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Surgical Recall > Orthopedic Surgery > Flashcards

Orthopedic Surgery Flashcards

1
Q

What is ORIF?

A

Open Reduction Internal Fixation

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2
Q

What is ROM?

A

Range Of Motion

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3
Q

What is FROM?

A

Free Range Of Motion

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4
Q

What is ACL?

A

Anterior Cruciate Ligament

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5
Q

What is PCL?

A

Posterior Cruciate Ligament

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6
Q

What is MCL?

A

Medial Collateral Ligament

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7
Q

What is PWB?

A

Partial Weight Bearing

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8
Q

What is FWB?

A

Full Weight Bearing

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9
Q

What is WBAT?

A

Weight Bearing As Tolerated

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10
Q

What is THA?

A

Total Hip Arthroplasty

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11
Q

What is TKA?

A

Total Knee Arthroplasty

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12
Q

What is THR?

A

Total Hip Replacement

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13
Q

What is TKR?

A

Total Knee Replacement

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14
Q

What is PROM?

A

Passive Range Of Motion

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15
Q

What is AROM?

A

Active Range Of Motion

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16
Q

What is AFO?

A

Ankle Foot Orthotic

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17
Q

What is AVN?

A

AVascular Necrosis

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18
Q

What is supination?

A

Palm up

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19
Q

What is pronation?

A

Palm down

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20
Q

What is plantarflexion?

A

Foot down at ankle joint

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21
Q

What is foot dorsiflexion?

A

Foot up at ankle joint

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22
Q

What is adduction?

A

Movement toward the body

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23
Q

What is abduction?

A

Movement away from the body

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24
Q

What is inversion?

A

Foot sole faces midline

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25
Q

What is eversion?

A

Foot sole faces laterally

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26
Q

What is volarflexion?

A

Hand flexes at wrist joint toward flexor tendons

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27
Q

What is wrist dorsiflexion?

A

Hand flexes at wrist joint toward extensor tendons

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28
Q

What is allograft bone?

A

Bone from human donor other than patient

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29
Q

What is a reduction?

A

Maneuver to restore proper alignment to fracture or joint

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30
Q

What is a closed reduction?

A

Reduction done without surgery (e.g. casts, splints)

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31
Q

What is an open reduction?

A

Surgical reduction

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32
Q

What is a fixation?

A

Stabilization of a fracture after reduction by means of surgical placement of hardware that can be external or internal (e.g. pins, plates, screws)

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33
Q

What is a tibial pin?

A

Pin placed in the tibia for treating femur or pelvic fractures by applying skeletal traction

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34
Q

What is an unstable fracture or dislocation?

A

Fracture or dislocation in which further deformation will occur if reduction is not performed

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35
Q

What is varus?

A

Extremity abnormality with apex of defect pointed away from midline

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36
Q

What is valgus?

A

Extremity abnormality with apex of defect pointed towards midline

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37
Q

What is a dislocation?

A

Total loss of congruity and contact between articular surfaces of a joint

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38
Q

What is a subluxation?

A

Loss of congruity between articular surfaces of a joint, though articular contact still remains

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39
Q

What is arthroplasty?

A

Total joint replacement (most last 10-15 years)

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40
Q

What is arthrodesis?

A

Joint fusion with removal of articular surfaces

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41
Q

What is osteotomy?

A

Cutting bone (usually wedge resection) to help realigning of joint surfaces

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42
Q

What is non-union?

A

Failure of fractured bone ends to fuse

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43
Q

What is the diaphysis of a bone?

A

Main shaft of long bone

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44
Q

What is the metaphysis of a bone?

A

Flared end of long bone

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45
Q

What is the physis of a bone?

A

Growth plate, found only in immature bone

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46
Q

How should fractured extremities be examined?

A
  1. Observe entire extremity (e.g. open, angulation, joint disruption)
  2. Neurologic (sensation, movement)
  3. Vascular (e.g. pulses, cap refill)
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47
Q

Which x-rays should be obtained for a fractured extremity?

A

Two views (also joint above and below fracture)

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48
Q

How are fractures described?

A
  1. Skin status (open or closed)
  2. Bone (by thirds: proximal/middle/distal)
  3. Pattern of fracture (e.g. comminuted)
  4. Alignment (displacement, angulation, rotation)
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49
Q

How do you define the degree of angulation, displacement, or both?

A

Define lateral/medial/anterior/posterior displacement and angulation of the distal fragment(s) in relation to the proximal bone

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50
Q

What is a closed fracture?

A

Intact skin over fracture/hematoma

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51
Q

What is an open fracture?

A

Wound overlying fracture, through which fracture fragments are in continuity with outside environment.
High risk of infection.

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52
Q

What is a simple fracture?

A

One fracture line, two bone fragments

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53
Q

What is a comminuted fracture?

A

Results in more than two bone fragments, i.e. fragmentation

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54
Q

What is a segmental fracture?

A

Two complete fractures with a segment in between

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55
Q

What is a transverse fracture?

A

Fracture line perpendicular to long axis of bone

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56
Q

What is an oblique fracture?

A

Fracture line creates an oblique angle with long axis of bone

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57
Q

What is a spiral fracture?

A

Severe oblique fracture in which fracture plane rotates along the long axis of bone.
Caused by twisting injury.

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58
Q

What is a longitudinal fracture?

A

Fracture line parallel to long axis of bone

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59
Q

What is an impacted fracture?

A

Fracture resulting from compressive force.

End of bone is driven into contiguous metaphyseal region without displacement.

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60
Q

What is a pathologic fracture?

A

Fracture through abnormal bone (e.g. tumor-laden or osteoporotic bone)

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61
Q

What is a stress fracture?

A

Fracture in normal bone from cyclic loading on bone

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62
Q

What is a greenstick fracture?

A

Incomplete fracture in which cortex on only one side is disrupted.
Seen in children.

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63
Q

What is a torus fracture?

A

Impaction injury in children in which cortex is buckled but not disrupted

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64
Q

What is an avulsion fracture?

A

Fracture in which tendon is pulled from bone, carrying with it a bone chip

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65
Q

What is a periarticular fracture?

A

Fracture close to but not involving the joint

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66
Q

What is an intra-articular fracture?

A

Fracture through the articular surface of a bone

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67
Q

What is Colles’ fracture?

A

Distal radius fracture with dorsal displacement and angulation, usually from falling on an outstretched hand

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68
Q

What is Smith’s fracture?

A

Distal radius fracture with volar displacement and angulation, usually from falling on the dorsum of the hand

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69
Q

What is Jones’ fracture?

A

Fracture at the base of the 5th metatarsal diaphysis

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70
Q

What is Bennett’s fracture?

A

Fracture-dislocation of the base of the 1st metacarpal with disruption of the carpometacarpal joint

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71
Q

What is a boxer’s fracture?

A

Fracture of the metacarpal neck, classically of the 5th digit

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72
Q

What is a nightstick fracture?

A

Ulnar fracture

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73
Q

What is a clay shoveler’s avulsion fracture?

A

Fracture of spinous process of C6-C7

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74
Q

What is a hangman’s fracture?

A

Fracture of the pedicles of C2

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75
Q

What is a transcervical fracture?

A

Fracture through the neck of the femur

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76
Q

What is a tibial plateau fracture?

A

Intra-articular fracture of the proximal tibia (the plateau is the flared proximal end)

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77
Q

What is a Monteggia fracture?

A

Fracture of the proximal third of the ulna with dislocation of the radial head

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78
Q

What is a Galeazzi fracture?

A

Fracture of the radius at the junction of the middle and distal thirds accompanied by disruption of the distal radioulnar joint

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79
Q

What is a Pilon fracture?

A

Distal tibial fracture

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80
Q

What is Pott’s fracture?

A

Fracture of distal fibula

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81
Q

What is Pott’s disease?

A

Tuberculosis of the spine

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82
Q

What are the major orthopedic emergencies?

A
  1. Open fractures or dislocations
  2. Vascular injuries
  3. Compartment syndrome
  4. Neural compromise
  5. Osteomyelitis or septic arthritis
  6. Hip dislocations
  7. Exsanguinating pelvic fracture
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83
Q

What is the main risk when dealing with an open fracture?

A

Infection

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84
Q

Which fracture has the highest mortality?

A

Pelvic fracture (up to 50% if open)

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85
Q

What 3 factors determine the extent of injury of a fracture?

A
  1. Age (suggests susceptible point in MS system)
  2. Direction of forces
  3. Magnitude of forces
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86
Q

What are indications for open reduction of a fracture?

A 
NO CAST:
Non-union
Open fracture
Compromise of blood supply
Articular surface malalignment
Salter-Harris grade III-IV fracture
Trauma patients who need early ambulation
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87
Q

What is a grade I open fracture?

A
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88
Q

What is a grade II open fracture?

A

> 1-cm laceration, minimal soft tissue damage

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89
Q

What is a grade IIIa open fracture?

A

Massive tissue devitalization or loss, contamination

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90
Q

What is a grade IIIb open fracture?

A

Massive tissue devitalization or loss and extensive periosteal stripping, contamination, inadequate tissue coverage

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91
Q

What is a grade IV open fracture?

A

Major vascular injury requiring repair

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92
Q

What are the 5 steps in the initial treatment of an open fracture?

A
  1. Prophylactic antibiotics to include IV gram-positive +/- anaerobic coverage (cefazolin, cefoxitin/gentamicin).
  2. Surgical debridement.
  3. Inoculation against tetanus.
  4. Lavage wound
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93
Q

What structures are at risk with a humeral fracture?

A

Radial nerve, brachial artery

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94
Q

What must be done when both forearm bones are broken?

A

Because precise movements are needed, open reduction and internal fixation are musts

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95
Q

How have femoral fractures been repaired traditionally?

A

Traction for 4-6 weeks

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96
Q

What is the newer technique to repair femoral fractures? What are its advantages?

A

Intramedullary rod placement.

Nearly immediate mobility with decreased morbidity/mortality.

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97
Q

What is the chief concern following tibial fractures?

A

Recognition of associated compartment syndrome

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98
Q

What is suggested by pain in the anatomic snuff-box?

A

Fracture of scaphoid bone

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99
Q

What is the most common cause of a pathologic fracture in adults?

A

Osteoporosis

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100
Q

What is acute compartment syndrome?

A

Increased pressure within a osteofacial compartment that can lead to ischemic necrosis

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101
Q

How is compartment syndrome diagnosed?

A

Clinically, using intracompartmental pressures is also helpful (> 40 mmHg requires fasciotomy)

102
Q

What are the causes of compartment syndrome?

A

Fractures, vascular compromise, reperfusion injury, compressive dressings.
Can occur after any musculoskeletal injury.

103
Q

What are common causes of forearm compartment syndrome?

A

Supracondylar humerus fracture, brachial artery injury, radius or ulna fracture, crush injury

104
Q

What is Volkmann’s contracture?

A

Final sequela of forearm compartment syndrome.

Contracture of the forearm flexors from replacement of dead muscle with fibrous tissue.

105
Q

What is the most common site of compartment syndrome?

A

Calf (4 compartments: anterior, lateral, deep posterior, superficial posterior compartments)

106
Q

What 4 situations should immediately alert one to be on the lookout for a developing compartment syndrome?

A
  1. Suprcondylar elbow fracture in children
  2. Proximal or midshaft tibial fracture
  3. Electrical burn
  4. Arterial or venous disruption
107
Q

What are the symptoms of compartment syndrome?

A

Pain, paresthesias, paralysis

108
Q

What are the signs of compartment syndrome?

A

Pain on passive movement (out of proportion to injury), cyanosis or pallor, hypoesthesia (decreased sensation, decreased 2-point discrimination), firm compartment

109
Q

Can a patient have a compartment syndrome with a palpable or Doppler-detectable distal pulse?

110
Q

What are the possible complications of compartment syndrome?

A

Muscle necrosis, nerve damage, contracture, myoglobinuria

111
Q

What is the initial treatment of the orthopedic patient developing compartment syndrome?

A

Bivalve and split casts, remove constricting clothes and dressings, place extremity at heart level

112
Q

What is the definitive treatment for compartment syndrome?

A

Fasciotomy within 4 hours, if possible

113
Q

What motor and sensation tests are used to assess the radial nerve?

A

Motor: wrist extension.
Sensation: dorsal web space, between thumb and index finger.

114
Q

What motor and sensation tests are used to assess the ulnar nerve?

A

Motor: little finger abduction.
Sensation: little finger-distal ulnar aspect

115
Q

What motor and sensation tests are used to assess the median nerve?

A

Motor: thumb opposition or thumb pinch
Sensation: index finger-distal radial aspect

116
Q

What motor and sensation tests are used to assess the axillary nerve?

A

Motor: arm abduction
Sensation: deltoid patch on lateral aspect of upper arm

117
Q

What motor and sensation tests are used to assess the musculocutaneous nerve?

A

Motor: elbow flexion
Sensation: lateral forearm

118
Q

How is a peripheral nerve injury treated?

A

Controversial, although clean lacerations may be repaired primarily.
Most injuries are followed for 6-8 weeks with EMG.

119
Q

What fracture is associated with a calcaneus fracture?

A

L-spine fracture (usually from a fall)

120
Q

What are the nerves of the brachial plexus?

A

A.M. RUM:

Axillary, Median, Radial, Ulnar, Musculocutaneous

121
Q

What are the 2 indications for operative exploration with a peripheral nerve injury?

A
  1. Loss of nerve function after reduction of fracture.

2. No EMG signs of nerve regeneration after 8 weeks (nerve graft).

122
Q

What is the most common type of shoulder dislocation?

A

95% are anterior (posterior are associated with seizures or electrical shock)

123
Q

Which 2 structures are at risk in a shoulder dislocation?

A
  1. Axillary nerve

2. Axillary artery

124
Q

How is a shoulder dislocation diagnosed?

A

Indentation of soft tissue beneath acromion

125
Q

What are the 3 treatment steps for a should dislocation?

A
  1. Reduction via gradual traction
  2. Immobilization for 3 weeks in internal rotation
  3. ROM exercises
126
Q

What is the most common type of elbow dislocation?

127
Q

Which 3 structures are at risk in an elbow dislocation?

A
  1. Brachial artery
  2. Ulnar nerve
  3. Median nerve
128
Q

What is the treatment for an elbow dislocation?

A

Reduce and splint for 7-10 days

129
Q

When should hip dislocations be reduced?

A

Immediately, to decrease risk of avascular necrosis

130
Q

What is the most common cause of a hip dislocation?

A

High velocity trauma

131
Q

What is the most common type of hip dislocation?

A

Posterior (often involves fracture of posterior lip of acetabulum)

132
Q

Which structures are at risk in a hip dislocation?

A
  1. Sciatic nerve

2. Blood supply to femoral head

133
Q

What is the treatment for a hip dislocation?

A

Closed or open reduction

134
Q

What are the common types of knee dislocations?

A

Anterior or posterior

135
Q

Which structures are at risk in a knee dislocation?

A
  1. Popliteal artery and vein
  2. Peroneal nerve
  3. ACL
  4. PCL
136
Q

What is the treatment for a knee dislocation?

A

Immediate attempt at relocation, arterial repair, ligamentous repair

137
Q

What are the 5 ligaments of the knee?

A
  1. Anterior cruciate ligament
  2. Posterior cruciate ligament
  3. Medial collateral ligament
  4. Lateral collateral ligament
  5. Patellar ligament
138
Q

What is the Lachman test for a torn ACL?

A

Thigh is secured with one hand while the other hand pulls the tibia anteriorly

139
Q

What is the meniscus of the knee?

A

Cartilage surface of the tibia plateau (lateral and medial meniscus).
Tears are repaired usually by arthroscopy with removal of torn cartilage fragments.

140
Q

What is McMurray’s sign?

A

Medial tenderness of knee with flexion and internal rotation of the knee.
Seen with a medial meniscus tear.

141
Q

What is the unhappy triad?

A

Lateral knee injury resulting in:

  1. ACL tear
  2. MCL tear
  3. Medial meniscus tear
142
Q

What is a locked knee?

A

Meniscal tear that displaces and interferes with the knee joint and prevents complete extension

143
Q

What is a bucket-handle tear?

A

Meniscal tear longitudinally along contour of normal “C” shape of the meniscus

144
Q

In collateral ligament and menisci injuries, which are more common, the medial or the lateral?

145
Q

What are the signs of an Achilles tendon rupture?

A

Severe calf pain; bruised swollen calf; two ends of ruptured tendon may be felt; weak plantar flexion from great toe flexors that should be intact

146
Q

What is the test for an intact Achilles tendon?

A

Thompson’s test:

Squeeze of the gastrocnemius muscle results in plantar flexion of the foot.

147
Q

What is the treatment for an Achilles tendon rupture?

A

Young: surgical repair
Old: Many can be treated with progressive splints

148
Q

What 4 muscles form the rotator cuff?

A

SITS:

  1. Supraspinatus
  2. Infraspinatus
  3. Teres minor
  4. Subscapularis
149
Q

When do rotator cuff tears usually occur?

A

5th decade

150
Q

What is the usual history for a rotator cuff tear?

A

Intermittent should pain especially with overhead activity, followed by an episode of acute pain corresponding to a tendon tear.
Weak abduction.

151
Q

What is the treatment for a rotator cuff tear?

A

Usually symptomatic pain relief.

Later, if poor muscular function persists, surgical repair is indicated.

152
Q

What is Dupuytren’s contracture?

A

Thickening and contracture of palmar fascia.

Incidence increases with age.

153
Q

What is Charcot’s joint?

A

Joint arthritis from peripheral neuropathy

154
Q

What is tennis elbow?

A

Tendonitis of the lateral epicondyle of the humerus.

Classically seen in tennis players.

155
Q

What is turf toe?

A

Hyperextension of the great toe (tear of the tendon of the flexor hallucis brevis).
Classically seen in football players.

156
Q

What are shin splints?

A

Exercise-induced anterior compartment hypertension (compartment syndrome).
Seen in runners.

157
Q

What is a heel spur?

A

Plantar fasciitis with abnormal bone growth in the plantar fascia.
Classically seen in runners and walkers.

158
Q

What is Kienbock’s disease?

A

Avascular necrosis of the lunate

159
Q

What is traumatic myositis?

A

Abnormal bone deposit in a muscle after blunt trauma deep muscle contusion

160
Q

How does a cast saw cut the cast but not the underlying skin?

A

It is an oscillating saw that goes back and forth cutting anything hard while moving the skin back and forth without injuring it

161
Q

What is osteomyelitis?

A

Inflammation or infection of bone marrow and adjacent bone

162
Q

What are the most likely causative organisms in osteomyelitis?

A 
Neonates:  Staph aureus, Strep
Children:  Staph aureus, H. flu, Strep
Adults:  Staph aureus
Immunocompromised:  Staph aureus, gram-negatives
Sickle cell:  Salmonella
163
Q

What is the most common organism isolated in osteomyelitis in the general adult population?

A

Staph aureus

164
Q

What is the most common organism isolated in osteomyelitis in patients with sickle cell disease?

A

Salmonella

165
Q

What is seen with osteomyelitis on physical exam?

A

Tenderness, decreased movement, swelling

166
Q

What are the diagnostic steps for osteomyelitis?

A

H&P, needle aspirate, blood cultures, CBC, ESR, bone scan

167
Q

What are the treatment options for osteomyelitis?

A

Antibiotics +/- surgical drainage

168
Q

What is a Marjolin’s ulcer?

A

Squamous cell carcinoma that arises in a chronic sinus from osteomyelitis

169
Q

What is septic arthritis?

A

Inflammation of a joint beginning as synovitis and ending with destruction of articular cartilage if left untreated

170
Q

What are the causative agents with septic arthritis?

A

Same as osteomyelitis, except that gonococcus is a common agent in the adult population

171
Q

What are the findings on physical exam with septic arthritis?

A

Joint pain, decreased motion, joint swelling, joint warm to the touch

172
Q

What are the diagnostic steps for septic arthritis?

A

Needle aspirate, x-ray, blood cultures, ESR

173
Q

What is the treatment for septic arthritis?

A

Decompression of the joint via needle aspiration and IV antibiotics.
Hip, shoulder, and spine must be surgically incised, debrided, and drained.

174
Q

What is the most common type of orthopedic tumor in adults?

A

Metastatic

175
Q

What are the common sources of orthopedic tumors?

A

Breast, lung, prostate, kidney, thyroid, multiple myeloma

176
Q

What is the usual presentation of an orthopedic tumor?

A

Bone pain or as a pathologic fracture

177
Q

What is the most common primary malignant bone tumor?

A

Multiple myeloma

178
Q

What is the differential diagnosis of a possible bone tumor?

A

Metastatic disease; primary bone tumor; metabolic disorder (hyperparathyroidism); infection

179
Q

What are the 8 benign bone tumors?

A

Osteochondroma; enchondroma; unicameral/aneurysmal bone cyst; osteoid osteoma; chondroblastoma; fibroxanthoma; fibrous dysplasia; non-ossifying fibroma

180
Q

What are the 7 malignant bone tumors?

A

Multiple myeloma; osteosarcoma; chondrosarcoma; Ewing’s sarcoma; giant cell tumor; malignant melanoma; metastatic

181
Q

What is the difference in bone reaction from benign and malignant bone tumors?

A

Benign: Sclerotic bone reaction
Malignant: Little reaction

182
Q

Are most pediatric bone tumors benign or malignant?

A

80% are benign

183
Q

Are most adult bone tumors benign or malignant?

A

66% are malignant

184
Q

What are the 4 diagnostic steps for bone tumors?

A
  1. Physical and lab tests
  2. Radiographs
  3. CT, technetium scan
  4. Biopsy
185
Q

What are the radiographic signs of malignant bone tumors?

A

Large size; aggressive bone destruction; poorly defined margins; ineffective bone reaction to tumor; extension to soft tissues

186
Q

What are the radiographic signs of benign bone tumors?

A

Small size; well-circumscribed; sharp margins; effective bone reaction to the tumor; no extension

187
Q

What are specific radiographic findings with osteosarcoma?

A

Sunburst pattern

188
Q

What are specific radiographic findings with Ewing’s sarcoma?

A

Onion skinning

189
Q

What are specific radiographic findings with fibrous dysplasia?

A

Bubbly lytic lesion, ground glass

190
Q

What is the mainstay of treatment for bone tumors?

A

Surgery (excision and debridement) for both malignant and benign tumors.
XRT and chemotherapy as adjuvant therapy for many malignant tumors.

191
Q

What is the usual age of presentation with osteosarcoma?

A

10-20 years

192
Q

What is the gender distribution for osteosarcoma?

193
Q

What is the most common location for osteosarcoma?

A

66% in the distal femur, proximal tibia

194
Q

What is the radiographic sine qua non for osteosarcoma?

A

Bone formation somewhere within tumor

195
Q

What is the treatment for osteosarcoma?

A

Resection (limb sparing if possible) and chemotherapy

196
Q

What is the 5-year survival for osteosarcoma?

197
Q

What is the most common site of metastasis for osteosarcoma?

198
Q

What is the most common benign bone tumor?

A

Osteochondroma

199
Q

What is a chondrosarcoma?

A

Malignant tumor of cartilaginous origin.

Presents in middle-aged and older patients and is unresponsive to chemotherapy and XRT.

200
Q

What is the usual presentation of Ewing’s sarcoma?

A

Pain, swelling in involved area

201
Q

What is the most common location for Ewing’s sarcoma?

A

Around the knee (distal femur, proximal tibia)

202
Q

What is the usual age of presentation with Ewing’s sarcoma?

A

Evenly spread among those

203
Q

What are the associated radiographic findings with Ewing’s sarcoma?

A

Lytic lesions with periosteal reaction termed “onion skinning”, which is calcified layering.
Central areas of tumor can undergo liquefaction necrosis, which may be confused with purulent infection.

204
Q

What is the 5-year survival rate for Ewing’s sarcoma?

205
Q

How can Ewing’s sarcoma mimic the appearance of osteomyelitis?

A

Bone cysts

206
Q

What is a unicameral bone cyst?

A

Fluid-filled cyst most commonly found in the proximal humerus in children 5-15 years

207
Q

What is the usual presentation of a unicameral bone cyst?

A

Asymptomatic until pathologic fracture

208
Q

What is the treatment for a unicameral bone cyst?

A

Steroid injections

209
Q

What is an aneurysmal bone cyst?

A

Hemorrhagic lesion that is locally destructive by expansile growth, but does not metastasize

210
Q

What is the usual presentation of an aneurysmal bone cyst?

A

Pain and swelling.

Pathologic fractures are rare.

211
Q

What is the treatment for an aneurysmal bone cyst?

A

Curettage and bone grafting

212
Q

Which arthritides are classified as degenerative?

A

Osteoarthritis, post-traumatic arthritis

213
Q

What signs characterize osteoarthritis?

A

Heberden’s nodes; Bouchard’s nodes; symmetric destruction; usually hip, knee, spine

214
Q

What are Bouchard’s nodes?

A

Enlarged PIP joints of the hand from cartilage or bone growth

215
Q

What are Heberden’s nodes?

A

Enlarged DIP joints of the hand from cartilage or bone growth

216
Q

What is post-traumatic arthritis?

A

Usually involves one joint of past trauma

217
Q

What are the treatment options for degenerative arthritis?

A
  1. NSAIDs for acute flares, not long-term
  2. Local corticosteroid injections
  3. Surgery
218
Q

What are the characteristics of rheumatoid arthritis?

A 
Autoimmune reaction in which invasive pannus attacks hyaline articular cartilage.
Rheumatoid factor (anti-IgG/IgM) in 80% of patients.
219
Q

What is pannus?

A

Inflammatory exudate overlying synovial cells inside the joint

220
Q

What are the classic hand findings with rheumatoid arthritis?

A

Wrist: radial deviation
Fingers: ulnar deviation

221
Q

What are the surgical management options for joint or bone diseases?

A
  1. Arthroplasty
  2. Arthrodesis
  3. Osteotomy
222
Q

What is the major difference between gout and pseudogout?

A

Gout: caused by urate deposition, negative birefringent, needle crystal.
Pseudogout: caused by calcium pyrophosphate positive birefringent square crystals.

223
Q

What is a Charcot’s joint?

A

Arthritic joint from peripheral neuropathy

224
Q

What are the major differences between pediatric and adult bones?

A

Children: increased bone flexibility and bone healing, physis is weak point

225
Q

What types of fractures are unique to children?

A

Greenstick fractures, torus fractures, and fracture through physis

226
Q

What does the Salter-Harris classification system describe?

A

Fractures in children involving physis

227
Q

What is a Salter I fracture?

A

Through physeal plate only

228
Q

What is a Salter II fracture?

A

Involves metaphysis and physis

229
Q

What is a Salter III fracture?

A

Involves physis and epiphysis

230
Q

What is a Salter IV fracture?

A

Extends from metaphysics through physis into epiphysis

231
Q

What is a Salter V fracture?

A

Axial force crushes physeal plate

232
Q

What acronym can help you remember the Salter classification?

A 
SALTR:
Separated
Above
Lower
Through
Ruined
233
Q

Why is the growth plate of concern in childhood fractures?

A

Growth plate represents the weak link in the child’s musculoskeletal system.
Fractures involving the growth plate of long bones may compromise normal growth, so special attention should be given to them.

234
Q

What is the chief concern when oblique or spiral fractures of long bones are seen in children?

A

Child abuse is a possibility

235
Q

What is usually done during reduction of a femoral fracture?

A

Small amounts of overlap is allowed because increased vascularity from injury may make the affected limb longer if overlap is not present.
Treatment after reduction is a spica cast.

236
Q

What is unique about ligamentous injury in children?

A

Most ligamentous injuries are actually fractures involving the growth plate

237
Q

What two fractures have a high incidence of associated compartment syndrome?

A
  1. Tibial fractures

2. Supracondylar fractures of the humerus

238
Q

What is the epidemiology of congenital hip dislocation?

A

F > M, firstborn children, breech

239
Q

What percentage of congenital hip dislocations are bilateral?

240
Q

How is the diagnosis of congenital hip dislocation made?

A

Barlow’s maneuver, Ortolani’s sign, radiographic confirmation is required

241
Q

What is Barlow’s maneuver?

A

Detects unstable hip.
Patient is placed in the supine position and attempt is made to push femurs posteriorly with knees at 90 degrees and hip will dislocate.

242
Q

What is Ortolani’s sign?

A

Clunk produced by relocation of a dislocated femoral head when the examiner abducts the flexed hip and lifts the greater trochanter anteriorly.
Detects a dislocated hip.

243
Q

What is the treatment for congenital hip dislocation?

A

Pavlik harness (maintains hip reduction with hips flexed at 100-110 degrees)

244
Q

What is scoliosis?

A

Lateral curvature of a portion of the spine.
Nonstructural: corrects with positional change
Structural: does not correct

245
Q

What are 3 treatment options for scoliosis?

A
  1. Observation
  2. Braces (Milwaukee brace)
  3. Surgery
246
Q

What are the indications for surgery for scoliosis?

A

Respiratory compromise; rapid progression; curves > 40 degrees; failure of brace

247
Q

What is Legg-Calve-Perthes disease?

A

Idiopathic avascular necrosis of femoral head in children

248
Q

What is a slipped capital femoral epiphysis?

A

Migration of proximal femoral epiphysis on the metaphysis in children.
The proximal femoral epiphysis externally rotates and displaces anteriorly from the capital femoral epiphysis, which stays reduced in the acetabulum.

249
Q

What is Blount’s disease?

A

Idiopathic varus bowing of tibia

250
Q

What is nursemaid’s elbow?

A

Dislocation of radial head (from pulling toddler’s arm)

251
Q

What is Little League elbow?

A

Medial epicondylitis

252
Q

What is Osgood-Schlatter’s disease?

A

Apophysitis of the tibial tubercle resulting from repeated powerful contractions of the quadriceps.
Seen in adolescents with an open physis.

Surgical Recall (68 decks)

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