Orthopedic trauma - Cheung

Question 1

for open fractures, name 2 urgent medical managements

Answer 1

tetanus and antibiotics

- surgical debridement

Question 2

what image modality is most sensitive for fractures

Answer 2

MRI

Question 3

what bone graft is osteogenic, osteoinductive, and osteoconductive

Answer 3

autogratfs

Question 4

define fractures

Answer 4

disruptions in continuity of bone

Question 5

define open fracture

Answer 5

broken bone is exposed through skin

emergency

Question 6

high energy fractures are associated with what

Answer 6

extensive soft tissue damage, leading to disruption of healing pathways

Question 7

acute fractures are associated with what

Answer 7

trauma, sometime high energy

Question 8

stress fractures have what history

Answer 8

insidious onset of pain, particularly with weight bearing

Question 9

for a fracture what else must you examine

Answer 9

skin
regional joint stability
nerve and vessels for injury

Question 10

If high energy, one must evaluate other limbs and spine for

Answer 10

occult injury

Question 11

for fractures what is the best test for order

Answer 11

X-rays

Question 12

long does it take stress fractures to show up on X-ray

Answer 12

1-4 weeks

Question 13

how well are CT scans for fractures

Answer 13

difficult for 3-D fractures

Question 14

what are the 4 R’s for fracture

Answer 14

recognition
Reduce
Retain
Rehab

Question 15

retain?

Answer 15

keep reduction either with cast or surgery

Question 16

reduce?

Answer 16

set bone straight, either with manipulation or surgery

Question 17

nonunion

Answer 17

bone does not heal

-lack of radiographic evidence of progression of callus formation over a 3-5 month period

Question 18

malunion

Answer 18

bones heals in unacceptable way

Question 19

compartment syndrome

Answer 19

swelling from soft tissue damage compresses nerves and vessels, causing permanent damage
- wear loose clothing

Question 20

Nerve and vessel damage how to treat

Answer 20

Emergency!

repaired or bypassed

Question 21

what is primary fracture healing

Answer 21

rigid fixation from plates

• direct healing with no callous
• intramembranous

Question 22

what is secondary fracture healing

Answer 22

• enchondral
• indirect formation of bone from uncommitted mesenchymal cells
• controlled motion

Question 23

what are the 3 stages of secondary fracture healing

Answer 23

inflammatory for 48 hours
- reparative for 8 weeks
remodeling for 1 year

Question 24

what are some risk factors for nonunion

Answer 24

smoking
malnutrition
poor immunization

Question 25

name 3 types of bone grafts

Answer 25

osteogenic
osteoinductive
osteoconductive

Question 26

osteogenic

Answer 26

bone forming

- only autologous bone graft contains viable osteoblasts

Question 27

osteoinductive

Answer 27

bone stimulation
- encourages differentiation of mesenchymal cells into osteoblasts
BMP-2
BMP-7

Question 28

osteoconductive

Answer 28

bone scaffold

cancellous allograft

Question 29

Allografts

Answer 29

osteoconductive

carry infection

Question 30

demineralized bone matrix

Answer 30

inductive

expensive

Question 31

synthetic substitutes

Answer 31

inductive and conductive
good compressive strength
expensive

Question 32

BMP

Answer 32

inductive

expensive

Question 33

external ultrasound can improve what

Answer 33

healing potential

Question 34

Are IM nails load sharing

Answer 34

no, load bearing