Ortho Flashcards
A splintered or crushed fracture is known as a _____ fracture.
Comminuted
____ is the study of choice for the dx of an occult hip fx.
MRI
The treatment of simple fractures often involves:
Closed reduction with cast placement
Complicated or unstable fractures require:
ORIF
_____ (type of fracture) occurs when one side of the cortex buckles as a result of compression injury (e.g. FOOSH). Differs from a greenstick fracture by the mechanism of injury.
Torus fracture
*Treatment= 4-6 weeks in cast
____ (type of fracture) occurs in long bones when bowing causes a break in one side of the cortex.
Greenstick fx
*If angulation >15 degrees you need referral to an ortho surgeon
Salter-Harris fractures involve the growth plate of long bones in pediatric patients. The classification is:
• I → entire physis
• II → entire physis + portion of metaphysis
• III → portion of the epiphysis
• IV → portion of epiphysis + portion of the metaphysis
• V → compression injury of epiphyseal plate
S-A-L-TE-R
S- Straight across A- Above (Most common!) L- Lower TE- Through Everything R- cRush
Dislocation v. Subluxation…
o Dislocation → total loss of congruity that occurs between the articular surfaces of the joint
o Subluxation → any less serious loss of congruity, or a less than complete dislocation.
____ is the MC type of shoulder dislocation.
Anterior glenohumeral
*Humeral head is anterior and inferior to glenoid
Clinical manifestation of an anterior shoulder dislocation is:
Arm is ABDUCTED, EXTERNALLY ROTATED
How is an anterior shoulder dislocation managed?
Reduction
*Must RULE OUT axillary nerve injury
A posterior shoulder dislocation is most commonly associated with _____ (type of medical event).
Seizures (electric shock and trauma)
Clinical manifestations of a posterior shoulder dislocation are:
Arm ADDUCTED, INTERNALLY ROTATED; Anterior shoulder is flat, humeral head is prominent
*Management- reduction and immobilization
Axillary and Y views are the most helpful in determining _____ v. _____ dislocations.
Anterior v. Posterior Shoulder
_____ injuries are MC in athletes or laborers performing repetitive overhead movements. They are the MC cause of shoulder pain in people > 40y.
Rotator cuff
*SUPRASPINATUS MC!!
Some PE findings with rotator cuff injuries include:
- Passive ROM greater than active!
- Supraspinatus strength test- empty can test
- Impingement tests of subscapular nerve/supraspinatus:
- Hawkins test
- Drop arm test
- Neer test - Subacromial lidocaine test: can help distinguish tendinopathy from tears (normal strength with pain relief= tendinopathy)
Management of tedinitis and tears includes:
- Tendinitis: shoulder pendulum/wall climbing exercises, ice, NSAIDs, stop offending activity
- Tear: Conservative- rehab, NSAIDs, intraarticular corticosteroids, ROM preservation- surgery
AC joint dislocation (“shoulder separation”) dx using ____ to reveal mild separations.
Weights
There are 5 classes of AC joint dislocation that progressively worsen (5 is worse than 1). In class ___ the AC ligament is ruptured and the coracoclavicular ligament is sprained.
2
*Class 3- Rupture of BOTH AC and CC ligaments- may need SURGERY
In humeral shaft fractures you must r/o ___ nerve injury. This injury may cause wrist drop.
Radial nerve
*Check deltoid sensation to assess for brachial plexus injury
The MOI for humeral shaft fractures is:
FOOSH or direct trauma
The MC fractured bone in children, adolescents, and newborns during birth is the _____.
Clavicle
*If proximal 1/3 get ortho consult
Thoracic outlet syndrome can cause nerve compression, especially on ____ side of hand.
Ulnar
A PE of Thoracic Outlet Syndrome may reveal a positive Adson sign which is:
Loss of radial pulse with head rotation to affected side.
*TOS diagnosed by MRI
____ fractures are most commonly seen in children 5-10y and manifest by swelling, tenderness at the elbow and prominent olecranon.
Supracondylar Humerus Fx
Xray of a supracondylar fx may show-
- Abnormal anterior humeral line
2. Anterior or posterior fat pad sign
Median nerve damage and brachial artery injury is known as:
Volkmann ischemic contracture
*RADIAL NERVE INJURY
Management humerus fractures involve:
- Nondisplaced- posterior splint
2. Displace- ORIF
____ fractures often result from a FOOSH and result in the inability to fully extend the elbow.
Radial head fx
Suppurative flexor tenosynovitis is an infxn of the flexor tendon synovial sheath of the finger. MC skin flora is ____.
Staph aureus
*MOI- often penetrating trauma or spread from other tissues
Kanavel’s signs: FLEXor tenosynovitis
- Finger held in flexion
- Length of tendon sheath is tender
- Enlarged finger
- Xtension of the finger causes pain
- Definitive Dx- aspiration and/or biopsy
- *Treatment- I&D with irrigation and debridement +/- abx
Olecranon fx may cause ____ nerve dysfunction.
Ulnar
An abrupt “goose egg” swelling of the elbow (boggy, red) with limited ROM with flexion is suspicious for:
Olecranon bursitis
Monteggia fx v. Galeazzi fx
SEE P. 182
Radial head subluxation (nursemaid’s elbow) MC occurs in ___ (age group) from ____ (activity).
2-5y from lifting/swinging/pulling (of a child)
- Manifestations- children show up with arm slightly flexed, refusing to use it
- *Treatment- reduction (pressure on radial head with supination and flexion)
Lateral elbow pain especially with gripping, forearm pronation, and wrist extension against resistance is seen with ____.
Lateral epicondylitis (Tennis Elbow)
_____ is most commonly seen in golfers and patients who do household chores.
Medial epicondylitis
*Worse with pulling activities and wrist flexion against resistance!
____ is the MC type of elbow dislocation.
Posterior!
Management of an elbow dislocation involves:
EMERGENT reduction! Posterior splint at 90 degrees. If unstable then ORIF.
A positive Tinel’s sign at the elbow is indicative of:
Cubital Tunnel Syndrome- ulnar nerve compression
The MC carpal fracture is _____ fracture. Often caused by a FOOSH.
Scaphoid (Navicular)
*Look for snuffbox tenderness! Concern for avascular necrosis
How is a scaphoid fracture treated?
If nondisplaced–> thumb spica
Displaced–> ORIF
____ fracture is common after a FOOSH in a postmenopausal woman or a woman with osteoporosis.
Colles fracture
*distal radius fracture with dorsal/posterior angulation
MC complication of a colles fracture is a rupture of the ____ tendon.
Extensor pollicus longus
Management of a colles fracture is:
Stable–> sugar tong splint/cast
Unstable or comminuted–> ORIF
Ventral angulated fracture (of wrist) is seen with a _____ fx.
Smith fracture
When the lunate doesn’t articulate with the ____ or the _____ it is known as a lunate dislocation and needs ORIF immediately!
Capitate or the Radius
*piece of pie and spilled teacup signs (p. 185)
____ fx is the most serious carpal fx :(
Lunate- worry about avascular necrosis (Kienbock’s dz)
An extensor tendon avulsion after a sudden blow to tip of an extended finger with forced flexion can cause a _____ finger.
Mallet (baseball) finger
*Management- splint the DIP x 6wks (or surgical pinning)
When the finger is flexed at the PIP joint and hyperextended at the DIP joint this is known as a _____ deformity.
Boutonniere
When the finger is hyperextended at the PIP joint and flexed at the DIP joint this is known as a ____ deformity.
Swan neck
_____ thumb is seen when there is a sprain or tear of the ulnar collateral ligament and the thumb is far away from the other digits.
Gamekeeper’s/Skier’s
Fracture of the 5th metacarpal is known as a _____ fracture.
Boxer’s
- MOI: Punching with a clenched fist
- *Always check for bit wounds- if present treat with Augmentin!!
Bennett v. Rolando fractures
- Bennett- Intraarticular fx through the base of the 1st metacarpal (MCP)
- Rolando- COMMINUTED Bennett’s fx
Excessive thumb use with repetitive action can lead to _____ which manifests with pain along the radial aspect of the wrist radiating to the forearm.
de Quervain Tenosynovitis
- Positive Finkelstein test!
- *Treated- thumb spica splint x 3 weeks
Carpal tunnel syndrome can lead to ____ nerve entrapment.
Median
Clinical manifestations of carpal tunnel syndrome include:
Paresthesias, pain of palmar 1st 3 digits (especially at NIGHT), Thenar muscle wasting
*Dx- + Tinel’s sign, + Phalen’s sign
Carpal tunnel syndrome is managed with a ___ splint.
Volar
Contractures of the palmar fascia due to nodules/cords is known as _____.
Dupuytren contracture
*Genetic predisposition, ETOH abuse, DM
____ is the MC cause of a hip dislocation.
Trauma- MVA, fall
____ (Anterior/Posterior) is the most common type of hip dislocation. Complications include:
Posterior
-Complications: avascular necrosis, sciatic nerve injury, DVT, bleeding
With hip dislocations the leg is often shortened and ____ (internally/externally) rotated.
Internally
With hip fractures the leg is often shortened and _____ (internally/externally) rotated.
Externally
*High incidence of AVASCULAR NECROSIS with femoral neck fractures
**Legg-Calve-Perthies Disease- avascular osteonecrosis of the femoral head in KIDS–>PAINLESS LIMPING
_____ (type of fracture) is MC in 7-16y, obese, A.A., males during growth spurt (due to weakness of growth plate and hormonal changes at puberty).
Slipped Capital Femoral Epiphysis
*if seen before puberty suspect hormonal/systemic d/o like HYPOthyroidism
SCFE manifestations include a _____ limp (painless/painful).
PAINFUL (hip, thigh, or knee pain)
*Treatment- non weigh-bearing with crutches–> ORIF
MCL injury is associated with ____ (valgus/varus) stress and LCL injury is associated with ____ (valgus/varus) stress.
MCL- Valgus
LCL- Varus
- +/- Surgical repair for Grade III (complete tears)
The MC knee ligament injury is _____.
ACL injury
- 70% sports related- NONCONTACT PIVOTING INJURY
- *Think pop, swelling, and hemarthrosis
Tests for ACL injury include ___ & ___.
Lachman’s & Anterior drawer
____ injuries are most commonly associated with dashboard injury.
PCL
- Tests- pivot shift and posterior drawer
- *Almost always treated SURGICALLY
____ (Medial/Lateral) meniscal tear is 3x more common than ____ (medial/lateral).
Medial more common than lateral
*Positive McMurray Sign!
MC cause of a patellar fracture is _____.
A direct blow
- MC in young patients
- *Sunrise view radiographs are best for dx
A forceful quadriceps contraction (fall on flexed knee) can lead to a _____ rupture.
Patellar or Quadriceps tendon
- MC males > 40y, hx of DM, gout, obesity, renal dz
- *(Patellar rupture usually < 40y)
Patella baja- palpable defect above knee is seen with a ____ (quad/patellar) rupture.
Patella alta- palpable defect below knee is seen with a ____ (quad/patellar) rupture.
Baja- Quad rupture
Alta- Patella tendon rupture
*Treatment- knee immobilizer, RICE, NWB, surgical repair within 7-10 days
Patellar dislocations are MC in ____ (males/females) and usually occur ____ (medially/laterally).
Females, laterally
A knee (tibial-femoral) dislocation is SEVERE LIMB THREATENING!! (popliteal artery rupture severe complication)
Needs prompt reduction via longitudinal traction
_____ fractures are MC in children in MVAs. The lateral plateau is MC.
Tibial plateau
- Check for peroneal nerve injury- foot drop!
- *May need to confirm with CT or MRI
MC cause of chronic knee pain in young, active adolescents is ______.
Osgood-Schlatter Disease
- Manifestation- tenderness to anterior tibial tubercle
- *Treatment- NSAIDs, RICE, Quad stretching
Anterior knee pain around the patella that MC’ly seen in runners is ______.
Patellofemoral Syndrome (idiopathic softening of the patellar articular cartilage)
MC cause of knee pain in runners is ____.
Iliotibial Band Syndrome (ITB)
*Causes LATERAL knee pain during onset of running
_____ (Posterior/Anterior) is the MC type of ankle dislocation.
Posterior
*Treatment- closed reduction and posterior splint
There is an increased risk of an achilles tendon rupture with _____ (medication class) use.
Fluoroquinolone
Sudden, sharp calf and heel pain with a positive Thompson’s test is associated with ____ rupture.
Achilles tendon
*Treatment- splint in plantar flexion with subsequent splinting employing gradual dorsiflexion towards neutral
Weber ankle fracture classification
p. 199
____ fracture is common in athletes and military personnel due to overuse. 3rd Metatarsal MC!
Stress (March) Fracture
Heel pain and tenderness of the plantar fascia of the medial foot that gets worse with rest is known as _____.
Plantar Fasciitis
Pain/numbness at the medial malleolus, heel, & sole AND posterior tibial nerve compression is associated with:
Tarsal Tunnel Syndrome
*Pain increases throughout the day (v. plantar fasciitis)
Charcot’s Joint is also known as _____.
Diabetic Foot
Transverse fracture through the diaphysis of the 5th metatarsal is known as a ____ fracture.
Jones
Lisfranc Injury
p. 203
_____ is associated with sciatica- back pain radiating to the thigh/buttock–> down L5-S1 dermatome (increases with Valsalva).
Herniated disc (nucleus pulposus)
Herniated disc findings:
- Positive SLR
- L4- Weakness= ankle dorsiflexion, loss of knee jerk
- L5- Walking on toes is easier than heels (Think (L)5- you have 5 toes!)
- S1- Walking on heels is easier than toes (Think (S)1- you have 1 heel), loss of ankle jerk
With _____ you may have new onset urinary/bowel retention/incontinence with Saddle Anesthesia, uni/bilateral leg radiation, and DECREASED anal sphincter tone on rectal exam (no “anal wink”)
Cauda Equina
*Neurosurgical emergency!! Corticosteroids to reduce inflammation
Lumbosacral sprain/strain
Acute strain or tear of the paraspinal muscles, especially after twisting/lifting injuries
-Manifestations: Back muscle spasms!, decreased ROM, No neurologic changes :)
Spondylolysis & Spondylolisthesis
- Spondylolysis- pars interarticularis defect from either failure of fusion or stress fracture (can be seen in football players and gymnasts)
- Spondylolisthesis- forward slipping of a vertebrae on another (high grade requires surgical management)
_____ (Acute/Chronic) osteomyelitis is MC seen in children (S. aureus MC organism).
_____ (Acute/Chronic) osteomyelitis is MC in adults, secondary to open injury (trauma or recent surgery).
Acute in children
Chronic in adults
Clinical manifestations of osteomyelitis include:
- Gradual onset. Signs of bacteremia- high fever, chills, malaise
- Local signs: inflammation/infxn, pain over the involved bone, decreased ROM in adjacent joint
- Refusal to use extremity/bear weight (Hip MC in kids)
How is Osteomyelitis diagnosed?
- Increased WBC and ESR
- MRI is most sensitive test in early dz.
- Radiographs
- Bone aspiration (increased activity seen, not specific)
Management of acute osteomyelitis involves…
Abx 4-6 weeks (at least 2 weeks via IV)- may need debridement
- Newborn (< 4mos)- Group B Strep, gram negative= Nafcillin or 3rd gen Ceph.
- > 4 mos Staph aureus-
- MSSA: Nafcillin or Cefazolin (Ancef)
- MRSA: Vancomycin - Sick Cell Disease- Salmonella= 3rd gen Ceph. or FQ
- Puncture wound- Pseudomonas= Cipro or Levo
Management of chronic osteomyelitis involves…
- Surgical debridement
- Cultures- abx depends on biopsy culture and sensitivities
- Antibiotics- empiric abx usually NOT recommended
____ is an infection of the joint cavity. It is a MEDICAL EMERGENCY because it can rapidly destroy the joint.
Septic Arthritis
___ is the most common site of septic arthritis.
Knee
*Usually have a single, swollen, warm, painful joint with decreased ROM with fever!
How is septic arthritis diagnosed?
Arthrocentesis- WBCs > 50,000- primarily PMNs
How is septic arthritis treated?
- Prompt abx guided by gram stain
2. Arthrotomy with joint drainage (2-4 week course)
Gram stain & Abx regimen for septic arthritis
- Gram positive cocci–> Nafcillin (Vanc if MRSA suspected)
- Gram negative cocci or GC suspected –> Cetraixone
- Gram negative rods –> Ceftriaxone + Gentamicin
- No organism seen –> Nafcillin or Vanc + Ceftriaxone
Acute inflammation of the costochondral, costosternal, or sternoclavicular joints is known as ______.
Costochondritis
*Common after viral infxn or MSK trauma (physical strain, excess coughing)
Pleuritic chest pain that is worse with inspiration, worse with coughing, and worse with certain movements of the upper limbs or torso is can be _____.
Costochondritis
*Palpation reproduces the pain
Uric acid deposition in the soft tissues, joints, & bone is known as ____.
Gout
*MC due to underexcretion of uric acid
Secondary causes of gout include: foods and meds (name some)
Foods- alcohol, liver, seafood, yeasts
Meds- Diuretics, ACEI, Aspirin, ARBs (EXCEPT Losartan)
Clinical manifestations of gout include:
- Acute gouty arthritis- severe joint pain, erythema, swelling and stiffness (1st MTP joint MC, also knees, feet, and ankles)
- Tophi deposition
- Uric acid nephrolithiasis & nephropathy
How is gout diagnosed?
- Arthrocentesis- Negatively birefringent needle-shaped urate crystals!!
- Radiographs- Punched out erosions with overhanging margins
- Clinical- increased ESR and WBC during acute attacks
Acute management of gout involves:
- NSAIDs (Indomethacin, Naprosyn)–> AVOID aspirin
2. Colchicine
Chronic management (prophylaxis) of gout involves:
- Allopurinol- reduces production and increases excretion (caution with renal dz)
- Febuxostat
- Colchicine
Pseudogout…
Acute arthritis- red, swollen, tender joint. Knee MC! MC in females!!
- Dx- Arthrocentesis- POSITIVELY BIREFRINGENT, RHOMBOID SHAPED CPPD CRYSTALS
- Treatment- Acute attacks: Intraarticular steroids, NSAIDs, Colchicine; Chronic: Colchicine
_______ has the ability to cause analgesia when used for acute compression fracture of the vertebral body.
Calcitonin
