Orthopedics

Question 1

What are the Kocher criteria?
Hint = just a FEWw Kocher criteria

Answer 1

1) non-weight bearing status on the affected side
2) ESR >40
3) fever
4) WBC >12

Question 2

What are the probabilities of a septic joint with the following Kocher criteria?
1/4
2/4
3/4
4/4

Answer 2

1/4: 3%
2/4: 40%
3/4: 93%
4/4: 99%

Question 3

What is Sever’s disease?

Answer 3

Calcaneus apophysitis

Question 4

How do you treat kingella kingae osteomyelitis?

Answer 4

Clindamycin

Question 5

In the symptomatic patient, classic history will include a child or adolescent athlete playing a sport that requires repetitive lumbar extension and rotation. The onset of pain may be either acute or insidious over several weeks. Patients will report their low back pain increases with strenuous activity or hyperextension and improves with relative rest. Pain typically remains located in the low back with occasional radiation to the buttock and/or proximal lower extremities, while neurologic symptoms such as numbness/tingling in the lower extremities are uncommon.

Answer 5

spondylolysis

Question 6

What is spondylolysis?

Answer 6

Pars interarticularis defect

Question 7

What is spondylolisthesis?

Answer 7

L5-S1 anterior displacement

Question 8

What should you consider with a limp, sub-acute non-focal back pain, refusal to walk, difficulty sitting upright and perhaps hip pain?

Answer 8

Discitis!

Question 9

What is the name of traction apophisitis at the inferior pole of the patella at the infrapatellar tendon?

Answer 9

Larsen-Johansson disease

Question 10

How do you diagnose developmental hip dysplasia?

Answer 10

U/S if <4 months, x-rays thereafter

abnormal abduction, abnormal skin folds, limb length discrepancy

Question 11

What is the first line antibiotic of choice for septic arthritis?
What are the top three bugs?

Answer 11

Cefazolin! In the US: clindamycin (MRSA)

S. aureus
Kingella kingae
S. pyogenes (GAS)

Question 12

What do you call an abscess in the deep space of the finger?

Answer 12

Felon

Question 13

What do you call an osteonecrosis of the subchondral bone secondary to overuse?
How do you manage it?

Answer 13

osteochondritis dissecans

start with restricted activity
then immobilization and non-WB
then laparascopic repair unstable joint or free floating bone

Question 14

How do you treat Lyme arthritis?

Answer 14

Doxycycline po x 1 month

Question 15

If you spot a bony tumour and cortical destruction, how should you manage?

Answer 15

Do not weight bear!

Refer to orthopedics

Question 16

What is the line to interpret a cervical pseudosubluxation?

Answer 16

the line of Swishuk!
used to distinguish between C2-C3 pseudosubluxation VS Hangman’s fracture
If the delta is >2mm then it is abnormal!

Question 17

What is a Monteggia injury?

Answer 17

ulnar fracture with radial head dislocation

Question 18

What is a Galeazzi fracture?

Answer 18

radial fracture with ulnar head dislocation

Question 19

What is the Ottawa ankle rule?

Answer 19

An ankle X-Ray series is only required if there is any pain in the malleolar zone and…
Bone tenderness at the posterior edge or tip of the lateral malleolus (A)
OR
Bone tenderness at the posterior edge or tip of the medial malleolus (B)
OR
An inability to bear weight both immediately and in the emergency department for four steps

Question 20

What is the Ottawa foot rule?

Answer 20

A foot X-Ray series is only required if there is any pain the midfoot zone and…
Bone tenderness at the base of the fifth metatarsal (C)
OR
Bone tenderness at the navicular (D)
OR
And inability to bear weight both immediately and in the emergency department for four steps

Question 21

What are two possible injury complications of a shoulder dislocation?

Answer 21

Hill Sachs deformity: compression fracture of the posterolateral humerus
Bankhart lesion: detached antero-inferior part of the labrum from the glenoid

Question 22

What are potential complications of an acute patellar dislocation?

Answer 22

osteochondral fracture of the femoral condyles or tibial plateau (best seen on MRI)

Question 23

What distinguishes a greenstick from a torus fracture?

Answer 23

greenstick: only one side of the cortex is broken
torus: buckle fracture, cortex intact

Question 24

What distinguishes a Tillaux fracture from a Triplane fracture?

Answer 24

The lack of a fracture component in the coronal plane (evaluated with lateral x-ray or CT) distinguishes a Tillaux fracture from a triplanar fracture.