Orthopedic Surgery Flashcards
Hawkins and Near shoulder tests for what?
Impingement
Yergason test Speed test for shoulders tests?
Biceps instability or tedinopathy
What does Trandelenberg gait indicate re: muscle weakness?
Weak abductor
Thomas test for hip/pelvis tests what?
Flexion contracture
What is FABER hip/pelvis test and what does it test for?
Flexion, ABduction, External Rotation and Extension
for SI joint
What does Lachman test for re: knee?
Anterior/posterior instability
What does McMurrary test for re: knee?
Meniscal injury
Thompson test re: ankle for what?
Achilles tendon rupture
What is windlass test re: foot for?
Plantar fasciitis
Investigations for infectious workup
CBC, CRP, ESR, blood cultures
Rheumatology workup for what differential?
Inflammatory
How many vertebrae? What are the segments?
33
- 7 cervical
- 12 thoracic
- 5 lumbar
- 5 sacral
- 4 coccygeal
What joint is most neck flexion/extension through?
Atlanto-occipital joint
What is most neck rotation through?
C1 and C2
What is spondylolysis?
Stress fracture in pars interarticularis
- caused by hyperextension/ rotation
- common in young athletes
What is spondylolisthesis?
Anterior or posterior slippage of vertebra relative to vertebra below
What is spinal stenosis?
Narrowing of spinal canal
What is disc herniation?
Herniation of vertebral disc
- causing compression/ irritation to adjacent nerve roots
Cervical radiculopathy sx and tx
- radiating pain down arm
- dermatomal sensory loss
- myotomal muscle weakness
tx - rest, activity modification, nerve root steroid injections, analgesia (NSAIDs, GABA inhibitors)
+/- discectomy +/- fusion
Lumbar radiculopathy definition and sx
= sciatica
- compression of nerve root by herniated disc
sx - back pain with leg pain along distribution of irritated nerve
- pain = burning, electrical and shooting
Is inflammatory back pain worse with rest or activity? Morning stiffness?
Worse with rest and better with activity
- severe morning stiffness for hours
Ddx inflammatory back pain
- ankylosing spondylitis
- psoriatic arthritis
- reactive arthritis
- enteropathic arthritis
Risk factors for infection re: back pain
- immunocompromised
- IVDU
- TB exposure
- age
Infectious cause of back pain - ddx
- discitis
- osteomyelitis
- epidural abscess
- > often hematogenous spread
Cauda equina syndrome
- compression of nerve bundle extending from bottom of spinal cord
- caused by ruptured or herniated disc, tumor or abscess
back pain with saddle anesthesia, bowel/bladder sx (incontinence, retention)
-> surgical emergency
Sx Cauda Equina
- saddle anesthesia
- loss of voluntary bladder and bowel function
- bilateral radicular pain, loss of sensation, weakness
- hypo/areflexia
Where are common sites of metastasis to spine?
- breast
- prostate
- lung
- renal
- thyroid
Red flags re: back/neck pain on history
- acute onset localized back pain
- night pain that wakes pt
- malignancy hx
- progressive neurologic deficit
- immunosuppression
- constitutional sx
- fever
- hx trauma
- bladder or bowel sx
- saddle anesthesia
- motor weakness
- point vertebral tenderness
What does straight leg raise test for?
Nerve root irritation
What does occiput to wall distance above 0 suggest?
Osteoporotic degeneration
What does Schober test assess?
Amount of movement in lumbar spine
Canadian C-spine rules
Major risk factors -> if yes then XR
- > 65yo
- complaining of parenthesis in extremities
- experience a dangerous mechanism of injury: fall from 1m/ 5 stairs, axial load to head (diving), MVA >100km/h/ rollover/ ejection, motorized recreational vehicle accident, bicycle collision with immovable object (parked car, tree)
Minor risk factors -> if no then XR
- simple rear end motor vehicle accident
- in sitting position at ED
- ambulating at any time
- delayed onset neck pain
- no pain in midline cervical spine
If minor risk factor and not able to actively rotate neck 45 degrees left and right -> XR
Define dislocation
complete loss of contact between articular surfaces of a joint
Define subluxation
incomplete dislocation
Define open fracture
soft tissue wound penetrates to fracture site
Stages of secondary fracture healing
- hematoma: bleeding from bone and soft tissue
- inflammation: hematopoietic cells produce GF; fibroblasts, mesenchymal cells and osteoprogenitor cells recruited to # site
- callus: action of osteoblasts and osteoclasts; bridging soft callus (wks) and becomes replaced by woven bone (hard callus)
- remodelling: lamellar bone replaces woven bone (wk - yrs); responds to mechanical stress through the bone (Wolff’s law)
What is Wolff’s Law?
lamellar bone replacing woven bone responds to mechanical stress through the bone
When does primary bone healing occur and what is it?
- seen with rigid internal fixation (plate and screw fixation)
- begins with remodelling process
- if external callus evident and pt continues to have pain, fixation may be loose and aseptic or septic nonunion
What does rate of fracture depend on?
- biologic factors - blood supply, soft tissue coverage, pt age, comorbidities, nutrition, smoking, about of bone loss, neuromuscular status
- mechanical factors - stability, amount of comminution
What is a pathologic fracture? Causes?
- abnormal bone + normal force
- generalized bone disease - Paget, metabolic bone disease (osteoporosis, hyperparathyroidism, osteomalacia), EtOH use, poor nutrition
- local disease - infection (TB), bone cyst
- malignancies - primary (sarcoma, multiple myeloma), metastatic (breast, lung, prostate, renal, thyroid)
What is fragility fracture?
- # occurring after fall from standing height or less, or in absence of trauma
- associated with low bone density
- often distal radius, hip, spine
Saltar-Harris classification
Pediatric # around growth plates
I = physis (through growth plate) II = metaphysis (proximal) III = epiphysis (distal) IV = ME (metaphysis + epiphysis) V = crush
Can greenstick # occur in adults?
No - unique to peds
- # on one side of bone and plastic deformation on other side of bone (i.e. both cortices not broken)
