Ortho Basics

Question 1

3 Basic Parts of the Bone

Answer 1

Epiphysis - end

Metaphysis - widening

Diaphysis - long, stick-like

Question 2

Fracture Description

Answer 2

NO LARD

N - neurovascularly intact?

O - open or closed?

L - location (including direction of frax lines)

A - alignment / angulation / articular involvement

R - rotation (is it spiral?)

D - displacement (describe where the distal segment is displaced in relation to proximal segment, give % displacement)

Question 3

Angulation Terms (Complete and Incomplete Frax)

Answer 3

COMPLETE

• transverse (straight across)
• oblique (diagonal line)
• spiral (like a staircase)
• comminuted (3+ pieces)

INCOMPLETE

• bowing
• buckle / torus (sticking out on both sides)
• greenstick (bent w/ partial linear break)

Question 4

Alignment Terms

Answer 4

• Always describe the distal fragment in relation to proximal fragment
• Valgus = apex to midline
• Varus = apex away

Question 5

Articulation Terms

Answer 5

Subluxation - partial loss of joint continuity

Dislocation - complete loss of joint continuity

Question 6

Septic Arthritis

Answer 6

Sx: warm, swollen, dec ROM, cannot bear wt, RF (OM, direct inoculation, surgery, bacteremic)

Work-Up: tap joint + cx

Tx: vanc + ceftriaxone

When to call ortho urgently? if prosthetic call BEFORE tap, if tap unsuccessful but high suspicion

Question 7

Flexor Tenosynovitis

Answer 7

4 kanavel signs:

• sausage digit
• in passive flexion position at rest
• pain w/ passive extension
• pain when palpate tendon sheath

Tx: vanc + ceftriaxone + ortho consult

Question 8

Fight Bite

Answer 8

Human bacteria can seed hand; MCP most common

Tx: Unasyn +/- vanc, tetanus shot, X-ray, hand surgery consult

Question 9

Compartment Syndrome

Answer 9

Sx: pain w/ passive stretch (most sensitive), 5 P’s rarely present in real life

Work-Up: measure compartment pressures (abnormal if >30 or delta of 30)

Tx: immediate ortho consult for fasciotomy

Question 10

Open Frax Mgt

Answer 10

Neurovascular exam, tetanus irrigaate, abx

Sterile dressing and split

Gustilo Classification
I - open < 1 cm (1st gen cephalosporin)
II - open 1-10 cm (1st gen cephalosporin)
III - open > 10 cm (+ gentamicin or pip-tazo)

**If farm injury or bowel contamination add PCN for clostridium coverage

Question 11

Traumatic Finger Amputation Mgt

Answer 11

• If < 1 cm with no bone exposed … heal on own
• If > 1 cm with no bone exposed … suture shut
• If small bone exposure distal to DIP joint w/o flexor tendon involvement can cover w/ surrounding soft tissue –> d/c with oral abx and ortho follow-up
• If proximal to DIP or flexor tendon involvement … hand surg consult

Question 12

Galeazzi Frax

Answer 12

Involves distal 1/3 radius and distal radial-ulnar joint b/c ligaments disrupted

Usually from FOOSH

Ortho consult

Question 13

Monteggia Frax

Answer 13

Involves proximal 1/3 ulna w/ radial head dislocation

Peds&raquo_space; adults

Usually from FOOSH

Splint

Question 14

Perilunate v. Lunate Dislocation

Answer 14

Peri-lunate = dorsal swelling 
Lunate = volar swelling 

Look for acute carpal tunnel

Closed reduction + splint + ortho consult

Question 15

Clavicle Frax

Answer 15

Look for subclavian artery injury, brachial plexus injury or PTX

Need ORIF

Question 16

How can posterior sternoclavicular dislocation present?

Answer 16

tracheal or esophageal injury

need CT surgery

Question 17

Lisfran Injury

Answer 17

Any tarsal-metatarsal joint frax or dislocationi

Mech: axial load on hyper-plantar flexed foot

Sx: bruising of mid-plantar foot, cannot bear wt

If displaced … ORIF
If not displaced on wt bearing films and no bony injury on CT scan … d/c with orders for non-WB immobilization and ortho follow-up

Question 18

Knee Dislocation

Answer 18

Check popliteal artery (delayed loss of pulses) and peroneal nerve injury

Reduce immediately (50% reduce spont) and CT angio (popliteal injury?) and immobilize

Question 19

Hip Dislocation

Answer 19

Post&raquo_space; ant

Posterior - limb is shorter and interiorly rotate

Anterior - limb externally rotated

**should be reduced with 6 hrs to avoid avascular necrosis (try to do on own before consulting ortho)