Orthopaedics Flashcards
An 18yo football player is seen in the mergency ward with severe knee pain incurred after being hit by a tackler while running. which of the following findings on exam is most sensitive for anterior cruciate ligament injury?
a. excessive valgus laxity of the knee
b. excess varus laxity of the knee
c. locked knee
d. positive lachman test
e. positive posterior drawer test
D
lachman = sensitive & relaible clinical test
posterior drawer test = PCL injury
“locked knee” = displaced meniscal tear; prevents full extension of the knee
excess valgus laxity = MCL injury
excess varus laxity = LCL injury
34yo man is extricated from an automobile after a MVA. the pt has an obvious deformity of his R thigh consistent with a femur fracture. upon closer exam of the R thigh, there is bone visible through an open wound. which of the following is the most appropriate management of his open femur fracture?
a. IV antibiotics and cast / splint placement
b. IV antibiotics and internal/external fixation
c. early irrigation & debridement, IV abx & cast / split placement.
d. early irrigation & debridement, IV abx & external/internal fixation
e. early irrigation & debridement, IV abx & compartment decompression, and internal/external fixation
E
Open fracture = early irrigation & debridement (w/ repeats 48-72h)
muscle damage in open fracture = fasciotomies performed during debridement
internal/external fixation –> greater access to wound care; for stabilization.
wound coverage usually accomplished w/in 1 wk of injury
65yo man presents with acute onset of pain, swelling and erythema of the L knee. he denies previous episodes or trauma to the knee. the diffdx includes septic arthritis and gout. which ofthe following is the best study to differentiate b/w gout and septic arthritis?
a. WBC
b. xray of the knee
c. MRI of the knee
d. bone scan
e. evaluation of synovial fluid aspirate
E
synovial fluid analysis = best to diagnose
while playing with his children, a 44yo man falls and lands on his R shoulder. there is immediate pain and deformity. in an uncomplicated dislocation of the glenohumeral joint, the humeral head usually dislocates primarily in which of the following directions?
a. anteriorly
b. superiorly
c. posteriorly
d. laterally
e. medially
A
many more tendons protecting arm posteriorly
Posterior = teres minor, infraspinatous, long head of triceps
Anteriorly = pectoralis major, long head of biceps
29yo construction worker fell 15 ft from a roof and broke his R humerus in the distal half of the humeral shaft, as depicted in the accompanying radiograph: with proximal portion of humerus displaced posteriorly. given his injury, which of the following nerves is most at risk?
a. median nerve
b. radial nerve
c. posterior interosseus nerve
d. ulnar nerve
e. ascending circumflex brachial nerve
B
in the radial groove - radial nerve as it courses into the forearm compartment; high risk of injury
in a failed suicide gesture, a depressed student severs her radial nerve at the wrist. which of the following is her expected disability?
a. loss of ability to extend the wrist
b. loss of ability to flex the wrist
c. wasting of the intrinsic muscles of the hand
d. sensory loss over the thenar pad and the thumb web
e. palmar insensitivity
D
distal radial nerve = sensory to dorsum of hand from radial aspect of 1st-4th digits; sensation of thenar pad & thumb web
proximal radial nerve = extension of wrist and digits, forearm supination
after being injured by a bull on his mother’s farm, a young man is placed in a cast for a supracondylar fracture of his humerus. a few h later he begins to experience intense pain, swelling, and weakness in the ipsilateral hand. pulses are normal in the bl upper extremities. which of the following is the most appropriate initial management of this pt?
a. observation
b. repeat imaging of the humerus
c. elevation of the extremity
d. removal of the cast
e. surgical decompression (fasciotomy)
D
compression syndrome = increasing pressures in fascial compartments; compromise of capillary blood flow
1) loss of O2 delivery to tissues from increased capillary permeability.
2) venous and lymphatic flow compromised –> further edema
3) arterial flow compromised –> LATE FINDING = pulse changes
Tx
1) remove the cast
2) surgical fasciotomy
39yo man presents with an isolated fracture of the tibia after being hit in the leg with a car. the pt is stable and a radiograph of the leg shows a tibial fracture with severe dislocation. which of the following is the most appropriate management of the fracture.
a. closed reduction & application of a long leg cast
b. intramedullary nailing
c. surgical fixation with unreamed nailing
d. external fixation
e. plate fixation
B
long, strong bone
stable pt; severe tibial shaft fracture = surgical fixation with intramedullary nailing (reamed cannulated nails)
high energy trauma + polytrauma (significant soft tissue & vascular injuries) = external fixation
periarticular injuries too proximal / distal for intramedullary nailing = plate fixation of tibial fractures
tibial shaft fractures of minor severity & dislocation = closed treatment
CONS of
- unreamed nailing = nonunion; malunion
for each description, select the type of fracture or dislocation with which it is most likely to be associated.
a. navicular (scaphoid) fracture
b. monteggia deformity
c. night stick fracture
d. anterior shoulder dislocation
e. fracture of the scapula
a pt presents with pain in the shoulder after a fall. on exam, the shoulder internally rotated.
D
tx = closed reducgtion + sling
for each description, select the type of fracture or dislocation with which it is most likely to be associated.
a. navicular (scaphoid) fracture
b. monteggia deformity
c. night stick fracture
d. anterior shoulder dislocation
e. fracture of the scapula
a pt has tenderness over the forearm after being attacked by gang members with baseball bats
C
night stick fracture = of ulnar shaft that result from direct blow to the ulnar forearm by a club or night stick
tx = cast
for each description, select the type of fracture or dislocation with which it is most likely to be associated.
a. navicular (scaphoid) fracture
b. monteggia deformity
c. night stick fracture
d. anterior shoulder dislocation
e. fracture of the scapula
30yo cyclist falls and injures her forearm. the radial head is dislocated and the proximal third of the ulna is fractured
B
Montaggia ddeformity = dislocation of radial head + fracture of proximal 1/3 of ulna
tx = internal fixation of ulna + closed reduction of radial head
late complications = heterotopic ossification and redislocation of the radial head.
for each description, select the type of fracture or dislocation with which it is most likely to be associated.
a. navicular (scaphoid) fracture
b. monteggia deformity
c. night stick fracture
d. anterior shoulder dislocation
e. fracture of the scapula
a pt has tenderness in the anatomical snuffbox
A
fall on outstretched hand –> fracture of navicular (scaphoid) bone
= tendernesss to palpation at anatomic snuffbox
tx = immobilization with thumb spica splint
for each description, select the type of bone disease with which it is most likely to be associated.
a. osteogenesis imperfecta
b. osteopetrosis
c. osteitis fibrosa cystica
d. osteomalacia
e. osteitis deformans (Paget’s disease)
a pt with elevated parathyroid hormone levels presents with brown tumors in the long bones
C
long term effect of hyperPTHism = increased bone turnover
high alk phos
brown / osteoclastic tumors & bone cysts
tx = parathyroidectomy
for each description, select the type of bone disease with which it is most likely to be associated.
a. osteogenesis imperfecta
b. osteopetrosis
c. osteitis fibrosa cystica
d. osteomalacia
e. osteitis deformans (Paget’s disease)
a pt with chronic renal failure presents with skeletal deformity and pain
D
due to tertiary hyperparathyroidism
low Ca
high PO4.
osteomalacia = low bone turnover; skeletal deformity, fratures, pain
for each description, select the type of bone disease with which it is most likely to be associated.
a. osteogenesis imperfecta
b. osteopetrosis
c. osteitis fibrosa cystica
d. osteomalacia
e. osteitis deformans (Paget’s disease)
a genetically determined disorder in the structure or processing of type I collagen may require your pt to wear various orthoses to protect himself.
A
blue sclera
brittle bones (type 1 collagen) osteopenia, low uscle mass, heria
Vikings - Ivar the boneless