ORTHOPEDICS

Question 1

Hip dysplasia

Answer 1

Diagnosis:

• Uneven gluteal folds
• Hip easily dislocated
• Use SONOGRAM because hip not calcified so x-ray doesn’t work

Treatment: Abduction splinting with Pavlik harness for 6 months

Question 2

What is Legg-Calve-Perthes disease

Answer 2

Avascular necrosis of capital femoral epiphysis

Happens around age 6

Question 3

Slipped capital femoral epiphysis

Answer 3

Orthopedic emergency
Males around age 13
Groin/knee pain, limping

Question 4

Acute hematogenous osteomyelitis

Answer 4

Little kids with a febrile illness
Severe localized pain in bone with no history of trauma
Diagnose with MRI
Treat with antibiotics

Question 5

Supracondylar fractures

Answer 5

Hyperextension of elbow
Only fracture to worry about in a child
Volkmann contracture - vascular/nerve injury

Question 6

Osteogenic sarcoma

Answer 6

Ages 10-25
Around the knee (lower femur or upper tibia)
Sunburst pattern on x-ray

Question 7

Ewing sarcoma

Answer 7

Ages 5-15
Grows in diaphyses of long bones
Onion skinning on x-ray

Question 8

Multiple myeloma

Answer 8

Old men
Fatigue, anemia, localized pain at specific places on several bones
Diagnose with X-RAY - multiple punched out lytic lesions

Question 9

Soft tissue sarcomas

Answer 9

Relentless growth of soft tissue mass
Firm and fixed to surrounding structures
Metastasize to lungs but NOT lymph nodes
Diagnose with MRI and biopsy

Question 10

Compartment syndrome

Answer 10

Forearm or lower leg
Often in a fracture with a closed reduction - prolonged ischemia
Compartment feels tight and tender to palpation
Pulses may be normal
Emergency fasciotomy required for treatment

Question 11

Radial nerve injuries

Answer 11

Unable to dorsiflex (extend) the wrist
Might regain function when fracture is reduced and arm placed on hanging cast
No function regained? Nerve paralysis so do surgery

Question 12

Popliteal artery injuries

Answer 12

Posterior dislocation of knee

Assess: integrity of pulses, Doppler studies, CT angiography

Question 13

Lumbar disk herniation

Answer 13

L4-L5 or L5-S1
Several months of vague aching pain and then sudden neurogenic pain
Straight leg testing has bad pain

Question 14

Cauda equina syndrome

Answer 14

Distended bladder
Flaccid rectal sphincter
Perineal saddle anesthesia

Surgical emergency that needs immediate decompression

Question 15

Diabetic ulcers

Answer 15

Start because of neuropathy

Fail to heal because of microvascular disease

Question 16

Marjolin ulcer

Answer 16

Squamous cell carcinoma of skin developing in chronic leg ulcer

Question 17

Morton neuroma

Answer 17

Inflammation of common digital nerve at 3rd interspace between 3rd and 4th toes

Treat with wearing better shoes cause most likely caused by point high heels or pointy cowboy boots

Question 18

Gout

Answer 18

Acute treatment - indomethacin and colchicine

Chronic treatment - allopurinol and probenecid