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*OldSurgery > Ortho > Flashcards

Ortho Flashcards

1
Q

what does ortho not include?

A 
Skull
Mandible
Ribs
Sternum
Osteoporosis (except associated fractures)
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2
Q

what should always be first in a trauma eval?

A

airway

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3
Q

what should you look for a trauma eval?

A 
Deformities
Wounds
Lacerations / Punctures
Joint Pain/Swelling
DNVF (distal neurovascular function)
Isolated areas of Tenderness
Laxity
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4
Q

i very high trauma, you should look at what else besides the affected joint?

A

joints above and below

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5
Q

how do you treat open fractures until surgery?

A

Sterile dressings

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6
Q

what are important prophylaxis in trauma accidents?

A

tetanus and abx prophylaxos

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7
Q

A disruption in the continuity of a bone

A

fracture

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8
Q

how many view do you need for an x-ray?

A

at least 2 views at 90 degrees from one another

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9
Q

do all mal or nonunions need to be fixed?

A

not necessarily, if it is painless and functional

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10
Q

what are big complications of LE fractures?

A

DVTs/ PEs

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11
Q

what is between the epiphysis and metaphysis?

A

physeal plate of cartilage

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12
Q

The skin overlying the fracture site is intact – no vector for entry of foreign objects / bacteria

A

closed fracture

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13
Q

Skin is disrupted overlying the site of the fracture (something could have gone in or out) not a scratch

A

open fracture

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14
Q

what to mention when describing a fracture

A 
open vs. closed
type
displacement
angulation
location
other
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15
Q

when do open fractures need to be treated?

A

OR within 4-8 hours (ideally less than 6)

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16
Q

What does initial OR treatment for an open fracture include?

A

I&D
+/- Fixation
+/- skin closure
repair of vascular / nerve injuries (if possible)

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17
Q

what abx do you give for open fractures?

A

1st generation cephalosporins

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18
Q

for a larger wound/ soft tissue damage what abx should you consider?

A

add aminoglycoside

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19
Q

what abx is good for farm injuries

A

penicillin

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20
Q

what is a common infection w/ a tennis show injury

A

pseudomonas

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21
Q

what is an open type I injury

A

low energy MOI
often inside out (not penetrating)
bone pops out then slides back in
less than 1 cm in length

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22
Q

what type fracture are open type 1 typically?

A

transverse or show oblique fractures

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23
Q

What is an open type II?

A

Greater than 1 cm
greater injury
more of a crush type injury

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24
Q

what is an open type III fracture?

A

greater than 10 cm
significant soft tissue injury
high energy
closely contaminated

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25
Q

what is an open type III a fracture

A

adequate bone coverage of reamining tissue

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26
Q

what is an open type III b fracture?

A

bone exposure that requires a flap or graft

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27
Q

What is an open type IIIc fracture?

A

circulatory compromise requiring vascular repair or reconstruction to reperfusion of the limb

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28
Q

A “bulge” in the cortex of the bone
Does go all the way thru
only seen in children

A

Torus fracture

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29
Q

when do torus fractures hurt?

A

day it happens, not anymore

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30
Q

what view are torus fractures seen most easily on

A

lateral

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31
Q

a fracture that is a break in one cortex

childhood fracture

A

greenstick fracture

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32
Q

fracture through the bone horizontally

A

transverse

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33
Q

Fracture runs at an oblique angle to the long axis of the bone

A

oblique fracture

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34
Q

Wraps in a spiral fashion along the long axis of the bone

classic is a toddler’s fracture (tibia)

A

spiral fracture

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35
Q

a spiral fracture in a femur in child that isn’t weight bearing is…..

A

child abuse

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36
Q

a fracture that is in pieces

A

comminuted

37
Q

a distinct segment is “broken out”

A

segmental fracture

38
Q

Bone is pulled off by ligament or tendon

common in runners

A

avulsion fracture

39
Q

Bone fragments driven into one another

common in elderly

A

impacted fracture

40
Q

injuries in or through the growth plates

A

salter-harris fracture

41
Q

SH fracture physis + metaphysis

A

Itype II

42
Q

SH fracture through physis

A

type I

43
Q

SH fracture through metaphysis, physis and epiphysis

A

type IV

44
Q

SH fracture through physis + epiphysis

A

type III

45
Q

_________ is more susceptible to injury than ligaments in children

A

physis

46
Q

SH type with impaction of physeal plate

A

type V

47
Q

what does SALTER stand for?

A 
Separated (through physis)
Above (the physis)
Lower (than the physis)
Thru (the physis)
ER- Everything is ruined
48
Q

Two ends of the fracture or not separated from each other

A

non-displaced

49
Q

fracture where Bone ends are separated

A

displaced

50
Q

fracture near a joint imprant

A

periprosthetic fracture

51
Q

how long can ischemic nerves survive?

A

4 hours w/o irreversible injury

nerve death w/i 8 hours

52
Q

settings for compartment syndrome?

A 
crush injuries
multiple fractures
burns
casting
dislocations (especially knee)
53
Q

what are the 5 Ps of compartment syndrome

A 
Pulselessness
Paresthesias
paralysis
Pallor
pain
54
Q

what is the most sensitive test for compartment syndrome?

A

passive stretch of the muscle w/i the compartment

patient should be in extreme pain

55
Q

what are late findings of compartment syndrome

A

pulseless extremity

nerve deficit

56
Q

what drugs can cause compartment syndrome in a relatively underwhelming fracture?

A

anti-coagulated patients

plavix, coumadin, xarelto, ASA, etc

57
Q

what do you need to monitor head injury patients for?

A

DIC

58
Q

what is the first sign of DIC

A

H&H good then plummets

59
Q

Tx for compartment syndrome

A

fasciotomy

excision of necrotic tissue

60
Q

how do you monitor compartment syndrome?

A

take pressure in compartment and compare to BP

61
Q

what is the most common type of amputation?

A

fingers

62
Q

how to tx an amputation

A

stop bleeding, salvage if possible

wrap in sterile gauze- soak in lactated ringer’s, place in plastic bag and then place on ice

63
Q

what is Virchow’s triad?

A

stasis
intimal injury
hyper coagulability

64
Q

what PE signs are significant for DVT

A

Homan’s Sign (+/-) unreliable
palpable cords (feels like guitar strand)
tenderness
edema

65
Q

what is the gold standard for DVT

A

venography

66
Q

what is the typical imaging for DVT

A

venous doppler (US)

67
Q

Signs of a PE

A

pleuritic chest pain
tachypnea
tachycardia
EKG R BBB

68
Q

tx for PE

A

IV heparin

69
Q

what usually causes necrotizing fascitis

A

Group A Strep > clostridia

70
Q

best places to treat nacrotizing fascitis

A

burn center

71
Q

most common hand infection – at nail fold – nail bitters

A

paronchyia

72
Q

what shows an infection, will be tender along sheath proximally – finger held flexed with pain on passive ext., sausage digit

A

Kanavel Sign’s

73
Q

what abx do you use for a “fight bite”

A

Augmentin

74
Q

Abx to use for dog or cat bites?

A

augmentin

75
Q

All trauma pts. should remain in a cervical collar until c

A

complete C-Spine XR from occiput to T1 are (-), including AP, LAT, Odontoid Views
awake, sober, alert, and full range of motion w/o pain and no neuro deficits

76
Q

if a trauma patient has an ALOC what should you get?

A

XR of entire spine

77
Q

what is a C1 ring fracture called

A

Jefferson’s

78
Q

What is a C2 isthmus fx known as

A

hangman’s fracture

79
Q

What is an avulsion fracture of the spinous process from C6-T1 known as?

A

Clay shoveler’s

80
Q

what are the three columns of spine injury?

A

anterior
middle
posterior

81
Q

failure of the anterior column with preservation of the middle column

A

compression fracture

82
Q

fracture of the anterior and middle column with axial load +/- posterior column involvement (more likely to be unstable)

A

Burst fracture

83
Q

where does the spinal cord usually end?

A

L2

84
Q

sacral fracture have a high incidence of what?

A

neuro injury (check for drop foot)

85
Q

what is the gold standard for coccyx fracture?

A

pain w/ rectal exam and defecation

86
Q

tx for coccyx fracture

A

stool softener
donut pad
time

87
Q

what drug can you give to trauma patients for any neuro deficit

A

methylprednisolone

88
Q

who is methylprednisolone C/I in

A

Pregnancy
Age < 13
Open Spine Injury
Uncontrolled DM

*OldSurgery (22 decks)

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