Orthopedics Flashcards
What is the next imaging step for babies with uneven gluteal folds and a hip that jerks and clicks?
Ultrasound! (X ray not helpful because the hip is not calcified in the newborn)
What is the treatment of developmental dysplasia of the hip?
Abduction splinting with Pavlik harness for 6 months
Hip pathology may show up as pain in these two places:
hip or knee
What is Legg-Calve-Perves disease and how is it diagnosed?
avascular necrosis of the capital femoral epiphysis; occurs around age 6yo. Diagnosis by AP and lateral hip xrays
What is the treatment of SCFE?
Surgical treatment to pin the femoral head back into place
When the hip is flexed and turns externally, cannot be turned internally, chubby teenager, think:
SCFE; X rays diagnostic
What is genu varum? Genu valgus?
Genu varum = bow legged
Genu valgus = knock kneed
What is genu varum past age 3?
Blount disease (a disturbance of the medial proximal tibial growth plate); treatment is surgery
Genu valgus is normal between ages _______. No treatment is necessary
4-8`
What is Osgood-Schlatter disease? What is the treatment?
Osteochondrosis of the tibial tubercle (persistent pain); esp with contraction of quadriceps
Treatment is RICE: rest, ice, compression, elevation, but extension or cylinder cast for 4-6 weeks if conservative measures unsuccessful
Those infants whose club foot (talipes equinovarus) do not respond to serial plaster casting require surgery, typically done between which ages?
9-12 months
At the onset of menses, skeletal maturity is about ___%
80%
T/F: Sometimes Achilles tenotomy is required for talipes equinovarus.
True
= clubfoot
What fracture can lead to Volkmann’s contracture (permanent flexion of the hand at the wrist)?
supracondylar fracture of the humerus
Hyperextension of the elbow in a child who falls on the hand with the arm extended puts them at risk for this kind of fracture:
supracondylar fracture of the humerus
This primary bone tumor is described with a typical “sunburst” pattern:
Osteogenic sarcoma (usually around the knee–> lower femur or upper tibia)
When do you use closed vs open reduction in fractures involving the growth plate in children?
If the epiphyses and growth plate are displaced laterally from the metaphysis but are in one piece (does not cross epiphyses or growth plate and does involve the joint), closed reduction is fight. Otherwise open reduction and internal fixation.
What is the most common primary malignant bone tumor?
Osteogenic sarcoma (sunburst)
What is the second most common primary malignant bone tumor and what is its characteristic X ray appearance?
Ewing sarcoma; diaphyses of long bones; onion-skinning seen on X rays
Most malignant bone tumors in adults are metastatic; from where in women and where in men?
lytic lesions from breast in women
blastic lesions from prostate in men
X rays showing multiple punched out lesions. Treatment?
Multiple myeloma! Treatment is chemotherapy; thalidomide can be used if chemo fails
Where do soft tissue sarcoma metastasize?
Lungs, but not to lymph nodes!!
How do you treat clavicular fractures?
sling; typically at junction of middle and distal thirds
In anterior shoulder dislocation, might have rotated outward arm with numbness in a small area over the deltoid, from stretching of the __________ nerve
axillary
What is the most common etiology of posterior shoulder dislocation?
epileptic seizure or electrical burn
Since X rays can easily miss posterior dislocation of shoulder (unlike anterior dislocation, in which AP and lateral x rays are diagnostic), you should do what views?
axillary or scapular lateral views
Old osteoporotic woman falls on outstretched hand. X ray looks like dinner fork: dorsally displaced, dorsally angulated fracture of distal radius:
Treatment?
Colles fracture! Treat with closed reduction and long arm cast`
Fracture resulting from direct blow to the ulna (such as on a raised protective arm hit by a nightstick).
Monteggia fracture = Diaphyseal fracture of the proximal ulna, with anterior dislocation of the radial head:
Open reduction and internal fixation; dislocated radial head is closed reduction
Distal third of radius gets direct blow and fractures with dorsal dislocation of the distal radioulnar joint.
Galeazzi fracture: open reduction and internal fixation with closed reduction of dislocated ulna
What is the treatment of carpal navicular fracture?
scaphoid fracture! thumb spica cast if X ray negative; open reduction and internal fixation of X ray shows fracture
Metacarpal neck fractures (typically the fourth, fifth, or both) happen when
a closed fist hits a hard surface (like a wall)
What is the treatment of metacarpal neck fractures?
closed reduction and ulnar gutter splint for mild ones; Kirschner wire or plate fixation for bad ones
Patient in stretcher with affected leg shortened and externally located:
hip fracture!
Which is more likely to lead to avascular necrosis of the femoral head: intertrochanteric fractures or femoral neck fractures?
femoral neck fractures
How are intertrochanteric fractures treated?
ORIF and post-op anticoagulation (necessary immbilization during healing)
How are femoral shaft fractures treated?
Intramedullary rod fixation, but if bilateral and comminuted, may lead to shock so require external fixation. If open, they are an orthopedic emergency requiring surgery within 6 hours. Can produce fat emboli.