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*OldSurgery > Ortho 2 > Flashcards

Ortho 2 Flashcards

1
Q

the most commonly missed fracture is the ______ fracture on the XR

A

second

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2
Q

2 main types of pelvic fractures

A

superior or inferior pubic rami fractures

high energy fractures

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3
Q

how do you treat a superior or inferior pubic rami pelvic fracture?

A

conservatively
PT/OT
may need hospitalization for pain control or inpatient rehab if lack support system

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4
Q

What do you need to watch with for a pelvic fracture (especially superior rami fracture)

A

acetabular extension of fracture

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5
Q

who normally gets high energy pelvic fractures?

A

young people in MVA/ MCA

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6
Q

a pelvic fracture w/ an accompanying L5 transvere process fracture suggests what?

A

instability

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7
Q

Do most people with a high energy pelvis fracture have that as their only injury

A

No, 85% have another injury

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8
Q

what will people with high energy fractures die of?

A

hemorrhage (greater risk with open fracture)

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9
Q

what other injury is common with a high energy pelvic fracture?

A

urogenital injury

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10
Q

what is the MOI of an open book pelvic fracture

A

A/P compression (car crashes)

need 6-15 units of blood

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11
Q

what causes a vertical shear pelvic fracture

A 
lateral compression (hit from side) T-bone accident
most common to have a pelvic vascular injury
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12
Q

is most the bleeding from a pelvic fracture arterial or venous

A

venous

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13
Q

what exams need to be done w/ a pelvic exam

A

rectal and vaginal exam

check for urethral bleeding prior foley insertion

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14
Q

Immediate treatment for pelvis fracture

A

large Bore IV access x 2 (need 18 gauge)

AP Pelvic XR if + then get inlet/outlet XR + CR scan

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15
Q

how do you manage MAST trousers?

A

deflate slowly

monitor vitals carefully

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16
Q

if a patient w/ a pelvic fracture is unstable what should you do?

A

check and r/o other sources of bleeding from abdomen first

consider abdominal binder +/- external fixator (metal screws)

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17
Q

If a patient is still instable after abdominal binder/ external fixator what do you do?

A

have interventional radiologists do angiography

very commonly needed w/ open book fracture

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18
Q

what do pelvis fracture eventually need?

A

ORIF

open reduction internal fixation

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19
Q

what typically causes a clavicle fracture?

A

fall on shoulder

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20
Q

where is the most common location of a clavicle fracture?

A

midshaft

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21
Q

what do you need to get for a clavicle fracture?

A

check XR for rib, AC/SC joint injuries

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22
Q

is it common to have nerve/ vessel injury w/ a clavicle fracture?

A

No. but medial border does have some risk of major vessel trauma (especially on left side)

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23
Q

how do you tx a clavicle fracture?

A

sling vs. figure 8 brace (6-12 weeks)

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24
Q

when do you do surgery for a clavicle fracture?

A

open fractures or w/ vascular injury

or skin is tented

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25
Q

Complications w/ clavicle fractures

A

non-union
painful malunion
fibrous non-union

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26
Q

if the skin is tented with a clavicle fracture what can happen?

A

skin will necrosis

bone will cut through

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27
Q

what must you tell patients to avoid fibrous non-union

A

will feel much better, but need to let it heal so there isn’t a fibrous problem

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28
Q

what is an AC joint injury

A

fall on tip of shoulder

“separated shoulder”

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29
Q

What grades are there of a AC joint injury

A

Grade I- Grade III

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30
Q

how do you treat Grade I and II AC jt. injury

A

NSAIDs, PT, sling

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31
Q

how do you treat Grade III AC jt. injuries

A

surgical

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32
Q

how do you treat SC joint injury

A

anterior- typically watch

posterior- may need surgery due to high vascular area

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33
Q

what is the MOI of scapula fracture

A

significant direct trauma

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34
Q

is a scapula injury usually isolated?

A

No, usually there is another injury

pulmonary contusions, pneumothorax, brachial plexus injury

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35
Q

management for scapula fracture

A

Chest xray

3 view shoulder (needs to see the glenoid)

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36
Q

when do you need surgical tx for a scapula fracture?

A

glenoid involvement

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37
Q

who normally gets proximal humerus fractures

A

adults/ elderly

Little League pitchers

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38
Q

how do you tx proximal humerus fractures

A

closed

will need surgery if more than 1/2 of the humerus off the humeral head

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39
Q

what is an associated problem w/ a proximal humerus fracture?

A

Rotator cuff tear (will fix this later after fracture is healed)

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40
Q

what sign is seen w/ an anterior/inferior shoulder dislocation?

A

empty socket sign

or pt. holds arm at sign

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41
Q

what causes posterior shoulder dislocations

A

electrocutions

seizures

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42
Q

what can a patient not do w/ a posterior shoulder dislocation

A

external rotation

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43
Q

what is the MOI of shoulder dislocation?

A

FOOSH (feel on outstretch hand)

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44
Q

After a shoulder dislocation what must you get?

A

3 views post reduction

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45
Q

where is a hill sachs lesion

A

head of humerus has divet in it

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46
Q

what is a bankart lesion

A

inferior chip of the glenoid labrum

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47
Q

Tx for shoulder dislocation

A

reduction and immobilization

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48
Q

young people are more likely to have what?

A

bankart

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49
Q

if a patient is older what lesion are they more likely to have?

A

hill sachs

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50
Q

what is helpful to evaluated a bankart lesion/ RC tear?

A

MRI

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51
Q

how do you tx a bankart lesion?

A

surgery now (even first time dislocator)

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52
Q

how do you reduce a shoulder?

A

traction/ counter traction
patient is supine w/ sheet around thorax
downward pressure on elbow/ humerus
Hippocratic method- foot in shoulder and pull down

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53
Q

what are the SITS muscles?

A

supraspinatus
infraspinatus
teres minor
subscapularis

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54
Q

what causes rotator cuff pathology?

A

impingement of suprspinatus at subacromial space
eccentric overload (overhead throwing)
GH jt. instability
poor training/ overuse

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55
Q

features of a rotator cuff tear

A

dull ache
poor sleep
increased pain w/ tears
poor abduction/ ER

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56
Q

what is significant on exam w/ a rotator cuff tear?

A 
\+ empty can
\+ drop arm
w/ impingement + Hawkins + Neer's
strength loss w/ ER/ horizaontal abd 
will say pain is at deltoid insertion (have been using deltoid to life arm up)
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57
Q

what imaging do you need for a rotator cuff injury?

A

X-ray (look for impinging osteophytes at AC joint)
always get 3 views for shoulders
MRI to evaluate for tear, degree of impingement

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58
Q

Tx for RC tear?

A

NSAIDs, PT, Rest, Ice

cortisone injection

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59
Q

when can you do arthroscopic subacromial decompression

A

persistent impingement

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60
Q

how do you treat full-thickness tears?

A

surgery

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61
Q

what is the most common location of a humerus fracture?

A

midshaft

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62
Q

what nerve must you check with a mid shaft fracture?

A

radial nerve

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63
Q

how do you test the radial nerve?

A

have them do a thumbs up sign

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64
Q

how do you evaluate a humerus fracture

A

xrays

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65
Q

how do you tx a humerus fracture?

A

coaptation splint/ humeral fracture brace

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66
Q

how do you treat a open humerus fracture

A

ORIF

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67
Q

what is the MOI Of a supracondylar humerus fracture

A

FOOSh + hyperexte. of elbow

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68
Q

what artery may be injured w/ a suprcondylar humerus fracture?

A

brachial artery

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69
Q

what happens if the brachial artery is affected w/ a supracondylar humerus fracture.

A

Volkmann’s ischemic contractures

70
Q

Tx for supracondylar humerus fracture

A

Peds- cast, closed reduction +cast, CRPP (closed reduction percutaneous pinning) , ORIF
adults- ORIF

71
Q

what is the most common type of elbow dislocation

A

posterior lateral

72
Q

how do you tx an elbow dislocation ?

A

correct med/lateral deformity first
then flex elbow to 90 degree + distal traction to correct AP
splint at 90 degrees and ortho referral

73
Q

what’s the risk w/ elbow dislocaiton?

A

get stiff, will get put in a hinge brace by ortho

74
Q

Subluxation of the radial head caused by excessive longitudinal traction

A

nursemaid’s elbow

75
Q

when are nursemaid’s elbows most common?

A

before age 4

76
Q

what happens if you can’t get a radial head back in w/ a nursemaid’s elbow

A

annular ligament may be interposed

77
Q

how do you reduce a nursemaid’s elbow

A

Hold above wrist and below elbow with thumb over radial head while fully supinating and flexing the forearm while directing pressure posteriorly – “screwing action” on radial head

78
Q

if there is a fracture in the radius and ulna what else do you need an xray of?

A

elbow and wrists

79
Q

how do you treat ulna/ radius fracture

A

adult- ORIF

kids- cast

80
Q

most radial fracture are what?

A

collies

dorsal angulation

81
Q

Tx for radius fracture w/ pred

A

reduction, can accept 15 degrees of angulation

82
Q

tx for adults w/ raidus fracture

A

ORIF if displaced or angulated

83
Q

Most commonly missed isolated fracture

A

scaphoid fracture

84
Q

what is there a risk of w/ a scaphoid fracture

A

AVN

85
Q

pain at the _________ is a scaphoid fracture

A

anatomic snuffbox

86
Q

what diagnostics do you need for a scaphoid fracture

A

carpal series

MRI or CT to confirm

87
Q

Tx for scaphoid fracture

A

splint/cast must initially immobilize the thumb, wrist, elbow (pronation/ supination affects scaphoid)
displacement of 1 mm or more required ORIF

88
Q

what will AVN look like for a scaphoid fracture

A

“ground glass appearance” or increased bone density early

89
Q

what is a fracture of the 5th MC?

A

“Boxer’s”

loss of prominence of knuckle w/ pain

90
Q

what must you evaluate for w/ a 5th MC fracture?

A

puncture wound

91
Q

If there is a “fight” bite from a 5th MC fracture what needs to happen?

A

I & D (E. Corrodens)

92
Q

Tx for 5th MC fracture

A

40 degrees or less- closed

40 degress or more- ORIF

93
Q

what is a fracture of the distal phalynx

A

tuft - direct blow

94
Q

how do you tx a Tuft fracture?

A

evaluation for nail bed injury (need to r/o open fracture)

95
Q

what is the name for a downward blow to distal phalanx in extension – avulsion of distal extensor tendon for base of distal phalanx

A

Mallet fracture

96
Q

with a mallet fracture what do you lose the ability to do?

A

extend at DIP

97
Q

tx for mallet fracture

A

splint in extension

refer to hand surgeon

98
Q

Avulsion of distal flexor tendon

A

Jersey fracture

99
Q

Tx for jersey fracture

A

flinger splint in neutral

surgery

100
Q

most common location of finger dislocation

A

DIP

101
Q

when does a finger dislocation need surgery?

A

central slip may be caught

102
Q

Most common mononeuropathy

A

CTS

103
Q

when is CTS often seen

A

pregnancy

104
Q

PE w/ CTS

A

+ Tinnel’s + Phalen’s
night pain, numbness
paresthesias

105
Q

Gold standard for diagnosing CTS

A

EMG

106
Q

Tx for CTS

A 
Activity Modification
Volar Splint (especially at night)
NSAID’s
Steroid injection
Surgery for decompression
107
Q

MOI for acetabular fractures

A

Blow to Greater Troch. can cause Fx. thru inner wall
Hip Dislocation – Posterior Wall
Rami Fx – Medial Wall / Post. Wall

108
Q

diagnostis for acetabular fractures

A

XRay and CT

109
Q

what do you need to evaluate for w/ acetabular fracture

A

sciatic nerve injury

110
Q

tx for unstable/ displaced acetabular fractures

A

surgery if unstable/ displaced

111
Q

MOI of hip dislocations

A

blow to flexed knee (MVA- dashboard)

112
Q

what can be seen with hip dislocations?

A

sciatic nerve injury

113
Q

how will patients w/ a anterior hip dislocation present

A

ER
ABD
mild flexion

114
Q

tx for hip dislocations

A

reduction w/i 12 hours to reduce risk of AVN of femoral head

115
Q

how to reduce a posterior hip dislocation?

A

Pt. supine – one person stabilizes pelvis – another pulls in-line traction with gentle simultaneous flexion, abd, and Rotation – with difficulty add lateral force – impressive clunk

116
Q

what x-ray view do you get with a hip dislocation

A

shoot through lateral

117
Q

where does true hip pain present?

A

groin pain + trauma

118
Q

how will a patient with hip fracture hold their leg

A

leg shortered and ER

119
Q

what traction do you do for hip fracture before surgery

A

buck’s traction

120
Q

what can cause stress fracture of the femoral neck?

A 
Distance Runners
Eating Disorder
Amenorrhea
Osteoporosis
Vit D / Parathyroid / Other Endocrine
121
Q

Tx for stress fractures of femoral neck

A

surgical vs. non-surgical

discuss AVN risk

122
Q

what is a major risk w/ femur fractures?

A

compartment syndrome

hemorrhage

123
Q

spinal femur fracture in a non-ambulatory child is what?

A

child abuse

124
Q

for a femur fracture what must the xray include?

A

hip and knee

125
Q

how do you tx children w/ a femur fracture

A

spica

126
Q

MOI for patellar fracture

A

fall on bent knee

127
Q

what test do you need to do w/ patellar fracture

A

straight leg raise

if positive- quad tendon is intact

128
Q

tx for paterllar fracture

A

surgery- ORIF vs. patellaectomy

129
Q

what is a knee dislocation

A

Complete dislocation between tibia and femur

130
Q

what is there a high risk of w/ a knee dislocation

A

popiteal artery/ nerve injury

131
Q

why is there a high risk of amputation/ death w/ knee dislocation

A

popiteal artery is affected

132
Q

diagnostics for knee dislocation

A

XR pre and post
neurovascular exams
CT angiogram
MRI later

133
Q

MOI of a patella dislocation

A

direct blow or twist, usually lateral

134
Q

how do you reduce a patella dislocation

A

extend knee and then immobilize knee and refer to ortho

135
Q

may injury is common w/ a patella dislocation

A

medial patellafemoral ligament (MPFL) injur

136
Q

Rotational force of the femur on tibia

Medial > Lateral

A

meniscal injury

137
Q

PE presentation for meniscal injury

A

Inability to Ext. described as locking

138
Q

what is the gold standard for meniscal injury

A

MRI

139
Q

Tx for meniscal injury

A

Knee arthroscopy

140
Q

who are ligament injuries more common in

A

females

141
Q

what is the most sensitive test for ACL?

A

Lachman’s (hold femur stable while moving tibia)

142
Q

what can happen w/ ACL injuries

A

lateral tibial plateau

143
Q

Tx for ACL tear

A

surgery

6-9 month injury

144
Q

what collateral ligament is more often injured

A

MCL

145
Q

Tx for MCL or LCL

A

PT
brace
RICE
NSAIDs

146
Q

Apophysitis of the tibial tubercle due to trauma or overuse in 8-15 y/o. will have anterior knee at tubercle

A

osgood-schlatter dz

147
Q

Tx for osgood-schlatter dz

A

Activity modification – RICE, PT, NSAID’s

148
Q

what are most tibial plateau fractures

A

intra articular (vs. extra)

149
Q

what nerve can be injured by tibial plateau fracture

A

peronal- leads to foot drop

150
Q

what type fracture does a old peron w/ a tibial pleateau fracture have

A

depressed

151
Q

what type fracture does a young peron w/ a tibial pleateau fracture have

A

split

152
Q

how do you diagnose a tibial plateau fracture

A

Xray

MRI soft tissue

153
Q

what is the most common long bone fracture

A

tibia/ fibular fracture

154
Q

what is there a risk w/ for tibia/ fibular fracture

A

compartment syndrome

155
Q

who are stress fractures in the tibia/ fibula common in?

A

runners
dancer
military recruits

156
Q

when do you cast a tibia / fibular fracture

A

toddler’s

stress

157
Q

if an ankle is dislocated it is probably what

A

broken

158
Q

what view do you need for a posterior ankle fracture?

A

lateral

159
Q

is there always a fracture w/ aSyndesmosis Disruption

A

no

160
Q

what typically causes an ankle sprain

A

inversion injury

Anterior talofibular ligament most common

161
Q

Tx for ankle sprain

A

RICE
NSAIDs
WBAT
PT

162
Q

Tx for talus fracture?

A

surgery usually

can cast if non-displaced but still some AVN risk

163
Q

what causes calcaneal fractures?

A

fall from height

164
Q

what views do you need for a calcaneous fracture?

A

Os calcis view

CT scan

165
Q

tx for calcaneal fractures

A

ORIF or closed

horrible outcome

166
Q

inversion injury with Fx at diaphyseal junction of 5th MT

A

Jones fracture

167
Q

if someone has an ankle sprain what must you press to check for jones fracture

A

5th metatarsal

168
Q

tx for jones fracture

A

surgery

169
Q

Fracture /Ligament rupture between base of second metatarsal and medial cuneiform – tenderness dorsally

A

lisfranc injury

170
Q

Tx for lisfranc injury

A

surgery

171
Q

best imaging to diagnose lisfranc injury

A

MRI

*OldSurgery (22 decks)

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