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MSDR > Orthopedics > Flashcards

Orthopedics Flashcards

1
Q

In patient history, what does CODIERS stand for?

A

CODIERS:

Course

Onset

Duration

Intensity

Exacerbating factors

Relieving factors

Symptoms

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2
Q

For the following nerves, indicate the 1. muscle innervated and its function and 2. the sensory area innervated:

  • axillary n.
  • musculocutaneous n.
  • median n.
  • ulnar n.
  • radial n.
A
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3
Q

For the following nerves, indicate the 1. muscle innervated and its function and 2. the sensory area innervated:

femoral n.

deep branch of fibular (peroneal) n.

superficial branch of fibular (peroneal) n.

tibial n.

A
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4
Q

How is strength tested and what does each score indicate?

A

Strength Testing is scored out of 5:

  • 0/5: No muscle movement
  • 1/5: Visible muscle movment, but no movement at joint
  • 2/5: Movement at joint, but not against gravity
  • 3/5: Movement against gravity, but not added resistance
  • 4/5: Movement against resistance, but less than usual
  • 5/5: NORMAL strength
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5
Q

How are nerve reflexes tested and what does each score indicate?

A
  • 0 = absent
  • 1+ = hypoactive
  • 2+ = normal
  • 3+ = hyperactive, no clonus
  • 4+ = hyperactive, with clonus
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6
Q

Define gait and what is considered the normal horizantal length and what is considered the normal step length?

A
  • Gait
    1. Watching a patient walk
      • Normal horizontal distance between feet: 4 inches
      • Normal step length: 15 inches
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7
Q

What are the different types of imaging used (5 types) and what are they each used for?

A
  1. Radiograph – used mainly for simple bone and joint imaging
    • IMPORTANT: If joint is weight bearing order weight bearing x-rays
    • order x-rays for joints above and below if visualizing long bone
    • obtain perpendicular images
  2. CT – great for bone visualization
    • ALWAYS order CT before MRI
  3. MRI – great for soft tissue, spine, and joints
  4. Ultrasound – good for real time assessment of dynamic movement
  5. Bone Scans – not used, can see deformities of the bone
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8
Q
  • What type of orthopedic pathology is tendinopathy considered to be?
  • Define some symptoms of tendinopathy.
  • What are the two types of tendinopathy and what is each characterized by?
  • What is the histology of a normal tendon vs an abnromal tendon?
A
  1. Type of Pathology: Overuse injury
  2. Tendinopathy – pain, swelling, impaired performance
    • Tendinitis – inflammation
    • Tendinosis – degradation
      • Normal Tendon: tightly packed collagen fibers, few cells, little vascularization
      • Abnormal Tendon: spread out collagen fibers, many cells, more vascularization
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9
Q
  • What type of orthopedic pathology do shin splints fall under?
  • What is the medical term for shin splints?
  • What are they characterized by?
A
  1. Pathology: overuse injury
  2. Medial Tibia Stress Syndrome: Shin Splints
    • Periostitis caused by abnormal traction of deep flexor/soleus muscles with tibia
    • Generalized pain along the anterior tibia
    • Happens when there is sudden increase in exercise
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10
Q
  • What type of orthopedic pathology do stress fractures fall under?
  • What are they characterized by?
  • Treatment?
A
  1. Patholgy: overuse injury
  2. Stress Fractures
    • Focalized pain in a specific area of the body
    • Low risk vs. high risk based on where it happens
      • High risk: if risk of dealyed union or propensity for re-fracture
    • Treatment: Non-operative (4-8 weeks) and Operative
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11
Q

What 5 tests are used to evaluate basic tendon and nerve function in the hand?

A
  • Make fist
  • Abduct and adduct fingers
  • Make okay sign
  • Cross fingers
  • Abduct thumb
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12
Q

What is the pathogenesis of trigger finger?

A
  • Pathologic process: locking of flexor tendons due to size mismatch between the tendon and pulley/tunnel/sheath
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13
Q

What are the three types of trigger finger and what are they associated with?

A
  • Types
    • Primary: idiopathic
    • Secondary: associated with systemic disease (i.e. diabetes and rheumatoid arthritis)
    • Infantile: early after birth
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14
Q

For trigger finger, what are the treatments for children and what are the treatment for adults?

A
  • Treatments
    • Children: observation
    • Adults: steroid injections to reduce inflammation or surgical intervention
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15
Q

Define De Quervains tenosynovitis:

A
  • De Quervains tenosynovitis: tendonitis of thumb extensor as they pass through the thenar snuffbox
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16
Q

What structures are involved in De Quevains tenosynovitis? Remember the pneumonic!

A

Pneumonic: SEX LAP of the 1st Dorsal Compartment

SEX: EXtensor Pollicis Brevis (S=short)

LAP: Abductor Pollicis Longus

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17
Q

What is the treatment for De Quervains tenosynovitis?

A
  • Treatment:
    • Non-operative
      • Brace
      • NSAIDS
      • Injection
    • Operative
      • Release of tunnel
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18
Q

Where does carpal tunnel occur? What are the motor and sensory changes in carpal tunnel?

A

Carpal Tunnel Syndrome: affects median nerve at wrist

  • Motor changes
    • Weakness
    • Thenar muscle wasting
  • Sensory changes
    • Dropping objects due to inability to feel
    • Numbness
    • Tingling of thumb, index, and middle finger
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19
Q

Where does cubital tunnel occur? What are the motor and sensory changes in cubital tunnel?

A

Cubital Tunnel Syndrome: affects ulnar nerve at elbow

  • Motor changes
    • Atrophy of first dorsal interosseous muscle (between thumb and index finger)
    • Clawing of ring and pinky finger
  • Sensory changes
    • Numbness and tingling of pinky and medial half of ring finger
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20
Q

What are two physical examination tests to diagnose carpal tunnel syndrome?

A
  • Tinel Sign at wrist
    • Produces electric shock
  • Phalen’s Test but doesn’t isolate the median nerve from radial nerve
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21
Q

What are two physical exam findings with cubital tunnel syndrome?

A
  • Elbow flexion with Tinel
  • Elbow compression-flexion with Tinel
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22
Q

What are the 4 most common causes of decreased shoulder motion? Describe them in terms of passive/active motion.

A

Passive motion = active motion → physical barrier to motion

  1. Arthritis
  2. Adhesive capsulitis (frozen shoulder): scar tissue forms after stiffening of joint
  3. Locked dislocation

Passive motion > active motion → no physical barrier to motion

  1. Pain/weakness
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23
Q

What are the three phases of adhesive capulitis (frozen shoulder)? How does the pain and ROM progress in each phase? How long does each phase last?

A

Freezing

  • Progressive increase in pain
  • Worsening range of motion
  • Lasts 6 weeks to 9 months

Frozen

  • Pain goes away but unable to move shoulder
  • Lasts 4 to 6 months

Thawing

  • Range of motion returns slowly
  • Lasts 6 months to 2 years
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24
Q

What are the 4 muscles of the rotator cuff and what are their functions?

A
  1. Supraspinatus: ABduct 0-15
  2. Infraspinatus: Externally rotate with arm at SIDE
  3. Teres minor: Externally rotate with arm abducted
  4. Subscapularis: Medially/internally rotate
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25
Q

How can you test the supraspinatus m?

A

Empty Can test

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26
Q

How can you test the infraspinatus m?

A

External rotation with arm at side

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27
Q

How can you test the teres minor m?

A

External rotation with arm ABducted

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28
Q

What is one of the two tests for the subscapularis m?

A

Lift Off Test

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29
Q

What is the second of the two tests for the subscapularis m?

A

Belly Press Test

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30
Q

What is rotator cuff impingement?

A

Pinching of rotator cuff muscles inferior to coracoacromial arch

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31
Q

What are the 4 tests for rotator cuff impingement?

A
  1. Neer’s Sign (shown in picture)
  2. Hawkin’s Sign (shown in picture)
  3. Bicep Tendon Test
    1. Yergason’s: Pushing against supination
    2. Speed’s: Pushing against flexion
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32
Q

What are three potential causes of weakness of the rotator cuff?

A
  1. Disuse (i.e. atrophy due to bed-bound)
  2. Denervation (i.e. suprascapular nerve compression or lesion)
  3. Tendon rupture (i.e. rotator cuff tear causing muscle to be detached with no action)
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33
Q
  1. What is lateral epicondylitis?
  2. What are the involved structures?
  3. What are the treatement measures for lateral epiconylitis?
A
  • Lateral epicondylitis: inflammation due to overuse or injury (aka Tennis Elbow)
  • Involved structures: extensor carpi radialis brevis
  • Non-operative treatments: stretching, anti-inflammatory medications, bracing, resting ECRB, injections with steroids
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34
Q

List the cervical nerve roots and describe how to evaluate them on physical examination (corresponding strength, sensation, and reflexes).

A
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35
Q

List the lumbar nerve roots and describe how to evaluate them on physical examination (corresponding strength, sensation, and reflexes).

A
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36
Q

Describe appropriate use of radiography in orthopedics.

A
  • No imaging before six weeks unless there is presence of red flag symptoms
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37
Q

Describe and list the treatment for cervical strain.

A
  • Cervical Strain
    • Description: whiplash injury – rapid flexion/extension of the neck (i.e. MVA)
    • Treatment: NSAIDS and moving muscles
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38
Q

Describe and list the treatment for cervical radiculopathy.

A
  • Cervical Radiculopathy
    • Description: compression of cervical nerve root peripheral neurogenic symptoms
      • Young: disc related
      • Old: osteoporosis
      • Pain is relieved with affected arm above head
    • Treatment: NSAIDs and PT
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39
Q

Describe and list the treatment for chronic low back pain.

A
  • Chronic Low Back Pain
    • Description: low back pain that lasts longer than 3 months
    • Treatment: narcotics
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40
Q

Describe and list the treatment for lumbar spinal stenosis.

A
  • Description: narrowing of the spinal canal with pain that worsens with extension and gets better with flexion
    • Neurogenic claudication: leg pain/heaviness resulting from compression of lumbar spinal nerves (differentiate from peripheral vascular disease because PVD gets better after rest/laying down)
    • Occurs in individuals >60yo
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41
Q

Describe spondylolysis.

A
  • Description: defect in the pars interarticularis (near the facet joint) that results in stress fracture after repetitive hyperextension of lumbar region (super common in athletes)
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42
Q

Describe and list the treatmenet for spondylolisthesis.

A
  • Spondylolisthesis
    • Description: forward slippage of vertebral body due to degeneration of facet joint/intervertebral disc (degenerative) or fracture of the pars interarticularis leading to forward slippage (isthmic)
      • Usually asymptomatic
    • Treatment: NSAIDs and activity modifications
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43
Q

Describe and list the treatment for cauda equina syndrome.

A
  • Cauda equine Syndrome
    • Description: acute compression of cauda equina due to disc herniation (L2-S4 nerve roots) causes urinary/bowel incontinence/retention
    • Emergent condition because it can cause irreparable damage to nerves
    • Treatment: immediate surgery
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44
Q

Recognize red flags for lower back pain (theres a lot).

A
  • Age greater than 50
  • Fever
  • Trauma
  • Indications of Cancer
    • Unrelenting Night Pain
    • Weight Loss
    • History of Cancer or Family History
  • Progressive neurologic deficits
  • Failure to improve after 6 weeks of conservative therapy
  • Urinary or bowel incontinence or retention
  • Immunosuppression
  • Drug, oral, IV, steroid abuse
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45
Q

Define the piezoelectric property of the bone and what process does it play a role in?

  • What are the two sides and on what side do the osteoblasts and what side do osteoclasts lie in?
A
  • Piezoelectric property of bone – mechanical loading of bone via weight and force produce small electric currents that causes remodeling of bone (think bowed legs and how the body is trying to correct them)
    • Concave side – negative charge where osteoblasts form bone
    • Convex side – positive charge where osteoclasts remove/resorb bone
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46
Q

What are the stages of bone healing? There are 4. Provide the approximate range of days.

A
  1. Inflammation (0-5 days)
  2. Repair - Soft Callus (5 - 21 days)
  3. Repair - Hard Callus (21 days - 4 months
  4. Remodeling
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47
Q

What takes place in the inflammation phase of bone healing? What does the stage begin with and end with?

A

Inflammation (0-5 days)

  • Begins at impact and lasts until cartilage formation occurs
  • Correlates with pain and swelling
  • Events in Phase
    • Hematoma
    • Fibroblasts form granulation tissue replacing hematoma
    • Osteoclasts remove necrotic tissue
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48
Q

What takes place in the repair - soft callus phase of bone healing? What does the stage begin with and end with?

A
  • Repair – Soft Callus (5 – 21 days)
    • Stage ends when fracture fragments are no longer clinically moveable
    • Events in Phase
      • Increased vascularity and cellularity
      • Recruitment of mesenchymal stem cells
      • Fibrocartilaginous callus bridges fracture site
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49
Q

What takes place in the repair - hard callus phase of bone healing? What does the stage begin with and end with?

A
  • Repair – Hard Callus (21 days – 4 months)
    • Begins when soft callus is completed
    • Ends with clinical and radiographic union (bones look united with no air in between)
    • Events in Phase
      • Blood supply is fully returned
      • Endochondral ossification (creation of bone through cartilage replacement)
        • Calcification of cartilage
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50
Q

What takes place in the remodeling phase of bone healing?

A
  • Conversion of woven bone to lamellar bone
  • Diameter of callus is reduced to normal
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51
Q

What is the sequence of tissue types that appear during bone healing?

A
  • Fibroblasts make granulation tissue (can form with 100% strain) – collagen type 3
  • Chrondroblasts make cartilage (requires less than 10% strain to form) – collagen type 2
  • Osteoblasts make bone (requires less than 2% strain to form) – collagen type 1
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52
Q

Define strain in terms of bone healing.

A
  • Strain = change in length per unit length
    • As you bring bone close together, any movement will cause strain
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53
Q

What are the requirements for bone healing?

A
  • Mechanical environment to reduce strain
    • Rods and casts
  • Biological environment to promote healing
    • Bridging capillary network – blood flow
    • Presence of stem cells and signaling molecules like TGF-B
54
Q

Differentiate between primary and secondary bone healing.

A
  • Primary bone healing – direct bone healing without intermediate tissue
    • Requires surgical stabilization with plate fixation
    • Bone to bone contact under compression
    • Used in articular fractures and simple fracture patterns
  • Secondary bone healing – undergoes phases of healing using endochondral ossification
55
Q

Define nonunion spectrum in terms of fractures.

A
  • Nonunion spectrum (improper fracture healing/reunion) – lack of clinical and radiographic progression toward healing due to mechanical and/or biological responses
56
Q

What are the three different types of strains and define what is the result of each type of strain.

A
  • Hypertrophic strain – excessive strain causing abundant callus
    • Need to bring strain below 2% for bone formation
  • Oligotrophic strain
  • Atrophic strain – inadequate biological response causing minimal callus
    • Need to restart the healing cascade via osteoinduction (i.e. grafting)
57
Q

What is the general timeline for compartment syndrome?

A
  • Surgical emergency
  • After two hours, damage begins to accumulate
  • After 8 hours, the limb may not be salvageable
58
Q

What is the pathophysiology for compartment syndrome?

A
  • Pathophysiology
    • Muscle and other vital tissues are contained in fixed volume by enveloping fascia
    • Increase pressure in the compartment enclosed in fascia leads to ischemia
      • Decreased compartment size (tight dressing or cast)
      • Increased compartment content (bleeding, swelling, capillary permeability)
    • Ischemia leads to tissue death
59
Q

What is the clinical presentation of comaprtment sydrome?

A

Five P’s

  • Pain
  • Paresthesia – numbness, tingling, and burning sensation
  • Pallor – paleness
  • Paralysis
  • Pulseness – occurs when capillaries collapse (normal is 30 mmHg)
    • Can be determined by sticking A-line into compartment
60
Q

What is the treatment and what are the complications for compartment syndrome?

A
  • Treatment
    • Emergent fasciotomy – cutting of fascia
  • Complications
    • Muscle necrosis
    • Nerve damage
    • Amputation of limb
61
Q

Define what an open fracture means and what problems do open fractures pose?

A

Open Fracture

  • Overview
    • Bone pierces through skin
  • Problems
    • Barrier is broken which allows bacteria and foreign debris to get in – osteomyelitis (infection of the bone)
62
Q

What is the treatment for an open fracture?

A
  • Treatment
    • Restore alignment (ASAP)
    • Stabilize join (ASAP)
    • Antibiotics (ASAP)
63
Q

What are the typical mechanisms of pelvic injuries?

A
  • Mechanism of pelvic injury
    • MVA
    • Fall from height
    • Significant compressive force
    • Strong external rotation at femur
64
Q

Why is a pelvic fracture signficant (think pelvic volume)?

A
  • Pelvic volume is important because it comprises 30% of your total blood volume and bleeding into pelvis is considered bleeding into free space and patients can bleed out
    • Human blood is 5L total
    • Pelvic volume is 1.5L
65
Q

What is the treatment for pelvic fractures and what is the importance of mechanical stablilty?

A
  • Treatment
    • Sheet/binder application for compression of pelvic region and to bring anatomy close together
  • Importance of mechanical stability
    • Posterior ligaments act as suspension bridge and allow weight transmission from spine and torso into lower extremities and provide stability
66
Q

What are the two main types of ankle sprains and define each type? Which ligaments are “sprained” in each ankle sprain type?

A
  • Lateral ankle sprain: typical inversion/plantar flexion injury in which anterior talofibular ligament (ATFL) is sprained
  • High ankle sprain: forced dorsiflexion and eversion of ankle in which the ligaments attaching the tibia to the fibula (syndesmotic ligaments) are torn
67
Q

What are the diagnostic tests for the two types of the ankle sprains?

A

Lateral ankle sprain:

  • Ankle Drawer Test: if a ATFL is torn, talus dislocates anteriorly

High ankle sprain

  • Squeeze test (compress mid calf): pain at ankle joint is positive for high ankle sprain
  • External rotation test: knee bent to 90 degrees with ankle in dorsiflexion with force applied to ankle; positive if pain
68
Q

What is the treatment for the two types of ankle sprains?

A
  • Lateral Ankle Sprain Treatment
    • “PRICE” – Protection, Rest, Ice, Compression, Elevation
      • Stirrup splint
    • Surgery is rare
  • High Ankle Sprain Treatment
    • If mild, can treat conservatively with walker boot
    • If severe, can be candidate for surgery
69
Q

What are the Ottawa Ankle and Foot Rules of X-Rays of ankle/foot injuries? There are 6 rules.

A
  • Ottawa Ankle and Foot Rules for X-Rays
    • Cannot take four steps at time of injury
    • Cannot take four steps in clinic
    • Pain at posterior medial malleolus
    • Pain at posterior lateral malleolus
    • Pain at navicular bone
    • Pain at base of 5th metatarsal
70
Q

What is the achilles tendon made up of? What are the intrinsic and extinsic risk factors for achilles tendinopathy?

A

Achilles’ Tendinopathy

  • Achilles tendon is a combined tendon of the gastrocnemius and soleus muscles
  • Risk Factors
    • Intrinsic
      • Hypovascularity – blood supply decreases with age
    • Extrinsic
      • Exercise – overuse can lead to injury
71
Q

What are the three types of achilles tendinopathies? Define what ocurs with each type.

A
  • Tendinitis is acute inflammation of a tendon whereas tendinosis is chronic and degenerative
    • Pain over tendon, heel pain, stiffness
  • Bursitis (bursa are extra-articular synovial fluid-filled sacs that cushion muscles)
    • Pain at back of heel, worsens with activity, improves with rest, pain wearing shoes
  • Rupture
    • “Pop”
    • “Kicked in the back of the ankle”
72
Q

What are the treatments for the three tendinopathies?

A

Tendinitis

  • Treatment: PRICE and NSAIDs and PT (NO STEROID INJECTIONS because increases likelihood of rupture)

Bursitis

  • Treatment: NSAIDs, stretching, and surgery if no improvement

Rupture

  • Treatment: surgery + immobilization OR surgery alone
73
Q

What is medial heel pain known as? What occurs and what nerve is compressed? What is the treatment?

A

Medial Heel Pain: Tarsal Tunnel Syndrome

  • Compression by the flexor retinaculum ligament on the posterior tibial nerve
  • Tingling, burning and numbness of heel
  • Treatment: PT but can refer to specialist for surgery
74
Q

What occurs in plantar fascitis and when is the pain worse? What is the treatment?

A

Plantar Fasciitis

  • Biomechanical overuse that is worse in the morning
  • Microtears in the thick fibrous bands of the plantar fascia
  • Treatment: PT/splint but can refer to specialist for surgery
75
Q

What occurs in metatarsal stress fracture and what are three types?

A

Metatarsal Stress Fracture

  • Fracture along different points of the 5th metatarsal
  • Jones’s Fracture, diaphyseal stress fracture, and tuberosity avulsion fracture
76
Q

What is morton’s neuroma and where does the pain occur? What is the treatment?

A

Morton’s Neruoma

  • Pain in webspace between toes due to plantar digital nerve irritation
  • Treatment: get better shoes
77
Q

What is Lisfranc Injuries and where does the pain occur? What is the treatment?

A

Lisfranc Injuries

  • Disruption of the TMT joint ligaments due to vertical force on the heel
  • Treatment: surgery
78
Q

What are the two main type of halluxes and what occurs in each?

A

Halluxes

  • Hallux valgus = bunion
    • Lateral deviation of the 1st MTP joint
  • Hallux rigidis = osteoarthritis of 1st MTP joint
79
Q

In toe fractures, what ocurs? What is the most common toe to be injured? What is the treatment?

A

Toe Fractures

  • Caused by direct trauma and usually the 5th toe
  • Treatment: tape toes together
80
Q

Differentiate between corns (hard and soft) and calluses.

A

Corns and Calluses

  • Corns
    • Hard = occurs over bony prominences
    • Soft = between toes and webspace
  • Calluses
    • Hyperkeratonic lesion of skin due to pressure over bony prominences
81
Q

List the 8 types of acute knee pain.

A
  • ACL tear
  • Patellar dislocation
  • Tibial plateau fracture
  • Meniscal tear
  • Extensor mechanism disruption
  • Bucket-handle tear
  • Quadriceps tendon rupture
  • Patellar tendon rupture
82
Q

What are the symptoms and treatment for an ACL tear?

A
  • ACL tear
    • Symptoms: moderate effusion, lack terminal 5 degrees of extension, and asymmetric laxity with Lachman and anterior drawer test
    • Treatment: surgery
83
Q

What are the symptoms and treatment for patellar dislocation?

A
  • Patellar dislocation
    • Symptoms: + effusion, limited ROM, medial tenderness
      • Tear of medial patellofemoral ligament (MPFL)
    • Treatment: bracing versus surgery depending on severity
84
Q

What are the symptoms for extensor mechanism disruption?

A
  • Extensor mechanism disruption
    • Symptoms: unable to perform straight leg raise, full passive extension, palpable defect
85
Q

What are the symptoms and treatment for bucket-handle meniscus tear?

A
  • Bucket-handle meniscus tear
    • Symptoms: limited and painful ROM, unable to fully passively extend, no palpable defect, “locked knee”, occurs with ACL tear
    • Treatment: requires surgery
86
Q

What are the symptoms for a quadriceps tendon rupture?

A
  • Quadriceps tendon rupture
    • Symptoms: no active extension, defect superior patella
87
Q

What are the symptoms for patellar tendon rupture?

A
  • Patellar tendon rupture
    • Symptoms: no active extension, defect inferior patella
88
Q

List the two main types of chronic knee pains?

A
  • Meniscus tear
  • Osteoarthritis
89
Q

For meniscus tear, what are the symptoms and how is it diagnosed?

A
  • Meniscus tear
    • Symptoms: joint line tenderness
    • Diagnosis via MRI (soft tissue)
90
Q

For osteoarthritis, what is the pathophysiology and how is it treated?

A
  • Osteoarthritis
    • Pathophysiology: global loss of articular cartilage
    • Treatment: NSAIDs, injections, bracing, and total knee replacement
91
Q

What are the two limb-threatening injuries?

A
  • Knee dislocation
  • Tibial plateau fracture
92
Q

Why is a knee dislocation so serious (what is at risk: nerve and artery)? Is it the same thing as a patellar dislocation?

A
  • Knee dislocation (≠ patellar dislocation)
    • Popliteal artery and fibular nerve are at risk!
93
Q

In terms of urgent surgical intervention, what are three knee injuries are there and what two hip injuries are there?

A
  • Knees
    • Extensor mechanism disruptions
    • Displaced tibial plateau fractures
    • Bucket-handle meniscal tears
  • Hips
    • Femoral neck fractures
    • Hip dislocations
      • Increase risk of peroneal nerve palsy and avascular necrosis
94
Q

What is the mortality rate within one year for hip fractures and why?

A
  • Hip fractures
    • 12-37% die within 1 year because elderly have many comorbidities
95
Q

What are the three type of hip fractures?

A
  • Interotrochanteric
  • Subtrochanteric
  • Femoral neck fractures
96
Q

Is there a compromise to blood supply for interotrochanteric hip fractures? What is the treatment?

A
  • Intertrochanteric
    • No compromise to blood supply
    • Requires surgery
97
Q

For femoral neck fractures, what is the treatment for younger and older patients respectively? What is there a risk for with this condition?

A
  • Femoral neck fractures
    • Younger get screws and older gets replacement
    • Risk for avascular necrosis
98
Q

What are the two differential diagnoses for lateral hip pain: trochanteric?

A
  • Lateral hip pain: trochanteric
    • Bursitis
    • Abductor tendinopathy
99
Q

What are the 5 differential diagnoses for chronic groin pain: hip pain?

A
  • Hip osteoarthritis
  • Avascular necrosis of femoral head
  • Acetabular impingement→acetabular labral tear
  • Hernia
  • Nephrolithiasis
100
Q

What is the pathophyisology and treatment of hip osteoarthritis?

A
  • Hip osteoarthritis
    • Pathophysiology: global loss of articular cartilage
    • Treatment: NSAIDs, injections, and total hip replacement
101
Q

What is avascular necrosis caused by and what can it lead to?

A
  • Avascular necrosis of femoral head
    • Caused by disruption of blood flow to femoral head
    • Can lead to collapse of femoral head
102
Q

When acetabular impingement leads to acetablar labral tear, what two things can it be caused by?

A
  • Acetabular impingement → acetabular labral tear
    • Caused by deformity of femoral head (cam impingement) and/or acetabulum (pincer impingement)
103
Q

What condition is this?

A

Clubfeet

104
Q
  • Do adults or children get clubfeet more? Male or female?
  • What are some of the clinical features of clubfeet?
  • What is the universal method of treatment for clubfeet?
A
  • Children: Boys >> girls
  • Clinical features
    • Forefoot supination
    • Internal rotation (inverted)
    • Posterior crease (equinus = tight Achilles tendon)
  • Treatment
    • Serial Ponseti Casting – several stages of casting to correct bone growth
105
Q

What are three characteristics of developmental dusplasia of the hip (DDH)?

A
  • Developmental Dysplasia of the Hip
    • Dysplasia
    • Subluxation
    • Dislocation
106
Q

What are the risk factors of Developmental Dysplasia of the Hip (DDH)? Treatment?

A
  • Risk Factors
    • First-born
    • Female
    • Breech birth with other birthing defects
  • Treatment
    • Pavlik harness
107
Q

What are the two tests/maneuvers for developmental dysplasia of the hip and how are they performed?

A
  • Barlow Maneuver
    • Internal rotation followed by pushing gently backward
    • Ball of femur goes out of socket
  • Ortolani Maneuver
    • External rotation/abduction of hip
    • Ball of femur goes back into socket
108
Q

For slipped capital femoral epiphysis (SCFE), what is the general clinical presentation, what occurs, and what is the treatment?

A
  • Clinical presentation – obese teenage boy with knee pain
  • Femoral head slips off physis
  • Requires urgent surgical intervention
109
Q

Where do Salter-Harris frctures occur? How many types are there?

A
  • Salter-Harris fractures are fractures to proximal and distal ends of growing bones
  • 5 types
110
Q

List the 5 types of Salter-Harris fractures.

A

Pneumonic: SALTER

  • Type I – through physis (S – same)
  • Type II – through physis and metaphysis (A – above)
  • Type III – through physis and epiphysis (L – lower)
  • Type IV – through metaphysis, physis, and epiphysis (TE – through everything)
  • Type V – crush injury to entire physis (R – rammed)
111
Q

What is the general clinical presentation of non-accidental trauma (NAT)?

A
  • NAT – non-accidental trauma
  • Clinical presentation
    • Fractured posterior rib
    • Fractured long bones (femur and humerus) before walking
    • Bruising, burns, scratches
112
Q

Where does scoiliosis occur and what defines scoliosis?

A
  • Scoliosis – severe curvature of thoracic and lumbar spine
  • Defined by curve size
    • Cobb angle must be greater than 10 degrees = draw perpendicular line from top bent vertebra and bottom bent vertebra and measure angle
113
Q

What are the parameters for bracing scoliosis? What are the parameters for surgery on scoliosis?

A
  • Parameters for bracing
    • 25-45 degree cobb angle
    • Still growing individual
    • Wear brace for 16-18 hours a day
  • Parameters for surgery
    • >50 degree cobb angle
114
Q

What is the general strategy for the work-up of orthopaedic infections?

A
  • Infections involving joint or bone require prompt recognition and usually emergent irrigation and debridement to prevent long-term consequences
  • Routine work-up for any suspected infection:
    • Radiographs of affected region
    • Serum CBC, ESR, and CRP
    • +/- synovial fluid aspirate
115
Q

What is septic arthritis and what treatment is generally used?

A
  • Septic arthritis
    • Hematogenous spread to various joints
    • Treatment: surgical I&D and antibiotics
116
Q

What are the common locations, organisms, and treatments involved in septic bursitis?

A
  • Septic bursitis
    • Bursa are extra-articular synovial fluid-filled sacs that cushion tendons/muscles
    • Common locations: pre-patellar and olecranon bursa
    • Common organism: S. aureus
    • Treatment: antibiotics and operative excision
117
Q

What is cellulitis, what are the symptoms, and what treatment is most often used?

A
  • Cellulitis
    • Infection involving skin and subcutaneous tissue
    • Painful at rest and tender to palpation
    • Treatment: antibiotics
118
Q

What is necrotizing fascitis and what is the general treatment?

A
  • Necrotizing fasciitis
    • Infection involving fascia
    • Extremely aggressive infection that causes hemodynamic instability
    • Treatment: emergent and extensive debridement and IV antibiotics
119
Q

What is osteomyelitis?

A
  • Osteomyelitis
    • Infection of bone
120
Q

What is lyme disease caused by, what is its appearance, and what is its treatment?

A
  • Lyme disease
    • Caused by bacteria Borrelia burgdorferi
    • Characteristic “bull’s eye” rash
    • Treatment: doxycycline
121
Q

What is aspiration in terms of joints?

A
  • Aspiration = drawing of fluids in joint space
122
Q

What diseases require aspiration and what diseases do not require aspiration? Think which ones swell and which ones do not swell.

A
  • Acute atraumatic swelling differential
    • Effusion (intra-articular) requiring aspiration
      • Septic arthritis, gout, lyme disease, hemarthrosis, reactive arthritis, osteoarthritis
    • No effusion (extra-articular) requiring NO aspiration
      • Cellulitis, bursitis, and necrotizing fasciitis
123
Q

What is flexor tenosynovitis? Where is it located and how is it diagnosed?

A
  • Flexor tenosynovitis
    • At phalanges of hand
    • Kanavel’s Signs
      • Flexed posture, pain with extension, tender over flexor tendon, fusiform swelling (across joint space)
124
Q

What is paronchia? What is it caused by? What is its treatment?

A
  • Paronychia
    • Most common hand infection
    • Caused by S. aureus
    • At distal phalanx
    • Treatment: soaking
125
Q

What is herpetic whitlow?

A
  • Herpetic whitlow
    • Painful vesicles filled with clear fluid and erythema
126
Q

What is a felon and what is it caused by?

A
  • Felon
    • Abscess of distal finger pulp
    • Caused by S. aureus
127
Q

What is a deep hand infection usually caused by?

A
  • Deep hand infection
    • Caused by penetrating injury
128
Q

What is Sporothrix schenckii and what is it generally caused by?

A
  • Sporothrix schenckii
    • Subcutaneous fungal infection
    • Caused by penetrating injury while handling rose thorn
129
Q

How is septic arthritis in children treated? Why is this condition more common in children?

A
  • Septic arthritis
    • Requires I&D
    • More common in kids because bones are more vascularized
130
Q

What is transient synovitis? What often follows after this condition? What is the general treatment?

A
  • Transient synovitis
    • Inflammation of hip capsule
    • Often follows viral infection
    • Treatment: NSAIDs

MSDR (7 decks)

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