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Emergency EOR > Ortho > Flashcards

Ortho Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Partial disruption of a joint, in which some degree of contact between the articular surfaces remains.

A

Subluxation

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2
Q

Complete disruption of a joint, such that the articular surfaces of the bones that comprise the joint are no longer in contact with one another.

A

Dislocation

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3
Q

A tearing injury to muscle fibers resulting from excessive tension or overuse.

A

Strain

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4
Q

A tearing injury to one or more ligaments of a joint, which occurs when the joint is forced beyond the limits of its normal planes of motion.

A

Sprain

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5
Q

“Fatigue” fractures from repetitive forces before the bone and supporting tissues have had time to adjust/accommodate to such forces

A

Stress fracture

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6
Q

Radiographs for stress fractures

A

often negative until weeks later - diagnose by presumption + point tenderness and swelling

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7
Q

Salter fractures aka

A

epiphyseal fractures - growth plate fractures in children

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8
Q

3 phases of fracture healing

A

inflammatory
reparative
remodeling

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9
Q

3 orthopedic emergencies - broad categories

A
  1. Open fracture
  2. Subluxation / dislocation
  3. Neurovascular injury
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10
Q

Potential major complication of open fracture

A

osteomyelitis

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11
Q

Urgency of reducing a dislocation / subluxation based on:

A
  1. Neuro / circular compromise - neurovascular bundle “kinked”
  2. Longer it’s dislocated, harder it is to reduce and less stable it will be (due to edema, muscle spasm, tissue changes)
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12
Q

Serious complication specific to hip dislocation

A

Avascular necrosis of femoral head

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13
Q

Why avascular necrosis of femoral head can occur in hip dislocation

A

Much of blood supply to femoral head is delivered through vessels that emerge from the acetabulum

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14
Q

Sling supplement to splint is useful for injuries to ___ and ___ because ____

A

wrist and forearm; because optimal immobilization includes joint above and below injury

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15
Q

On physical exam, patients with disruption of sternoclavicular joint or fracture of the humeral shaft may complain only of ___

A

shoulder pain

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16
Q

Common examples of fractures which may not appear on radiograph until 7-10 days post trauma

A

Fractures of scaphoid

Nondisplaced fracture of radial head

Stress fracture of metatarsal

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17
Q

“Fat pad sign” on elbow of adult often indicates

A

Radio head or neck fracture - most common cause of elbow joint effusions in adults

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18
Q

“Fat pad sign” on elbow of children often indicates

A

Supracondylar fracture - most common cause of elbow joint effusions in children

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19
Q

Clue in history to indicate posterior sternoclavicular dislocation

A

Shoulder pain + dysphagia

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20
Q

Mechanism: bilateral compression of shoulders, via MVA or “pile on” in football often results in ___

A

anterior (more common) or posterior (mediastinal structures at risk) sternoclavicular dislocation

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21
Q

Mechanism: direct blow to medial clavicle often results in ___

A

posterior sternoclavicular dislocation

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22
Q

Mechanism: fall, landing on apex of shoulder

A

acromioclavicular separation

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23
Q

Mechanism: direct blow to anterior shoulder; fall on outsretched arm; seizure or electroconvulsive muscular activity

A

posterior dislocation of shoulder

24
Q

Mechanism: Sudden traction force to toddler’s arm

A

Subluxed radial head

sometimes causes pseudoparalysis of arm and therefore can be misdiagnosed as brachial plexus injury

25
Q

Mechanism: fall, landing on outstretched arm or with elbow under body

A

Fracture of the radial head (may be occult on x ray)

26
Q

Mechanism: Forced dorsiflexion of wrist

A

Colles fracture
Fracture of scaphoid
Lunate dislocation

27
Q

Mechanism: striking knee against dashboard in MVA

A

Posterior dislocation of hip

28
Q

Mechanism: landing flat on feet from a height

A

Calcaneus fracture
Tibial plateau fracture
Acetabular fracture
Vertebral compression fracture - lumbar

29
Q

Mechanism: ankle inversion force

A

Fracture of any 3 of malleoli

Disruption of anterior tibiofibular ligament with proximal fibular fracture

30
Q

Mechanism: Inversion or medial or lateral stress to the forefoot; axial load on the metatarsal heads with the ankle plantarflexed

A

Midfoot dislocation (Lisfranc injury)

31
Q

One of the most common hip disorders in adolescents; often presents with hip pain but can present with groin pain, isolated thigh or knee pain.

A

Slipped capital femoral epiphysis Leg is externally rotated with an antalgic gait

32
Q

What is “broken off” in Salter Harris Type I

A

entire epiphysis

33
Q

What is “broken off” in salter Harris Type II

A

entire epiphysis along with portion of metaphysis

34
Q

What is “broken off” in salter harris type III

A

portion of epiphysis

35
Q

What is “broken off” in salter harris type IV

A

a portion of epiphysis along with a portion of metaphysis

36
Q

What is “broken off” in salter harris type V

A

Compression injury of epiphyseal plate

37
Q

Diagnosis of Type 1 Salter Harris

A

Presumptive - often not radiographically lucent

Based on tender and swelling at region of physis

38
Q

Diagnosis of Type V Salter Harris

A

Often not radiographically apparent

qPresumptive with significant “axial loading” force coupled with significant tenderness in physis region

39
Q

Open fracture antibiotic prophylaxis options

A

Cefazolin or Cipro
+ Gentamicin for > 10cm wound

+ Consider using Penicillin, metronidazole, or clindamycin if significant contamination with soil is present

40
Q

When to consult ortho

A

Compartment syndrome
Dislocation with fracture
Circulatory compromise
Open fracture

41
Q

Immobilization technique for shoulder dislocation, acromioclavicular separation, clavicle fracture, humeral neck fracture

A

Shoulder immobilizer - like a sling, but better

42
Q

Immobilization technique used for a variety of upper-extremity injuries, in conjunction with other immobilization techniques; may be used alone for nondisplaced or clinically suspected fracture of the radial head.

A

Sling

43
Q

Immobilization technique used for reduced elbow dislocation, displaced radial head fracture, supracondylar humeral fracture

A

Long-arm gutter

arm in sling position - elbow flexed at 90, palm facing abdomen

44
Q

Immobilization technique used for wrist or forearm fracture

A

Sugar tong splint
** often supplemented w sling **

(arm in sling position - elbow flexed at 90, palm facing abdomen

45
Q

Immobilization technique used for 4th - 5th ray metacarpal or proximal phalanx fracture

A

Ulnar short arm gutter splint

The metacarpophalangeal joints and interphalangeal joints are positioned in gentle flexion

46
Q

Immobilization technique used for 2nd or 3rd ray metacarpal or proximal phalanx fracture

A

Radial shrot arm gutter splint

The metacarpophalangeal joints and interphalangeal joints are positioned in gentle flexion

47
Q

Immobilization technique used for scaphoid fracture or thumb metacarpal/proximal phalanx fracture

A

thumb spica

48
Q

Immobilization technique used for:
Fracture or reduced subluxation of patella
Knee dislocation, postreduction (temporary)
Tibial plateau fracture
Knee ligament injury
Suspected meniscal tear (provided the knee can be fully extended)

A

Knee immobilizer

Use of an immobilizer for more than a few days in the elderly or for more than a week or two in young patients may result in painful stiffness of the knee joint. For that reason, orthopedic follow-up should occur within approximately 7 days.

49
Q

Immobilization technique used for:
Ankle dislocation or fracture-dislocation

Unstable ankle fracture (high distal fibular fracture or medial and/or posterior malleolar fracture)

Widened medial mortise (indicates disruption of stabilizing medial structures)

Metatarsal fracture (alternative immobilization dressings may be used)

A

Posterior ankle mold
* consider adjunctive use of ankle sugar-tong for unstable ankles*

While the dressing is setting, the ankle should be maintained in a position as close as possible to neutral dorsiflexion—that is, at 90 degrees to the leg. T

50
Q

Immobilization technique used for:
Simple ankle sprain

Stable lateral malleolus fracture (below the superior border of the talus) without other ankle involvement (no medial swelling or tenderness, posterior malleolus intact)

A

Ankle stirrup

51
Q

Immobilization technique used for:
Toe fracture

Some metatarsal fractures

A

Hard-soled shoe

52
Q

Immobilization technique used for:

Some toe or foot contusions or fractures where weightbearing is allowed

A

Short-leg walking boot

53
Q

When to get xray for neck pain

A

3-view cervical spine films in

  • chronic, weeks to months neck pain (+/- trauma)
  • history of malignancy or remote neck surgery
  • neck pain and preexisting spinal disorders
54
Q

When to get MRI for neck pain

A

MRI is indicated for patients with chronic neck pain with neurologic signs or symptoms regardless of the plain radiographic findings.5 MRI is also indicated when plain radiographs reveal bone or disk margin destruction, if there is cervical instability, and (with intravenous contrast) if epidural abscess or malignancy is suspected

55
Q

Symptoms of acute cervical disk prolapse

A

neck pain, headache, pain distributed to the shoulder and along the medial scapular border, dermatome pain, and dysesthesia in the spinal root distribution to the shoulder and arm

56
Q

What serious condition should be considered with neck pain in patients taking anticoagluants or bleeding disorder

A

Cervical spin epidural hematoma

Emergency EOR (4 decks)

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