ORTHO Flashcards
Is everything in ortho able to diagnose with xrays?
No… duh
Where does a clavicle fracture typically occur?
Distal 1/3
What physical exam finding is of the biggest concern with a clavicle fracture?
Look at the skin! If you see tenting it will convert into an open fracture
And make sure they don’t hurt at the sternoclavicular joint
And no neuro findings!
How do you treat a clavicle fracture?
Should immobilizer & sleep upright if need be
What’s it called when there is shortening?
Beynnett
What are the grades of an AC joint separation?
Grade 1-3
How do you treat an AC separation?
sling
Who do most commonly see humeral head fractures in and what MOI?
elderly with FOOSH
How do we treat humeral head fractures?
Typically conservative
If you find a scapula injury, what do you need to think?
There is most likely other trauma
What should we never say after an xray?
Don’t say: “Everything is okay”. Say: “I do not see obvious bony injury BUT we can’t see soft issue injury”
What’s the MOI for a shoulder dislocation?
Abd & Ext rotation
What will you see on PE with a shoulder dislocation?
Sulcus sign that you can place your thumb into it
What should we rule out with a shoulder dislocation?
Fracture & neuromuscular and a Hill-Sachs deformity
What would cause a posterior dislocation in an unconscious patient?
Seizure and Electrocution
What’s a good pain medication for shoulder dislocations?
Fentanyl (since it wears off quickly)
What should we ask about in history for shoulder dislocations?
Ask about prior dislocations & how long it has been out for & which hand is dominant
If a patient has a hill-sachs deformity, how difficult is it to relocate?
VERY (will often need full sedation)
What image would prove shoulder relocation?
Y (with humeral head touching all 3 views)
Once the shoulder is reduced, what do you do?
post reduction films, recheck neurovascular, and tell them to avoid abd/ext rot
Limited flexion ROM (can’t go past 90 degrees) is key in what diagnosis?
Rotator cuff injury
how do you treat a RTC tear?
Sling → send to ortho
What are the common elbow fractures?
Supercondylar (bad)
Radial head
Olecranon
If you see a distal humeral fracture in a child – what do you do?
REFER!!!! It’s a supracondylar fracture that is so likely to produce long term effects
A sail sign is for what?
Proximal radial head fracture
When do we see a posterior fat pad in the elbow?
Only when there is an injury; again proximal radial head fracture
What type of splint for a proximal radial head fracture?
Long arm
Which way does an elbow dislocate?
Posterior
After an elbow reduction, what do you do?
Are they neuromuscular intact -
have radiologist or ortho confirm that there’s no radial head fx
How do you reduce an elbow?
Countertraction, then pull out and flex forward
What’s special about the scaphoid?
Limited blood supply → high rate of non-unions
When do you need to handle a wrist injury rather than splinting and sending to ortho later?
Severely angulated or displaced
What splint for a distal radius?
volar
Any time you find a fracture in a two-bone structure what must you do?
Either crazy palpate or image higher up
What fractures in the wrist/forearm do you not want to miss?
Monteggia or Galiazzi
What does a positive finkelstein’s test?
DeQuervan’s
What does a positive tinel’s test?
Carpal tunnel
How do you treat carpal tunnel?
Splint day & night
If a patient has a hyperextension injury of the thumb – what diagnosis?
Gamekeeper’s Thumb
What must you test for gamekeeper’s?
MCL injury
If a grandma fell and her hip hurts and she won’t walk – what does that mean? What should you do?
There is most definitely something wrong → most likely an acetabular fracture
CT hip
What hip fracture is stable and the person can walk in on it?
Ramus or pelvic ring fractures
If you break higher up in the crest portion of the hip – will they walk on it?
Nope
What should you look for on PE in a pelvic fracture?
Crepitus, instability, weight bear, and rotation
Shortened and internally rotated hip is what?
Dislocation
What should you press onto to rule out significant injury in a pelvic injury?
Iliac crests – if you not crepitus → get trauma
What parts of body can you bleed into?
Head, chest, pelvis, and femur
Where is an open book fracture?
Pubic symphysis
What do you need to make sure or with a pelvic fracture (downtown)?
Make sure there’s no tear in their urethra → no blood present
What happens to hip fracture patients?
They get admitted
What classification system can we use for hip fractures?
Garden classification
If a patient cannot walk on their hip and their leg is externally rotated – what diagnosis is most likely?
Hip fracture
Who would most commonly dislocate their hip?
total hip patients
Which way do most hips dislocate?
Posterior
How do you manage a femur fraction in the ED?
Traction splint (Hare) → Surgical fixation is always necessary
If you have a patient with a suspected femur fracture, what must you remember?
Rule out any other injuries!!!
If there is some type of neurovascular compromise in a femur fracture, what must you do?
Pull traction
If you see a kid with a femur fracture – what must you suspect?
Child abuse
If a patient presents with a plant and twist mechanism with minimal pain?
ACL
PE findings of ACL tear?
+ Anterior drawer & + Lachman’s
PE findings for meniscal tear?
joint line tenderness & + Valgus
What is the meniscus connected to?
MCL
IF you have a true knee dislocation – what do you do?
DO NOT DO ANYTHING WITH IT! Call ortho for EMERGENT consult
Why? Because of the popliteal artery, and you assume neurovascular accident
We should ALWAYS check AROM in the knee – what are we ruling out?
Quad or patellar tendon rupture
What is difficult about tibial plateau fractures?
easy to miss & often don’t heal well
What must you always note on ankle xray?
Is the mortise intact
Which ankle injury is most common?
Lateral malleolus
If there is an ankle fracture what MUST you check, in order to rule out what?
DOCUMENT NO PROXIMAL TIBIAL TENDERNESS
In order to rule out a maisoneuve injury
If you have a bi or tri-malleolar fracture what happen to the mortise joint?
It is unstable
A positive Thompson test is for what?
Achilles rupture
How do you splint an Achilles tendon rupture?
Full plantar flexion
If you have a calcaneal fracture in the right side – what must you rule out?
ALWAYS x-ray the other foot
ALWAYS examine the spine!
