Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Med > Ortho > Flashcards

Ortho Flashcards

1
Q

Axillary nerve,

Motor, sensory, root

A

M: deltoid, teres minor, triceps long head

S: lateral upper arm

R: C5, C6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Musculocutaneous nerve

Motor, sensory, root

A

M: biceps, brachialis

S: lateral forearm

R: C5, C6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Median nerve

Motor, sensory, root

A

M: Wrist flexor, Wrist abductor, flexion of 1,2,3 digits

S: palmar thumb to radial half of 4th digit. Dorsal tips of digit 1 to radial half of digit 4
OK sign (AIN)

C6, C7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Ulnar nerve

Motor, sensory, root

A

M: wrist flexor, wrist adductor, Flexion of 4th, 5th digit

S: medial palm, dorsum of hand, 5 th digit and medial half of 4th digit
Spread fingers

R: C8, T1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Radial nerve

Motor, sensory, root

A

M: triceps (medial/lateral heads). Wrist, thumb, finger extensors

S: lateral dorsum of hand. Medial upper forearm. Thumbs up (PIN)

R: C5, C6,C7, C8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Tibial nerve

Motor, sensory, root

A

M: ankle plantar flexion, knee flexion, great toe flexion

S: sole of foot

R: L5, S1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Superficial peroneal nerve

Motor, sensory, root

A

M: ankle eversion

S: dorsum of foot

R: L5, S1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Deep peroneal

Motor, sensory, root

A

M: Ankle dorsiflexion and eversion

S: 1st web space

R: L5-S1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Sural nerve

Motor, sensory, root

A

M: -

S: lateral foot

R: S1, S2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Saphenous nerve

Motor, sensory, root

A

M: -

S: anteromedial ankle

R: L3, L4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Signs suggestive for open fx

A

Continuous bleeding from puncture site

Fat droplets in blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Angulation in transverse fx

A

< 30°

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Angulation in oblique fx

A

30-60°

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Fx description

A
  1. Name of injured bone
  2. Integrity of skin/soft tissue
  3. Location in bone
  4. Orientation/pattern
  5. Alignment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Indications for open reduction

A

Non-union

Open fx

Neurovascular compromise

Displaced intraarticular

Salter-Haris 3,4,5

Polytrauma

Failed close reduction

Not able to cast or apply traction due to site

Pathologic fx

Potential for improved function with ORIF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Evaluation of fx healing

A

No longer tender on palpation/ stressing

Xray: teabecula cross fx site, visible callus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Normal healing time course of fx

A

0-3 wk: hematoma, macrophages

3-6 wk: osteoclasts remove sharp edges. Callus forms

6-12 wk: Bone forms within the callus, bridging fragments

6-12 mo: cortical gap bridged by bone

1-2 y: normal architecture achieved through remodeling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

CRPS/RSD clinic

A

Exaggerated response to an insult

Hyperalgesia

Allodynia

Autonomic dysfunction:
Temperature asymmetry
Mottling
Hair/nail changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Swimmer’s view Xray

A

Helps to see C7-T1 junction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Controversial Initial Mx if open fx

A

1st generation cephalo or clinda. Upon arrival until 24 h after each debridement.

Culture from: delayed injury (>24 h), infected injury

Debridement of open fx ASAP

Wound closure: within 7 d ( after soft tissue stabilization and all non-viable tissue removal

Negative pressure wound therapy: decreases infection rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Initial Mx of open fx

A

ABC, primary survey

Removal of obvious foreign material

Irrigate with NS

Cover with sterile dressing

Immediate IV AB

Tetanus

Reduce and splint fx

NPO and prepare for OR:
Blood work, consent, ECG, CXR

Operative irrigation and debridement within 6-8 h

Wound left open to drain OR vacuum-assisted closure dressing

Re-examine + irrigation + debridement in 48 h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

AB for open fx

A 
If < 10 cm:
Cefazolin for 3 d
Or
Quinolone (if penicillin allergy)
Or
Vanco (if MRSA positive)

If > 10 cm:
Cefazolin + Genta for 3 d
+ penicillin if soil contamination (clostridium)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Time of muscle necrosis in compartment syndrome

A

4-6 h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

First symptom of compartment syndrome

A

Pain out of proportion to injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

The most sensitive sign of compartment syndrome

A

Pain with passive stretch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Inv for compartment syndrome

A

A clinical diagnosis
Don’t wait for five Ps

If child or if unconscious:
Compartment pressure monitoring with catheter AFTER clinical diagnosis is made

Normal: 0
Elevated: 30 or higher

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Treatment of compartment syndrome

A

Non-operative:
Remove constrictive dressings, Elevate limb at the level of the heart

Operative:
Urgent fasciotomy
48-72 h post-op: wound closure +/-necrotic tissue debridement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Volkmann’c contracture

A

Complication of compartment syndrome: ischemic necrosis of muscles followed by secondary fibrosis and finally calcification. especially following supracondylar fracture of humerus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

The most common cause/ mechanism of spread of osteomyelitis

A

S. Aureus

Hematogenous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Plain film of osteomyelitis

A

Soft tissue swelling

Lytic bone destruction (after 10-12 d)

Periosteal reaction (after 10-12 d)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Inv for osteomyelitis

A

CBC, diff
ESR, CRP
B/C
Aspirate culture/bone Bx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Tx of acute osteomyelitis

A

IV AB 4-6 wk

+/- surgery (abscess, significant involvement)

Hardware removal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Tx of chronic osteomyelitis

A

Surgical debridement

AB: systemic (IV) and local

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Most common cause of septic arthritis in adults

A

S. Aureus

If prior joint replacement: consider Staph coagulase negative

If newborn or sexually active adult: N. Gonorrhea

The most common route: hematogenous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Inv for septic joint

A 
Xray
ESR, CRP
WBC
B/C
Joint aspirate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Joint aspirate in septic arthritis

A 
Cloudy
Yellow
WBC > 50,000
PMN > 90%
Protein > 4.4 mg/dL
Glucose < 60% of blood
No crystal
Positive Gram stain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Tx of septic arthritis

A

IV AB

joint aspiration (if early Dx and superficial joint)

Arthroscopic/open irrigation, irrigation and drainage, decompression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Most common joint in infective arthritis

A

Knee > hip > elbow > ankle> sternoclavicular joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Plain film of septic joint

A

Day 0-3:
Normal
+/- soft tissue swelling, joint space widening

Day 4-6:
Joint space narrowing, destruction of cartilage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Monitoring response of septic joint to treatment by

A

CRP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Shoulder passive ROM

A 
Abduction 180°
Flexion 180°
Extension 45°
Addiction 45°
Internal rotation T4
External rotation 40-45°
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Most common type of shoulder dislocation

A

Anterior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Mechanism of anterior shoulder dislocation

A

Abducted arm is externally rotated/extended

Or

Blow to posterior shoulder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Symptoms of anterior shoulder dislocation

A

Arm slightly abducted and externally rotated.

Inability to internally rotate

Squared off shoulder

Positive apprehension test

Positive relocation test

Positive sulcus sign

Axillary/ musculocutaneous nerve malfunctions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Imaging in anterior shoulder dislocation

A

Axillary view: humeral head is anterior

Trans-scapular Y view: humeral head anterior to the centre of Mercedes-Benz sign

AP view: subcoracoid lie of humeral head

Hill-Sachs lesion: compression fx of posterior humeral head

Bony Bankart lesion: avulsion of anterior glenoid acetabulum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Tx of anterior shoulder dislocation

A

Close reduction

Post-reduction Xray

Post-reduction NVS check

Sling 3 wk (avoid abduction and external rotation)

Shoulder rehabilitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Mechanism for posterior shoulder dislocation

A

Adducted, internally rotated, flexed arm

Epileptic seizure

Electrocution

EtOH

Blow to anterior shoulder

FOOSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Clinic of posterior shoulder dislocation

A

Arm: held in internal rotation and adduction

External rotation blocked

Anterior shoulder flattening

Prominent coracoid

Palpable mass posterior to shoulder

Positive posterior apprehension test: only used to test recurrent posterior instability and NOT ACUTE INJURY

Axillary/ musculocutaneous nerves dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Radiology of posterior shoulder dislocation

A

Axillary view: humoral head posterior

Trans-scapular Y view: head posterior to centre of Mercedes-Benz

AP view: partial vacancy of glenoid fossa.
> 6mm space between anterior glenoid rim and humeral head (positive rim sign).
Light bulb sign

Reverse Hill-Sachs lesion (anterior humeral head)
Reverse bony Bankart: avulsion of the posterior glenoid labrum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Tx of posterior shoulder dislocation

A

Close reduction

Post-reduction Xray and NVS

Sling in abduction and external rotation x3 wk

Shoulder rehabilitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Recurrence rate in shoulder dislocation

A

Depends on age of first dislocation

More if age <20 yr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Complications of shoulder dislocation

A

Rotator cuff/ capsular/ labar tear

Shoulder stiffness

Axillary nerve/artery, brachial plexus injury

Most common complication: recurrent dislocation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Rotator cuff nerve supply

A

Teres minor: axillary

All others: suprascapular nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Function of rotator cuff muscles

A

Supraspinatus: abduction

Infraspinatus: external rotation

Teres minor: external rotation

Subscapularis: internal rotation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Rotator cuff examinati

A

Passive movements permitted

Pain worse with active movements, esp overhead

Weakness and loss of ROM, esp between 90-130°

Tenderness over greater tuberosity

R/O biceps tendoniosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Inv for rotator cuff disease

A

X-ray: AP view: high riding humerus indicative of large tear

MRI +/- arthrogram( geyser sign)

Arthrogram: can assess full thickness tear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Tx of rotator cuff disease

A

If mild or mod: PT, NSAID, +/- IACS

If severe or refractory to 2-3 mo PT and 1-2 IACS: arthroscopic/ open surgical repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Tests for supraspinatus

A

Jobe’s test

Lift-off or belly press test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Tests for infraspinatus and teres minor

A

Posterior cuff test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Rotator cuff impingement tests

A

Neer’s test:

Passive shoulder flexion. Pain between 130-170°

Hawkins-Kennedy Test:

Shoulder flexion to 90° and passive internal rotation. Pain suggests impingement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Test for rotator cuff tendinopathy

A

Painful arc test:

Pt actively abducts shoulder. Pain with abduction > 90°

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Speed’s test

A

Apply pressure to the forearm when arm is in forward flexion (90°) with elbow fully extended.

If pain in bicipital groove = biceps tendon pathology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Test with greatest specificity and sensitivity for rotator cuff disease

A

Painful arc test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

O’Brien’s test

A

SLAP lesion
Forward flexion of arm to 90°, while keeping arm extended, arm adducted to 10-15°. Internally rotate the arm so thumb is facing down. Apply downward force. Repeat test while externally rotated.

Pain or clicking in glenohumsral joint in internal but not external rotation = glenohumeral labral tears (superior labral tear from anterior to posterior)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

AC joint injury mechanism

A

Fall onto shoulder with adducted arm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Clinic of AC injury

A

Tenderness

Pain with adduction

Step deformity on AC (if dislocated)

Limited ROM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Inv of AC injury

A

Xray: bilateral AP, axillary view, Zanca view

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Tx of AC injury

A

Sling 1-3 wk, ice, analgesia, early ROM and rehabilitation

Surgery if complete tear + displacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Most common fx site in clavicle

A

Middle third

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Mechanism of clavicular fx

A

Fall on shoulder

FOOSH

Direct trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Inv for clavicle fx

A

NVS of entire upper arm

Xray

CT: if medial physeal fx, sternoclavicular injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Tx of clavicle fx

A

Medial and middle third:
Sling 1-2 wk
Early ROM and strengthening
If > 2cm shortened: ORIF

Distal third:
Undisplaced: sling 1-2 wk
Displaced: ORIF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Complications of clavicular fx

A 
Cosmetic bump
Shoulder stiffness
Weakness with repetitive activity
Pmeumothorax
Brachial plexus injury (esp with proximal third fx)
Subclavian vessel injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Pt with arm clasped to chest

A

Clavicular fx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Course of adhesive capsulitis

A

Progressive pain and stiffness

Spontaneous resolution after 18 mo

Freezing phase, frozen phase, thawing phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Mechanism of frozen shoulder

A

Primary:
Associated with DM

Secondary:
Prolonged immobilization most significant)
CRPS/RDS
MI
Stroke
Shoulder trauma
AI disease
Hyperthyroidism
Cervical disc disease
Poorer outcome

F> M
Age > 49

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Inv for adhesive capsulitis

A

Xray: Nl or bone demineralization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Tx of frozen shoulder

A

Freezing phase:
Active and passive ROM
NSAID and IACS to manage pain

Thawing phase:
Manipulation under anesthesia
Early PT
Arthroscopy for debridement/decompression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Clinic of frozen shoulder

A

Gradual onset

Diffuse shoulder pain

Pain worse at night, prevents sleeping on affected side

Decreased active and passive ROM

Increased stiffness as pain subsides :stiffness continues for 6-12 mo after pain has disappeared

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Proximal humerus fx mechanism

A

Young: high energy trauma

Elderly: FOOSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Inv for proximal humeral fx

A

Axillary nerve

Xray

CT: to evaluate articular involvement and fx displacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Tx for proxima humerus fx

A

Treat osteoporosis

If non-displaced: broad arm sling immobilization. Begin ROM within 14 d.

If minimally displaced (most common): close reduction, sling 2wk, gentle ROM

If anatomic neck fx, displaced, dislocated glenohumeral joint: ORIF, +/- arthroplasty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Complications of proximal humeral fx

A

AVN (esp if anatomical neck fx)

Nerve palsy

Malunion

Post-traumatic arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Humeral shaft fx mechanism

A

Young: high energy

Elderly: low energy: FOOSH, twisting, mets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Inv for humeral shaft fx

A

Radial nerve

Brachial artery

Xray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Tx of humerus shaft fx

A

Generally non-operatively

+/- reduction. Can accept deformity

Hanging cast, collar and cuff sling immobilization

After swelling subsides, Samiento functional brace, then ROM

Surgery if:
Pathological fx, floating elbow
ORIF: plating, IM rod, external fixation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

If radial nerve palsy in humeral shaft fx

A

Recovery expected within 3-4 mo

Otherwise: EMG

Other complications: non-union, decreased ROM, compartment syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Distal humeral fx mechanism

A

Young. High energy

Elderly: FOOSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Inv for distal humeral fx

A

Assess brachial artery
Xray
CT: when suspecting shear fx of capitulum/trochlea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Tx of distal humeral fx

A

Goal: restore ROM 30-130° flexion

Cast immobilization

Surgical if:
Displaced
Supracondylar
Bicolumnar

Closed reduction+ percutaneous pinning, ORIF, +/- total elbow arthroplasty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Supracodylar fx mechanism

A

FOOSH

Most common in children around 7 yr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Inv in suprachondylar fx

A

Median nerve (esp AIN)

Radial nerve

Radial artery

Xray: disruption if anterior humeral line. Fat pad sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Tx of suprachondylar fx

A

If non-displaced:
Long arm plaster slab in 90° flexion x 3 wk

surgery: percutaneous pinning, ORIF in adults if:
Displaced
Vascular injury
Open fx
Unacceptable angulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Complications of suprachondylar fx

A 
Stiffness (most common)
Brachial artery injury
Median, ulnar nerve injury
Compartment syndrom
Malalignment
Cubitus varus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

Radial head fx mechanism

A

Common in young adults

FOOSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

Inv of radial head fx

A

Xray: enlarged anterior fat pad (sail sign)

Presence of posterior fat pad

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Tx of radial head fx

A

If comminuted: excision and prosthesis

If displaced: ORIF

If non-displaced: elbow slab or sling x 3-5 d with early ROM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Complications of radial head fx

A

Myositis issificans

Recurrent instability ( if MCL injured and head excised)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

Do not immobilize elbow more than

A

2-3 wk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Olecranon fx mechanism

A

Direct trauma
Fall onto elbow
FOOSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Inv for olecranon fx

A

X ray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Tx of olecranon fx

A

If non-displaced (< 2mm, stable):
Cast, 3 wk (elbow 90°) then gentle ROM

If displaced: ORIF, early ROM if stable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Elbow dislocation mechanism

A

hyperextension (via FOOSH)
Or
Vulgar/supination stress during elbow flexion

Monteggia: radial head dislocated. Ulna remains

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

Inv for elbow dislocation

A

Xray

Radial/ ulnar arteries
Brachial artery
Median, ulnar nerves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Tx of elbow dislocation

A

Close reduction, Parvin’s method

Then long arm splint, forearm in neutral rotation, elbow 90°

Early ROM (<2wk)

ORIF if:
Complex dislocation
Persistent instability after close reduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

Complications of elbow disloction

A

Stiffness

Intraarticular loose body

NVS injury

Rasial head fx

Recurrent instability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

Tennis elbow

A

Lateral epicondylitis

Common extensor tendon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

Golfer’s elbow

A

Medial epicondylitis

Common flexor tendon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

Course of epicondylitis

A

Self limited, but may take 6-18 mo to resolve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

Tx of epicondylits

A 
Rest
Ice
NSAID
Brace, strap
PT, stretching, strengthening
CS injection

Operation if:
Failed 6-12 mo conservative therapy
Release of common tendon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

Radius and ulna shaft fx mechanism

A

High energy

Usually accompanied by displacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

Inv for radius/ulna shaft fx

A

Xray

CT if close to joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

Tx of ulna/radius shaft fx

A

Goal: anatomic reduction

ORIF with plate and screws

Poor results for close reduction (except in children)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

Complications of forearm fx

A

Soft tissue contracture resulting in limited forearm rotation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

Monteggia fx

A

Fx of proximal ulna with dislocation of radial head. Proximal radioulnar joint injury

Children: more common and better prognosis

Mechanism: direct blow. Hyperpronation. Fall on hyperextended elbow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

Inv for monteggia

A

Xray

PIN injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

Tx if monteggia

A

Adults:
ORIF of ulna, indirect reduction/ORIF of radius
Early post-op ROM if stable. If not, 6 wk immobilization

Children:
Attempt close reduction and immobilization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

Complications of monteggia

A

PIN: mist common nerve injury

Radial head instability

Radioulnar synostosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

Tx of PIN injury

A

Observe for 3 mo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

Nightstick fx

A

Isolated ulna fx, without radial head dislocation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

Tx of nightstick fx

A

If non-dislocated:
Below elbow cast x 10d, then brace

ORIF: if displaced, angulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

Galeazzi fx

A

Fx of distal radial shaft, disruption of distal radioulnar joint

Mechanism: FOOSH

Inv: Xray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

Tx of Galeazzi fx

A

All ORIF

If DRUJ stable and reducible:
Splint x 10-14 d, early ROM

If DRUJ unstable:
Pinning, ORIF. Long arm cast x6 wk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

Most common wrist fx in women > 40

A

Colles’ fx (dinner fork deformity)

FOOSH

transverse distal radius fx with dorsal displacement +/- ulnar styloid fx

Inv: Xray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

Tx of colles’ fx

A

Goal: restore radial height, radial inclination, volar tilt, DRUJ stability, forearm rotation

Closed reduction:

  1. Traction with extension
  2. Traction with ulnar deviation
  3. Pronation, flexion

Then dorsal slab, below elbow cast for 5-6 wk

Xray: 1 wk, 3 wk, at cessation of immobilization

Repeat reduction if necessary

Operative if:
Failed closed reduction, loss of reduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

Smith fx

A

Volar displacement of distal radius

Mechanism: fall onto the back of the flexed hand

Inv: Xray

Tx: ORIF

If poor candid for surgery, attempt closed reduction

Long arm cast in suppination x 6 wk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

Complications of wrist fx

A 
Poor grip strength
Stiffness
Radial shortening
Compartment syndrome
EPL rupture
Acute CTS
Venous block
CRPS/RSD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

Scaphoid fx examination

A

Pain with resisted pronation

Pain with long axis compression into scaphoid

Snuff box tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

Scaphoid fx inv

A

Xray
AP, Lat, scaphoid view (wrist extension and ulnar deviation)

+/- CT, MRI

Rarely bone scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

If suspicion of scaphoid fx

A

If negative Xray: treat as if positive

Repeat Xray 2 wk later. If still negative: CT or MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

Tx of scaphoid fx

A

Non displaced: long arm thumb spica cast x 4wk.

Then short arm cast until radiographic evidence of healing (2-3 mo)

If displaced: ORIF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

The most common complication of scaphoid bone fracture

A

Nonunion/malunion (use bone graft)

others:
AVN of proximal fragment (if fx through proximal third)
Delayed union (recommend surgical fixation)
Scaphoid nonunion advanced collapse and arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

Special testing for cervical radiculopathy

A

Compression test:
Pressure on head worsens radicular pain

Distraction test:
Traction on head relieves symptoms

Valsalva test:
Increases symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

C5 motor, sensory, reflex function

A

S: axillary nerve (patch over lateral deltoid)

M: deltoid, biceps, wrist extension

R: biceps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

C6 motor, sensory, reflex function

A

M: biceps, brachioradialis

S: thumb

R: biceps, brachioradialis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

C7 motor, sensory, reflex function

A

M: triceps, wrist flexion, finger extension

S: index, middle finger

R: triceps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

C8 motor, sensory, reflex function

A

M: interossei, digital flexors

S: ring and little fingers

R: finger jerk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

Abnormal findings on cervical Xray

A

Lateral:
Translation if vertebra body > 3.5 mm

Angulation between adjacent vertebral bodies > 11°

Anterior soft tissue space > 3 mm at C3 or > 8-10 mm at C4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

Special tests for thoracolumbar spine

A

SLR (pain in 30-70°)

Lasegue maneuver: dorsiflexion of leg during SLR brings makes symptoms worse, or brings on symptoms in less elevation

Femoral stretch test: pt prone, flex knee, extend hip results in pain in anterior thigh

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

L4 motor, sensory, reflex

A

M: quadriceps,

S: medial malleolus

R: patellar

Screen: squat and rise

Test: femoral stretch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

L5 motor, sensory, reflex

A

M: extensor hallucis longus, gluteus medius (hip abduction), tibialis anterior (ankle inversion + dorsiflexion)

S: 1st dorsal webspace, lateral leg

R: medial hamstring

Screen: heel walking

Test: SLR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

S1 motor, sensory, reflex

A

M: peroneus longus/brevis (ankle eversion), gastrocnemius/soleus (plantar flexion)

S: lateral foot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

Degenerative disc disease symptoms

A

Axial back pain

Pain worse with axial loading and flexion

Negative SLR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

Inv for degenerative disc disease

A

Xray
MRI
Provocative discography

Change in alignment of facet joints

Osteophyte formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

Tx of degenerative disc disease

A

Staying active with modified activity

Back strengthening

NSAIDs

Operative: rare: decompression, fusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

Clinic of spinal stenosis

A

+/- bilateral back and leg pain

Neurogenic claudication:
Worse with standing, exercise.
Walking distance variable.
Alleviation with flexion, sitting, lying down.
Relief in 10 min

+/- motor weakness

Normal back flexion

Difficulty back extension

Positive SLR

Pain not worse with valsalva

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

SLR in spinal stenosis

A

Positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

Inv for spinal stenosis

A

Gold std : CT myelography

CT/MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

Tx of spinal stenosis

A

Vigorous PT:
Flexion exercise
Stretch/strength exercise

NSAID

epidural CS

Decompressive surgery if:
Non-operTive failure > 6 mo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

Relief time in neurogenic claudication

A

10 min

2 min in vascular claudication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

Mechanical back pain clinical features

A

Not due to prolapsed disc or any other clearly defined pathology

Dull backache

Aggravated by activity and prolonged standing

Morning stiffness

No neurologic sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

Tx of mechanical back pain

A

PT
Analgesic
Resolves in 4-6 wk or becomes chronic

153
Q

Most common location for disc herniation

A

L5-S1 > L4-5 > L3-4

154
Q

Features of disc herniation

A

Back dominant pain (central herniation)

Or

Leg dominant pain (lateral herniation)

Muscle spasm

Loss of lumbar lordosis

Tenderness between spinous processes at affected level

Cauda equina syndrome in 1-10%

155
Q

Disc herniation tests

A 
Positive:
SLR
Contralateral SLR
Lasegue
Bowstring
156
Q

Disc herniation investigation

A

Xray
MRI
Post-void residual volume (to check for urinary retention)

If PVR > 100 ml, suspicious for cauda equina

157
Q

Tx of disc herniation

A

Extension protocol
NSAID

Surgery if:
progressive neurological deficit
Failure of symptoms to resolve within 3 mo
Cauda equina

158
Q

Neurogenic claudication is worse by

A

Position

159
Q

Vascular claudication is worse by

A

Exercise

160
Q

Prognosis of disc herniation

A

90% improve within 3 mo

161
Q

Mechanical back pain, disc origin

Pattern 1

A

Aggravated with flexion

Gradual onset

Long duration

Treatment: exercise, relief of strain

162
Q 
Mechanical back pain
Facet origin (pattern 2)
A

Worse with extension, standing, walking

More sudden onset

Shorter duration (days, weeks)

Tx: exercise, relief of strain

163
Q

Low back pain with direct nerve root compression, root compression
(Pattern 3)

A

Dominant in leg

Worse with flexion

Acute onset

Short episodes (attacks taking minutes)

Tx: relief of strain, exercise, surgical decompression if progressive/severe

164
Q

Back pain with direct nerve root compression, spinal stenosis (pattern 4)

A

Leg dominant

Worse with exercise, extension, walking, standing

Cngenital or acquired

Acute or chronic Hx

Tx: relief of strain, exercise, surgical decompression if progressive/severe deficit

165
Q

Defect in spondylolysis

A

Pars interarticularis

No movement if vertebral body

166
Q

Most common symptoms of sciatica

A 
Leg dominant pain
Constant
Burning
Radiates down leg +/- foot
Most common cause= disc herniation
167
Q

Features of spondylolysis

A

Activity related back pain

Pain worse with unilateral extension (Michelis’ test)

168
Q

Inv for spondylolysis

A

Oblique Xray:
Collar break in scottie dog’s neck

Bone scan

CT

169
Q

Tx of spondylolystesis

A

Activity restriction

Brace

Stretching exercise

170
Q

Adult isthmic spondylolisthesis

A

Defect in pars interarticularis with forward slippage of one vertebra on another

L5-S1> L4-5

Congenital or acquired, teratogenic, traumatic

171
Q

Features of spondylolisthesis

A

Low back pain radiating to buttocks
Relieved with sitting
Neurogenic claudication
L5 radiculopathy

May present as cauda equina

172
Q

Inv for spondylolisthesis

A

Xray

MRI

173
Q

Tx of spondylolisthesis

A

Activity restriction
Bracing
NSAID

IF intractable pain, > 50% operation:
Operation: decompression, spinal fusion

174
Q

Mechanism of pelvic injury

A

Young: high energy trauma

Elderly: fall from standing height, low energy trauma

175
Q

Inv for pelvic fx

A

Xray

CT (posterior pelvic injury, acetabular fx)

Assess GU injury (considered open fx)

176
Q

Tear drop displacement in pelvic Xray

A

Acetabular fx

177
Q

Tx of pelvic fx

A 
ABCDE
IV fluid/blood
Pelvic binder/sheeting
External fixation vs emergent angiography/embolization
\+/- laparotomy (if FAST/DPL + )

If stable fx:
Protected weight bearing

ORIF if:
Unstable pelvic ring injury
Disruption of anterior and posterior SI ligament
Symphysis diasthasis > 2.5 cm
Vertical instability of the posterior pelvis
Open fx

178
Q

Complications of pelvis fx

A 
Hemorrhage
Injury to rectum/UG 
Obstetrical dificulties
Sexual, voiding dysfunction
Persistent SI joint pain
Hip arthritis with acetabular fx
High risk of DVT
179
Q

Best time to reduce hip dislocation

A

Within 6 h (to decrease AVN)

180
Q

Mx of hip dislocation

A

ABC

NVS

reduction within 6 h

Hip precautions (no extreme flexion, adduction, internal or external rotation): avoid flexing > 90° or crossing legs for 6 wk

181
Q

Anterior hip dislocation mechanism

A

Posteriorly directed blow to knee, with hip widely abducted

182
Q

Symptoms of ant. Hip dislocation

A

Shortened, abducted, externally rotated limb

183
Q

Tx of anterior hip dislocation

A

Closed reduction

Post reduction CT

184
Q

Posterior hip dislocation mechanism

A

Severe force to knee with hip flexed and adducted

185
Q

Features of Posterior hip dislocation

A

Shortened
Adducted
Internally rotated

186
Q

Posterior hip dislocation Tx

A

Close reduction

ORIF if:
Unstable, intraarticular fragments, posterior wall fx,
Associated femoral neck fx, ipsilateral displacement

Post-reduction CT

If unstable reduction, put in traction x 4-6 wk

187
Q

Rochester method

A

To reduce Posterior hip dislocation:
Supine
Hip and knee flexed
Traction, internal rotation, then external rotation

188
Q

hip dislocation complications

A 
OA
AVN
Fx of femoral head, neck, shaft
Sciatic nerve palsy
HO
DVT/PE
189
Q

Clinic of hip fx

A

Unable to bear weight
Leg: shortened, externally rotated
Painful ROM

190
Q

Femoral neck (subcapital) fx Tx

A

ORIF +/- total/hemi hip arthroplasty in elderly

191
Q

Intertrochanteric hip fx

A

Closed reduction under fluoroscopy,

Then dynamic hip screw or IM nail

192
Q

Subtrochanteric hip fx Tx

A

Close/open under fluoroscopy, then plate or IM

193
Q

DVT prophylaxis for hip fx

A

LMWH on admission

Do not give <12 h before surgery

194
Q

AVN etiologies

A

Femoral neck fx, chronic CS, SCFE, Legg-Calvé-Perthes, SLE, RA

195
Q

Pain reduction for hip fx

A

Nerve blockade seems effective

Preoperative traction seems to not reduce acute pain

196
Q

First motion lost in hip arthritis

A

Internal rotation

197
Q

Features of hip arthritis

A

Pain (groin, medial thigh)

Pain better with rest: OA

morning stiffness > 1h, multiple joint swelling, hand nodules: RA

Decreased ROM (first internal rotation)

Crepitus

Effusion

Fixed flexion contracture

Trendelenburg sign

198
Q

Inv for hip arthritis

A

Xray

ANA, RF

199
Q

Tx of hip arthritis

A

Weight reduction, activity modification, PT, analgesics, walking aids

If advanced disease: operative

200
Q

Complications of arthroplasty

A 
Component loosening
Dislocation
HO
VTE
infection
NVS injury
Limb length discrepancy
201
Q

Xray of hip RA

A

Osteopenia
Erosions
Joint space narrowing
Subchondral cysts

202
Q

Xray of hip OA

A

Joint space narrowing
Subchondral cysts
Subchondral sclerosis
Osteophytes

203
Q

DVT prophylaxis in elective THA

A

Continue 10-35 d post-operative

Fondaparinox
LMWH
Warfarin

204
Q

Fx caused by bisphosphonate use

A

Femoral diaphysis fx

205
Q

Femoral diaphysis fx mechanism

A

High energy

Children: low energy (spiral)

Pathologic:
Malignancy, osteoporosis, bisphosphonate

206
Q

Femoral diaphysial fx clinic and inv

A

Shortened, Externally rotated leg (if displaced)

Inability to bear wt

Often open

Inv:
Xray

207
Q

Tx of femoral diaphysial fx

A

If non-displaced: long leg cast

ORIF with IM nail

External fixator if: unstable pt, open fx, highly vascular area

Plate and screw: for open growth plate

Early mobilization and strengthening

208
Q

Complications of femoral diaphysial injury

A

Blood loss

Fat embolism

Extensive soft tissue damage

Ipsilateral hip dislocation/fx

Nerve injury

209
Q

Mechanism, clinic, inv for distal femoral fx

A

High energy

Pain, effusion, NVS deficit

Xray, CT, Angio if diminished pulses

210
Q

Tx of distal femoral fx

A

If non-displaced and extraarticular: hinged knee brace

If displaced, intraarticular, non-union: ORIF

Early mobilization and strengthening

211
Q

Complications of distal femoral fx

A

Femoral/popliteal artery injury

Nerve injury

Extensive soft tissue injury

Angulation deformities

212
Q

DDx of knee locking

A

Torn meniscus
Loose bode in joint

Pseudo-locking:
Effusion
Muscle spasm
Arthritis

213
Q

Painful clicking

A

Torn meniscus

214
Q

DDx of knee giving away

A

Torn meniscus
Torn cruciate ligament
Patellar dislocation

215
Q

Anterior and posterior drawer sign

A

Knee 90° flexed

If able to sublux tibia anteriorly: torn ACL

If able to sublux tibia posteriorly: torn PCL

216
Q

Lachman test

A

Knee 10-20° flexed

Torn ACL

more reliable than anterior drawer test

217
Q

Pivot shift sign

A

Torn ACL

218
Q

Reverse picot shift test

A

Torn PCL

219
Q

Posterior sag sign

A

Torn PCL

Flex knees and hips to 90°

220
Q

Collateral ligament stress test

A

Opening felt on MCL or LCL while applying valgus and varus stress on knee respectively.

Showing MCL or LCL damage

221
Q

Thessaly test

A

Meniscal teat

Pt stands on one leg, flexes knee to 20°, rotates femur on tibia medially and laterally

Discomfort in medial or lateral joint line = meniscal tear

222
Q

Tests for meniscal tear

A

Joint line tenderness

Crouch compression test (pain with squatting)

McMurray test:
Lateral meniscus tear: internally rotate foot, varus stress, extend knee

Medial meniscus tear: externally rotate foot, valgus stress, extend knee

Painful Pop/click: torn meniscus

223
Q

Indications for Xray in acute knee injury

A

Age> 55
Tenderness at fibula head
Isolated tenderness of patellainability to flex to 9°
Inability to bear wt immediately and in ER

224
Q

Torn ACL exam

A

Effusion
Posterolateral joint lime tenderness

Positive anterior drawer

Positive lachmann

Pivot shift

225
Q

Tx of torn ACL

A

If stable knee with minimal functional impairment:
2-4 wk immobilization. Early ROM and strengthening

If high demand lifestyle: ligament reconstruction

226
Q

PCL tear exam

A

Cannot descend stairs

Pain with pushoff

Effusion

Anteromedial joint line tenderness

Positive posterior drawer

Reverse pivot shift

227
Q

Tx if torn PCL

A

Unstable knee, young person, high demand: ligament reconstruction

228
Q

Inv for collateral ligament tear

A

Xray

MRI

229
Q

Tx of collateral ligament injury

A

If partial tear:
Immobilization 2-4 wk
Early ROM and strengthening

If complete tear:
Immobilization at 30° flexion

Multiple ligamentus injuries:
Operative

230
Q

Pain in partial vs complete ligamentous tear

A

Pain more severe in partial tear

231
Q

Medial vs lateral meniscus tear

A

Medial > lateral

232
Q

Hemarthrosis in meniscus tear

A

Insidious (after 24-48 h)

233
Q

Inv in meniscus tear

A

MRI

arthroscopy

234
Q

Tx of meniscus tear

A

If not locked:
Non-operative ( ROM, NSAID, strengthening)

If locked or failed above measures:
Arthroscopic repair (if peripheral longitudinal tear with good vascular response), partial meniscectomy (if complex, degenerative, radial tear)
235
Q

RFs for quadriceps/patellar tendon rupture

A 
Obesity
DM
RA
SLE
Steroid use
RF on Dialysis
236
Q

Mechanism of patellar/quadriceps tendon rupture

A

Forceful contraction of quadriceps while attempting to stop

237
Q

Inv for quadriceps/patellar rupture

A

Unable to do SLR (if complete rupture)

Knee Xray (to exclude patella fx)

MRI (to distinguish between complete/partial rupture)

Lateral view:
Patella alta (patellar tendon rupture)
Patella baja (quadriceps tendon rupture)
238
Q

Tx of patellar/quadriceps tendon rupture

A

If incomplete:
Immobilization in brace

If complete/loss of extensor mechanism:
Early surgical repair (<6 wk)

239
Q

Inv for dislocated knee

A

Xray

ABI (<0.9 abn)

Arteriogram/ CT angio if abnormal vascular exam

240
Q

Tx of knee dislocation

A

Urgent closed reduction

Assess: peroneal nerve, tibial artery, ligaments

If vascular injury: emergent operative repair

If open fx/dislocation: emergent OR

non-reducible: emergent OR

Compartment syndrome: emergent OR

Knee immobilization x 6-8 wk

241
Q

Complications of knee dislocation

A

Popliteal artery injury

Peroneal nerve injury

Capsular tear

Chronic instability, stiffness, post traumatic arthritis

242
Q

Patellar fx inv

A

Xray

243
Q

Tx of patellar fx

A 
Non-displaced:
Straight leg immobilization, 1-4 wk with hinged knee brace.
Wt bearing as tolerated
Progress in flexion after 2-3 wk
PT

Operative if:
Displaced > 2mm
Comminuted
Disrupted extensor mechanism

244
Q

Complications of patellar fx

A 
Symptomatic wiring
Loss of reduction
Osteonecrosis (proximal)
Hardware failure
Knee stiffness
Nonunion
Infection
245
Q

RFs for patellar dislocation

A 
Young, female
Obesity
High-riding patella
Genu valgus
Q angle > 20°
Shallow intercondylar groove
Weak vastus medialis
Tight lateral retinaculum
Ligamentous laxity
246
Q

Patellar dislocation features

A

Knee catches/gives way with walking

Severe anteromedial pain/tenderness from rupture of capsule

Positive patellar apprehension test

Recurrent. Self reducing.

Weak knee extension/ inability to extend unless patella reduced

Concomitant MCL injury

Increase Q angle

J sign

247
Q

Inv for patellar dislocation

A

Xray

Check for medial patella and lateral femoral condyle fx

248
Q

Tx of patellar dislocation

A 
NSAID
Activity modification
Physical therapy
Short-term immobilization, then 6 wk controlled motion
Progressive wt bearing
Isometric quadriceps strengthening
Operative if:
Recurrent
Loose bodies present
Surgical tightening of medial capsule
Release if lateral retinaculum
Tibial tuberosity transfer
Proximal tibial osteotomy
249
Q

RFs fir patellofemoral syndrome

A 
Malalignment
(Genu valgus, Q > 20°)
Post-trauma
Deformity of patella or femoral groove
Recurrent dislocations
Ligamentous laxity
Excessive knee strain
250
Q

Mechanism of chondromalacia patellae

A

Softening, erosion, fragmentation of articular cartilage.

Predominantly medial aspect of patella.

Common in active young females

251
Q

Symptoms of patellofemural syndrome

A

Deep, aching anterior knee pain.

Pain exacerbated by prolonged sitting (theatre sign), strenuous athletic activity, stair climbing, squatting, kneeling

Insidious onset

Vague

Instability, pseudolocking

Pain with extension against resistance through terminal 30-40°

Pain with compression of patella with knee ROM

Palpable crepitus

NO/MINIMAL SWELLING

252
Q

Inv for patellofemural syndrome

A

Xray
CT
MRI: best to assess articular cartilage

253
Q

Tx of chondromalacia patellae

A 
Rest
Rehabilitation
Non-impact activities
NSAID
PT: vastus medialis and core strengthening
Operative:
If failed non-operative treatment
Tibial tubercle elevation
Arthroscopic shaving/debridement
Lateral release of retinaculum
254
Q

Tibial plateau fx mechanism

A

Varus/valgus load +/- axial loading

Lateral > bicondylar > medial

255
Q

Inv for tibial plateau fx

A

Xray
CT
ABI

256
Q

Complications of tibial plateau fx

A 
Ligamentous injuries
Meniscal lesion
AVN
infection
OA
Compartment syndrome
257
Q

Tx if tibia plateau depression

A

If depression < 3mm or varus/valgus instability < 15°:
Straight leg immobilization 4-6 wk, with progressive ROM Wt bearing

If depression > 3mm or significant varus/valgus instability > 15°:
ORIF (often with graft)

258
Q

Tibial shaft fx mechanism

A

Low energy torsional

High energy

Inv: Xray

259
Q

Tibial shaft fx Tx

A

If closed and minimally displaced or adequately reduced:
Long leg cast 8-12 wk, tgen functional brace

If open or displaced:
ORIF
+ AB, I&D, vascular coverage of open fx defect

260
Q

Tibial shaft fx complications

A

High incidence of:
NVS injury
Compartment syndrome

Poor soft tissue coverage

261
Q

Tx of ankle fx

A

If non-displaced, no history of dislocation:
Below knee cast, non weight bearing

Operative if:
Any fx-dislocation
Trimalleolar
Talar tilt > 10°
Open fx
Open joint injury
Medial clear space on Xray greater than superior clear space
262
Q

Complication of ankle fx

A

High incidence of arthritis

263
Q

Talar fx mechanism

A

Axial loading

Hyperdorsiflexion

Most common site: neck

264
Q

Complication of talar fx

A

High risk of AVN if displaced

265
Q

Inv for talar fx

A

Xray
CT
MRI (to define extent of AVN)

266
Q

Tx of talar fx

A

If non-displaced:
NWB, below knee cast x 6wk

ORIF if:
Displaced

267
Q

Calcaneal fx mechanism

A

High energy axial load

268
Q

Calcaneal fx inv

A

Calcaneal fx of other side

Compression fx of thoracic and lumbar spine

Xray (oblique view is mandatory)

Gold std: CT

269
Q

Tx of calcaneal fx

A

NWB cast x 3 mo, early ROM

Close vs open reduction controversial

270
Q

Achilles tendonitis mechanism

A

Activity
Poor-fitting footware
+/- heel bumps (retrocalcaneal bursitis)

271
Q

Inv for achilles tendonitis

A

Xray (lateral: bone spurs, calcification)
U/S
MRI

272
Q

Tx of achilles tendonitis

A

Rest

NSAID

Shoewear modification

Main stay of non-operative treatment: heel sleeves and pads

Gentle gastrocnemius-soleus stretching

Eccentric training with physical therapy

Deep tissue calf massage

Shockwave therapy in chronic tendonitis

273
Q

Forbidden treatment in achilles tendonitis

A

Steroid injection

274
Q

Achilles tendon rupture mechanism

A

Loading activity
Stop and go sports
Chronic tendonitis
Steroid injection

275
Q

Thompson test

A

Prone
Squeeze calf
If no passive plantarflexion= rupture

276
Q

Achilles rupture inv

A

Xray
U/S
MRI (partial vs complete)

277
Q

Tx for achilles rupture

A

If low athletic demand or elderly:
Non operative. Cast in plantar flexion x 8-12 wk

If high athletic demand:
Surgical repair, then cast in plantar flexion x 6-8 wk

Surgical repair reduces risk of rerupture

278
Q

Plantar fasciitis definition (heal spur syndrome)

A

Inflammation of plantar aponeurosis at calcaneal origin

279
Q

Plantar fasciitis associations

A

Athletes
Obesity
DM
Seronegative, seropositive arthritis

280
Q

Mechanism of plantar fasciitis

A

Repetitive strain injury causing microtears and inflammation of plantar fascia

281
Q

Nerve injury in achilles rupture

A

Sural

282
Q

Clinical features of plantar fasciitis

A

Insidious onset of heel pain

Pain when getting out of bed

Stiffness

Intense pain when walking from rest

Pain subsides as patient continues to walk

Pain worse at the end of day with prolonged standing

Swelling/tenderness over soal

Greatest at medial calcaneal tubercle and 1-2 cm distal along plantar fascia

Pain with toe dorsiflexion

283
Q

Inv for plantar fasciitis

A

Xray
Often there is bony exostosis
Spur is secondary to inflammation (not the cause of pain)

284
Q

Tx of plantar fasciitis

A

1st line:
Pain control, stretching programs

Rest
Ice
NSAIDs
Steroid injection
PT
Orthotics with heel cup

Surgical release of fascia if failed non-operative treatment

285
Q

Bunion associations

A

Poor fitting footwear (high heel, narrow toe box)

Hereditary (70%)

10 x more frequent in women

286
Q

Features of bunion

A

Painful bursa over medial eminence of 1st MT head

Pronation of great toe

Numbness over medial aspect of great toe

Toe deviation angle > 15°

287
Q

Inv for bunion

A

Xray

288
Q

Tx of bunion

A

Indications: painful (corn, bunion), overriding 2nd toe

1st line: properly fitted shoes and toe spacer

Operative:
Goal: to restore normal anatomy.
Osteotomy with realignment of 1st MTP
Arthrodesis

289
Q

Foot stress fxs

A

Midshaft 5th metatars

Shaft 2nd, 3rd metatars

290
Q

Tx of avulsion of base of 5th metatars

A

ORIF if displaced

291
Q

Tx of march fx (shaft of 2nd, 3rd fx)

A

Symptomatic

292
Q

Tx of 5th metatars midshaft fx

A

NWB BK cast x 6wk

ORIF if athlete

293
Q

1st metatars fx Tx

A

If displaced:ORIF

if non-displaced: 3 wk NWB BK cast then walking cast

294
Q

Lisfranc fx

A

Tarso-metatarsal fx-dislocation

295
Q

Most common fx site in children

A

Distal radius

2nd: phalanges

296
Q

Fxs in children suspicious of abuse

A

Hallmark: metaphyseal corner fx

Femur fx < 1yr

Humeral shaft < 3 yr

Sternal fx

Posterior rib fx

Spinous process fx

297
Q

Most common site of stress fx

A

Tibia

298
Q

Dx of stress fx

A

Localized pain and tenderness

Xray may not show fx for 2 wk

Bone scan positive in 12-15 d

299
Q

Tx of stress fx

A

Rest (from strenuous activity)

300
Q

Salter-Harris type I fx Tx

A

Closed reduction and cast immobilization

Exception: SCFE which requires ORIF

301
Q

Salter-Harris type II Tx

A

Closed reduction and cast

If failure: ORIF

302
Q

Salter-Harris type III Tx

A

ORIF

Avoid fixation across growth plate

303
Q

Salter-Harris type IV Tx

A

Closed reduction and cast if anatomic

Otherwise: ORIF

304
Q

Salter-Harris type V Tx

A

No specific Tx

305
Q

Most common adolescent hip disorder

A

SCFE

306
Q

RFs for SCFE

A

Male

Obesity (#1 factor)

Hypothyroid (risk of bilateral involvement)

AD

Black

Trauma (acute slip)

(Sex hormone secretion which stabilizes physis, not yet begun)

307
Q

Clinical features of SCFE

A

Acute: sudden severe pain with limp

Chronic: groin/anterior thigh pain, knee pain. Positive trendelenburg on affected side

Tender over joint capsule

Restricted: internal rotation, abduction, flexion (whitman sign: obligatory external rotation during passive hip flexion)

308
Q

Inv for SCFE

A

Xray ( including frog leg)

Disruption of Klein line

309
Q

Tx of SCFE

A

If mild-moderate slip:
Stabilize physis with pins in current position

If severe slip:
ORIF
Or
Pin physis without reduction, osteotomy after epiphyseal fusion

310
Q

Complications of SCPE

A

AVN

Chondrolysis

Pin penetration

Premature OA

Loss of ROM

311
Q

Most common orthopedic disorder in children

A

Developmental dysplasia of the hip

312
Q

If painful DDH

A

Suspect septic dislocation

313
Q

Tests for DDH

A

Limited abduction of the flexed hip

Barlow

Ortolani

Galeazzi (> 1yr)

Trendelenburg test and gait (> 2y)

314
Q

Predisposing factors to DDH

A 
Female
FHx
Frank breech
First born
Left hip
315
Q

Inv for DDH

A

U/S in first few month

Xray at 4-6 mo

316
Q

Tx of DDH

A

0-6 mo: reduce hip with Pavlic harness (maintains abduction and flexion

6-18 mo: reduction under GA, hip spica cast 2-3 mo (if pavlic fails)

> 18 mo: open reduction, pelvic/femoral osteotomy

317
Q

Complications of DDH

A

Inadequate reduction
Stiffness
Redislocation
AVN

318
Q

Legg-Calvé-Perthes (coxa plana)

A

AVN of femoral head

Idiopathic

4-8 y

M>F

319
Q

Associations of Legg-Calvé-Perthes (coxa plana)

A 
FHx
LBW
Abn pregnancy/delivery
ADHD
Delayed bone age
Second hand smoke
Asian
Inuit
Central European
320
Q

Legg-Calvé-Perthes (coxa plana) symptoms

A

Antalgic or Trendelenburg gait
+/- pain
Intermittent hip/knee/groin/thigh pain

Flexion contracture
Decreased internal rotation
Decreased abduction of hip
Limb length discrepancy

321
Q

Legg-Calvé-Perthes (coxa plana) inv

A

Xray (including frog leg)

May be negative early

If high index of suspicion, bone scan/MRI

322
Q

Tx of Legg-Calvé-Perthes (coxa plana)

A

Goal: preserve ROM and keep femoral head contained in acetabulum

Non-operative: PT, brace in flexion and abduction x2-3 mo

Operative:
Femoral or pelvic osteotomy (> 8y or severe)

323
Q

Who has better prognosis in Legg-Calvé-Perthes (coxa plana)

A

Male
<6 yr
< 50% of femoral head involved
Abduction > 30°

324
Q

Complications of Legg-Calvé-Perthes (coxa plana)

A

Early OA

Decreased ROM

325
Q

Osgood Schlatter (tibial tubercle apophysitis

A

Inflammation of patellar ligament at insertion point on tibial tuberosity

M> F

Boys 12-15y
Girls 8-12y

Mechanism: repetitive tensile stress, causing minimal avulsions and the inflammation

326
Q

Osgood Schlatter symptoms

A

Tender lump on tuberosity

Pain on resisted leg extension

Anterior knee pain, exacerbated by jumping, kneeling, relieved by rest

Mist common in adolescent athletes (jumping, sprinting)

327
Q

Inv for Osgood Schlatter

A

Xray: fragmentation of tibial tubercle

+/- ossicle in patellar tendon

328
Q

Osgood Schlatter Tx

A 
Benign
Self limited (does not resolve until growth halts)

Restrict activities (cycling, basketball)

NSAIDs

Rest

Flexibility, isometric stretch exercise

Casting if no resolution

If refractory: ossicle excision (if skeletally mature)

329
Q

Congenital talipes equinovarus

A

M: more common
F: more severe

CAVE:
Midfoot Cavus
Forefoot Adductus
Hindfoot Varus
Hindfoot Equinus

Talar neck medial and plantar deviated

Calcaneus: varus, medially rotated

Navicular and cuboid: medially displaced

330
Q

Inv for talipes equinovarus

A

DDH
Knee deformities
Back dysraphism

331
Q

Tx of club foot

A

Ponseti technique
Correct deformities in CAVE order
Change strapping/cast q1-2 wk

If refractory, surgical release (delayed until 3-4mo)

332
Q

Scoliosis

A

F> M
F: more severe
10-14 y

333
Q

Most common cause of scoliosis

A

Idiopathic

334
Q

Inv for scoliosis

A

Xray (3foot standing. AP. Lateral)

+/- Associated kyphosis

Cobb angle

335
Q

Tx of scoliosis

A

Based on Cobb’s angle

<25° : observe with serial radiographs

> 25° or progressive: bracing (do not reverse deformity, but halt/slow progression)

> 45° or cosmetically unacceptable or respiratory problem: surgical correction

336
Q

Benign bone lesion on Xray

A

No periosteal reaction

Thick endosteal reaction

Well developed bone formation

Intraosseous and even calcification

337
Q

Malignant bone lesions on Xray

A

Acute periosteal reaction:
Codman’s triangle
Onion skin
Sunburst

Broad border between lesion and normal bone

Varied bone formation

Extraosseous and irregular calcification

338
Q

Inv for bone tumor

A 
Xray
Blood work including liver enzymes
CT
bone scan
Bone Bx
MRI
339
Q

Red flags in bone pain

A

Persistent pain

Localized tenderness

Spontaneous fx

Enlarging mass/soft tissue swelling

340
Q

Osteoid osteoma

A

Osteoblasts

M>F

Proximal femur, tibia diaphysis

Radiolucent nidus, surrounded by dense sclerotic bone (bull’s eyes)

Severe intermittent pain, mostly at night

Tx: NSAIDs, surgical resection

341
Q

Fibrous cortical defect (non ossifying fibroma)

A

Children

Asymptomatic

M> F

Femur, proximal tibia

342
Q

Xray of fibrous cortical defect

A

Metaphyseal eccentric, bubbly lytic lesion

Near physis

Margin: thin, smooth, lobulated, well defined, sclerotic

343
Q

Tx of fibrous cortical defect

A

Resolves spontaneously

344
Q

Most common bone tumor in children

A

fibrous cortical defect (35%)

345
Q

Osteochondroma

A

2nd and 3rd decades

M>F

Painless slowgrowing mass

Most common benign tumor

Pdunculated or sessile (risk of malignant transformation)

Distal femur, proximal tibia, proximal humerus (metaphysis, near tendon attachment)

Risk of malignant degeneration if multiple

346
Q

Xray of osteochondroma

A

Mushroom

347
Q

Tx of osteochondroma

A

Observation

Excision if symptomatic

348
Q

Howlong does osteochondroma grow

A

Until skeletal maturity

349
Q

Enchondroma

A

Hyaline cartilage

Asymptomatic

2nd-3rd decades

Chondroblast

In medullary cavity

Single/multiple

350
Q

Most common sites for enchondroma

A

Small tubular bones of hand and foot

Others: femur, humerus, ribs

351
Q

Enchondroma Xray

A

Rarefied area

Lytic

Sharp margins

Irregular central calcification (stippled/punctate/popcorn)

1-2% malignant degeneration to chondrosarcoma (pain without fx)

352
Q

Tx of enchondroma

A

Serial Xray

If symptom/grow: curretage

353
Q

Solitary bone cyst

A

Children, young adults (1st 2 decades)

M>F

Proximal humerus
Distal Femur

354
Q

Xray of solitary bone cyst

A

Lytic/translucent

Metaphyseal side of growth plate

Thinned cortex

Expanded cortex

Well defined

355
Q

Tx of bone cyst

A

Aspiration, steroid injection

Curettage +/- bone graft

356
Q

Giant cell tumor

A

Peak 3rd decade

Skeletal maturity

Xray: eccentric, lytic, epiphysis, adjacent to subchondral bone

Enhanced on T2 MRI

3% pulmonary mets

357
Q

Osteoblastoma

A

3rd decade

Skeletal maturity

Distal femur, proximal tibia, distal radius, sacrum, tarsal bones, spine

Xray: non-specific, calcified central nidus, radiolucent halo, sclerosis

358
Q

Aneurusmal bone cyst

A

Solid with fibrous/granular tissue or blood filled

Cray: Expanded with honeycomb shape

359
Q

Tx of benign aggressive bone tumors

A

Gian cell tumor
Osteoblastoma
Aneurysmal bone cyst

Tx: curettage + bone graft or cement

Wide local excision of expandable bones

360
Q

Most common age group for osteosarcoma

A

2nd decade

361
Q

Sites of osteosarcoma

A

Distal femor, proximal tibia, proximal humerus

362
Q

Predisposing factors for osteosarcoma

A

Paget (elderly)

RT

363
Q

Xray of osteosarcoma

A

Codman’s triangle

Sunburst

May cross epiphyseal plate

364
Q

Tx of osteosarcoma

A

Complete resection (limb salvage)

Neoadjuvant chemo

Bone scan (R/O mets)

CT (R/O mets)

365
Q

Chondrosarcoma

A

Primary (2/3) > 40 yr
Or
Secondary (from osteochondroma or enchondroma) 25-45 yr

366
Q

Xray of chondrosarcoma

A

Popcorn calcification in medullary cavity

367
Q

Tx of chondrosarcoma

A

Aggressive surgical resection + reconstruction

Regular F/U Xrays: chest. Excision site.

368
Q

Ewing sarcoma

A

5-25 yr

Small round cells

Florid periosteal reaction

Metaphysis of long bones, diaphysial extension

Mets frequent

369
Q

Inv in ewing sarcoma

A

Fever

Increased WBC, ESR, LDH

Xray: moth-eaten. Periosteal lamellated pattern

370
Q

Tx of Ewing

A

Resection, chemo, RT

371
Q

Most common primary malignant bone tumor in adults

A

MM

> 40

M> F

African-Americans

372
Q

Xray of MM

A

Multiple punched out, welldemarkated lesions

No surrounding sclerosis

373
Q

Inv

A

Xray

CT guided Bx

Ca

ESR

Cr

CBC

SPEP/UPEP

374
Q

Tx of MM

A

Chemo

Bisphosphonate

RT

Surgery (impending fx, symptomatic lesion)

375
Q

Most common cause of bone lesion in adults age > 40

A

Mets (2/3 breast, prostate)

376
Q

Inv in bone mets

A

Bone scan

MRI for spine

377
Q

Tx of bone mets

A

Pain control

Bisphosphonates

Surgery ( if impending fx)

378
Q

Prevention of heterotopic ossification

A

Misoprostol + indomethacin

Med (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions