Ortho 2 Flashcards
1
Q
the most commonly missed fracture is the ______ fracture on the XR
A
second
2
Q
2 main types of pelvic fractures
A
superior or inferior pubic rami fractures
high energy fractures
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
4
Q
What do you need to watch with for a pelvic fracture (especially superior rami fracture)
A
acetabular extension of fracture
5
Q
who normally gets high energy pelvic fractures?
A
young people in MVA/ MCA
6
Q
a pelvic fracture w/ an accompanying L5 transvere process fracture suggests what?
A
instability
7
Q
Do most people with a high energy pelvis fracture have that as their only injury
A
No, 85% have another injury
8
Q
what will people with high energy fractures die of?
A
hemorrhage (greater risk with open fracture)
9
Q
what other injury is common with a high energy pelvic fracture?
A
urogenital injury
10
Q
what is the MOI of an open book pelvic fracture
A
A/P compression (car crashes)
need 6-15 units of blood
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
12
Q
is most the bleeding from a pelvic fracture arterial or venous
A
venous
13
Q
what exams need to be done w/ a pelvic exam
A
rectal and vaginal exam
check for urethral bleeding prior foley insertion
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
15
Q
how do you manage MAST trousers?
A
deflate slowly
monitor vitals carefully
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)
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
18
Q
what do pelvis fracture eventually need?
A
ORIF
open reduction internal fixation
19
Q
what typically causes a clavicle fracture?
A
fall on shoulder
20
Q
where is the most common location of a clavicle fracture?
A
midshaft
21
Q
what do you need to get for a clavicle fracture?
A
check XR for rib, AC/SC joint injuries
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)
23
Q
how do you tx a clavicle fracture?
A
sling vs. figure 8 brace (6-12 weeks)
24
Q
when do you do surgery for a clavicle fracture?
A
open fractures or w/ vascular injury
or skin is tented
25
Complications w/ clavicle fractures
non-union
painful malunion
fibrous non-union
26
if the skin is tented with a clavicle fracture what can happen?
skin will necrosis
| bone will cut through
27
what must you tell patients to avoid fibrous non-union
will feel much better, but need to let it heal so there isn't a fibrous problem
28
what is an AC joint injury
fall on tip of shoulder
| "separated shoulder"
29
What grades are there of a AC joint injury
Grade I- Grade III
30
how do you treat Grade I and II AC jt. injury
NSAIDs, PT, sling
31
how do you treat Grade III AC jt. injuries
surgical
32
how do you treat SC joint injury
anterior- typically watch
| posterior- may need surgery due to high vascular area
33
what is the MOI of scapula fracture
significant direct trauma
34
is a scapula injury usually isolated?
No, usually there is another injury
| pulmonary contusions, pneumothorax, brachial plexus injury
35
management for scapula fracture
Chest xray
| 3 view shoulder (needs to see the glenoid)
36
when do you need surgical tx for a scapula fracture?
glenoid involvement
37
who normally gets proximal humerus fractures
adults/ elderly
| Little League pitchers
38
how do you tx proximal humerus fractures
closed
| will need surgery if more than 1/2 of the humerus off the humeral head
39
what is an associated problem w/ a proximal humerus fracture?
Rotator cuff tear (will fix this later after fracture is healed)
40
what sign is seen w/ an anterior/inferior shoulder dislocation?
empty socket sign
| or pt. holds arm at sign
41
what causes posterior shoulder dislocations
electrocutions
| seizures
42
what can a patient not do w/ a posterior shoulder dislocation
external rotation
43
what is the MOI of shoulder dislocation?
FOOSH (feel on outstretch hand)
44
After a shoulder dislocation what must you get?
3 views post reduction
45
where is a hill sachs lesion
head of humerus has divet in it
46
what is a bankart lesion
inferior chip of the glenoid labrum
47
Tx for shoulder dislocation
reduction and immobilization
48
young people are more likely to have what?
bankart
49
if a patient is older what lesion are they more likely to have?
hill sachs
50
what is helpful to evaluated a bankart lesion/ RC tear?
MRI
51
how do you tx a bankart lesion?
surgery now (even first time dislocator)
52
how do you reduce a shoulder?
traction/ counter traction
patient is supine w/ sheet around thorax
downward pressure on elbow/ humerus
Hippocratic method- foot in shoulder and pull down
53
what are the SITS muscles?
supraspinatus
infraspinatus
teres minor
subscapularis
54
what causes rotator cuff pathology?
impingement of suprspinatus at subacromial space
eccentric overload (overhead throwing)
GH jt. instability
poor training/ overuse
55
features of a rotator cuff tear
dull ache
poor sleep
increased pain w/ tears
poor abduction/ ER
56
what is significant on exam w/ a rotator cuff tear?
```
+ 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)
```
57
what imaging do you need for a rotator cuff injury?
X-ray (look for impinging osteophytes at AC joint)
always get 3 views for shoulders
MRI to evaluate for tear, degree of impingement
58
Tx for RC tear?
NSAIDs, PT, Rest, Ice
| cortisone injection
59
when can you do arthroscopic subacromial decompression
persistent impingement
60
how do you treat full-thickness tears?
surgery
61
what is the most common location of a humerus fracture?
midshaft
62
what nerve must you check with a mid shaft fracture?
radial nerve
63
how do you test the radial nerve?
have them do a thumbs up sign
64
how do you evaluate a humerus fracture
xrays
65
how do you tx a humerus fracture?
coaptation splint/ humeral fracture brace
66
how do you treat a open humerus fracture
ORIF
67
what is the MOI Of a supracondylar humerus fracture
FOOSh + hyperexte. of elbow
68
what artery may be injured w/ a suprcondylar humerus fracture?
brachial artery
69
what happens if the brachial artery is affected w/ a supracondylar humerus fracture.
Volkmann's ischemic contractures
70
Tx for supracondylar humerus fracture
Peds- cast, closed reduction +cast, CRPP (closed reduction percutaneous pinning) , ORIF
adults- ORIF
71
what is the most common type of elbow dislocation
posterior lateral
72
how do you tx an elbow dislocation ?
correct med/lateral deformity first
then flex elbow to 90 degree + distal traction to correct AP
splint at 90 degrees and ortho referral
73
what's the risk w/ elbow dislocaiton?
get stiff, will get put in a hinge brace by ortho
74
Subluxation of the radial head caused by excessive longitudinal traction
nursemaid's elbow
75
when are nursemaid's elbows most common?
before age 4
76
what happens if you can't get a radial head back in w/ a nursemaid's elbow
annular ligament may be interposed
77
how do you reduce a nursemaid's elbow
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
if there is a fracture in the radius and ulna what else do you need an xray of?
elbow and wrists
79
how do you treat ulna/ radius fracture
adult- ORIF
| kids- cast
80
most radial fracture are what?
collies
| dorsal angulation
81
Tx for radius fracture w/ pred
reduction, can accept 15 degrees of angulation
82
tx for adults w/ raidus fracture
ORIF if displaced or angulated
83
Most commonly missed isolated fracture
scaphoid fracture
84
what is there a risk of w/ a scaphoid fracture
AVN
85
pain at the _________ is a scaphoid fracture
anatomic snuffbox
86
what diagnostics do you need for a scaphoid fracture
carpal series
| MRI or CT to confirm
87
Tx for scaphoid fracture
splint/cast must initially immobilize the thumb, wrist, elbow (pronation/ supination affects scaphoid)
displacement of 1 mm or more required ORIF
88
what will AVN look like for a scaphoid fracture
“ground glass appearance” or increased bone density early
89
what is a fracture of the 5th MC?
"Boxer's"
| loss of prominence of knuckle w/ pain
90
what must you evaluate for w/ a 5th MC fracture?
puncture wound
91
If there is a "fight" bite from a 5th MC fracture what needs to happen?
I & D (E. Corrodens)
92
Tx for 5th MC fracture
40 degrees or less- closed
| 40 degress or more- ORIF
93
what is a fracture of the distal phalynx
tuft - direct blow
94
how do you tx a Tuft fracture?
evaluation for nail bed injury (need to r/o open fracture)
95
what is the name for a downward blow to distal phalanx in extension – avulsion of distal extensor tendon for base of distal phalanx
Mallet fracture
96
with a mallet fracture what do you lose the ability to do?
extend at DIP
97
tx for mallet fracture
splint in extension
| refer to hand surgeon
98
Avulsion of distal flexor tendon
Jersey fracture
99
Tx for jersey fracture
flinger splint in neutral
| surgery
100
most common location of finger dislocation
DIP
101
when does a finger dislocation need surgery?
central slip may be caught
102
Most common mononeuropathy
CTS
103
when is CTS often seen
pregnancy
104
PE w/ CTS
+ Tinnel's + Phalen's
night pain, numbness
paresthesias
105
Gold standard for diagnosing CTS
EMG
106
Tx for CTS
```
Activity Modification
Volar Splint (especially at night)
NSAID’s
Steroid injection
Surgery for decompression
```
107
MOI for acetabular fractures
Blow to Greater Troch. can cause Fx. thru inner wall
Hip Dislocation – Posterior Wall
Rami Fx – Medial Wall / Post. Wall
108
diagnostis for acetabular fractures
XRay and CT
109
what do you need to evaluate for w/ acetabular fracture
sciatic nerve injury
110
tx for unstable/ displaced acetabular fractures
surgery if unstable/ displaced
111
MOI of hip dislocations
blow to flexed knee (MVA- dashboard)
112
what can be seen with hip dislocations?
sciatic nerve injury
113
how will patients w/ a anterior hip dislocation present
ER
ABD
mild flexion
114
tx for hip dislocations
reduction w/i 12 hours to reduce risk of AVN of femoral head
115
how to reduce a posterior hip dislocation?
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
what x-ray view do you get with a hip dislocation
shoot through lateral
117
where does true hip pain present?
groin pain + trauma
118
how will a patient with hip fracture hold their leg
leg shortered and ER
119
what traction do you do for hip fracture before surgery
buck's traction
120
what can cause stress fracture of the femoral neck?
```
Distance Runners
Eating Disorder
Amenorrhea
Osteoporosis
Vit D / Parathyroid / Other Endocrine
```
121
Tx for stress fractures of femoral neck
surgical vs. non-surgical
| discuss AVN risk
122
what is a major risk w/ femur fractures?
compartment syndrome
| hemorrhage
123
spinal femur fracture in a non-ambulatory child is what?
child abuse
124
for a femur fracture what must the xray include?
hip and knee
125
how do you tx children w/ a femur fracture
spica
126
MOI for patellar fracture
fall on bent knee
127
what test do you need to do w/ patellar fracture
straight leg raise
| if positive- quad tendon is intact
128
tx for paterllar fracture
surgery- ORIF vs. patellaectomy
129
what is a knee dislocation
Complete dislocation between tibia and femur
130
what is there a high risk of w/ a knee dislocation
popiteal artery/ nerve injury
131
why is there a high risk of amputation/ death w/ knee dislocation
popiteal artery is affected
132
diagnostics for knee dislocation
XR pre and post
neurovascular exams
CT angiogram
MRI later
133
MOI of a patella dislocation
direct blow or twist, usually lateral
134
how do you reduce a patella dislocation
extend knee and then immobilize knee and refer to ortho
135
may injury is common w/ a patella dislocation
medial patellafemoral ligament (MPFL) injur
136
Rotational force of the femur on tibia
| Medial > Lateral
meniscal injury
137
PE presentation for meniscal injury
Inability to Ext. described as locking
138
what is the gold standard for meniscal injury
MRI
139
Tx for meniscal injury
Knee arthroscopy
140
who are ligament injuries more common in
females
141
what is the most sensitive test for ACL?
Lachman's (hold femur stable while moving tibia)
142
what can happen w/ ACL injuries
lateral tibial plateau
143
Tx for ACL tear
surgery
| 6-9 month injury
144
what collateral ligament is more often injured
MCL
145
Tx for MCL or LCL
PT
brace
RICE
NSAIDs
146
Apophysitis of the tibial tubercle due to trauma or overuse in 8-15 y/o. will have anterior knee at tubercle
osgood-schlatter dz
147
Tx for osgood-schlatter dz
Activity modification – RICE, PT, NSAID’s
148
what are most tibial plateau fractures
intra articular (vs. extra)
149
what nerve can be injured by tibial plateau fracture
peronal- leads to foot drop
150
what type fracture does a old peron w/ a tibial pleateau fracture have
depressed
151
what type fracture does a young peron w/ a tibial pleateau fracture have
split
152
how do you diagnose a tibial plateau fracture
Xray
| MRI soft tissue
153
what is the most common long bone fracture
tibia/ fibular fracture
154
what is there a risk w/ for tibia/ fibular fracture
compartment syndrome
155
who are stress fractures in the tibia/ fibula common in?
runners
dancer
military recruits
156
when do you cast a tibia / fibular fracture
toddler's
| stress
157
if an ankle is dislocated it is probably what
broken
158
what view do you need for a posterior ankle fracture?
lateral
159
is there always a fracture w/ aSyndesmosis Disruption
no
160
what typically causes an ankle sprain
inversion injury
| Anterior talofibular ligament most common
161
Tx for ankle sprain
RICE
NSAIDs
WBAT
PT
162
Tx for talus fracture?
surgery usually
| can cast if non-displaced but still some AVN risk
163
what causes calcaneal fractures?
fall from height
164
what views do you need for a calcaneous fracture?
Os calcis view
| CT scan
165
tx for calcaneal fractures
ORIF or closed
| horrible outcome
166
inversion injury with Fx at diaphyseal junction of 5th MT
Jones fracture
167
if someone has an ankle sprain what must you press to check for jones fracture
5th metatarsal
168
tx for jones fracture
surgery
169
Fracture /Ligament rupture between base of second metatarsal and medial cuneiform – tenderness dorsally
lisfranc injury
170
Tx for lisfranc injury
surgery
171
best imaging to diagnose lisfranc injury
MRI
