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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
what is an open type III a fracture
adequate bone coverage of reamining tissue
26
what is an open type III b fracture?
bone exposure that requires a flap or graft
27
What is an open type IIIc fracture?
circulatory compromise requiring vascular repair or reconstruction to reperfusion of the limb
28
A “bulge” in the cortex of the bone Does go all the way thru only seen in children
Torus fracture
29
when do torus fractures hurt?
day it happens, not anymore
30
what view are torus fractures seen most easily on
lateral
31
a fracture that is a break in one cortex | childhood fracture
greenstick fracture
32
fracture through the bone horizontally
transverse
33
Fracture runs at an oblique angle to the long axis of the bone
oblique fracture
34
Wraps in a spiral fashion along the long axis of the bone | classic is a toddler's fracture (tibia)
spiral fracture
35
a spiral fracture in a femur in child that isn't weight bearing is.....
child abuse
36
a fracture that is in pieces
comminuted
37
a distinct segment is "broken out"
segmental fracture
38
Bone is pulled off by ligament or tendon | common in runners
avulsion fracture
39
Bone fragments driven into one another | common in elderly
impacted fracture
40
injuries in or through the growth plates
salter-harris fracture
41
SH fracture physis + metaphysis
Itype II
42
SH fracture through physis
type I
43
SH fracture through metaphysis, physis and epiphysis
type IV
44
SH fracture through physis + epiphysis
type III
45
_________ is more susceptible to injury than ligaments in children
physis
46
SH type with impaction of physeal plate
type V
47
what does SALTER stand for?
``` Separated (through physis) Above (the physis) Lower (than the physis) Thru (the physis) ER- Everything is ruined ```
48
Two ends of the fracture or not separated from each other
non-displaced
49
fracture where Bone ends are separated
displaced
50
fracture near a joint imprant
periprosthetic fracture
51
how long can ischemic nerves survive?
4 hours w/o irreversible injury | nerve death w/i 8 hours
52
settings for compartment syndrome?
``` crush injuries multiple fractures burns casting dislocations (especially knee) ```
53
what are the 5 Ps of compartment syndrome
``` Pulselessness Paresthesias paralysis Pallor pain ```
54
what is the most sensitive test for compartment syndrome?
passive stretch of the muscle w/i the compartment | patient should be in extreme pain
55
what are late findings of compartment syndrome
pulseless extremity | nerve deficit
56
what drugs can cause compartment syndrome in a relatively underwhelming fracture?
anti-coagulated patients | plavix, coumadin, xarelto, ASA, etc
57
what do you need to monitor head injury patients for?
DIC
58
what is the first sign of DIC
H&H good then plummets
59
Tx for compartment syndrome
fasciotomy | excision of necrotic tissue
60
how do you monitor compartment syndrome?
take pressure in compartment and compare to BP
61
what is the most common type of amputation?
fingers
62
how to tx an amputation
stop bleeding, salvage if possible | wrap in sterile gauze- soak in lactated ringer's, place in plastic bag and then place on ice
63
what is Virchow's triad?
stasis intimal injury hyper coagulability
64
what PE signs are significant for DVT
Homan's Sign (+/-) unreliable palpable cords (feels like guitar strand) tenderness edema
65
what is the gold standard for DVT
venography
66
what is the typical imaging for DVT
venous doppler (US)
67
Signs of a PE
pleuritic chest pain tachypnea tachycardia EKG R BBB
68
tx for PE
IV heparin
69
what usually causes necrotizing fascitis
Group A Strep > clostridia
70
best places to treat nacrotizing fascitis
burn center
71
most common hand infection – at nail fold – nail bitters
paronchyia
72
what shows an infection, will be tender along sheath proximally – finger held flexed with pain on passive ext., sausage digit
Kanavel Sign's
73
what abx do you use for a "fight bite"
Augmentin
74
Abx to use for dog or cat bites?
augmentin
75
All trauma pts. should remain in a cervical collar until c
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
if a trauma patient has an ALOC what should you get?
XR of entire spine
77
what is a C1 ring fracture called
Jefferson's
78
What is a C2 isthmus fx known as
hangman's fracture
79
What is an avulsion fracture of the spinous process from C6-T1 known as?
Clay shoveler's
80
what are the three columns of spine injury?
anterior middle posterior
81
failure of the anterior column with preservation of the middle column
compression fracture
82
fracture of the anterior and middle column with axial load +/- posterior column involvement (more likely to be unstable)
Burst fracture
83
where does the spinal cord usually end?
L2
84
sacral fracture have a high incidence of what?
neuro injury (check for drop foot)
85
what is the gold standard for coccyx fracture?
pain w/ rectal exam and defecation
86
tx for coccyx fracture
stool softener donut pad time
87
what drug can you give to trauma patients for any neuro deficit
methylprednisolone
88
who is methylprednisolone C/I in
Pregnancy Age < 13 Open Spine Injury Uncontrolled DM

*OldSurgery (22 decks)

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