Orthopedics Flashcards

0
Q

What is the treatment for a posteromedial tibial stress fracture?

A

Relative rest from running and avoiding other activities that cause pain. Once usual daily activities are pain-free, low impact exercise can be started and followed by a gradual return to previous levels of running. A pneumatic stirrup leg brace has been found to be helpful. Nonweightbearing is not necessary if the patient can walk without pain. Casting is not recommended. Ultrasonic pulse therapy has helped fracture healing in some instances, but has not been shown to be beneficial in stress fractures.

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1
Q

What type of tibial stress fractures are considered to be low risk?

A

Mid shaft postero medial tibial stress fractures

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2
Q

Calcaneum tuberosity fractures are associated with other fractures what percentage of the time?

A

There is a 26% risk of other fractures of the lower extremity, a 10% risk of concomitant lumbar compression fracture, and a 10% risk of contralateral calcaneal fracture.

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3
Q

What is the best way to diagnose stress fractures?

A

Plain x-rays should be done initially. If the initial films are negative and the diagnosis is not urgently needed, a second plain x-ray can be performed in 2 to 3 weeks. The second line imaging modality recommended is MRI, when playing radiographs are negative and clinical suspicion of stress fracture persists.

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4
Q

Which patients with fractures of the scaphoid bone of the wrist should be referred to orthopedists?

A

Fractures through the proximal third should be referred. This is because the scaphoid circulation enters the bone mostly through the distal half of the bone and proximal fractures are at risk to lose circulation. In addition patients with distal fractures who do not show evidence of union after 10 weeks of immobilization should be referred.

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5
Q

Name the parts of a long bone in a child.

A

The physis is the growth plate. The epiphysis is the area distal to the growth plate which is usually cartilage in children. The metaphysis is where the bone flares and is adjacent to the physis. The diaphysis is the shaft of the bone.

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6
Q

Describe the types of pediatric fractures according to the Salter-Harris classification system.

A

Type I fractures are straight across and disrupt the physis. Type II fractures involve a break from the growth plate up into the metaphysis with the periosteum usually remaining intact. Type III fractures are intra-articular fractures through the epiphysis that extend across the physis. Type IV fractures cross the epiphysis, physis, and metaphysis. Type V fractures are compression injuries to the physis. Type VI fractures are injuries to the perichondrium.

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7
Q

What is the mnemonic for Salter-Harris fractures?

A

S (type I) stands for straight across and refers to a fracture which goes straight across the physis.
A (type II) stands for above and refers to a fracture which involves both the physis and the diaphysis.
L ( type III) stands for lower or beLow and refers to a fracture which involves both the physis and the epiphysis.
T (type IV) refers to two or through. These are fractures that extend from the epiphysis through the physis to the metaphysis.
ER (type V) eRAsure or cRush of growth plate. These are compression injuries to the physis.

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8
Q

What is Little League elbow?

A

It is a condition characterized by elbow pain generally as the result of repetitive throwing. It is frequently seen in young prepubescent baseball pitchers. The injury involved is medial epicondyle apophysitis. Treatment is rest, pain medication and physical therapy. Surgery is occasionally needed if there is ulnar neuropathy or valgus instability.

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9
Q

What is Jersey finger?

A

It is often seen when a football player grabs the jersey of another player, leading to forced extension of the DIP joint. This causes an avulsion injury of the flexor digitorum profundus tendon. It is most often seen in the ring finger. Treatment is surgical repair.

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10
Q

What is osteochondritis to dissecans?

A

It is a disorder characterized by necrosis and ultimately separation of subchondral bone. It most commonly occurs on the medial femoral condyle and it is the most common cause of a loose body in the joint space in pediatric patients. It is usually due to repetitive stress to the bone. It typically presents in teenage athletes, who complained of the gradual onset of vague knee pain. Pain may worsen and swelling may develop following physical activity. Stable lesions may be managed conservatively by modifying activity. More advanced unstable lesions are managed with surgery.

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11
Q

What are the Kanavel signs of acute flexor tenosynovitis?

A

Excessive tenderness over the course of this tendon sheath, symmetric enlargement of the whole finger, pain on passive extension of the finger (along the entire sheath) and a flexed resting position of the finger.

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12
Q

What is the most common lower extremity stress fracture in children and adults?

A

Tibial stress fractures are most common in both children and adults.

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13
Q

What are the risk factors for osteoarthritis of the hip?

A

Obesity, high bone mass, old age, participation in weight-bearing sports, and hyperthyroidism.

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14
Q

What is the recommendation for vitamin D intake in women?

A

200 units per day for all women between nine and 50, 400 units per day for women aged 51 to 70, and 600 units per day for women over 70

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15
Q

What are the typical clinical features of pseudogout?

A

Pseudogout most often affects the elderly and usually affects the knee, wrist and ankle. It is 1.5 times more frequent in females than males. In pseudogout, joint fluid contains rhomboid shaped, weakly positive birefringent calcium pyrophosphate crystals.

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16
Q

What shoulder muscle is involved if there is pain with resisted abduction versus external rotation versus internal rotation?

A

Abduction involves is the supraspinatus. External rotation involves the infraspinatus. And intro rotation involves the subscapularis.

17
Q

What is the best initial treatment to decrease pain and improve function in patients with adhesive capsulitis of the shoulder?

A

3 to 4 weeks of low-dose prednisone of 20 mg per day.

18
Q

How long does adhesive capsulitis typically persist if untreated?

A

About three years.

19
Q

What percentage of olecranon bursitis is likely to be infected?

A

20%

20
Q

What is the definition of a high-risk stress fracture and in what anatomical sites are they typically found?

A

High-risk stress fracture is one that is likely to go on to a full thickness fracture and is at risk for nonunion.

Sites include the femoral neck, anterior mid tibia, navicular, body of talus, proximal second metatarsal, sesamoids, and pars interarticularis.

21
Q

What are Kanavel’s signs for suppurative tenosynovitis?

A

Slight digital flexion, uniform volar swelling, flexor tendon tenderness, and pain with passive extension.

22
Q

What injuries are commonly associated with ACL tears?

A

Meniscal tears in 60 to 75%, collateral ligament injury and 46%, and complete collateral ligament tears in 5 to 24%.

23
Q

What is the optimal therapy to prevent further dislocations in a person who is less than 25 years old?

A

Surgery will result in a less than 20% incidence of redislocation as opposed to 80% ini those who do not receive surgery.

24
Q

What is the incidence of fracture in an acute elbow injury with inability to fully extend the elbow?

A

100%, especially in pediatric patients.

25
Q

Typical features of transient synovitis in children

A

Age 4 to 11, antalgic gait, Limited hip range of motion, temperature less than 038.1, normal radiographs, white blood cell count less than 12, ESR less than 40, and CRP less than two.

26
Q

If there is concern about septic arthritis of the hip in a child what study should be done in addition to labs?

A

Hip ultrasound. If it shows fluid in the hip joint that should be aspirated, examined and sent for CNS.

27
Q

Typical features of slipped capital femoral epiphysis

A

Ages 11 to 16, males, African-Americans, obesity.

28
Q

What is the treatment for slipped capital femoral epiphysis?

A

If acute immediate surgical referral due to the risk for AVN, which occurs in 30% of cases. If chronic, a referral for nonemergent surgical reduction.

29
Q

What are the typical findings in Legg-Calvé-Perthes disease?

A

Ages 4 to 10, insidious onset of groin and anterior thigh pain, intermittent limp, radiation of pain to knee, and radiographs which eventually show aseptic necrosis of the hip.

30
Q

What is a Little League elbow and how is it treated?

A

Apophysitis of the medial epicondylar apophysis which occurs commonly in Little League pitchers. Treatment is that they must refrain from throwing for 3 to 6 weeks until pain-free and nontender, and then a progressive return to throwing.

31
Q

What is Sever’s disease? How is it treated?

A

Posterior heel pain due to calcaneal apophsitis at the Achilles attachment. It is commonly seen in soccer players and baseball players. It usually does not present acutely. It is treated by stretching the heel cord and by using heel lifts.

It is the most common cause of heel pain in children and usually occurs between five and 11. It is thought that in these children the bones grow faster than the muscles and tendons. Treatment involves decreasing the pain inducing activities, anti-inflammatories or analgesics as needed, ice, stretching and strengthening of the gastrocs/soleus, and the use of orthotics.

32
Q

What is Iselin’s apophysitis?

A

It is apophysitis that occurs at the proximal fifth metatarsal where the peroneus brevis attaches. The treatment is to stretch the peroneals, the heel cord and the tibialis anterior and posterior.

33
Q

What medical conditions disqualify children for sports?

A

Myocarditis, hypertrophic cardiomyopathy, diarrhea unless it is mild, fever, and uncontrolled seizures.

34
Q

What are the guidelines for return to play after a concussion?

A

Rest without any play until asymptomatic. Day one: light aerobic activity
Day 2: sport specific exercise
Day three: noncontact training drills Day four: Full Contact after medical clearance
Day five: gameplay.

If the athlete becomes symptomatic at any time then drop back to the previous activity after 24 hour rest and restart

35
Q

What is second impact syndrome?

A

It occurs in children and adolescents only. It occurs in a second concussion occurs prior to resolution of a first. There is rapid brain swelling, and no reliable treatment. There is a high rate of morbidity and mortality.

36
Q

What is the primary indication for joint replacement surgery in patients with osteoarthritis?

A

Intractable pain, which is almost always relieved by the surgery. Joint replacement may also be appropriate for patients with significant limitations of joint function or with altered limb alignment. Range of motion, joint laxity, and recurrent subluxation relate to musculotendinous dysfunction and are not reliably improved by joint replacement.

37
Q

What sports put increased demands on the spine involving hyperextension which may result in spondylolysis? At what level does the spondylolysis usually occur?

A

Football, gymnastics, weightlifting, soccer, volleyball and ballet. The spondylolysis usually occurs at L4 to L5.

38
Q

What stress fractures are high risk and should be referred to an orthopedist? Why?

A

Fractures of the femoral neck, the anterior cortex of the tibia and the proximal fifth metatarsal should should be referred to an orthopedist, as there is a high likelihood of fracture related complications.

39
Q

What are the signs and symptoms of femeroacetabular impingement?

A

Gradually worsening anterolateral hip joint pain that is sharply increased when pivoting latterly on the affected hip Or when moving from sitting to standing. Reproduction of the pain on range of motion exam by manipulating the hip into a position of flexion abduction and internal rotation, or the FADIR test, is the most sensitive physical finding.