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Orthopedic Surgery - Part 2 Flashcards

1
Q

What are the two main types of pelvic fractures?

A

Superior/inferior pubic rami fx (not fatal)

High-energy fx (can be fatal)

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2
Q

What is the usual cause of superior/inferior pubic rami fx?

A

Fall on butt (Elderly)

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3
Q

How are superior/inferior pubic rami fractures treated?

A

Non surgical
Pain control (may require hospitalization)
WBAT

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4
Q

What is the one factor of superior/inferior pubic rami fractures that should be looked for as they can be a major complication?

A

Extension of fx into acetabulum

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5
Q

What percentage of high energy pelvic fractures have other injuries?

A

85%

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6
Q

What are two common complications of high energy fractures?

A

Hemorrhage, urogenital injruy

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7
Q

What does an L5 transverse process fx suggest?

A

Instability because of disassociation of pelvis and spine

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8
Q

What is an open book pelvic fracture?

A

Separating of symphysis pubis. Can result in separation of SI joint

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9
Q

What is the MOI for an open book fracture?

A

AP compression

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10
Q

How many units of blood are typically needed for open book pelvic fractures?

A

6-15 units

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11
Q

What is a vertical shear pelvic fracture?

A

Open pubic symphysis, separated SI joint, fractured rami

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12
Q

What should be checked before foley insertion?

A

Ureteral bleeding

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13
Q

What IV access should be placed with pelvic fractures?

A

Large bore IV x 2

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14
Q

If AP pelvic xray is positive for pelvic fracture what other imaging should be ordered?

A

Inlet/Outlet XR and CT scan

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15
Q

What images are part of trauma imaging?

A

C-spine, abdominal, pelvic films

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16
Q

How should MAST trousers be removed to prevent distributive shock?

A

Deflate slowly and monitor vitals carefully

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17
Q

Should bleeding in pelvis or elsewhere be stopped first?

A

Elsewhere

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18
Q

Of there is no abdominal bleeding what can be placed to stabilize the pelvis until surgery?

A

Abdominal binder or external fixator

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19
Q

When should abdominal binder/external fixator be removed?

A

Not until ready to administer definitive care

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20
Q

How do you treat continued hemoinstability?

A

Transfusion followed by angiography

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21
Q

What will males experience following ORIF of a pelvic fracture?

A

Significant scrotal swelling

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22
Q

What is the MOI for clavicle fractures?

A

Fall on shoulder

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23
Q

Where are clavicles most commonly fractured?

A

Midshaft (80%)

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24
Q

What clavicle fracture has the highest risk of nerve and vessel trauma?

A

Medial border

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25
Q

What is the treatment for closed clavicle fracture?

A

Sling or figure 8 for 6-12 weeks

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26
Q

What movements should a patient with a clavicle fracture avoid?

A

Forward flexion, abduction, and external rotation of the shoulder joint

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27
Q

What is the MOI for a separated shoulder?

A

Fall on the tip of the shoulder

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28
Q

What is a separated shoulder?

A

Disruption of acromioclavicular joint

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29
Q

How are grade I and grade II separated shoulders treated?

A

Sling, NSAID, PT

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30
Q

How are grade III separated shoulders treated?

A

Surgically if it is an athlete or in a high demand job

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31
Q

How do you treat an anterior sternoclavicualr joint dislocation?

A

Conservatively

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32
Q

How do you treat a posterior sternoclavicular joint dislocation?

A

Surgically, high vascular area

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33
Q

What is the MOI for a scapular fracture?

A

Significant direct trauma

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34
Q

How often are scapular fractures associated with other injuries and what other injuries occur?

A

80% in clavicle, ribs, pulmonary contusion, pneumothorax, brachial plexus injury

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35
Q

What imaging should be ordered for a scapula fracture?

A 
Chest (look for pneumothorax) 
3V shoulder (Look at glenoid)
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36
Q

What is the treatment for scapula fractures?

A

Non surgical with the exception of glenoid involvement

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37
Q

What percent of displacement is acceptable before surgery is necessary in proximal humerus fractures?

A

50%

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38
Q

How is a proximal humerus fracture plus an associated rotator cuff tear managed?

A

Wait until the fracture is healed, the address RC tear

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39
Q

How does an anterior/inferior shoulder dislocation present?

A

Pt holds arm at side with arm down and in front

“empty socket sign”

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40
Q

What is the MOI for a shoulder dislocation?

A

FOOSH

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41
Q

If a patient has a severe seizure what imaging should be done?

A

Shoulder x-ray for posterior dislocation

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42
Q

How does a patient present with a posterior dislocation?

A

Cannot externally rotate

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43
Q

What imaging should be ordered for a shoulder dislocation?

A

3 view pre and post reduction x-ray

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44
Q

What is a Hill-Sachs lesion?

A

Chipped head of humerus following shoulder dislocation

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45
Q

What is a Bankart Lesion?

A

Chipped glenoid from shoulder dislocation

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46
Q

How are shoulder dislocations treated?

A

Reduction and immobilization, referral to ortho, PT

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47
Q

What percentage of patients re-dislocate their shoulder if they have a Bankart lesion?

A

80%

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48
Q

What is the treatment of shoulder dislocations with a Bankart lesion?

A

Surgery

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49
Q

What does the SITS pneumonic mean for rotator cuff muscles?

A

Supraspinatus, Infraspinatus, Teres minor, Subscapularis

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50
Q

What tests are sensitive for RC tear?

A

Empty can and Drop arm

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51
Q

What tests are sensitive for impingement of the rotator cuff?

A

Hawkins, Neers

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52
Q

How many Xray views should ALWAYS be ordered for shoulders?

A

3

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53
Q

What x-ray findings will be present with shoulder impingement?

A

Impinging osteophytes at AC joint

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54
Q

What imaging should be ordered to evaluate for tear or degree of impingement?

A

MRI

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55
Q

How are rotator cuff tears treated?

A

NSAIDS, PT, rest, ice, cortisone injection

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56
Q

How are persistent impingements treated?

A

Arthroscopic subacromial decompression

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57
Q

Where is the most common humerus fracture?

A

Midshaft

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58
Q

What nerve is easily damaged with humerus fracture?

A

Radial

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59
Q

How do you check if the radial nerve is intact?

A

Thumbs up

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60
Q

How is a closed humerus fracture treated?

A

Coaptation splint or humeral fracture brace

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61
Q

When is ORIF indicated for humerus fracture?

A

Open fx, vascular injuries, gross displacement, significant comminution

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62
Q

What is the MOI for a supracondylar humerus fx?

A

FOOSH + hyperextension of elbow

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63
Q

What could also be injured with supracondylar humerus fx?

A

Brachial artery

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64
Q

What is a Volkmann’s ischemic contracture?

A

Brachial artery gets injured - becomes spastic and spontaneously closes off

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65
Q

What should be monitored often to detect a Volkmanns ischemic contracture?

A

Radial pulse

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66
Q

What are the two signs on xray that indicate a supracondylar fracture?

A

Anterior sail or posterior fat pad

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67
Q

How are supracondylar fractures treated in children?

A

Cast, closed reduction + cast, CRPP, ORIF

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68
Q

How are supracondylar fractures treated in adults?

A

Usually ORIF

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69
Q

What is the most common elbow dislocation?

A

Posterior lateral

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70
Q

How does a pt with elbow dislocation present?

A

Elbow extended, arm abducted, forearm supinated

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71
Q

How is an elbow dislocation reduced?

A

Correct med/lat deformity first then flex elbow at 90 degree with distal traction

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72
Q

How is an elbow dislocation treated?

A

Reduce, splint posterior elbow at 90 degrees, refer to ortho

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73
Q

What is a nursemaids elbow and what is the MOI?

A

Subluxation of radial head caused by excessive longitudinal traction

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74
Q

What ligament can be affected by a nursemaids elbow?

A

Annular

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75
Q

How is a nursemaids elbow reduced?

A

Fully supinate and flex forearm

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76
Q

What should forearm fracture films include?

A

Elbow and wrist

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77
Q

How are forearm fractures treated?

A

reduce and long arm cast or ORIF especially in adults

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78
Q

What injury is commonly coincides with radius and ulna fracture?

A

Radial head dislocation

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79
Q

What is the MOI of a radial fracture?

A

FOOSH

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80
Q

What is a Collie’s fracture?

A

Dorsal angulation radius fracture

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81
Q

What is a Smith’s fracture?

A

Volar angulation radius fracture

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82
Q

How many degrees of angulation of a radial fracture is acceptable in children?

83
Q

What is the treatment for an angulated/displaced radial fracture in adults?

84
Q

What is the major complication of a scaphoid fracture?

85
Q

What is the physical exam sign of a scaphoid fracture?

A

Pain at the anatomic snuffbox

86
Q

What xray is ordered for a scaphoid fracture?

A

Carpal series

87
Q

What imaging is ordered to evaluate the severity of a scaphoid fracture?

88
Q

How is a scaphoid fracture treated?

A

Splint, cast, with immobilization of the thumb, wrist, and elbow

89
Q

How large of a displacement requires ORIF?

A

1 mm or more

90
Q

What is the diagnostic appearance for AVN of the scaphoid on xray?

A

Ground glass appearance or increased bone density early on

91
Q

What is a boxer’s fx?

92
Q

How does a boxer’s fx present?

A

Loss of prominence of knuckle with pain

93
Q

What is the most common fx of the phalanges?

94
Q

When should a fingernail be removed in association with a distal phalanx fracture?

A

If 50% or greater involvement

95
Q

What is the MOI of a Mallet injury?

A

Downward blow to distal phalanx in extension

96
Q

What is a Mallet injury?

A

Avulsion of distal extensor tendon from base of distal phalanx

97
Q

How will a mallet injury present?

A

Inability to extend at DIP

98
Q

How is a Mallet injury treated?

A

Splint in extension, refer to hand surgeon

99
Q

What is a Jersey injury?

A

Avulsion of distal flexor tendon

100
Q

How is a jersey injury treated?

A

splint in neutral, surgery

101
Q

What is the most common finger dislocation?

102
Q

How is a finger dislocation treated?

A

Reduction with pain control or not, splint, refer to hand specialist

103
Q

Difficulty in reduction of a finger dislocation is an indication of what?

A

A caught central slip. May need surgery

104
Q

What is the most common mononeuropathy?

A

Carpal tunnel

105
Q

What is carpal tunnel?

A

Compression of medial nerve under the transverse carpal ligament

106
Q

What are the clinical features of carpal tunnel syndrome?

A

Night pain, numbness, weakness, paresthesias, sparing the 5th digit, thenar atrophy in late

107
Q

What PE tests are sensitive for carpal tunnel syndrome?

A

Tinnels and Phalens

108
Q

What is the gold standard diagnostic tool for diagnosis of carpal tunnel?

109
Q

What is the treatment for carpal tunnel?

A 
Activity modification
NSAIDS
Volar splint (especially at night)
Steroid injection
Surgery for decompression
110
Q

What is the MOI for an acetabular fracture?

A

Blow to greater trochanter
Hip dislocation - posterior wall
Rami Fx - Medial wal or posterior wall

111
Q

What imaging should be ordered if there is a suspicion of an acetabular fracture?

112
Q

What nerve can be injured with an acetabular fracture?

113
Q

When is surgery indicated for an acetabular fracture?

A

If unstable or displaced

114
Q

What is the most common MOI for a dislocated hip?

A

Blow to flexed knee (MVA- dashboard)

115
Q

How does a posterior (90% of hip dislocations) dislocated hip present?

A

Hip flexed, internally rotated, adducted

116
Q

How does an anterior dislocated hip present?

A

Externally rotate, abducted, mildly flexed

117
Q

How is a dislocated hip treated?

A

Orthopedic emergency

Reduction

118
Q

Patients can experience AVN of the femoral head if hip is dislocated for how long?

119
Q

What xray should be ordered for a dislocated hip?

A

Shoot thru lateral

120
Q

How is a posterior hip dislocation reduced?

A

Pt supine, one person stabilizes the pelvis, another pulls in-line traction with simultaneous flexion, abduction and rotation

121
Q

What is a hip fx until proven otherwise?

122
Q

How does a patient with a hip fracture present?

A

Leg shortened, eternal rotation

123
Q

What imaging should be ordered for a hip fracture?

A

Xray or CT for occult

124
Q

What can be given before surgery to help with pain?

A

Buck’s traction 5-10 lbs

125
Q

A hip fracture is a surgical emergency in what demographic and why?

A

young because of AVN

126
Q

Are hip fractures surgical in elderly?

A

If they are stable

127
Q

Who commonly experiences a stress fx of the femoral neck?

A 
Distance runner
eating disorder
amenorrhea
Osteoporosis 
Vitamin D/PTH
128
Q

What risks are associated with a femur fracture?

A

Hemorrhage, compartment syndrome

129
Q

A spiral fx of a non-weight-bearing child is what?

A

Child abuse

130
Q

What must a femur fx x-ray include?

A

Hip and knee

131
Q

Hip fractures in children under 6 are treated how?

A

Cast (Spica)

132
Q

How is a hip fx treated in adults

133
Q

What is the MOI for a patellar fracture?

A

Fall on bent knee

134
Q

What is crucial in evaluating a patellar fracture to r/o quad tendon rupture?

A

Straight leg test

135
Q

What imaging is necessary for a patellar fracture?

A

xray

CT if surgical

136
Q

What are the two surgical treatments for a patellar fracture?

A

ORIF vs patellectomy

137
Q

What is a knee dislocation?

A

Complete dislocation of tibia from femur

138
Q

Why is a knee dislocation an orthopedic emergency?

A

High risk of popliteal artery/nerve injury. can lead to amputation or death

139
Q

What are common complications of a knee dislocation?

A 
Artery/nerve injury 
High rate of chronic function loss
Multi ligament disruption
High risk of OA in future 
Compartment syndrome
Rare return to sports
140
Q

When should a dislocated knee be xrayed?

A

Pre and post reduction

141
Q

What should be ordered for a dislocated knee for surgery planning?

142
Q

What is the MOI of a patella dislocation?

A

Direct blow or twist

143
Q

How is a patella dislocation reduced?

A

Extend knee

144
Q

How is a patella dislocation treated?

A

Knee immobilizer and refer to ortho

145
Q

What injury associated with a patellar dislocation is found on MRI?

A

Medial patellafemoral ligament injury

146
Q

What is the MOI of a meniscal injury?

A

Rotational force of femur on tibia

147
Q

Is a medial or lateral meniscal injury more common?

148
Q

What will PE reveal about meniscal injury?

A

Inability to extend because of locking

+McMurry’s, +Apley’s

149
Q

What is the gold standard for meniscal injuries?

150
Q

What is the treatment for meniscal injury?

A

arthroscopy

151
Q

What is the MOI for a cruciate ligament injury?

A

pivot/twisting

152
Q

Is ACL or PCL injury more common?

153
Q

What are the the sx of cruciate ligament injury?

A

A “pop” with instability and effusion (3-4 hrs later)

154
Q

What PE signs indicate cruciate ligament injury?

A

Lachman’s (most sensitive) and anterior drawer (posterior drawer for PCL)

155
Q

What is the gold standard imaging for cruciate ligament injury?

156
Q

What other imaging should be ordered for cruciate ligament injury?

A

XR to rule out fracture, especially lateral tibial plateau with ACL

157
Q

What is the treatment for cruciate ligament injury?

A

Surgery (6-9 mo recovery)

158
Q

What is the MOI for a collateral ligament?

A

Direct blow causing med or lat force

159
Q

What knee deformity indicates MCL injury

160
Q

What knee deformity indicates LCL injury

161
Q

What is the tx for a collateral ligament injury?

A

PT, brace, RICE, NSAIDS, surgery is rare

162
Q

What is Osgood-Schlatter disease?

A

Apophysitis of the tibial tubercle due to trauma or overuse

163
Q

In what age group is Osgood-Schlatter seen?

164
Q

What are the presenting sx of Osgood-Schlatter?

A

Anterior knee pain at tubercle

165
Q

What imaging should be ordered for OS and what will they show?

A

Lateral XR that may show fragmentation/avulsion

166
Q

What is the treatment for OS?

A

Activity modification, RICE, PT, NSAIDS

167
Q

What are the complications of a tibial plateau fx?

A

Ligament/Meniscal injury, foot drop due to peronal nerve injury

168
Q

What type of tibial plateau fx is more common in the elderly?

A

Depressed Fx

169
Q

What type of tibial plateau fx is more common in the young?

170
Q

Are most tibial plateau fractures medial or lateral?

171
Q

What is the most common long bone fracture?

A

Tibia/fibula

172
Q

What are common complications of tib/fib fractures?

A

compartment syndrome

173
Q

Who commonly gets tibial and fibula stress fractures?

A

runners, dancers, military

174
Q

What is the tx for most tib/fib fractures?

175
Q

What is the treatment for toddlers with tib/fib fractures and stress fractures?

176
Q

Where do most fractures associated with ankle dislocations occur?

A

foot, proximal tib/fib

177
Q

What xray should be ordered for an ankle fracture/dislocation?

A

3V ankle, dont miss the posterior

178
Q

What are the majority of ankle strains due to?

179
Q

What ligament is most commonly affected with ankle sprains?

A

Anterior talofibular

180
Q

What is the set of guidelines called that helps determine of a patient with ankle pain needs an xray?

A

Ottowa Ankle

181
Q

What is the treatment for an ankle sprain?

A

RICE
NSAID
WBAT
PT

182
Q

How long does it take to recover from an ankle sprain?

A

3-4 months

183
Q

The fracture of what bone in the foot is an orthopedic emergency due to possible AVN?

A

Talus fracture

184
Q

What is the MOI of a talus fx?

A

Fall with hyperflexed foot

185
Q

When should a talus fracture be displaced?

A

When it’s non-displaced

186
Q

When should a talus fracture be operated on?

A

When it is displaced

187
Q

What is the MOI for a calcaneal fx?

A

Fall from a height

188
Q

What injuries are commonly associated with calcaneal fractures?

A

Bilateral
Spine Fx
Leg fx

189
Q

What imaging should be ordered for a calcaneal fracture?

A

3V foot + Os calcis views

190
Q

What imaging should be ordered along with xrays for a calcaneal fracture?

A

CT. Xray seriously underestimates the severity of the injury

191
Q

What structure should be evaluated with a calcaneal fracture?

A

Achilles tendon

192
Q

What is the treatment for a calcaneal fracture?

A

ORIF or closed

193
Q

What is the MOI of a metatarsal fx?

A

Direct trauma, twist

194
Q

What imaging should be ordered for metatarsal fracture?

195
Q

What is the treatment for a metatarsal fracture?

A

NWB/ closed reduction if not displaced

196
Q

What is a Jones injury?

A

Inversion injury with fx at diaphyseal junction of the 5th MT

197
Q

How is a jones injury treated?

A

NWB, surgery

198
Q

What is a Lisfranc Injury?

A

Fracture/ligament rupture between base of second metatarsal and medial cuneiform

199
Q

What is the MOI of a lisfranc injury?

A

Extreme plantarflexion

200
Q

What imaging is ordered for a lisfranc injury?

A

3V XR of foot, consider stress views, CT or MRI

201
Q

What is the treatment for a Lisfranc injury?

202
Q

What treatment is ordered for phalangeal foot fx?

A

XR entire foot to evaluate for associated injury

203
Q

Which toe is most important to have perfect alignment?

A

1st toe b/c of balance and painful OA

204
Q

What is the treatment for a phalangeal fx of the foot?

A

Hard sole shoe and buddy taping

Surgery (10 decks)

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