Ortho

Question 1

Three classic findings with fat embolism after fracture and the classic clinical story it presents after?

Answer 1

Fat embolism = presence of fat globules in the lungs or peripheral circulation. Syndrome is when you get systemic inflammatory reaction that gives you those characteristic findings

Symptoms occur 1-2 days after injury or nail

ARDS, neurological involvement and thrombocytopenia

CT ground glass opacities or fat in urine

Young person with long bone fracture or older person with hip fracture

Question 2

5 reasons to consult ortho?

Answer 2

Open
Long bone
Neurovascular compromise
Joint involvement
Tendon injury

Question 3

Three general classifications of fractures?

Answer 3

ID - open or closed, where the fracture is, direction of the line (oblique, transverse, spiral), Simple or comminuted, position (displacement and allignment

Additional modifiers - angulation, avulsion, impaction (depressed or compressed), complete or incomplete

Special situations - pathologic or stress

Question 4

What does open mean?

Answer 4

Exposed to air at any time

Question 5

What is complete and incomplete?

Answer 5

Interrupts both cortexes
One cortex is intact

Question 6

What makes you suspect a pathologic fracture?

Answer 6

It is a fracture through abnormal or diseased bone
Suspect when trivial mechanism leads to fracture

Question 7

What causes a stress fracture

Where do they commonly occur?

Answer 7

repetitive stress can lead to the resorption of normal bone. Typically in lower extremities, may not show up on XRs

RF - training schedule, equipment, nutrition, hormones , anatomic varience

Any long bone - fibula, tibia, metatarsel, femoral shaft
Navicular and calcaneous

Question 8

Where are the epiphysis, metaphysis and diaphysis

Answer 8

Dia = shaft
Epi = below growth plate
physis - growth plate itself
Metaphysis - transition between shaft and epiphysis

Question 9

5 causes of patholgic fractures

Answer 9

Osteogenesis imperfectica
Paget disease of bone
Rickets
Scurvy
Malignancy
OA

Question 10

Why do we repeat XRs later?

Answer 10

Sometimes cant see fracture line right away
10-14 days more visible with inflammation, bone resportion, hyperemia

Question 11

What are four varients of bad fracture healing?

Answer 11

Mal union - still have a deformity
Non-union - doesnt come together
Delayed union - takes longer than expected at that site
Pseduoarthrosis - flase joint caused by non-union

Question 12

When can you advise someone to go back to activties?

Answer 12

Clinical evidence of stability (pain free WB)
Bridging of bone at cortex (actual line can still b there it takes months to go away)

Question 13

5 life or limb complications per Rosens of a fracture?

Answer 13

Open - OM
Compartment - ischemia
Vascular disruption - amputation

Pelvis fracture - bleed out
Hip dislocation - AVN

Question 14

Dosing for open fractures?

Answer 14

Ancef 2g q8
III gets gent at 5mg/kg daily
Farming or fecal contamination - penicillin for clostridium

Question 15

Outline grading of open fractures

Answer 15

Question 16

How much blood loss with each fracture?

Answer 16

Arm bones (radius, ulna, humerus) - 250ml
Tib and fib - 500cc
Femur 1 L
Pevlis up to 3L

Question 17

Outline the types of nerve injury

Answer 17

Question 18

What is normal two point discrimination at fingertips?

Answer 18

4mm

Question 19

Nerves injured at each site

Answer 19

Question 20

What are the 5 P’s of compartment syndrome? Why are they not the be all end of all your exam?

Answer 20

Pain out of proportion
Pallor
Paralysis
Paraesthsia
Pulselessness

Better signs of arterial occlusion. Other factors like Pain with passive stretch, active movement and POP are going to detect earlier

Question 21

5 complications of compartment syndrome?

Answer 21

Ischemia
Contractures
Ambputation
Myoglobinuria
Renal failure

Question 22

What number does Rosens give you for being worrisome?

Answer 22

> 30 or >20 from dialstolic or 30 from MAP

Question 23

10 causes of compartment syndrome? List examples in each major category

Answer 23

Increased content

Injection of solution
Fracture
Bleeding with coagulation disorder

Seizure
Tetany
reperfusion with bypass grafting

Decreased volume
Excessive traction
Closure of fascial defect

External pressure
Lying on limb
Cast too tight

Question 24

What are fracture blisters? What do you do with them, and why do you need to worry about them?

Answer 24

tense bulla or blisters seen after high energy injuries with lots of swelling

Happen where there is thin skin or less hair follicles

Cover with sterile dressing, ortho might change surgical approach, can be red flag for compartment syndrome

Question 25

Short term and long term fracture complications?

Answer 25

Question 26

Why do we get rib views

Answer 26

Cant see a fracture line if 90 degrees perpindicular. Turns with curvature of ribs to see better

Question 27

What are things that look like a fracture that arent and features of it?

Answer 27

nutrient vessel (less radiolucent, obique, does not cross both cortices, Mach effect, calcifications)
Soft tissue
Bandages overtop

Question 28

Common paired fractures?

Answer 28

Calcaneous and lumbar spine
Ring pelvis
Ring mandible
Distal tib and proximal fib

Question 29

High risk for development of a strain?

Answer 29

Non athelete
Forced strech
Strong contraction

(weekend warrior pushing off of planted leg)