFE on X-ray

A

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

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29
Q

What endocrinopathy is most commonly associated with SCFE?

A

hypothyroidism

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30
Q

In what percentage of cases are SCFE bilateral?

A

25%

31
Q

What are signs of SCFE on physical exam?

A

limited internal rotation
pain with external rotation

32
Q

What is the difference between a SH1 fracture and a SCFE?

A

in SCFE the perichondrium remains intact

33
Q

Risk factors for SCFE

A

pre-pubertal/around puberty
M>F
African american
Obesity
Vertically inclined physeal angles
Hypothyroidism
Renal failure
Radiation therapy

34
Q

What is the time period for chronic vs acute SCFE?

A

Chronic > 3 weeks

35
Q

Where does the chin point in a muscular torticollis?

A

chin points toward unaffected side

36
Q

What pressure is diagnostic of compartment syndrome?

A

30mmHg

37
Q

What is rotatory subluxation?

A

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
Q

What xray finding could be indicative of rotary subluxation?

A

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
Q

Possible traumatic causes of torticollis

A

cervical fracture
atlanto-axial subluxation
muscle spasm
rotary dislocation
SAH with extension into neck

40
Q

Non-traumatic causes of torticollis

A

Spinal column infection (discitis, osteomyelitis, epidural abscess)
RPA
Cervical adenitis
Myositis of SCM
Rotary dislocation (Grisel’s syndrome)

41
Q

Complications of splinting of an MSK injury

A

Neurovascular compromise
Pressure ulcers
Contact dermatitis
Contracture if prolonged splint or not in position of function

42
Q

Volkmann’s Contracture

A

Ischemic contracture resulting from unrecognized vascular compromise due to a supracondylar fracture, vessel injury during reduction or compartment syndrome - anterior interosseous artery

43
Q

Most common pathogens of diskitis and vertebral osteomyelitis

A

Staph
GAS
E.Coli
Kingella kingae (< 3 years)

44
Q

What is the clinical appearance of a volkmann’s contracture?

A

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
Q

Contraindications to knee aspiration

A

No absolute contraindications. Relative contraindications include:
-overlying cellulitis
- coagulopathy/bleeding disorders
- a joint prosthesis
- acute fracture
- adjacent osteomyelitis
- uncooperative patient.

46
Q

What is a Jefferson fracture

A

bursting fracture of ring of C1
result of axial load

47
Q

radiographic criterion for Jefferson fracture

A

lateral offset of lateral mass of C1 more than 1mm from vertebral body of C2

48
Q

In what age grops can a “pseudo-jefferson fracture” be seen?

A

0-6 yrs

49
Q

What is a hangman’s fracture

A

traumatic spondylolisthesis of C2 resulting from hyperextension

50
Q

sublixation associated with hangman’s fracture

A

anterior subluxation C2 on C3

51
Q

How can the distinction be made between a subtle hangman’s fracture and pseudosubluxation

A

using Swischuk’s posterior cervical line - > 1.5-2mm suggests occult fracture

52
Q

Causes of ligament instability that can lead to atlantoaxial subluxation

A

tonsillitis
cervical adenitis
pharyngitis
arthritis
connective tissue disorders
T21

53
Q

Radiographic findings suggestive of atlantoaxial subluxation

A

widened predental space on lateral radiograph

54
Q

4 types of atlantoaxial subluxation

A

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
Q

what is the most common cause of atlantoaxial subluxation in young children?

A

dens fracture

56
Q

Cause of cervical distraction injures

A

rapid acceleration or deceleration incidents
eg. MVC, pedestrian accident, infant abusive head trauma

57
Q

Measurements for potential distraction injuries of cervical spine

A

atlantooccipital distance should not exceed 5mm
C1-C2 interspinous distance should not exceed 10mm

58
Q

What is sun’s ratio

A

C1-C2:C2-C3
should be < 2.5 - if more, suggests potential ligamentous instability

59
Q

most frequent cause of vertebral compression injuries

A

axial loading and hyperflexion

60
Q

radiographic findings of vertebral compression injuries

A

isolated anterior wedging, teardrop fracture, burst vertebral bodies

61
Q

What is SCIWORA?

A

spinal cord injury without radiographic abnormality
mainly children < 8 y
symptoms consistent with cervical cord injuries but no abnormal radiographs

62
Q

How to distinguish between muscular torticollis vs SCM spasm

A

muscular = chin points toward unaffected side
SCM - chin points toward affected side

63
Q

when should rotary subluxation be considered in a patient with torticollis

A

when patients head cannot be rotated past midline
chin pointed towards same side as SCM spasm

64
Q

radiographic findings of rotary subluxation

A

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
Q

MOst useful diagnostic tool in rotary subluxation

A

CT scan

66
Q

treatment of mild rotary subluxation

A

cervical collar
analgesia

67
Q

What is anterior cord syndrome

A

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
Q

What is posterior cord syndrome?

A

loss of proprioceptive function,. deep pressure, pain, vibratory sense with preservation of temperature sensation and motor function

69
Q

What is Brown-Sequard syndrome?

A

hemisection of the cord
contralateral loss of pain and temperature sensation with ipsilateral motor findings below the lesion

70
Q

What is central cord syndrome

A

injury most severe in center of the cord
motor strength more severely depressed in arms than legs

71
Q

Which lesions of the spinal cord are usually non-reversible?

A

anterior cord syndrome
complete transection

72
Q

What type of thoraco-lumbar spinal fracture requires immediate surgical consult?

A

any chance or burst fracture associated with 15+ degrees of kyphosis or any degree of neurologic impairment

73
Q
A

PEM Lectures dirigées (28 decks)

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