Orthopaedics 1

Question 1

6 steps of fracture healing

Answer 1

1. Hematoma and soft tissue swelling
2. Hyperemia and organization of fibous callus (this is why you must immobilize and splint)
3. Primary osseus callus (~4 weeks) - initial bone is layed down
4. Reabsorption of Primary callus & formation of secondary callus (~7 weeks)
   5 (13 weeks) & 6:(18 months) Gradual reformation of normal bone contours

Question 2

If there is a calcaneal fracture, what else must you do?

Answer 2

Must also X-ray lumbosacral spine b/c disc could have explored. Identify it by seeing loss of height btwn spaces

Question 3

What’s the diff btwn Hillsach’s deformity and Bankart lesion? (both lead to anterior dislocation of the humeral head)

Answer 3

Hillsach: the fracture is on the humeral head
Bankart: the fracture is on the inferior glenoid of the scapula

Question 4

Regarding distal humeral fractures, what’s the diff btwn Extra-articular and Supracondylar fractures?

Answer 4

Extraarticular - does not involve jiont
Supracondylar - can injure brachial artery, causing loss of blood supply to the muscles it supplies, leading to compartment syndrome

Question 5

What is Volkmann’s Ischemic Contracture?

Answer 5

Permanent flesion contracture of hand and wrist, causing a clawlike deformity
Most common in children
Caused mainly by supracondylar fracture of humerus & the resulting ischemia & necrosis
On exam fingers are white, blue, and cold. radial pulse is absent

Question 6

A Supracondylar fracture may lead to:

Answer 6

Volkmann’s ischemic contracture; or compartment syndrome

Question 7

What’s the name of the classification for Distal Humeral Fractures?

Answer 7

Muller classification of intra-articular extension

Question 8

4 types of radial head fractures

Answer 8

I) nondisplaced fracture. no surgical tx
II) <30% of radial head. Less than 2 mm between. Tx: reduction and fixation with screws or plate
III) Comminuted. this now involves entire radial head. Treat w/ reduction and fixation if possible. it most likely will not be, so put in prosthesis.
IV) Complex. Type III + dislocation of elbow joint. Tx both of those

Question 9

If the olecranon is fractured, what can the patient NOT do? Why?

Answer 9

Can’t extend arm. B/c triceps inserts there.

Question 10

Tx of Olecranon fracture:

Answer 10

Place screw thru olecranon & hold it in place with wire and reestablish extensive mechanism of arm.

Question 11

Fractures of the forearm:

Monteggia vs Galleazi fracture

Answer 11

Monteggia: Ulnar fracture + dislocation of radial head
Galleazi: Radial fracture + dislocation of the distal radioulnar joint

Question 12

You don’t ___ an acute injury

Answer 12

cast

Question 13

Bennet’s Fracture at the base of the thumb involves a tear of what ligament? What’s it also known as?

Answer 13

Tear of ulnar-collateral ligament (at the base of thumb) aka Gameskeeper’s thumb

Question 14

Tx of forearm torus fracture (mc fracture in lower forearm of children)

Answer 14

short arm cast (won’t affect growth plates)

Question 15

What imaging test will you do if you suspect avascular necrosis in the anatomic snuffbox?

Answer 15

MRI

Question 16

What is avascular necrosis in the lunate bone called?

Answer 16

Kienbock’s disease

Question 17

If there’s a patella fracture, they won’t be able to __

Answer 17

extend at knee

Question 18

___ malleolus is held in by the deltoid ligament (strongest ligament in the body)

Answer 18

medial malleolus

Question 19

What is a Maisonneuve fracture?

Answer 19

fracture of the upper 1/3 of the fibula, with ankle fracture.
Ruptured interosseus membrane, syndesmosis disruption, torn deltoid ligament, increase in medical clear space.
Tx: reduction, fixation w/ syndesmotic screws.

Question 20

A patient slips on ice, and has swelling at the base of 5th metatarsal. What do they have?

Answer 20

Jones fracture