Orthopaedics 2

Question 1

Open fractures are prone to __ because…

Answer 1

contamination (staph aureus) b/c they’re exposed to environment

Question 2

What’s fracture fever? When does it occur?

Answer 2

due to long bone fracture’s inflammation/repair process. Within 24-48 hours of admission

Question 3

What does the latest literature say about sucking fluid out from a compartment?

Answer 3

don’t do it. It prolongs blood loss and causes bleeding to stop. then they require more blood, which puts that at higher risk of fection.

Question 4

What must you make sure you do post-op for a patient who got surgery for fractured hips?

Answer 4

Make sure they’re on stool softeners and promotility agents. To deal with Prolonged Ileus postop.

Question 5

Rhabdo may occur secondary to Crush syndrome. Name 2 tests that dx it.

Answer 5

high CPK-MM; high serum adolase (from damaged muscle)

Question 6

Treatment for Crush Syndrome/Rhabo

Answer 6

Bicarbonate - get to alkalinity goal without making patient alkalotic.

Question 7

What is the triad to diagnose Fat Embolism Syndrome?
Imaging?
Tx:

Answer 7

Bergman’s triad - AMS, petachiae, & dyspnea.
CXR: looks like ARDS b/c fat particles cause pneumonitis
Tx: Heparain, Vent supported PEEP.

Question 8

What’s a frequent complication of FES?

Answer 8

DIC

Question 9

What are the 4 key signs for Infectious Tenosynovitis?

The tx?

Answer 9

Kanavel’s cardinal signs

1. Uniform swelling of entire finger
2. Finger is flexed
3. Intense pain when straightening finger
4. Tenderness along course of tendon sheath.

Tx: Augmentin or Unasyn; incision & drainage if severe

Question 10

Tx of Osteomyelitis

Answer 10

Surgical drainage, debridement, splinting, & antibiotics.

Question 11

A chronic diabetic foot ulcer is called

Answer 11

Malperforans ulcer

Question 12

3 phases of Sudek’s atrophy

Answer 12

Early phase - extreme hot/cold, burning pain, skin is red then white, sensitivity to touch or cold.
Late phase - if early phase goes untreated. Extremity is blue, hair follicle changes, loss of muscle tone and strength. Cyanotic, sweaty skin, edema’s spread beyond initial site.
Very late phase: 6-12 monghts after early phase. Osteoporosis, decreased blood flow, decreased skin temperature. Now x-ray shows demineralization of bone (darkening)

Question 13

What’s the overall treatment of Sudek’s atrophy?

Answer 13

Aggressive physical therapy early on.

Question 14

What pressures dx compartment syndrome?
What’s the key symptom?
Tx?

Answer 14

compartment pressure >30
or compartment pressure >30 than diastolic bp
key sx: decreased pinprick sensation in first webbed space.
Tx: Fasciotomy.