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Ortho Flashcards

1
Q

Picture labels

A
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2
Q

Salter Harris mnemonic

prognostic significance
negative x-rays for types?

Most common type

A

Prognosis for growth disturbance worsens with increasing grade; injuries affecting epiphysis have worse outcomes as the blood supply traverses it
types 1 and 5
type 1

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3
Q
A
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4
Q

Recurrent median nerve function

amputated part care

indications for replant (6)

A

Helps oppose thumb

inside plastic bag inside another plastic bag with ice

replant

–Multiple digits

–Thumb

–Single digit between PIP & DIP (distal to the superficialis insertion)

–Metacarpal (palm)

–Wrist, forearm

–Almost any part in child

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5
Q

Pictured entity and labels

treatment

Paronychia acute versus chronic cause

A

Splint PIP in extension, referral

staph versus candida and other fungi with chronically moist hands

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6
Q

Pictured entity

jersey finger - what (see picture)
mallet finger-what, treatment

A

Herpetic whitlow

jersey: FDP avulsion from the distal phalanx “grabbing a jersey” leaving fingertip unable to flex

Mallet: extensor tendon disruption at the DIP, splint in extension

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7
Q

Likely associated injury

A

Mallet finger - disruption of extensor tendon

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8
Q

Pictured entity, Rose Gardner; tx

gamekeeper’s thumb, what? tx (2)

A

Sporotrichosis, itraconazole

UCL disruption +/- avulsion; tx thumb Spica +/- surgery

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9
Q

Metacarpal neck fractures

maximum angulation for 5th, 4th, 3-2nd

additional indication for surgical repair

metacarpal shaft fractures modification of above

A

45°, 35°, 15°
any rotational deformity

metacarpal shaft: above tolerances minus 5°; surgery often needed for 2nd-3rd

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10
Q

Metacarpal head fractures

tx

picture 1: what, tx (2)

picture 2: what, tx (2)

Prognosis

A

tx: all require hand referral, likely surgery

Bennett’s: ulnar aspect thumb baseline with dislocation CMC; thumb spica + ORIF

Rolando: similar but comminuted

Bennett’s is Bad but Rolando is Really bad

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11
Q

Pictured entity

fingertip injury zone 1 vs 2&3

DIP dislocation, splint position, can’t reduce?

MCP dislocation, why difficult to reduce?

A

Flexor tenosynovitis

zone 1 > 2/3 proximal nail bed preserved, no exposed bone, heals with secondary intention
Zone 2-3: needs surgery

DIP: 30° flexion; entrapment of volar plate

MCP: volar plate almost always entrapped

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12
Q

Finger flexion, FDP vs FDS

intrinsic plus position - description, indication

A

FDP goes to the Point (tip) -> DIP, FDS Stops short -> PIP

wrist 20° extension, MCP 90° flexion, fingers straight

metacarpal and unstable proximal/middle phalange fractures; NOT for DRF

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13
Q

Pictured injury, most commonly injured nerve

Guyon’s Canal Syndrome - what, tx (2)

A

Colles fracture, median nerve

Guyon’s: entrapment of the ulnar nerve in Guyon’s canal between pisiform and hamate due to cyst or rope the trauma (cyclist, golf, baseball)

splint, surgical decompression

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14
Q

Injury type, most commonly injured structures (2)

A

Smith’s fracture, median nerve, flexor tendons

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15
Q

Injury?
Mechanism
diagnostic criteria
treatment (2)

A

Scapholunate dissociation

FOOSH

> 3 mm space between scaphoid and lunate as pictured

thumb spica, refer

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16
Q

Injury

mechanism

associated injury (2)

distinction from similar injury

A

Perilunate dislocation

forceful hyperextension
scaphoid fracture, median nerve injury
Perilunate: lunate still lined up with radius

Lunate: lunate is displaced from radius

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17
Q

Injury

snuff box tenderness with negative x-ray @ 2 weeks, next steps?

High-pressure injection injury - tx

A

Perilunate dislocation

CT/MRI (or bone scan at 3 days)

emergent debridement and decompression (imaging for radiopaque substance)

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18
Q

Tinel’s and Phalen’s sign suggest ? Sign definitions

+ Finkelstein’s test suggest? define

A

Carpal tunnel - entrapment of median nerve

Tinel’s sign: Tap volar wrist -> paresthesias

Phalen’s sign: hyperflex wrist -> paresthesias

+Finkelstein’ (ulnar deviation of fisted hand reproduces dorsal/radial pain) -> DeQuervain’s tenosynovitis

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19
Q

Pictured injury, difference from “cousin” injury

full injury description

complication

Tx:

A

GRUM: Galeazzi- (distal)Radial fx; (proximal)Ulnar fx - Monteggia

Galeazzi: distal radius shaft fracture with disrupted radio-ulnar joint

complication: all are nerve injury

Tx: ORIF

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20
Q

Pictured injury, description

associated mnemonic

complications (3)

tx

A

Monteggia fracture; proximal ulnar with the radial head dislocation/annular ligament disruption

GRUM: Galeazzi- (distal)Radial fx; (proximal)Ulnar fx - Monteggia

radial nerve injury, radial head fracture, nonunion

ORIF

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21
Q

Injury type?

Classic clinical presentation

Tx

A

Essex-Lopresti Injury

severe wrist pain after FOOSH with negative x-rays

Tx: ORIF

  • Radial head fracture
  • Dislocation of distal RU joint
  • Interosseous membrane disruption
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22
Q

Injury?
Missed associated injury and complications

A

Nightstick fracture

–Missed Monteggia fracture

(radiohumeral dislocation)

– Radial nerve injury

– Nonunion

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23
Q

Injury

force required?
Treatment

feared complication

A

Both bone forearm fracture

high energy

ORIF except sometimes in children

compartment syndrome

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24
Q

Injury, cause, tx

A

Volkmann’s Contracture - forearm pronation, flexion of wrist and digits, paralysis of intrinsic muscles due to compression of forearm/poor circulation

presents similar to compartment syndrome

tx: remove source of compression (eg cast)

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25
Bursitis, contraindicated/preferred procedure procedure distinguishes between? Tennis elbow = Little League elbow = treatment for both
Don't I&D, aspirate septic and non-septic bursitis lateral epicondylitis medial epicondylitis avoid overuse/rest, NSAIDS
26
Elbow dislocation, most common position vascular injury nerve injury associated fracture in children stability depends on
Posterior vascular injury - brachial artery nerve injury - ulnar nerve children - medial upper condyle stability depends on presence of coranoid fracture
27
Elbow radiography fat pad that is always abnormal and indicates (3+) radial head fracture types (4) and tx
Posterior, occult radial head fracture, intra-articular or intra-capsular hemorrhage, gout ## Footnote **–Type I:** nondisplaced - brief sling and early range of motion **–Type II:** marginal impaction, displacement and angulation - same as type I, unless no improvement or mechanical block **–Type III:** comminuted radial head - radial head excision **–Type IV:** any of the above plus elbow dislocation - treated for both dislocation and fracture
28
Pictured entity and radiographic finding complications (5) -\> precaution
Supracondylar fracture, anterior humeral line test complications: median nerve injury, brachial artery injury, compartment syndrome, Volkman's contracture, vascular compromise precaution: admit to hospital for neurovascular checks for any displaced fracture
29
Subacute shoulder pain, cause categories (2) and key PEX diference muscles of the rotator cuff acronym
Impingement syndrome - impaired active, normal passive ROM due to rotator cuff tendinitis, subacromial tendinitis and bursitis adhesive capsulitis after immobilization, impaired active and passive rotator cuff - SITS –Supraspinatus –Infraspinatus –Teres minor –Subscapularis
30
Pictured entity and clinical significance
Hill-Sachs deformity; predisposes to recurrent dislocation
31
Pictured entity, cause, clinical significance shoulder dislocation, complications (4) posterior dislocation, classic mechanisms (3) compared to anterior, posterior neurovascular injury frequency posterior xray sign
Bankart lesion, labral tear + anterior glenoid rim fracture - \> leads to joint laxity, recurrent dislocation complications: axillary nerve injury, adhesive capsulitis, avascular necrosis, rotator cuff injury mechanisms: fall, seizure, electric shock less common sign - see picture
32
Clavicle fracture - most common location may need ORIF when location: look for associated injuries and reasons
Middle third distal third with significant displacement due to ruptured coraco-clavicular joint with significant medial elevation associated injuries: medial third due to very high force required; subclavian artery and vein injuries
33
Humerus fracture nerve injury, proximal, test nerve injury mid the shaft, test rotator cuff injury, most compromised motions (2) most commonly injured muscle
Axillary nerve, deltoid sensation radial nerve, wrist extension motions: external rotation, abduction supraspinatus
34
Thoracic outlet syndrome what clinical test
Compression of brachial plexus, subclavian vein or artery usually due to cervical rib EAST: elevated arm stress test and raised arm three minutes opening and closing fist; positive test is unable to complete due to paresthesia or claudication
35
Pelvic fractures - types (4) and tx pictured entity
1: avulsion - conservative 2: single ring-conservative 3: double ring-fixation, hemorrhage control 4: acetabular fracture, ORIF if displaced Pictured: Malgaigne Disruption
36
Hip dislocation: Less common type and position pictured entity - name and pathophysiology common age, sex, presentation tests if x-rays negative
Anterior, externally rotated Legg-Calve-Perthes: avascular necrosis of the femoral head boys 4 to 8 years, limp MRI or bone scan
37
Infants, most common cause of painful hip normal etiology, etiology with sickle cell, adolescents pictured entity most common age, sex, habitus helpful diagnostic x-ray view treatment
Tip septic arthritis, staph aureus, salmonella, gonorrhea slipped capital femoral epiphysis adolescent obese boys frog leg view ORIF
38
Children, most common cause painful hip cause categories presentation diagnosis treatment
Toxic synovitis postviral, allergic, trauma limp/inability to bear weight arthrocentesis to rule out septic arthritis conservative treatment: rest, NSAIDs
39
Pictured entity increase risk in? Treatment (3)
Traumatic myositis ossificans - formation of bone in muscle after injury thrombocytopenia, hemophilia nonweightbearing, wrapped from foot to groin knee at 90°, elevation
40
when medial pressure is applied over the lateral aspect of the knee in extension and the joint opens medially suggests ? Anterior drawer versus Lachman test - injury type, which is better Varus vs Valgus stress mnemonic
Disruption of MCL and PCL for ACL injuries; AD = 90°, Lachman superior, done at 30° pulling tibia anterior Val**_GU_**s stress push medially from lateral aspect towards the **_GU_**t
41
McMurray test-injury type, what Apley compression/distraction test - what and purpose
Medial meniscus injury popping/locking with internal leg rotation with Volga's stress extending knee from 90° patient prone, knee at 90°, examiner internally/externally rotates foot applying both compression and distraction to knee; pain worse with compression = meniscal injury, worse with the distraction equals ligamentous injury
42
Ottowa knee rules (4) Baker's cyst - what, management
Age greater than 55, patellar or fibular tenderness, unable to bear weight for steps immediately and in ED, unable to flex to 90° Baker's: gastrocnemius bursitis which often communicates to the knee joint and contains the synovial fluid (more common primary in children); tx: joint aspiration with intra-articular steroid injection
43
Pictured entity - what, tx (avoid....) Osteochondritis Dissecans - symptom (2), location, what
Osgood-Schlatter Disease patellar tendon apophysitis at tibial tubercle, rest, NSAIDs, avoid forced extention medial knee pain and locked joint due to loose body from subchondral fracture
44
Knee dislocation often \_\_\_\_\_\_\_ commonly associated with caveat pictured entity
Reduces spontaneously no vascular injury (popliteal artery peroneal nerve) caveat: signs of vascular injury initially absent quadriceps tendon rupture with high riding patella
45
Tibial plateau fracture complications (2) and test most common location/cause of compartment syndrome compartment: earliest symptom, indication for surgery
Neurovascular injury (pulses, angiogram), deep peroneal nerve injury with lateral plateau fracture (test sensation first dorsal webspace) compartment: anterior tibial compartment due to tibial fracture pain, pressure \> 40-50 other sx: 5Ps - Pain, pallor, paresthesia, paralysis, pulselessness
46
Positive Thompson test = most commonly injured ligaments, ankle sprain (3) Ottawa Ankle Rules (4)
Lack of passive plantar flexion with calf squeeze -\> Achilles tendon rupture Anterior talofibular, Calcaneofibular, Posterior talofibular rules: posterior edge distal 6 cm malleolar or fibular tenderness, fifth metatarsal base, navicular tenderness, inability to bear weight immediately and in emergency department
47
Medial ankle pain, swelling, x-ray shown, consider? Describe injury and mechanism xray finding tx
Maisoneuve Fracture external ankle rotation -\> deltoid ligament rupture + prox fib fx widened medial mortise likely surgery
48
Calcaneal fracture - x-ray type and finding dancers versus Jones fracture, tx; xray shows?
Harris view showing Bohler's angle 20-40 (decreased with fracture) both 5th metatarsal D: avulsion fracture of base, cast shoe J: transverse of proximal diathesis, ORIF or cast
49
Pictured entity and description treatment describe: tarsal tunnel March fracture Morton's neuroma severs disease
Lisfranc’s - disruption of tarsal metatarsal joint +/- MT base fx possible ORIF tarsal tunnel: entrapment neuropathy of posterior tibial nerve, +Tinnel's March fracture: second metatarsal stress fracture from pushing off Morton's neuroma: interdigital nerve neuropathy severs disease: Achilles apophysitis
50
51
Osteomyelitis - best early test, lab frequent fractures misdiagnosed as child abuse - disease and other pex findings (2)
Bone scan osteogenesis imperfecta; blue sclera, flaccid joints
52
Cervical spine distances predental space adults and kids pre-vertebral soft tissue space
Adults \< 3 mm, Peds \< 5 mm 6 mm at C2, 22 mm at C6
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55
Cervical spine NEXUS criteria (5) unstable cervical spine fractures mnemonic (6)
No midline tenderness, distracting injury, altered level of alertness, neuro- deficit, intoxication Jefferson bit off a hangman's toe * J - Jefferson Fracture (burst of C1) * B - Bifacet dislocation +/- fracture * O - Odontoid types II and III * A - Any fracture/dislocation * H - Hangman’s fracture (posterior element C2) * T - Teardrop fractures
56
Atlantoaxial dislocation - associated underlying conditions (2) pictured injury Clay shoveler's =
Atlantoaxial rheumatoid arthritis, ankylosing spondylitis bilateral facet dislocation-high incidence of associated injuries Clay shoveler's = spinous process, usually C6-T1
57
Pictured injury Jeffersons = ?; Seen best on what view Odontoid fx, types (3), stability, xray finding?
hangman's = bilateral C2 pedicle fracture, C2 on C3 spondyloisthesis C1 burst fracture from axial load, lateral masses of C1 displaced out on odontoid Type I: tip avulsion Type II: at neck of dens - unstable Type III: through body of C2 - unstable abnormal atlanto-dens space (3mm/5mm adults/kids)
58
Most common pediatric cervical spine fracture pictured entity, diagnostic key Brown-Sequard Syndrome - what key findings
Odontoid fracture pseudo-subluxation of C2 on C3 key (to the fact that it is normal) - normal spiinolaminal line unilateral cord injury with **_crossed_** findings below level iipsilateral weakness loss of position and vibration contralateral loss of pain and temperature
59
Pictured entity anterior cord-key findings, others, mech
Unilateral facet dislocation-bowtie deformity-can be unstable anterior: complete motor paralysis below injury, vibration proprioception preserved mechanism: retropulsion
60
Spinal cord anatomy
61
Central cord - key finding, associated finding posterior cord-key finding, nontraumatic mechanisms (2)
Arm \> leg weakness; loss of bladder control, sacral sparing loss of position/vibration; B12 deficiency, tertiary neurosyphilis
62
SCIWORA - dx, tx etiology of neurogenic shock; location of injury skin findings (2) tx
SCIWORA - MRI, often self-limited in children, consider surgery for disc herniation in adults shock: unopposed parasympathetic, T1 and above skin: warm and dry tx: fluids
63
Lumbar fractures - burst versus chance mechanism stability associated injuries pictured injury What is a chance fx
Lumbar fractures - burst versus chance mechanism - axial load versus flexion/distraction (car accident) stability -burst unstable associated injuries - chance associated with intra-abdominal injury horizontal fracture through entire vertebral body, usually L1-2
64
65
Wedge fracture stable? Unique treatment burning of the lateral thigh suggests Common sufferers
Stable if \< 50% compression Salmon calcitonin •Meralgia paraesthetica - Lateral femoral cutaneous nerve compression where it passes between the ilium and inguinal ligament – Pregnant women – Workmen with belts
66
Pictured entity, main sx, calcium level lumbar disc syndromes, shortcuts for L4-S1
Paget's disease - –Rapid, chaotic bone resorption followed by chaotic bone formation, very frequent fractures, normal calcium ## Footnote L4 : Absent knee jerk L5 : Absent dorsiflexion of great toe S1 : Absent ankle jerk, numbness of lateral foot

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