ortho and radiology basics Flashcards

1
Q

acute injuries

A
  • less than 6 weeks
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2
Q

chronic injuries

A
  • greater than 6 weeks
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3
Q

provocative tests

A
  • recreate mechanism of injury to reproduce pts pain
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4
Q

stress tests

A
  • apply load to test ligament stability
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5
Q

functional test

A
  • assess injury severity and ADLs
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6
Q

open fracture

A
  • break in skin and underling soft tissue

- surgical tx within six hours

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7
Q

why would you immobilize a joint after a fracture?

A
  • maintain anatomic position
  • prevent movement of fx and further injury
  • limits NV injury
  • pain control
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8
Q

methods of immobilization

A
  • splint
  • cast
  • closed reduction percutaneous pinning (CRPP)
  • open reduction internal fixation (ORIF)
  • external fixator
  • intramedullary rodding
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9
Q

how long does it take for fx to heal? phases of healing?

A
  • 6 weeks
  • inflammatory phase- hematoma
  • reparative phase- callus that lasts 3-4 months
  • bone remodeling
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10
Q

splinting a fracture

A
  • splint for 2-3 days to allow swelling to decrease
  • refer to ortho for possible cast
  • splints allow soft tissue swelling
  • minimize NV compromise
  • immobilize joint above and below injury
  • eval distal circulation, motor function and sensation before AND after splinting**
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11
Q

casting a fracture

A
  • usually on for 4-6 weeks
  • changed at about 3 week mark if no fx movement
  • treatment of choice for most non-operative fx
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12
Q

what do you use short arm casts for?

A
  • wrist fx
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13
Q

what do you use long arm casts for?

A
  • forearm fx

- unstable wrist fx to prevent pronation and supination

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14
Q

what do you use thumb spica casts for?

A
  • scaphoid or radial styloid fx
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15
Q

what is the best immobilization option for LE fxs?

A
  • splint/ walking boot
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16
Q

what do you use short leg casts for?

A
  • foot fx
  • ankle fx
  • achilles injury
  • server’s syndrome
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17
Q

what do you use long leg casts for?

A
  • tib/fib fx

- quad tendon repair

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18
Q

closed reduction

A
  • reduce bone to near anatomic position
  • “recreate the fx” to align
  • MUST be a stable fx
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19
Q

closed reduction percutaneous pinning

A
  • reduce/hold stable closed fx if cannot cast
  • decreases need for ORIF
  • risk if skin or nerve/vessel damage
20
Q

ORIF

A
  • holds unstable fx
  • “internal splint”
  • restores length
  • needs 6 cortices above and below
  • rod- prevents ant/post mvmt
  • locking screws- prevent bone from rotation around rod
21
Q

external fixator

A
  • used when major non-lifesaving procedures must be avoided

- “bridge” to ORIF

22
Q

sprain

A
  • stretching/ tearing of ligaments
  • inversion vs/ eversion injury
  • ankle most common d/t inversion and plantar flexion
23
Q

strain

A
  • injury to muscle or muscle and tendon
  • muscle fibers tear
  • usually caused by overextension or over stretching
  • pain worse with use
  • cramping, muscle spasm/ weakness, swelling
24
Q

treatment for sprains/strains

A
  • RICE
  • splinting
  • NSAIDs
  • early ROM
  • PT
25
dislocations
- displacement of bone from normal position - joint forced beyond normal ROM - damage NV structures by compression or tearing - must be treated soon
26
PE findings for dislocations
- pain and TTP - inability to move extremity - loss of distal pulse increases severity of injury - eval NV status before AND after reduction
27
tendinitis
- inflammation/ irritation of tendon - pain and tenderness - common in shoulders, elbows, wrists, knees - treat with rest, ice, brace, NSAIDs, PT, cortisone
28
tendon rupture
- force applied to tendon may be 5X body weight | - treat with splint, ice, NSAIDs, surgery, early ROM, pt
29
most common tendon ruptures
- achilles - biceps (proximal) - RTC - quad
30
initial imaging study of choice for skeletal trauma
- XRAY | - need at least 2 views and be sure to examine pt first
31
basics for interpreting x-rays
- open vs. closed - anatomic location - morphology of fx line - displacement - distraction - angulation - rotation
32
CT scans
- best for determining subtle fx - good for visualization of articular extension of fx - good for assessment of presence of articular step off/ gap
33
MRI
- mainly for soft tissue eval - dx of occult fx i.e. femoral neck fx - modality of choice for disc herniation and internal derangement of joints
34
ultra sound
- assess soft tissue injury | - achilles tendon and quad tendon ruptures
35
bone scan
- best for assessment of metastases
36
how do most fracture lines appear on x-ray
- radiolucent lines | - need 2 views to assess
37
mach band
- appears at site of cortex overlap or skin fold over cortex - may mimic lucent lines - most common site- ankle where tibia overlaps fibula
38
sclerotic line
- usually d/t compression fx | - common in vertebral bodies or distal radius
39
impaction fx
- wedged into each other | - generally stable
40
avulsion fx
- d/t abnormal tensile stress on ligaments or tendons | - common in hands, feet, pelvis
41
transverse fx
- perpendicular to long axis of bone - usually d/t direct force - most common in forearm and leg - generally stable
42
oblique fx
- compression and angulation forces cause shear force - usually d/t indirect force - unstable -> OR
43
spiral fx
- caused by twisting mvmt through long bone axis -> rotation/ shear forces - unstable -> OR - least common
44
comminuted fx
- more than 2 fx fragments | - unstable -> OR
45
butterfly fx
- fragment produced along concave compression side | - bending of bone -> tension vector on convex side and compression vector on concave side
46
greenstick fx
- incomplete fx of long bone on convex side - concave side is bent - usually in forearm of young kids - d/t bending force applied perpendicular to shaft of bone
47
buckle fx
- aka torus fx - incomplete fx - occurs at metaphyseal diaphyseal junction after FOOSH - stable - heal faster than greenstick