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Ortho Residency > ortho basics > Flashcards

ortho basics Flashcards

1
Q

rule of 2s when assessing patient

A

two joints
two views (AP lateral)
two times ( pre post reduction)
two limbs ( for comparison)
two injuries ( calcaneal + spine)

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2
Q

cause of spiral fx

A

torsional force

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3
Q

define translation on xrays

A

displacement of distal segment compared to proximal segment (medial, lateral, anterior, posterior)

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4
Q

define angulation on xrays

A

draw arrow going down, if bone going towards midline = varus if going away from midline = valgus

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5
Q

define length on xrays

A

shortening vs distraction

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6
Q

define rotation on xrays

A

IR vs ER

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7
Q

how to comment on xrays

A

patient details
location (right or left)
bone
part of bone: proximal, middle, distal
type of fx
TALR:
- translation
- angulation
- length
- rotation

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8
Q

early fx complications (local)

A

open fx
compartment syndrome
neurovascular injury
infection
implant failure
soft tissue complications (blisters)

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9
Q

early fx complications (systemic)

A

sepsis
DVT/PE
ARDS
Fat mebolism
haemorhagic shock

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10
Q

late fx complications

A

malunion/nonunion
AVN
osteomyelitis
HO
post traumatic arthritis
CRPS

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11
Q

Gustillo Anderson type 1

A

<1cm, 1st generation cephalosporin for 72 hrs

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12
Q

Gustillo Anderson type 2

A

1-10cm, 1st generation cephalosporin for 72 hrs

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13
Q

Gustillo Anderson type 3A

A

> 10cm, soft tissue converage, 1st generation cephalosporin (pos&neg) + gentamicin (aminoglycoside for neg)

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14
Q

Gustillo Anderson type 3B

A

<10cm, no soft tissue converage, enough soft tissue coverage to close primarily, 1st generation cephalosporin (pos&neg) + gentamicin (aminoglycoside for neg)

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15
Q

Gustillo Anderson type 3C

A

> 10cm,high energy, no soft tissue converage, 1st generation cephalosporin (pos&neg) + gentamicin (aminoglycoside for neg), MAJOR VASCULAR INJURY PRESENT

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16
Q

exceptions to Gustillo-Anderson thatll make a fx 3 immediately

A

farmland/dirty soil/water contamination, exposure to oral flora, shotgun, fx duration > 8hrs

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17
Q

abx role in open fx

A

to prevent osteomyelitis by staph aureus

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18
Q

farmland/soil injury open fx extra treatment?

A

penicillin (anaerobic) to cover clostridium infection

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19
Q

management of open fx (emergency room)

A
  1. ATLS to rule out other life ending injuries
  2. stop haemorhage: direct pressure preferred over tourniquet
  3. give analgesia and tetanus if needed
  4. IV abx <1hr and to continue for 72 hrs
  5. photo
  6. NV assessment, realign limb (splint etc), repeat NV, document
  7. Remove gross contamination and place sterile saline-soaked dressing on wound
  8. imaging if pt stable
  9. prepare pt for OT: NPO, labs, consent
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20
Q

management of open fx (OT)

A
  1. irrigation with NS
  2. debridement within 24 hours
  3. stabilise with ex fix
  4. delayed closure preferred in 72 hours
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21
Q

criteria of fracture related infections (4)

A
  1. fistula/sinus/wound
  2. purulent drainage
  3. two cultures positive
  4. high wbc
22
Q

chance of infection in GA classification

A

closed and type 1: 1-4%
type 2 & 3A: 3-8%
type 3B & C: 10-30%

23
Q

fracture related infection bacteria (early <10 weeks vs late >10 weeks)

A

early: staph aureus, E.coli
late: staph epidermidis

24
Q

fresh water vs salt water open fx abx

A

fresh cipro salty doxy (FC SD)

25
Q

tetanus situation in open fx?

A

if unknown or no booster in 5 years then give tetanus toxoid
if clostridium infection/immunocompromised/no booster in 10 years then tetanus IG

26
Q

how many L to irrigate open fx?

A

3,6,9L for for Gustillo type 1,2,3

27
Q

why stabilise fx? (3 reasons)

A

prevent further soft tissue injury
maintain alignment
reduce pain

28
Q

what is closed reduction?

A

no direct exposure to bone, traction along axis of bone and reverse MOI under analgesia

29
Q

indications for open reduction over closed

A

NO CASP:
nonunion
open fx
compromised neurovascular
articular fx displaced
Salter Harris 3,4,5
Polytrauma

30
Q

non-operative fx management options

A

brace
splint
cast
slab
traction

31
Q

Ex Fix indications (6)

A

severe open fx (3b+)
contaminated fx
infected non-unions
initial stabilisation (damage control) in polytrauma
pelvic fx
unstable elbow, elbow, knee dislocations

32
Q

components of ex fix (3)

A

pin (in bone)
rod
clamp

33
Q

contraindications to ORIF (5)

A

active infection/osteomyelitis
severe osteoperosis
severe communition
severe soft tissue injury
non-displaced fx

34
Q

ORIF options? (4)

A

screws: cortical, cancellous, locking
nails
k wire
plates

35
Q

why use splint in fx management? 5

A

reduce pain
facilitate transport of pt
allow soft tissue swelling which reduces risk of compartment
reduces risk of closed fx becoming open
reduces risk of soft tissue and NV damage

36
Q

why use traction in fx?

A

maintain length, alignemnt, rotation of limb
reduces muscle spasms
extra note: skeletal traction is done distal to fx

37
Q

pathophysiology of compartment syndrome

A

increased TISSUE PRESSURE within a FIBROSSEOUS compartment, which exceeds VENOUS and CAPILLARY PERFUSION pressure > muscle ISCHAEMIA and NECROSIS > accumulation of WASTE > LACTIC ACIDOSIS > PAIN and loss of SENSATION due to NERVE IRRITATION

38
Q

intra-compartmental causes of compartment syndrome 5

A

trauma
fx (tibia, supracondylar)
Revascularisation injury
crush injury
haemophilia, venom, tumours, anaphylaxis, DVT

39
Q

extra-compartmental causes of compartment syndrome 3

A

tight dressing/cast
circumfrential burns
lithotomy position (well leg compartment syndrome): Prolonged surgical procedures in the lithotomy or the hemilithomy position along with perioperative hypoperfusion lead to ischaemia and increased capillary permeability, followed by a reperfusion injury once the leg is released from the compromising position.

40
Q

most important clinical sign in compartment syndrome + 3 descriptive words

A

pain
1. out of proportion to injury
2. not relieved by strong analgesics
3. increased by passive extension of compartment

41
Q

how will the limb feel in compartment syndrome

A

firm and wooden on deep palpation

42
Q

5Ps of acute ischaemia compartment syndrome (late signs)

A

pain
pallor
parasthesia
pulsenessness
paralysis
perishingly cold

43
Q

most common early finding of compartment syndrome

A

loss of 2 point discrimination (not loss of cap refill or pulses)

44
Q

compartment syndrome diagnosis

A

clinical

45
Q

when to use stryker needle in compartment syndrome

A

atypical presentation, unconscious pt

46
Q

how to measure intracompartmental pressure (2 ways)

A

delta P: diff bw diastolic and intra-comparmtental pressure <30 then fasciotomy
absolute P >30 then fasciotomy
(delta P is better than absolute P)
(absolute P is direct intra-comparmtental pressure)

47
Q

compartment syndrome complication

A

rhabdo, check for CK, RFTs, urinalysis, urine myoglobin

48
Q

compartment syndrome management

A

remove cast
limb placed at level of heart to not decrease arterial flow even more
observe one hour, if no improvement then fasciotomy
delayed closure with shoelace technique/skin graft/vacuum assisted closure over 72 hrs

49
Q

compartment syndrome untreated comlpication

A

Volkmann contracture: muscle necrosis and fibrosis

50
Q

compartment syndrome fasciotomy leg thigh forearm ?

A

leg: double incision laterally and medially to open all 4 comps
thigh: lateral incision to open ant and post, adductor rarely requires
forearm: volar and dorsal

51
Q

4 Cs to assess muscle for fasciotomy

A

colour
consistency
contractility
capillary bleeding

Ortho Residency (11 decks)

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