Ortho Flashcards
Children have uneven gluteal folds, and physical examination of the hips show that they can be easily dislocated posteriorly with a jerk and a “click,” and
returned to normal with a “snapping.”
What condition?
Congenital dysplasia of the hip runs in families
_________ disease is avascular necrosis of the capital femoral epiphysis and occurs around age 6,
with insidious development of limping, decreased hip motion, and hip or knee pain
Legg-Calve-Perthes
The typical patient is a chubby (or lanky) boy around age 13 who complains of
groin or knee pain, and who ambulates with a limp
Slipped capital femoral epiphysis (SCFE)
Persistent varus age >3 is most commonly ___________a disturbance of the medial proximal
tibial growth plate, for which surgery is corrective
Blount disease,
_________) is normal between ages 4–8; no treatment is needed
Genu valgus (knock-knee
________ is seen in teenagers
with persistent pain right over the tibial tubercle, which is aggravated by contraction
of the quadriceps
Osgood-Schlatter disease (osteochondrosis of the tibial tubercle)
Osgood-Schlatter disease (osteochondrosis of the tibial tubercle) Tx
treatment is immobilization of the knee in
an extension or cylinder cast for 4–6 weeks
Most Sn finding for Scolio
The most sensitive screening finding is to look at the girl from behind while
she bends forward, a hump will be noted over her right thorax
The only areas where children have special problems include_____ and _________
supracondylar fractures of the humerus and fractures of any bone that involve the growth plate or epiphysis.
_____________ occur with hyperextension of the elbow in a child who falls on the hand with the arm extended
Supracondylar fractures of the humerus
Why are supracon fx dangerous?
The injuries are particularly dangerous due to
the proximity of the brachial artery and ulnar nerve.
Fractures that involve the growth plate or epiphysis can be treated by closed reduction if ________
the
epiphyses and growth plate are displaced laterally from the metaphysis but they are in one piece
(i.e., the fracture does not cross the epiphyses or growth plate and does not involve the joint).
X-rays for suspected fracture in adults should always include the following:
1
2
3
• Two views at 90° to one another
• Joints above and below the broken bone
• If suggested by the mechanism of injury, bones that are in “the line of force,” which
might also be broken (
Clavicular fracture is typically at the junction of_____
middle and distal thirds.
Less popular Tx for clavicular fx
Figure-of-8 bandage treatment is now less popular
______is by far the most common shoulder dislocatio
Anterior dislocation of the shoulder
What nerve may be affected by Anterior dislocation of the shoulder ?
There may be numbness in a small area over the deltoid, from stretching of the axillary nerve.
___________ is rare and occurs after massive uncoordinated muscle contractions,
such as epileptic seizure or electrical burn.
Posterior shoulder dislocation
The deformed and painful wrist looks like a “dinner fork.” The main lesion is an older, dorsally
displaced, dorsally angulated fracture of the distal radius. Treatment is with close reduction
and long arm cast.
Colles’ fracture
________ results from a direct blow to the ulna (i.e., on a raised protective arm hit by a nightstick).
There is diaphyseal fracture of the proximal ulna, with anterior dislocation of the radial head
Monteggia fracture
_________ is the mirror image: the distal third of the radius gets the direct blow and has the fracture, and there is dorsal dislocation of the distal radioulnar joint
Galeazzi fracture
_________ affects a young adult who falls on an outstretched hand. Chief complaint is typically wrist pain, with physical exam revealing localized tenderness to palpation over the anatomic snuff box
Fracture of the scaphoid (carpal navicular)
TX of scaphoid fx
thumb spica cast is indicated just with the history and physical findings.
X-rays will show the fracture 3 weeks later.
Scaphoid fractures are notorious for a very high rate of nonunion secondary to_____
avascular necrosis
______(typically the fourth or fifth, or both) happens when a closed fist hits a hard surface (like a wall)
Metacarpal neck fracture
Tx of Metacarpal neck fracture
Kirschner wire or plate fixation is indicated for bad fractures
Intertrochanteric fracture is less likely to lead to avascular necrosis, and is usually treated
with open reduction and pinning
Femoral shaft fracture is often treated with ______
intramedullary rod fixation
Open femoral shaft fx tx?
If open, it is an orthopedic emergency, requiring OR irrigation and closure within 6
hours
_______ is usually sustained when the force of impact
is the side of the knee, a common sports injury
Collateral ligament injury
Abduction demonstrates the medial injuries ______, whereas adduction diagnoses the lateral injuries _______
(valgus stress test)
varus stress test
With the knee flexed 90°, the leg can be pulled anteriorly, like a drawer being opened (anterior drawer test).
Anterior cruciate ligament injury
What test for ACL injury?
knee flexed at 20° by grasping the thigh with
one hand, and pulling the leg with the other (Lachman test).
Tx of meniscal tear Cx
• Complete meniscectomy leads to the late development of degenerative arthritis
_____________ is seen in young men subjected to forced marches. There is tenderness to palpation over a very specific point on the bone, but x-rays are initially normal
Tibial stress fracture
_________ is seen in out-of-shape middle-age men who subject themselves to severe strain (tennis, for instance).
As they plant the foot and change direction, a
loud popping noise is heard (like a rifle shot), and they fall clutching the ankle
Rupture of the Achilles tendon
Precipitating events of compartment syndrome
Precipitating events include prolonged ischemia followed by reperfusion, crushing
injuries, or other types of trauma
In the lower leg, by far the most common cause of compartment syndrone is a ________
fracture with closed reduction
The most reliable physical finding of compartment syndrome is ________
excruciating pain with passive extension.
Pain under a cast is always handled by________
removing the cast and examining the limb.
_______________ occurs when the femur is driven backward, such as in a headon
car collision where the knees hit the dashboard
Posterior dislocation of the hip
Tx of gas gangrene
Treatment includes IV penicillin, extensive emergency surgical debridement, and possibly hyperbaric oxygen
The ______ can be injured in oblique fractures of the middle to distal thirds of the humerus
radial nerve
Why the need to evaluate popliteal artery with UTZ
the popliteal artery must be evaluated with U/S, because even if distal pulses which were absent return following reduction of the dislocation, there may be an intimal flap
or local dissection that may need either further evaluation with CT angiogram or surgical
exploration.
Falls from a height landing on the feet may have obvious foot or leg fractures, but fractures of the _______
lumbar or thoracic spine may be less obvious and must be assessed.
Head-on automobile collisions may produce obvious injuries in the face, head, and
torso, but if the knees hit the dashboard, the________
femoral heads may be driven backward
into the pelvis or out of the acetabulum and thus cause a fracture or dislocation
Dx of CTS
The diagnosis is clinical, but the American Academy of Orthopaedic Surgery recommends that wrist x-rays (including carpal tunnel view) be done to rule out other
pathology
_________ is more common in women and presents with acute finger flexion and the inability to extend it unless pulled with the other hand, which results in a painful “snap.”
Trigger finger
Tx of Trigger finger
Steroid injection is the first line of therapy; surgery is the treatment of last resort
_______________ is seen in young mothers who, as they carry their baby, force their
hand into wrist flexion and thumb extension to hold the baby’s head. They complain of pain
along the radial side of the wrist and the first dorsal compartment.
De Quervain tenosynovitis
There
is contracture of the palm of the hand, and palmar fascial nodules can be felt. Surgery may be
needed when the hand can no longer be placed flat on a table.
Dupuytren contracture
A_________ is an abscess in the pulp of a fingertip, caused by a neglected penetrating injury
felon
_________ is an injury to the flexor tendon sustained when the flexed finger is forcefully extended (as in someone unsuccessfully grabbing a running person by the jersey).
When making a fist, the distal phalanx of the injured finger does not flex with the others
Jersey finger
What to do with traumatically amputated digits
The amputated digit should be cleaned with sterile saline, wrapped in a saline-moistened gauze, placed in a
sealed plastic bag, and the bag placed on a bed of ice. The digit should not be placed in antiseptic
solutions or alcohol, should not be put on dry ice, and should not be allowed to freeze
_________ is seen in men in the third and fourth decades of life who complain of chronic back pain and morning stiffness
Ankylosing spondylitis
MC mets in the spine
The most common pathology is lytic breast cancer metastases in women and blastic prostate metastases in men
Diabetic ulcer is typically indolent and located at pressure points (heel and metatarsal head).
It starts because of the neuropathy, and does not heal because of the ___________
microvascular disease
It looks dirty, with a pale base devoid of granulation tissue. The patient has other manifestations of arteriosclerotic occlusive disease (absent pulses, trophic changes, claudication, or rest pain)
Ulcer from arterial insufficiency
_________ develops in chronically edematous, indurated, and hyperpigmented skin
above the medial malleolus
Venous stasis ulcer
Tx for Venous stasis ulcer
Treatment revolves around physical support to keep the veins empty: support stockings, Ace
bandages, and Unna boot.
Surgery may be required (vein stripping, grafting of the ulcer, injection sclerotherapy); endovascular ablation with laser or radiofrequency may also be used
________ is a squamous cell carcinoma of the skin that has developed in a chronic leg ulcer
Marjolin’s ulcer
What is the classic setting of a Marjolin’s ulcer?
The classic setting is one of many years of healing and breaking down, such as seen in untreated third-degree burns that underwent spontaneous healing, or in chronic draining sinuses secondary to osteomyelitis
_______is a very common but poorly understood problem affecting older, overweight patients who complain of disabling, sharp heel pain every time their foot strikes the ground
Plantar fasciitis
Xray of plantar fascitis
X-rays show a bony spur matching the location of the pain, and physical exam shows exquisite tenderness to palpation over the spur, although the bony spur is not likely
the cause of the problem as many asymptomatic people have similar spurs
_________ is an inflammation of the common digital nerve at the third interspace, between the third and fourth toes.
Morton’s neuroma
Tx for gout
Treatment for the acute attack is indomethacin
and colchicine; treatment for chronic control is allopurinol and probenicid
_________ is the most common primary malignant bone tumor.
–– It is seen in ages 10–25, usually around the knee (lower femur or upper tibia).
–– A typical “sunburst” pattern is often described on x-rays
Osteogenic sarcoma
–– It affects younger children (ages 5–15) and it grows in the diaphyses of long bones.
–– A typical “onion skinning”–type pattern is often seen on x-rays.
Ewings
Most malignant bone tumors in adults are metastatic, from the breast in women (_______ lesions)
and from the prostate in men (______ lesions).
lytic
blastic
Other dx tests for MM
They also have Bence-Jones protein in the urine and abnormal immunoglobulins
in the blood, best demonstrated by serum proptein electrophoresis (SPEP
Tx of MM
Treatment is chemotherapy; thalidomide can be used in the event that chemotherapy
fails.
has relentless growth of soft tissue mass over several months. It is firm and typically fixed to surrounding structures.
Soft tissue sarcoma
Soft tissue sarcoma mets
lungs
