Orthopedic Surgery

Question 0

How does LCP disease present?

Answer 0

Avascular necrosis of the femoral head

Present in a kid with limping, hip pain, and limited hip ROM; dx X-ray, Tx cast + crutches

Question 1

What do you see in congenital hip dysplasia?

Answer 1

Presents as uneven gluteal folds, posterior dislocating hips (with “snapping”) in a newborn; dx U/S since hip isn’t calcified for X-ray
Tx splinting

Question 2

How does hip dislocation present?

Answer 2

Presents as a chubby kid limping due to groin pain, hip has limited internal rotation; dx X ray, tx pin femoral head back in place

Question 3

How does a septic hip present?

Answer 3

Presents in toddlers who refuse to move hip following a septic illness; dx hip aspiration under anesthesia, tx perc drain

Question 4

How does osteomyelitis present in kids?

Answer 4

Presents in kids with severe localized bone pain following a septic illness; dx bone scan since X ray will be false negative, tx antibiotics

Question 5

What are genu varum and valgus?

Answer 5

genu varum (bowlegs): 3 y/o surgical correction
genu valgus (knock knee) : observation

Question 6

What is Osgood-Schlatter disease?

Answer 6

Presents in teens with persistent pain over the tibial tubercle, aggravated by quad contraction; tx immobilization in cast

Question 7

How does club foot present?

Answer 7

Presents as bilateral inverted feet in a newborn

tx serial plaster casts on adducted forefoot –> hindfoot varus –> equinus

Question 8

How do you treat scoliosis?

Answer 8

Laterally curved spine
Common in teenage girls
Tx spine brace until mature, surgery if severe

Question 9

How does an osteosarcoma present?

Answer 9

Presents as low-grade knee pain in a 10-25 y/o, X ray shows Codman’s triangle and sunburst appearance

Question 10

How does Ewing sarcoma present?

Answer 10

Presents as low-grade epiphyseal pain in a child, X ray shows onion skinning, due to t(11;22)

Question 11

How do metastatic bone cancers present?

Answer 11

Usually from breast (lytic) and prostate (blastic), causing bone pain and pathologic fractures
Dx: bone scan
Tx: radiation

Question 12

How does multiple myeloma present?

Answer 12

Plasma B cell tumor results in CRAB
hypercalcemia 
renal failure
anemia
bone pain (punched out lesions on Xray)
Dx: urinary Bence-Jones protein
Tx: chemo

Question 13

How do you work up fractures?

Answer 13

All require 2 X-rays 90 degrees from each other including joints above and below fractured bone; anticoagulation of choice is fondaparinux + leg compression devices

Question 14

How do you manage a clavicular fracture?

Answer 14

Typically between mid-to-distal third of clavicle; tx figure of eight device for 4-6 weeks

Question 15

How does an anterior shoulder dislocation present?

Answer 15

Presents with outward rotated arm + deltoid numbness due to axillary palsy

Question 16

How does a posterior shoulder dislocation present?

Answer 16

Presents with internally rotated arm held close to body

Question 17

What is a Colles fracture?

Answer 17

Distal radial fx in osteoporotic women falling on outstretched hand
Tx is reduction + cast

Question 18

What is a monteggia fracture?

Answer 18

Diaphyseal fx of proximal ulna + radial dislocation, following direct trauma to ulna

Question 19

What is a Galezzi fracture?

Answer 19

Diaphyseal fracture of distal radius + ulnar dislocation, following direct trauma to radius

Question 20

How does a scaphoid fracture present?

Answer 20

Presents as wrist pain and tender anatomic snuffbox in a young person falling on outstretched hand; tx thumb spica cast

Question 21

How does a metacarpal neck fracture present?

Answer 21

Presents as swollen and tender hand after punching a wall; tx splint or plate

Question 22

How does a hip fracture present?

Answer 22

presents as shortened and externally rotated hip in an osteoporotic woman; tx depends on location of fracture

Question 23

What is the risk of a femoral neck fracture?

Answer 23

May lead to avascular necrosis of femoral head

Tx prosthetic replacement of head

Question 24

How do you treat a femoral shaft fracture?

Answer 24

intramedullary rod fixation, high risk of hypovolemic shock and fat embolism

Question 25

How do knee injuries present?

Answer 25

Swelling
Unhappy triad: ACL, MCL, and medial meniscus following blow to lateral leg
ACL tear: swelling, pain, positive anterior drawer sign
Meniscal tear: pain, swelling, and clicking of knee with forceful extension
MRI is dx for all

Question 26

How does a tibial stress fracture present?

Answer 26

Presents as localized tibial pain in a soldier following a long march
tx cast and f/u Xray in 2 weeks

Question 27

How does an Achilles tendon rupture present?

Answer 27

Presents as “popping noise” in ankle following exertion with pain and swelling
tx cast or surgery

Question 28

How do you treat an ankle fracture?

Answer 28

Common after falling on inverted or everted foot

tx ORIF

Question 29

How do you manage an open fracture?

Answer 29

Require cleaning and reductino within six hours to prevent ischemia of distal limb

Question 30

How does gas gangrene present?

Answer 30

Presents as tender, swollen, discolored wound site with crepitus following a penetrating injury; tx high-dose penicillin G, hyperbaric oxygen, and debridement