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EM Final Study Guide > Ortho > Flashcards

Ortho Flashcards

1
Q

Should cast be circumferential in OR?

A

“Posterior mold / Splint “
Never - this is reserved for doc who will be following the patient long term
- This allows for swelling
- Should follow up as o/p in a week

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2
Q

Which joints should be immobilized?

A

Both above and below

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3
Q

What does ER cast / posterior mold consist of?

A
  1. Padding
  2. Plaster
  3. Ace bandage
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4
Q

What to always do after casting?

A

Repeat neurovascular exam

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5
Q

What does axial loading of thumb check for?

A

Snuff box injury: push thumb down towards wrist to check for pain

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6
Q

Why are we worried about scaphoid injury?

A

Blood supply to scaphoid is only coming from the radial artery
- At extremely high risk for avascular necrosis from this

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7
Q

What is an occult fracture?

A

So small that can not be screened on xray

- Should be visible in 7-10 days in callus formation if there was a fracture

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8
Q

How to treat scaphoid injury?

A

Thumb - spica immobilization

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9
Q

What does a thumb spica entail?

A
  1. ABduct thumb (holding wine glass)
  2. Distal to IP joint of thumb
  3. Proximal along distal 2/3 radial forearm
  4. Wrist at 20 degrees
  5. Pad along radial aspect of arm
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10
Q

What is the ulnar collateral ligament?

A

Ligament running on medial aspect of thumb

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11
Q

How to check for ulnar collateral injury?

A

Flex thumb and apply radial stress to check for laxity of ulnar ligament and tenderness over ligament

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12
Q

When is thumb spica used?

A
  1. Ulnar collateral ligament injury
  2. Scaphoid injury
  3. Lunate injury
  4. Quervain tenosynovitis
  5. 1st Mc fracture
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13
Q

What is the last joint on index finger?

A

“DIP”

Distal interphalangeal joint

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14
Q

What is mallet deformity?

A

DIP droops down

  • Can be from hammering it “mallet”
  • Or from blunt trauma to end of finger (softball)
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15
Q

How to treat mallet injury?

A

Prolonged stint with finger in extension (6-8 weeks)

- Do not take off for any reason

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16
Q

What is clam digger?

A

Splint that looks like your holding a sandwich

  • Fingers are flexed at MCPs so you dont limit ROM of collateral ligaments upon removal
  • MCP at 90
17
Q

When is sugar tong used?

A

Distal ulnar or radius fracture

18
Q

How to place sugar tong?

A
  1. Palmar MCP, Around Elbow, Dorsal MCP
  2. Elbow at 90 - use sling
  3. Hand in functional positioning
19
Q

When is posterior mold used?

A
  1. Elbow fracture or soft tissue injury

2. Proximal radius / ulnar injury

20
Q

How to place posterior mold?

A
  1. Distal hand at palmar crease
  2. Along forearm proximal to humerus
  3. Elbow 90
  4. Wrist and hand neutral
  5. Abduct thumb, Wrist at 20
21
Q

What views to get when imaging extremities?

A
  1. A/P
  2. Lateral
  3. Oblique
22
Q

First things to do if neurovascular compromise expected?

A

Straighten out the limb!

23
Q

What caulse an avulsed fracture?

A

A ligament pulling a piece of bone off

24
Q

Leigh man term for shattered bone?

A

Comminuted

25
Q

Difference between open and closed fracture?

A

Open needs to go to OR - much higher risk of infection and complication

26
Q

What abx for open fracture?

A

Cefazolin or ancef

27
Q

What can cause compartment syndrome?

A

Anything that can restrict blood supply

  1. Casts
  2. Fractures
  3. Swelling
28
Q

Signs of compartment syndrome?

A

If you wait till all present it is too late:

  1. Pain - there is no way to control it and it gets worse
  2. Paresthesias
  3. Pallor
  4. Pulselessness
  5. Poikilothermia
29
Q

Bacteria in septic joint?

A
  1. Staph

2. Neisseria

30
Q

Diagnosis septic joint?

A
  1. Lactate over 10

2. WBC over 50k

31
Q

When is MRI needed in back pain?

A
  1. Weakness not related to pain
  2. Loss of bladder function
  3. No fever / suspected epidural abscess
  4. Saddle anesthesia
32
Q

Who to xray in low back pain?

A
  1. Over 50
  2. Cancer
  3. Drug use
  4. Osteoporosis
  5. Fever
33
Q

Bedrest or bending activity better for low back pain?

A

Activity avoiding painful activities

34
Q

Nexus criteria?

A
  1. No tenderness posterior midlines
  2. No neurologic deficit
  3. Normal alertness
  4. No intoxication
  5. No distracting injury
35
Q

What can a fracture at base of fifth metatarsal mimic?

A

Ankle fracture

36
Q

Risk supracondylar fracture in peds?

A

Brachial artery and medial nerve compromise w/ posteriorly displaced fracture

37
Q

What is nursemaid’s elbow?

A

Toddler with arm yanked, or fall

- Arm held at side slightly flexed at elbow, semiflexed, prone

38
Q

What does the lachmans test examen?

A

Injury to ACL

EM Final Study Guide (29 decks)

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