Orthopaedics 6

Question 1

Tx for Intertrochanteric fracture

Answer 1

they heal on their own

Question 2

What’s a Bimalleolar vs Trimalleolar fracture?

Answer 2

Bimalleolar = both the medial and lateral malleolus are fractured.
Trimalleolar = both + distal tip of tibia.

Question 3

What can be done to help prevent hip fractures?

Answer 3

Supplement Ca, Mg. Protective ballooning underpants!

Question 4

When should a patient with a fracture/injury NOT be seen primarily by an orthopaedist?

Answer 4

If it’s not a simple injury (trip and fall, accident)… if there is a believed underlying medical reason (osteoporosis)

Question 5

What is the mechanism of a hip fracture?

How do you identify it during exam?

Answer 5

Fall’s impact causes extremities to rotate laterally

During exam, internally rotating their hip will hurt.

Question 6

Lateral circumflex artery provides most of the blood to where?

Answer 6

Femoral head & neck

Question 7

What’s the classification system for femur neck fractures? Go through it.

Answer 7

Garden’s classification
I) Incomplete, therefore nondisplaced fracture of femoral neck
II) Non-displaced fracture
III) Partial displacement
IV) Complete displacement - most likely to cut off all blood supply to rest of leg.

Question 8

What is garden’s classification for?

Answer 8

Femur neck fractures.

Question 9

Tx of Femoral neck fractures

Answer 9

Thompson splint - cranking device for aligning foot with extremity & immobilizing fracture

Question 10

How will the leg be presented in an Intertrochenteric fracture? (btwn trochanters)

Answer 10

Leg shortening & external rotation

Question 11

What is Stimson’s maneuver?

Answer 11

To manage a hip displaced posterior to acetabulum. Pop femoral head back into place.

Question 12

If a leg looks shorter post trauma, what most likely happened?

Answer 12

Femoral fracture, causing the powerful quadriceps to pull up on the proximal portion of the fractured bone.

Question 13

What is the classification system for femoral fractures?

Answer 13

Winquist & Hansen Comminution

Question 14

Tx for Femoral fractures
Nonoperative?
Opereative?

Answer 14

Nonoperative: Steinmann pin, cast bracing
Operative: Intermedullary nailing, compression plates, external fixator

Question 15

What is a tibial plateau fracture?
Sx?
Imaging? If >6mm, what must you do?
Tx?
*Complication? What test for that?

Answer 15

top end of the tibia is cracked somewhere or a combination.
Sx: Painful, swollen knee, unable to bear weight, decrease ROM.
Imaging: CT to assess damage. If >6mm need to repair continuity of articular surface
Complication: Ligamentous injuries - do MRI.

Question 16

If there is a tibia fracture, what must you check on exam?

Tx?

Answer 16

check Dorsi/Plantarflexion of toes & foot

Tx: long leg cast for at least 8 weeks

Question 17

What’s the classification system of Open Fractures?

Answer 17

Gustillo classification

Type 1,2,3,3a,3b,3c…that one.

Question 18

If you decide a patient’s open fracture (tibial, or anywhere) is Type IIIC. what must you do now?

Answer 18

MESS classification to choose between amputation or limb salvage.

Question 19

An air cast for ankle SPRAIN allows ___, but prevents ___

Answer 19

allows plantar, dorsiflexion

prevents inversion & eversion

Question 20

What’s the classification system for ankle fractures? Type C of this affects what?

Answer 20

Danis-Weber classification

Type C will have a syndesmosis tear.

Question 21

Grade 1 ankle sprain is __

Grade 3 is __

Answer 21

From
Grade 1 - stretch, minor tear
Grade 3 - complete tear