Orthopedics Flashcards
What is the treatment for a posteromedial tibial stress fracture?
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.
What type of tibial stress fractures are considered to be low risk?
Mid shaft postero medial tibial stress fractures
Calcaneum tuberosity fractures are associated with other fractures what percentage of the time?
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.
What is the best way to diagnose stress fractures?
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.
Which patients with fractures of the scaphoid bone of the wrist should be referred to orthopedists?
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.
Name the parts of a long bone in a child.
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.
Describe the types of pediatric fractures according to the Salter-Harris classification system.
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.
What is the mnemonic for Salter-Harris fractures?
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.
What is Little League elbow?
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.
What is Jersey finger?
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.
What is osteochondritis to dissecans?
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.
What are the Kanavel signs of acute flexor tenosynovitis?
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.
What is the most common lower extremity stress fracture in children and adults?
Tibial stress fractures are most common in both children and adults.
What are the risk factors for osteoarthritis of the hip?
Obesity, high bone mass, old age, participation in weight-bearing sports, and hyperthyroidism.
What is the recommendation for vitamin D intake in women?
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
What are the typical clinical features of pseudogout?
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.
