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Orthopedics Flashcards

1
Q

Developmental dysplasia of hip

A
  1. familial
  2. uneven gluteal folds
  3. p/e shows easy dislocation (click and snap0
  4. sonogram diagnostic
  5. tx = abduction splinting 6 months
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2
Q

Hip pathology

A

hip pain or knee pain

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3
Q

Legg-Perthes disease

A
  1. = Avascular necrosis of the capital femoral epiphysis
  2. starts at age six- slow development limping, less hip motion, pain
  3. antalgic gait, guarded hip motion
  4. dx = Ap/lat hip x rays
  5. tx = contain femoral head w/ casting + crutches
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4
Q

slipped capital femoral epiphysis

A

ORTHO EMERGENCY! 13 y/o boys, groin/knee pain, sole of affected food points to other food, limited hip motion, no internal rotation, dx w/ x-ray, tx w/ pins

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5
Q

Septic hip

A

Toddlers w/ febrile illness, won’t move hip, hold hip flexed (slgith abduct/external rotate), sed rate up, dx = aspirate hip + open drainage

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6
Q

Acute hematogenous osteomyelitis

A

little kids w/ fever, local sever pain in a bone, nothing on x-rays, do bone scan + abx

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7
Q

Genu varum

A

Bow legs (normal up to age 3, no tx), persistent beyond age 3 = Blount disease (do surgery, growth plate messed up)

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8
Q

Genu valgus

A

Knock knee normal aages 4-8

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9
Q

Osgood-Schlatter

A

Osteochondrosis of tibial tubercle, teenagers w/ persistent pain over tubercle, worse w/ quad contraction, no knee swelling, keep knee in cylinder cast 4-6 wks

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10
Q

Club Foot (talipes equinovarus)

A

Both feet inward, plantar flexion of ankle, inverted food, adduction forefoot, internal rotated tibia. Casts in neonatal period correct 1/2, others need surgery between 8 mo-2 years

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11
Q

Scoliosis

A

Adolescent girls, thoracic spine curves right- bend forward (hump?), deformity progresses till skeletal maturity, can decrease pulm function, braces/surgery

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12
Q

Remodeling

A

Happens A LOT in kid’s fractures, so high degrees angulation ok! Also kids heal faster. Only bad for supracondylar fractures of humerus + growth plate

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13
Q

Supracondylar humerus fracture

A

hyperextend elbow in child who falls on hand. Vasc/nerve injuries, Volkmann contracture possible- monitor closely. Tx w/ cast or traction

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14
Q

Growth plate fractures

A

Closed reduction if later displacement of epiphyses/growth plate, but in one piece. If two pieces, open reduction + internal fixation (otherwise uneven growth!)

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15
Q

primary malignant bone tumors (KIDS)

A

persistent low grade pain, x-ray = adjacent soft tissue invasion, sunburst pattern, periosteal onion skinning.

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16
Q

osteogenic sarcoma

A

most common primary malig bone tumor, ages 10-25, around knee (lower femur/upper tibia), sunburst

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17
Q

Ewing sarcoma

A

2nd most common, grows in diaphyses of long bones, onion skinning

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18
Q

adult malig bone tumors

A

METAStATIC (breast, prostate). Localized pain, bone scan more sensitive (follow up with x-ray), sometimes lytic lesions appear w/ pathologic fracture

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19
Q

multiple myeloma

A

old men, fatigue, anemia, localized pain at several bone places, x-ray shows punched out lytic lesions. Bence- jones proteins in urine, abnormal IG in blood 9immunoelectrophoresis). Chemo + Thalidomide

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20
Q

Soft tissue sarcomas

A

relentless growth of soft tissue mass anywhere, firm/fixed to surroundings, mets to lungs but not lymph nodes. MRI for dx + incisional biopsy by expert

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21
Q

X-ray for fractures

A

2 views at 90 degrees to each other, always include joints above and below. Take x-rays of other bones in line of force!

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22
Q

Closed reduction

A

for broken bones not badly displaced or angulated, external manipulation + a cast

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23
Q

Open reduction

A

sever displacement/angulation or not easily aligned

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24
Q

Clavicular fractures

A

Between middle and distal third, give figure-of-eight device for 4-6 weeks

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25
anterior dislocation of shoulder
most common, hold arm close but rotate outward 9ready to shake hands0, may be deltoid numbness from axillary nerve stretch.
26
posterior shoulder dislocation
rare, occurs after massive uncoordinated muscle contractures (seizure/electric burn), arm held close to body, internal rotation, need scapular or axillary view to see it
27
Colles fracture
Fall on outstretched hand, old ladies, wrist looks like dinner fork, dorsal dispalce/angulated distal radius fracture. Closed reduction + long arm cast
28
Monteggia fracture
direct blow to ulna (PROTECT YOURSELF FROM THE NIGHTSTICK!), diaphysial fracture of proximal ulna + anterior dislocation of radial head
29
Galeazzi fracture
mirror of monteneggia, distal 1/3 of radius gets the blow, dorsal dislcation of dsital RU joint. Open reduction/internal fixation
30
Schapoid fracture
Young adult, outstretched hand, wrist pain, tenderness over SNUFF BOX. undisplaced = neg xray, thumb spica, xray 3 weeks later. if xray shows dispalced/angulated, ORIF. Scaphoid =>nonuion
31
Metacarpal neck fractures
Fourth, fifth or both. Closed fist hits hard surface, hadn swollen, tender. xray dx. tx dep on angulation/displacement/rotary. Closed reduction +ulnar gutter spint for mild, Kirschner wire/plat for bad
32
Hip fractures
Old ppl fall down, hip hurts, class position = shortened affected leg, externally rotated. Tx dep on location
33
Femoral neck fractures
Compromise tenous supply to femoral head. Fast heal/early mobilize w/ femoral head prosthesis
34
Intertrochanteric fractures
Less likely to cause avasc necrosis, tx = OR and pin, immobilization can => DVT/PE, so anticoag
35
Femoral shaft fractures
tx= intramedullary rod fixation. Bilat/comminuted => shock, do external fixation. Open frac = ortho emergency- or clean/closure. Multiple frac => fat embolism!
36
Knee injuries
Swelling of knee = poor mam's MRI
37
Collateral ligament injuries
Knee hit sideways. Medial blows mess up lateral, vice versa. Swollen knee + local pain, and 30 deg flexion with passive abd or add makes pain. Abduction for medail (valgus), adduction for lateral (varus). Tx = hinged cast, several ligaments needs surgical repair
38
ACL injury
more common than PCL. Severe knee swelling + pain. Anterior drawer sign (at 90 deg), or knee at 20, grab thigh and pull leg with other (Lachman test).
39
PCL
opposite findings of ACL. MRI dx. Sednetary pts with immboiliz/rehab. Athletes need arthroscopic reconstruction
40
Meniscal tears
Dx w/ MRI. Protractd pain/swelling, catch/lock + click. Arthroscopic repair to save meniscus. Compete meniscectomy => late degen arthritis
41
Tibial stress fractures
young men doing forced marches. Tenderness at specific point, normal x ray initially. tx w/ cast, xray in 2 weeks. or crutches
42
Tib/fib fracture
Pedestrian hit by car. P/e w/ angulation, dx w/ xray. Cast for easy reducable, intramed nailing if not alignable. Lower leg => compt sndrome common. Pain? remove cast!
43
Ruptured achilles
Out of shape middle aged men playing tennis. Hear a lout pop, cluch and fall. Lim plantarflexion, pain/swelling/limping, feel a gap in tendon, cast in equinus position or surgery for faster cure
44
Ankle fracture
Fall on everted or inverted foot. Both malleoli break. Ap, laterla, mortise xrays dx. ORIF if fragments displaced
45
Compt syndrome
Forearm or lower leg. Prolonged ischemia then reperfusion, crush or trauma => syndrome. Pain, limited use of extremity, tight/tender to palpation. Excrutiating pain with passive extension, maybe normal pulses. TX = emergency fasciotomy
46
Pain under cast?
REMOVE THE CAST!
47
Open fracture
Cleanin OR, suitable reduction within 6 hours
48
Posterior hip dislcoation
Femur driven back (head/on car collision, knees hit dashboard0. Hip pain, leg shortened, adducted, INTERNALLy rotated (opp). Emergency reduction to avoid avasc necrosis
49
Gas gangrene
Deep penetrating dirty wounds, in 3 days pt sick, toxic, moribund. Affected site tender, swollen, discolered, gas crepitus. Tx = IV penicillin, debridement, hyperbaric o2
50
Radial Nerve
injured in oblique frac to distal 2/3 of humerus. No dorsiflex but regained w/ reduction, then cast/sling! But if nerve paralysis, entrapped nerve, surgery required
51
Popliteal artery injuries
Occur w/ posterior disloc of knee. Look at pulses, doppler, arteriogram. Reduce fast to save vasculature, otherwise fasciotomy
52
Second hidden fracture
Direction of force may produce a second frac. Fall from a height might break spine (along w/ obv leg). Head on MVC might mess up femurs, facial fractures could indicate C-spine issue
53
Carpal tunnel
women doing repetitive hand work. Numb/tingly hands esp at night, on radial 3.5 fingers. Reproduce sx by hanging hand limp or tappig median nerve. clin dx but xray good to rule out. tx = splint + antiinflamm. If need surgery, do EMG
54
Trigger finger
Favors women. Wake up w/ acutely flexed finger, snaps when they pull it. Steroid injection, surgery as last resort
55
De Quervain tenosynovitis
Young mothers form carrying baby, wrist flexion/thumb extension. pain on radial side + first dorsal compt. Reproduce sx if hold thumb inside fist and force ulnar deviation. Splint, antiinflamm, steroid injection. Rare surgery
56
Dupuytren contracture
Older Norwegian men. Palm contracture, feel palmar fascia nodules. Tx = surgery if can't place hand flat
57
Felon
Abscess in fingertip pulp- from neglected penetrating injury. Throbbing pain + fever. Urgent surgical drainage to avoid tissue necrosis
58
Gamekeeper thumb
Ulnar collateral ligament injury from forced thumb extension (skiing injury). P/e shows laxity at thumb-MCp joint, can lead to arthritis. CAST IT
59
Jersey finger
Injury to flexor tendon, forcefully extended (grab a running person's jersey). Can't flex. SPLINT IT
60
Mallet finger
Opposite of jersey. Extended finger forcefully flexed, extender tendon ruptures. SPLINT
61
Traumatic digit amputation
clean with saline, rap in gause, place in bag w/ ice Reattach w/ surgery. Dont' freeze or put in alcohol
62
Lumbar disk herniation
L4-5 or L5-S1, age 45-6, severa months of vague aching pain, then sudden neurogenic pain w/ forced movement, very severe, shoots down leg. Exac by cough, sneeze, poop. No ambulation, hold leg flexed. Straight leg-raising => PAIN, MRI dx. Bed rest 3 weeks, pain control w/ nerve blocks. Surgery if progressive muscle weakess, emergency if cauda equina sydrome ()
63
Cauda Equina syndrome
distended bladder, flaccid rectum, perineal saddle anesthesia, emergency decompression
64
Ankylosing spondylitis
Young men in 30s/40s, back pain + mroning stiffness, worse at rest, improves w/ activity. Progressive sx => xray with bamboo spine. Antiinflamm + PT, many pt have HLA B-27 antigen, w/ uveitis and IBD
65
Metastatic malignancy
Suspect in oldies w/ progressive back pain worse at night unrelieved by rest/position change. Weight loss. X-ray shows lesions if advanced (from breast cancer in pedicles or blastic mets from prostate). Early mets on bone scan. MRI is best dx (but $$)
66
Diabetic ulcers
INdolent, at pressure pts (heel, metatarsal head, toe tips). Neuropathy, don't health b/c microvasc disease. Can heal w/ good diabetic control, clean, elevated leg. But often get worse and => amputation
67
Ulcers from aterial insufficiency
Tip of toes, look dirty, pale base w/ not granu tissue. Pt also has other sx- absent pulses, trophic changes, claudication, rest pain. W/u w/ doppler studies for pressure gradient (if not +, no surgry). Then arteriogram, surgical revasc
68
Venous stasis ulcers
In chronically edematous, indurated, hyperpig skin about medial malleolus. Painless, granulating bed. Varicose veins + cellulitis. Tx w/ physical support to keep vains empty (support stockings, etc). Surgery maybe (vein stripping, ulcer grafting)
69
Chronic foot ulcers
look for diabetes and arteriosclerotic occlusive disease (both can coexist)
70
Marjolin ulcer
Squam cell carcinoma of skin in chronic leg ulcer. Many years of healing/breaking down (untx third degree burns or chronic draining sinuses after osteomyelitis). Dirty, deper ulcer w/ heaped growth. Biopsy, wide local excision, skin graft
71
Plantar fascitis
Older, overweight patients w/ diabling sharp heel pain when foot hits ground, worse in mornings. Xray shows bony spur at pain location, exquis tenderness. But spur is not issue. Spontaneous resolution in 12-18 mo.
72
Morton neuroma
Inflamm of digital nerve @ between toe 3 and 4, palpable/very tender. Don't wear high heels or cowboy boots. Tx analgesics + sensible shoes, or surgical excision
73
Gout
Typical swelling, redness, exquiste sudden pain @ first Metatarsal-Phalangeal joint. Middle age fat men w/ high serum uric acid. See crystal sin joint fluid. Tx acute w/ indomethacin + colchicine. Allopurinol + porbenicid for chronic

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