Ortho Recall Flashcards
WBAT
Weight bearing as tolerated
Unstable fracture or
dislocation
Fracture or dislocation in which further
deformation will occur if reduction is not
performed
Varus
Extremity abnormality with apex of defect pointed away from midline (e.g., genu varum bowlegged; with valgus, this term can also be used to describe fracture displacement) (Think: knees are very varied apart)
Valgus
Extremity abnormality with apex of
defect pointed toward the midline
(e.g., genu valgus knock-kneed)
Dislocation
Total loss of congruity and contact
between articular surfaces of a joint
Subluxation
Loss of congruity between articular
surfaces of a joint; articular contact still
remains
Arthroplasty
Total joint replacement (most last 10 to
15 years)
Arthrodesis
Joint fusion with removal of articular
surfaces
Osteotomy
Cutting bone (usually wedge resection) to help realigning of joint surfaces
Non-union
Failure of fractured bone ends to fuse
Diaphysis
Main shaft of long bone
Metaphysis
Flared end of long bone
Physis
Growth plate, found only in immature
bone
Define extremity
examination in fractured
extremities.
- Observe entire extremity (e.g., open,
angulation, joint disruption) - Neurologic (sensation, movement)
- Vascular (e.g., pulses, cap refill)
Which x-rays should be
obtained? (trauma)
Two views (also joint above and below fracture)
How are fractures
described?
- Skin status (open or closed)
- Bone (by thirds: proximal/middle/
distal) - Pattern of fracture (e.g., comminuted)
- Alignment (displacement, angulation,
rotation)
How do you define the
degree of angulation,
displacement, or both?
Define lateral/medial/anterior/posterior
displacement and angulation of the distal
fragment(s) in relation to the proximal
bone
Closed fracture
Intact skin over fracture/hematoma
Open fracture
Wound overlying fracture, through which
fracture fragments are in continuity with
outside environment; high risk of infection
(Note: Called “compound fracture” in
the past)
Simple fracture
One fracture line, two bone fragments
Comminuted fracture
Results in more than two bone fragments;
a.k.a. fragmentation
Segmental fracture
Two complete fractures with a “segment”
in between
Transverse fracture
Fracture line perpendicular to long axis
of bone
Oblique fracture
Fracture line creates an oblique angle
with long axis of bone
Spiral fracture
Severe oblique fracture in which fracture
plane rotates along the long axis of bone;
caused by a twisting injury
Longitudinal fracture
Fracture line parallel to long axis of bone
Impacted fracture
Fracture resulting from compressive force;
end of bone is driven into contiguous
metaphyseal region without displacement
Pathologic fracture
Fracture through abnormal bone (e.g.,
tumor-laden or osteoporotic bone)
Stress fracture
Fracture in normal bone from cyclic
loading on bone
Greenstick fracture
Incomplete fracture in which cortex on
only one side is disrupted; seen in
children
Torus fracture
Impaction injury in children in which
cortex is buckled but not disrupted
(a.k.a. buckle fracture)
Avulsion fracture
Fracture in which tendon is pulled from
bone, carrying with it a bone chip
Periarticular fracture
Fracture close to but not involving the joint
Intra-articular fracture
Fracture through the articular surface of a bone (usually requires ORIF)
Colles’ fracture
Distal radius fracture with dorsal
displacement and angulation, usually
from falling on an outstretched hand
(a common fracture!)
Smith’s fracture
“Reverse Colles’ fracture”—distal radial
fracture with volar displacement and
angulation, usually from falling on the
dorsum of the hand (uncommon)
Jones’ fracture
Fracture at the base of the fifth
metatarsal diaphysis
Bennett’s fracture
Fracture-dislocation of the base of the first metacarpal (thumb) with disruption of the carpometacarpal joint
Boxer’s fracture
Fracture of the metacarpal neck,
“classically” of the small finger
Nightstick fracture
Ulnar fracture
Clay shoveler’s avulsion
fracture
Fracture of spinous process of C6–C7
Hangman’s fracture
Fracture of the pedicles of C2
Transcervical fracture
Fracture through the neck of the femur
Tibial plateau fracture
Intra-articular fracture of the proximal tibia
the plateau is the flared proximal end
Monteggia fracture
Fracture of the proximal third of the ulna
with dislocation of the radial head
Galeazzi fracture
Fracture of the radius at the junction of
the middle and distal thirds accompanied
by disruption of the distal radioulnar joint
Tibial “plateau” fracture
Proximal tibial fracture
“Pilon” fracture
Distal tibial fracture
Pott’s fracture
Fracture of distal fibula
Pott’s disease
Tuberculosis of the spine
What are the major
orthopaedic emergencies?
- Open fractures/dislocations
- Vascular injuries (e.g., knee
dislocation) - Compartment syndromes
- Neural compromise, especially spinal
injury - Osteomyelitis/septic arthritis; acute,
i.e., when aspiration is indicated - Hip dislocations—require immediate
reduction or patient will develop avascular
necrosis; “reduce on the x-ray table” - Exsanguinating pelvic fracture (binder,
external fixator)
What is the main risk when
dealing with an open fracture?
Infection
Which fracture has the
highest mortality
Pelvic fracture (up to 50% with open pelvic fractures)
What factors determine the
extent of injury (3)?
1. Age: suggests susceptible point in musculoskeletal system: Child—growth plate Adolescent—ligaments Elderly—metaphyseal bone 2. Direction of forces 3. Magnitude of forces
What is the acronym for
indications for OPEN
reduction?
“NO CAST”: Nonunion Open fracture Compromise of blood supply Articular surface malalignment Salter-Harris grade III, IV fracture Trauma patients who need early ambulation
Define open fractures by
Gustilo-Anderson
classification:
Grade I?
1-cm laceration
Define open fractures by
Gustilo-Anderson
classification:
Grade II?
1 cm, minimal soft tissue damage
Define open fractures by
Gustilo-Anderson
Grade IIIA?
Open fracture with massive tissue
devitalization/loss, contamination
Define open fractures by
Gustilo-Anderson
Grade IIIB?
Open fracture with massive tissue
devitalization/loss and extensive
periosteal stripping, contamination,
inadequate tissue coverage
Define open fractures by
Gustilo-Anderson
Grade IIIC?
Open fracture with major vascular injury
requiring repair
What are the five steps in
the initial treatment of an
open fracture?
1. Prophylactic antibiotics to include IV gram-positive anaerobic coverage: Grade I—cefazolin (Ancef ®) Grade II or III—cefoxitin/gentamicin 2. Surgical débridement 3. Inoculation against tetanus 4. Lavage wound 6 hours postincident with high-pressure sterile irrigation 5. Open reduction of fracture and stabilization (e.g., use of external fixation)
What structures are at risk
with a humeral fracture?
Radial nerve, brachial artery
What must be done when
both forearm bones are
broken?
Because precise movements are needed,
open reduction and internal fixation are
musts
How have femoral fractures
been repaired traditionally?
Traction for 4 to 6 weeks
What is the newer technique?femoral fractures
Intramedullary rod placement
What are the advantages?
Intramedullary rod placement
Nearly immediate mobility with
decreased morbidity/mortality
What is the chief concern
following tibial fractures?
Recognition of associated compartment
syndrome
What is suggested by pain in
the anatomic snuff-box?
Fracture of scaphoid bone (a.k.a.
navicular fracture)`
What is the most common
cause of a “pathologic”
fracture in adults?
Osteoporosis
What is acute compartment
syndrome?
Increased pressure within an osteofascial
compartment that can lead to ischemic
necrosis`
How is it diagnosed? acute compartment
syndrome?
Clinically, using intracompartmental pressures is also helpful (especially in unresponsive patients); fasciotomy is clearly indicated if pressure in the compartment is 40 mm Hg (30 to 40 mm Hg is a gray area)
acute compartment
syndrome?What are the causes?
Fractures, vascular compromise,
reperfusion injury, compressive dressings;
can occur after any musculoskeletal
injury
What are common causes
of forearm compartment
syndrome?
Supracondylar humerus fracture, brachial
artery injury, radius/ulna fracture, crush
injury
What is Volkmann’s
contracture?
Final sequela of forearm compartment
syndrome; contracture of the forearm
flexors from replacement of dead muscle
with fibrous tissue
What is the most common
site of compartment
syndrome?
Calf (four compartments: anterior,
lateral, deep posterior, superficial
posterior compartments)
What situations should immediately alert one to be on the lookout for a developing compartment syndrome (4)?
1. Supracondylar elbow fractures in children 2. Proximal/midshaft tibial fractures 3. Electrical burns 4. Arterial/venous disruption
What are the symptoms of
compartment syndrome?
Pain, paresthesias, paralysis
What are the signs of
compartment syndrome?
Pain on passive movement (out of
proportion to injury), cyanosis or pallor,
hypoesthesia (decreased sensation,
decreased two point discrimination), firm
compartment
Can a patient have a
compartment syndrome
with a palpable or Dopplerdetectable
distal pulse?
YES!
What are the possible
complications of
compartment syndrome?
Muscle necrosis, nerve damage,
contractures, myoglobinuria
What is the initial treatment
of the orthopaedic patient
developing compartment
syndrome?
Bivalve and split casts, remove
constricting clothes/dressings, place
extremity at heart level
What is the definitive
treatment of compartment
syndrome?
Fasciotomy within 4 hours (6–8 hours
maximum) if at all possible
MISCELLANEOUS TRAUMA INJURIES AND COMPLICATIONS
Name the motor and sensation tests used to assess the following peripheral nerves: Radial
Wrist extension; dorsal web space;
sensation: between thumb and index finger
Name the motor and
sensation tests used to assess
the following peripheral
nerves:Ulnar
Little finger abduction; sensation: little
finger-distal ulnar aspect
Name the motor and
sensation tests used to assess
the following peripheral
nerves:Median
Thumb opposition or thumb pinch
sensation: index finger-distal radial aspect
Name the motor and
sensation tests used to assess
the following peripheral
nervesAxillary
Arm abduction; sensation: deltoid patch
on lateral aspect of upper arm
Name the motor and
sensation tests used to assess
the following peripheral
nerves:Musculocutaneous
Elbow (biceps) flexion; lateral forearm
sensation
How is a peripheral nerve
injury treated?
Controversial, although clean lacerations
may be repaired primarily; most injuries
are followed for 6 to 8 weeks (EMG)
What fracture is associated
with a calcaneus fracture?
L-spine fracture (usually from a fall)
Name the nerves of the
brachial plexus.
Think: “morning rum” or “A.M. RUM”
Axillary, Median, then Radial, Ulnar, and
Musculocutaneous nerves
What are the two indications
for operative exploration
with a peripheral nerve
injury?
- Loss of nerve function after reduction
of fracture - No EMG signs of nerve regeneration
after 8 weeks (nerve graft)
