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Surgery Shelf > Ortho > Flashcards

Ortho Flashcards

0
Q

Legg-Calve-Perthes disease: a vascular necrosis of capital femoral epiphysis

A 
Around age 6
Insidious onset limping, decreases hip motion, and hip/knee pain
Antalgic gait 
Passive motion of hip guarded
Dx with AP/lat X-ray of hip
Casting and crutches
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1
Q

Developmental dysphasia of the hip

A

Runs in families
Should be dx at birth
Uneven gluteal folds
Easily dislocated posterior with jerk and click and returned with snap
U/S is diagnostic
Tx w/ abduction splint w/ pavlik harness 6 mo

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2
Q

Slipped capital femoral epiphysis

A 
Ortho emergency
Chubby boy age 13 
Pain in groin or knee with limp
Dangle legs, sole of foot on affected side points to other foot
Limited hip motion
When hip flexed thigh externally rotates and can't be rotated internally
Dx with X-ray
Tx with pins in femoral head
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3
Q

Septic hip

A

Emergency
Toddlers who’ve had febrile illness then refuse to move hip
Hold hip flexed slight abduction and ext rotation
Won’t allow passive movt
Elevated sed rate
Dx: aspiration under anesthesia
Open drainage if pus

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4
Q

Acute hematogenous osteomyelitis

A

Kids with febrile illness
Severe localized pain in bone no trauma
MRI dx
Antibiotics tx

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5
Q

Genu varum

A

Bowlegs
Normal to age 3, no tx
Beyond age 3 often Blount disease-disturbance of medial proximal tibial growth plate
Surgery to tx

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6
Q

Genu valgus

A

Knock knee
Normal age 4-8
No surgery

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7
Q

Osgood schlatter disease

A

Teens with persistent pain over right tibial tubercle
Aggravated by quads contraction
Localized tenderness over tibial tubercle
No swelling
RICE if unsuccessful then cast

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8
Q

Club foot

A

Seen at birth
Both feet turned in, ankle plantar flexed, adduction of forefoot, tibia internal rotation
Tx with serial casts in infant
Often Achilles tenotomy and long term braces
If no response, surgery 9-12mo

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9
Q

Scoliosis

A 
Adolescent girls spine curves to RT
Seen from Behind while bending over
Progresses until skeletal maturity
Severe cases decrease pulmonary fxn
Braces stop, surgery if severe
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10
Q

Supracondylar fractures of humerus

A

Hyperextension of elbow in child w/ FOOSH
Neurovascular injuries can easily occur
Can lead to Volkmann contacture (claw like deformity due to necrosis of flexors)
Tx w/ casting or traction, seldom surgery
Must monitor neurovascular integrity and compartment syndrome

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11
Q

Growth Plate Fractures

A

CLosed reduction if epiphysis and plate displaced laterally from metaphysis in one piece
Open reduction with internal fixation if in 2 pieces

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12
Q

Osteogenic sarcoma

A

most common primary malignant bone tumor
Ages 10-25
Usually around knee- lower femur or upper tibia
Sunburst pattern on x ray

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13
Q

Ewing Sarcoma

A

2nd most common primary malignant bone tumor
Ages 5-15
Grows on diaphysis of long bones
Onion skinning on x ray

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14
Q

Adult Malignant bone tumors

A

Most metastatic
From breast in women (lytic)- pathologic fracture
From prostate in men (blastic)
MRI best dx

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15
Q

Multiple Myeloma

A

Old men w/ fatigue, anemia, localized pain on several bones
X ray shows multiple punched out lytic lesions
Bence-jones proteins in urine
Abnormal immunoglobulins
Tx w/ chemo, if fails, use thalidomide

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16
Q

Soft Tissue Sarcoma

A 
Relentless growth anywhere in body 
Firm, fixed to surrounding structures
Mets to lungs but NOT LNs
MRI may dx
Very wide excision with radiation
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17
Q

Clavicular Fractures

A

Junction of middle and distal 3rd
Treated with sling
Young females with displaced fx may have surgery

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18
Q

Anterior dislocation of the shoulder

A

By far most common type
Hold arm close but rotated out as if to shake hands
May have numbness over deltoid from stretching axillary nerve
AP/lateral X ray dx

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19
Q

Posterior dislocation of shoulder

A

Rare- often seizure or electrical shock
Arm held close with internal rotation
Axillary views or scapular lateral views to dx

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20
Q

Colles Fracture

A

FOOSH in old ladies
Deformed wrist looks like dinner fork
Dorsally displaced and angulated fracture of distal radius
Tx w/ closed reduction and long arm cast

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21
Q

Monteggia fracture

A 
Direct blow to ulna 
Diaphyseal fx of proximal ulna
Anterior dislocation of radial head
Open reduction and internal fixation if fx
Closed reduction if only dislocated
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22
Q

Galeazzi Fracture

A

Distal 3rd of radius direct blow w/ fx
Dorsal dislocation of distal radioulnar joint
Open reduction and internal fixation if fx
Closed reduction if only dislocated

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23
Q

Scaphoid fracture

A

Young adult FOOSH
Wrist pain and tenderness in anatomic snuff box
Undisplaced: spika thumb cast even if neg xray
Displaced and angulated: open reduction internal fixation
Very high rate of nonunion

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24
Q

Metacarpal neck fracture

A 
Typically 4th or 5th or both
Closed fist hits hard surface
Hand swollen and tender; X ray dx
Closed reduction and ulnar gutter splint if mild
K wire or plate fixation if bad
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25
Q

Hip fracture

A

Little old ladies fallen and can’t get up

Affected leg shortened and externally rotated

26
Q

Femoral neck fracture

A

Compromise femoral head blood supply

Best tx is femoral head replacement

27
Q

Intertrochanteric hip fractures

A

Less likely to lead to avascular necrosis
Open reduction and internal fixation’
Immobilization has high risk of DVT and PE- anticoagulation recommended

28
Q

Femoral shaft fractures

A

Intramedullary rod fixation
Can have substantial blood loss
If open, emergency req OR cleaning and closure <6h
May lead to fat embolism

29
Q

Collateral ligament injuries

A

Sideways blow to knee
Medial blow disrupts lateral ligaments vice versa
Swollen localized pain on palpation
Abduction pain (valgus stress) shows medial tear
Adduction pain (varus stress) shows lateral tear
Hinged cast; surgery if several tears

30
Q

ACL injuries

A 
More common than PCL
Severe swelling and pain
Anterior drawer test and Lachman test
MRI dx
Tx with arthroscopic reconstruction
31
Q

PCL Injuries

A

Less common
Severe swelling and pain
Posterior drawer test
MRI dx

32
Q

Meniscal Tears

A

Seen on MRI
Protracted pain and swelling after knee injury
Catching and locking and clicking when forcefully extended
Repair done to save as much meniscus as possible
Complete meniscectomy leads to late development of degenerative arthritis
Injury to medial meniscus, MCL and ACL ofter simultaneous

33
Q

Tibial stress fractures

A

Young men forced marches
Tenderness to palpation over specific bone point
X ray normal, repeat 2 wk
Cast and crutch

34
Q

Leg fracture of tibia and fibula

A 
Pedestrian hit by car
Angulation on exam
Dx X ray
Casting if easily reduced
Intramedullay nail if not aligned
Lower leg can get compartment syndrome
35
Q

Ruptured achilles

A

out of shape middle age men working thru strain
Loud pop with plant and pivot; fall and clutch
Limited plantar flexion, pain, swelling, limp
palpation of tendon reveals gap
Casting in equius position or surgery

36
Q

Ankle fracture

A

Fall on inverted or everted foot
Both malleoli break
Dx: AP lateral and mortise x rays
Open reduction and internal fixation if displaced fragments

37
Q

Compartment syndrome

A 
Often forearm and lower leg
Causes: crush or trauma; lower leg fx w closed reduction
Pain and limited use
Feels tight and TTP 
Excruciating pain w/ passive extension
Emergency fasciotomy
38
Q

Open fractures

A

Req cleaning in OR within 6 hrs

39
Q

Posterior dislocation of hip

A

Femur driven backwards like head on crash
Hip pain w/ leg shortened, adducted and internally rotated
Emergency reduction to avoid avascular necrosis

40
Q

Gas gangrene

A

Deep penetrating dirty wounds
3 dats later sick, toxic, moribund
Tender swollen discolored and gas crepitus
Tx IV penicillin, emergency surgical debridement

41
Q

Radial nerve injury

A

Oblique fracture of middle to distal 3rd humerus
If reduction improves dorsiflexion then no surgery
If paralysis after reduction then Surgery

42
Q

Popliteal artery injury

A

Posterior dislocation knee
Pulses by Doppler ct angio
Prompt reduction minimize vascular compromise

43
Q

Carpal tunnel syndrome

A

Women w repetitive hand work
Numbness and tingling in hands esp at night
Esp radial 3.5 fingers-median nerve distro
Phalens and tynells signs
X-ray to r/o others
Initial splints and anti inflammatory
Surgery w/ preop EMG

44
Q

Trigger finger

A

Favors women
Acutely flexed and unable to extend
Must pull out to extend- painful snap
Steroid injection first. Surgery last

45
Q

DeQuervain tenosynovitis

A

Young mothers carrying baby with wrist flexion and thumb extension
Pain in radial wrist and first dorsal compartment
Reproduce by thumb inside fist and ulnar deviation
Splint and anti inflammatory or steroid injection

46
Q

Dupuytren contracture

A

Old Norwegian men
Contracture of Palm of hand, with nodules and cords
Surgery if advanced and can’t place palm flat

47
Q

Felon

A

Abscess of fingertip pulp from penetrating injury
Throbbing pain w abscess symptoms-fever
Multiple fascial trabeculae, pressure can build and cause necrosis
Urgent surgical drainage

48
Q

Gamekeeper thumb

A

Ulnar collateral ligament injury from forced hyper extension of thumb
Often skiing
Collateral laxity at thumb MCP joint
Untreated can lead to dysfunction, pain, and arthritis
Casting done

49
Q

Jersey finger

A

Flexor tendon injury when finger forcefully extended
When making fist, dista phase doesn’t flex
Splinting

50
Q

Mallet finger

A

Extended finger forcefully flexed & extensor tendon rupture-volleyball
Tip flexed when fingers extended
Splinting

52
Q

Traumatic amputation of digits

A

Surgically reattach
Cleaned with sterile saline, wrapped in saline moist gauze put in a bag and placed on ice
No antiseptic, no alcohol, no dry ice
Use electric nerve stim to preserve neuromuscular fxn

53
Q

Lumbar disk herniation

A

Almost exclusively at L4-5 or L5-S1
Incidence age 45-46
Several month aching pain from pressing anterior spinal ligament
Then sudden onset neurgenic pain from movt
Electric shock down the leg to big toe (L4-5) or little toe (L5-S1)
Pain exacerbated by cough, sneeze, poop
Cannot ambulate or flex affected leg
Excruciating pain w/ straight leg test
MRI to confirm
tx: 3wk bed rest and pain control (nerve block)
Surgery if persistent neurologic deficits
Emergency if cauda equina symptoms- distended bladder, flaccid rectal sphincters, saddle anesthesia

54
Q

Cauda Equina syndrome

A

distended bladder, flaccid rectal sphincters, saddle anesthesia
Surgical emergency req immediate decompression

55
Q

Ankylosing spondylitis

A 
Young men 30-40
Chronic back pain and morning stiffness
Pain worse at rest and improves with activity
Progressive symptoms
Xray shows bamboo spine eventually 
Anti inflammatories and PT
HLA B27 antigen
Associated with uveitis and IBD
56
Q

Metastatic malignancy to spine

A 
Elderly
Progressive back pain worse at night 
Unrelieved with rest or position change
Weight loss
Women: lytic breast cancer mets at pedicles
Men: blastic prostate mets
MRI best dx
57
Q

Diabetic ulcers

A

Typically indolent
Located at pressure points: heel, metatarsal head, tips of toes
Start due to neuropathy
Fail to heal b/c microvascular disease
Heal with good diabetic control, clean, elevated leg for many weeks
Often get worse and lead to amputations

58
Q

Ulcers from arterial insufficiency

A

Usually at tips of toes
Dirty, pale base devoid of granulation tissue
Other symptoms of arteriosclerotic occlusive disease: absent pulses, trophic changes, claudication or pain at rest
Doppler studies looking for pressure gradient
CT angio, MRI angio, or arteriograms
Surgical revascularization angioplasty, or stents

59
Q

Venus stasis ulcers

A

In chronically edematous, indurated and hyperpigmented skin above medial malleolus
Painless with granulation bed
Patient has varicose veins and frequent cellulitis
Duplex scan
Tx: support stockings, ace bandages unna boot
Surgery: vein stripping, ulcer graft
Endovascular ablation

60
Q

Marjolin ulcer

A

Squamous cell carcinoma of skin developing in chronic leg ulcer
Setting of chronic healing and breakdown such as untreated 3rd degree burns, chronic draining sinus
Dirty, deep ulcer, healing at edges
Biopsy dx
Wide local excision and skin grafting

61
Q

Plantar Facitis

A 
Older, over weight
Disabling sharp heel pain when foot strikes
Worse pain in AM
Xray shows bony spur at location of pain
Exquisite TTP over the spur
Spontaneous resolution 12-18mo
Symptomatic tx until resolves 
Podiatrist remove bony spurs
62
Q

Morton neuroma

A

Inflammation of common digital nerve at 3rd interspace b/t 3rd & 4th toes
Neuroma is palpable at very tender point there
Caused by pointed high-heels that bunch toes
Conservative: analgesics and sensible shoes
Surgery to remove

63
Q

Gout

A

Swelling, redness, exquisite pain of sudden onset at 1st MTP joint
Middle age obese man with high serum uric acid
Uric acid crystals in joint fluid
Acute tx is indomethacin and colchicine
Long term allopurinol and probenicid

Surgery Shelf (8 decks)

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