Ortho 1

Question 1

What infections are common with open fractures of the foot that damages shoes?

Answer 1

Pseudomonas

Question 2

What ABX should be used for open fractures associated with farm injuries?

Answer 2

Penicillin

Question 3

What general ABX should be given for open fractures?

Answer 3

1st gen. cephalosporin

-Larger wounds/soft tissue damage: Aminoglycoside

Question 4

How are open fractures classified?

Answer 4

Type 1, 2, and 3

Question 5

What characterizes a type 1 open fracture?

Answer 5

Low energy impact

• Less then 1 cm
• Inside-out
• Transverse or oblique

Question 6

What characterizes a type 2 open fracture?

Answer 6

• More energy
• Greater than 1 cm
• Mild to moderate crushing
• Often some comminution

Question 7

What characterizes a type 3 open fracture?

Answer 7

Greater than 10 cm
Significant fracture fragment comminution
Extensive soft tissue damage
Grossly contaminated

Question 8

Which type of open fracture has 3 subtypes?

Answer 8

Type 3

Question 9

What characterizes a type A open fracture?

Answer 9

Adequate tissue coverage of bone

Question 10

What characterizes a type B open fracture?

Answer 10

Bone exposure that requires a flap or graft

Question 11

What characterizes a type C open fracture?

Answer 11

Circulatory compromise

-Requires vascular repair or reconstruction to reperfuse the limb

Question 12

What is a torus fracture?

Answer 12

• Bulge in cortex
• Goes all the way through
• Common in children
• Pain limits function but does not cause complaints

Question 13

What is a greenstick fracture?

Answer 13

• A break in one cortex

- Childhood fracture; bones are softer and more flexible

Question 14

Which type of fracture is known as the “toddler’s fracture”?

Answer 14

Spiral

Question 15

What characterizes a spiral fracture?

Answer 15

• Break wraps around long axis of bone

- Often the tibia

Question 16

What characterizes a segmental fracture?

Answer 16

Bone broken with distinct segment broken out

Question 17

What are pathologic fractures?

Answer 17

Fractures caused by benign or malignant lesions

Question 18

What are some common locations for compartment syndrome?

Answer 18

• Foot
• Leg
• Thigh
• Forearm
• Hand
• Shoulder
• Butt

Question 19

After how many hours does compartment syn. cause permanent damage, including muscle and nerve death?

Answer 19

8 hours

Question 20

After how many hours of compartment syndrome can tissues be totally viable?

Answer 20

4 hours

-More variable after 6 hours

Question 21

What condition are the 5 Ps associated with?

Answer 21

Compartment syndrome

Question 22

What is the most sensitive test for compartment syndrome?

Answer 22

Severe pain with passive ROM

Question 23

What is the treatment for compartment syndrome?

Answer 23

Surgery:

• Fasciotomy
• Excision of necrosed tissue

Question 24

What condition is associated with Virchow’s Triad?

Answer 24

DVT

Question 25

What are Virchow's Triad?

Answer 25

- Stasis - Intimal injury - Hypercoagulability

Question 26

What is Homan's sign?

Answer 26

Pain in calf during dorsiflexion of foot at ankle joint while knee is fully extended -DVT

Question 27

What are the symptoms of a PE?

Answer 27

- Pleuritic chest pain - Tachypnea - R BBB on EKG - Tachycardia

Question 28

What bacteria are associated with necrotizing fasciitis?

Answer 28

Group A Strep | -Also Clostridium

Question 29

What is a felon?

Answer 29

Pulp of nail at tip of finger | -I&D

Question 30

What is Kanavel's sign?

Answer 30

- Sausage fingers - Inflammation of tendon sheath - Finger held flexed w/ pain on passive movement

Question 31

Where is most common bite wound involving human-to-human contact?

Answer 31

3rd and 4th MC joint | -Fight bite

Question 32

What bacteria are associated with human bites?

Answer 32

Strep. viridans - S. aureus - Eikenella (Augmentin)

Question 33

What bacteria are associated with dog bites?

Answer 33

S. viridans - Pasteurella - S. aureus (Augmentin)

Question 34

What bacteria are associated with cat bites?

Answer 34

Pasteurella - S. aureus - Augmentin

Question 35

What is a C1 ring fracture called?

Answer 35

Jefferson's fracture

Question 36

What is a C2 isthmus fracture?

Answer 36

Hangman's

Question 37

What is a C6-T1 spinous process avulsion fracture?

Answer 37

Clay shoveler's

Question 38

What comprises the anterior column of the spinal column?

Answer 38

Anterior longitudinal ligament (ALL) and anterior vertebral body

Question 39

What comprises the middle column of the spinal column?

Answer 39

The posterior vertebral body to the posterior longitudinal ligament (PLL).

Question 40

What comprises the posterior column of the spinal column?

Answer 40

The PLL to the spinous process.

Question 41

What is a compression fracture?

Answer 41

Failure of the anterior column w/ preservation of the middle column.

Question 42

What is a burst fracture?

Answer 42

Failure of the anterior and middle columns w/ axial load; +/- posterior column involvement -More likely to be unstable

Question 43

Where does the spinal cord end in most adults?

Answer 43

L2

Question 44

Treatment for a coccyx fracture?

Answer 44

Donut pad Stool softener Time

Question 45

A burst fracture where can cause bladder/bowel dysfunction?

Answer 45

L1-L2

Question 46

What drug should we give patients if we suspect a neuro deficit with a spinal injury?

Answer 46

IV Methylprednisolone

Question 47

In whom is methylprednisolone contraindicated?

Answer 47

Pregnancy Age <13 Uncontrolled DM Open spine injury

Question 48

How long should a spinal injury patient be on Methylprednisolone if they are not given it within the first 3 hours?

Answer 48

48 hours

Question 49

How long should a spinal injury patient be on methylprednisolone if they are given it within 3 hours?

Answer 49

24 hours