Orthopedic Surgery Flashcards
Child with uneven gluteal folds. Physical exam of hips reveals that one can be easily dislocated posteriorly with a jerk and a click and return to normal position with a snapping. What is it? How do you diagnose? Management.
Developmental dysplasia of the hip. Congenital dislocation of the hip.
Physical exam.
Abduction splinting with Pavlik harness
Nerve at risk for injury in Colle’s fracture
Colles fracture may occur when falling on outstretched arm and may injure MEDIAN nerve.
Six-year-old boy has insidious development of limping with decreased hip motion. He complains occasionally of knee pain on that side. He walks into the office with an antalgic gait. Passive motion of the hip is guarded. What is it? Management.
Legg-Perthes disease– Avascular necrosis of the capital femoral epiphysis.
AP and lateral x-rays for diagnosis. Contain the femoral head within the acetabulum by casting and crutches
A 13-year-old obese boy complains of pain in the groin and is noted by the family to be limping. He sits in the office so if his foot on the affected side pointing toward the other foot. Physical exam is normal for the knee, but shows limited hip motion. As the hip is flexed, the leg goes into Extertal rotation and cannot be rotated internally. What is it? Management.
Slipped capital femoral epiphysis. An orthopedic emergency.
AP and lateral x-rays for diagnosis. The orthopedic surgeons will pin the femoral head in place.
A little toddler has a febrile illness. Disorder of the hip. What is it?
Septic hip.
Aspirate and drain. This is a surgical emergency!
Hip problem in a six year old.
Avascular necrosis.
Hip problem at around the age of 13, male, chubby, or tall and lanky.
Slipped capital femoral epiphysis
Disorder of the hip in a newborn?
Developmental dysplasia of the hip. Congenital dislocation of the hip.
A child with a febrile illness but no history of trauma has persistent, severe localized pain in a bone. What is it? Management.
Acute hematogenous osteomyelitis.
X-ray will not show anything for two weeks. MRI is diagnostic. Then antibiotics.
Genu varum
Bow leg, normal up to Age 3
Genu valgus
Knock knee.
Normal between the age of 4–8.
Varum deformity or bowlegs persists beyond its normal age range, beyond age of three
Blount disease – Disturbance of the medial proximal tibial growth plate. Surgery.
Persistent pain right over the tibial tubercle aggravated by contraction of the quadriceps. Localized tenderness over the tibial tubercle on physical exam. What is it? Treatment?
Osgood-schlatter disease – osteochondrosis of the tibial tubercle.
Treated with immobilization of the knee and an extension or cylinder cast for 4 to 6 weeks.
Baby boy born with both feet turned inward. Inversion of the foot. What is it? Treatment
Club foot – Talipes equinovarus
Treatment needs serial plaster casts started in the neonatal period. Those require surgery are operated on after the age of 6 to 8 months, but before 1 to 2 years of age.
16-year-old boy complains of low grade but constant pain in the distal femur present for several months. X-rays show a large bone tumor breaking through the cortex into the adjacent soft tissue and exhibiting a “Sunburst” pattern.
What is it?
Which ages is this commonly seen in?
Where does it commonly occur?
Osteogenic sarcoma – The most common primary malignant bone tumor.
Seen in ages 10 to 25 and usually occurs around the knee – lower femur or upper tibia
10-year-old complains of persistent pain in the middle of the thigh. X-rays show a large, fusiform bone tumor, pushing the cortex out and producing periosteal onion skinning.
What is it?
Age groups?
Common location?
Ewing sarcoma
Ages 5 to 15
Grows in the diaphysis of long bone
A 66-year-old woman picks up a bag of groceries, and snaps her arm broken.
What is it?
A pathologic fracture means bone tumor, metastatic.
Get x-rays to diagnose the broken bone, whole body bone scans to identify other metastases and start looking for the primary.
Woman – breast, lytic bone lesions
Men – lungs
58-year-old woman with soft tissue tumor in her thigh.
Soft tissue sarcoma. Start with MRI.
Which x-rays should you order for a fracture?
Always get x-rays at 90° to each other
Always a good the joints above and below and check other bones might be in the same line of force
Treatment for a fractured clavicle?
Arm in a sling or figure of eight splint. Young women may request fixation by surgery to achieve better cosmetic result.
Injury to shoulder. Arm held close to body, but rotated outward. Numbness in a small area of her shoulder, over the deltoid muscle.
Anterior dislocation of the shoulder, axillary nerve damage.
Type of x-rays ordered for a posterior dislocation?
Order axillary view or scapular lateral. Do not order AP and lateral.
Treatment for Colles fracture?
Close reduction and long arm cast
Management of displaced femoral neck fracture?
Replace the femoral head with a prosthesis
Management of an intertrochanteric fracture?
Open reduction and pinning with post op anticoagulation
Patient in mid 40s, has electric shooting pain down the leg, worse with straining. What is the next step in management?
Herniated lumbar disc
MRI
Patient is elderly, has had weight-loss, worse at night, unrelieved by rest or positional changes.
Metastatic malignancy
Ulcer at the tip of the toe
Arteriosclerotic occlusive disease
Ulcer at a pressure point
Diabetes
Ulcer above the medial malleolus, with the skin surrounding hyperpigmented
Venous stasis
Ulcer develops after many years of repeated breaking down and healing processes
SCC
