Orthopaedics 5

Question 1

Distinguish between Lordosis, Kyphosis, and Scoliosis

Answer 1

Lordosis - significant curve in lower back (think pregnant woman who has hand on her back)
Kyphosis - >50º angled upper back curve
Scoliosis - sideways curve (S or C shaped)

Question 2

Sx of Ankylosing Spondylitis

and Tx

Answer 2

Sx: Gradual low back pain and insidious loss of spinal mobility
Tx: NSAIDs (indocin aka indomethacin) asap after they’re diagnosed.

Question 3

If iliac crests are palpated as uneven, whaddya do?

Answer 3

Use footboards to raise to equal height.

Question 4

Spinous process tenderness suggests:

Answer 4

Vertebral fracture

Question 5

Spondylolisthesis is a slipoff at L_

Answer 5

L5

Question 6

Atlanto-axial dislocation is what?
Who is it most common in?
Tx?

Answer 6

Tearing of alar ligaments & tectorial membrane
Loss of ligament stablity between C1 and C2.
Most common in kids.
Tx: Halo 4-12 months
Ultimate tx: operatie fusion of C3 (or C2) up to occiput with plates and screws to reattach head to spinal column

Question 7

What is a Jefferson fracture?
Who is it most common in?
Sx? Best imaging?

Answer 7

Burst of C1 ring in 3 or more places.
MC in kids
Sx: neck stiffness, limited ROM, suboccipital pain, neurologically intact), headaches, muscle spasm.
Best imaging: CT

Question 8

Who gets Odontoid fracture?

What’s the tx?

Answer 8

elderly patients who fall

tx: Miami J Collar

Question 9

What’s Hangman’s fracture?
What’s the main cause?
Best tx?

Answer 9

C2 pedicles break transversely.
Most are due to MVA, causing hyperextension then flexion separating C2
Tx: Halo

Question 10

Shoveling puts a load where?

So what’s seen in Clay Shoveler’s fracture?

Answer 10

C7

shearing of C7 spinous process

Question 11

What is Central Cord Syndrome?

What tx must you NOT do?

Answer 11

An already osteoarthritic spine has an overextension injury. There is GREAT motor loss in upper extremities, less motor loss in lower extremities.
Don’t give steroids (methylprenisolone). No tx.

Question 12

What is the Sacral Spring triad? What’s it used for?

Answer 12

Perianal sensation, Rectal tone, Great toe flexion inability.
To dx sacroiliac dysfunction

Question 13

What is Paget’s disease?
Where is it most common? In who?
What lab test helps identify this/

Answer 13

Excessive breakdown & formation of bone, leading to disorganized bone remodeling. Most common pelvis, femur.
Common after 55 years old. Need to identify this disorganized bone remodeling with x-ray.
Labs: high ALP (b/c of increased bone formation)

Question 14

What is the Cobb angle used for?

Answer 14

identify a curved vertebrae based on its angle.

Question 15

What is Malgaigne fracture?

Answer 15

Fall from height onto lower limbs. Both pubic rami are fractured as well as the sacroiliac complex. This is unstable.

Question 16

In pelvic fractures (Malgaigne & Open book) what might be seen on a male’s physical exam?

Answer 16

high riding prostate and blood within urethral meatus.

Foley catheter is CI.

Question 17

If a trauma patient isn’t responding to fluids or blood, what should be done next?

Answer 17

Interventional radiology to find source of bleed/shock

Question 18

How would you treat pelvic fractures (Malgaigne, Open book)? (2)

Answer 18

Pelvic stabilization, Dallas pelvic binder

Question 19

How would you assess suspected intraabdominal bleeding?.

how do you perform DPL?

Answer 19

FAST + diagnostic peritoneal lavage

DPL - vertical incision made supra-pubically.