Orthopedics

Question 1

What are the Kocher criteria?

Answer 1

1) non-weight bearing status on the affected side
2) ESR >40
3) fever
4) WBC >12

Question 2

What are the probabilities of a septic joint with the following Kocher criteria?
1/4
2/4
3/4
4/4

Answer 2

1/4: 3%
2/4: 40%
3/4: 93%
4/4: 99%

Question 3

What is Sever’s disease?

Answer 3

Calcaneus apophysitis

Question 4

How do you treat kingella kingae osteomyelitis?

Answer 4

Clindamycin

Question 5

What is spondylolysis?

Answer 5

Pars interarticularis defect

Question 6

What is spondylolisthesis?

Answer 6

L5-S1 anterior displacement

Question 7

What should you consider with a limp, sub-acute non-focal back pain, refusal to walk, difficulty sitting upright and perhaps hip pain?

Answer 7

Discitis!

Question 8

What is the name of traction apophisitis at the inferior pole of the patella at the infrapatellar tendon?

Answer 8

Larsen-Johansson disease

Question 9

How do you diagnose developmental hip dysplasia?

Answer 9

U/S if <4 months, x-rays thereafter

abnormal abduction, abnormal skin folds, limb length discrepancy

Question 10

What is the first line antibiotic of choice for septic arthritis?
What are the top three bugs?

Answer 10

Cefazolin! In the US: clindamycin (MRSA)

S. aureus
Kingella kingae
S. pyogenes (GAS)

Question 11

What do you call an abscess in the deep space of the finger?

Answer 11

Felon

Question 12

What do you call an osteonecrosis of the subchondral bone secondary to overuse?
How do you manage it?

Answer 12

osteochondritis dissecans

start with restricted activity
then immobilization and non-WB
then laparascopic repair unstable joint or free floating bone

Question 13

How do you treat Lyme arthritis?

Answer 13

Doxycycline po x 1 month

Question 14

If you spot a bony tumour and cortical destruction, how should you manage?

Answer 14

Do not weight bear!

Refer to orthopedics

Question 15

What is the line to interpret a cervical pseudosubluxation?

Answer 15

the line of Swishuk!
used to distinguish between C2-C3 pseudosubluxation VS Hangman’s fracture
If the delta is >2mm then it is abnormal!

Question 16

What is a Monteggia injury?

Answer 16

ulnar fracture with radial head dislocation

Question 17

What is a Galeazzi fracture?

Answer 17

radial fracture with ulnar head dislocation

Question 18

What is the Ottawa ankle rule?

Answer 18

An ankle X-Ray series is only required if there is any pain in the malleolar zone and…
Bone tenderness at the posterior edge or tip of the lateral malleolus (A)
OR
Bone tenderness at the posterior edge or tip of the medial malleolus (B)
OR
An inability to bear weight both immediately and in the emergency department for four steps

Question 19

What is the Ottawa foot rule?

Answer 19

A foot X-Ray series is only required if there is any pain the midfoot zone and…
Bone tenderness at the base of the fifth metatarsal (C)
OR
Bone tenderness at the navicular (D)
OR
And inability to bear weight both immediately and in the emergency department for four steps

Question 20

What are two possible injury complications of a shoulder dislocation?

Answer 20

Hill Sachs deformity: compression fracture of the posterolateral humerus
Bankhart lesion: detached antero-inferior part of the labrum from the glenoid

Question 21

What are potential complications of an acute patellar dislocation?

Answer 21

osteochondral fracture of the femoral condyles or tibial plateau (best seen on MRI)

Question 22

What distinguishes a greenstick from a torus fracture?

Answer 22

greenstick: only one side of the cortex is broken
torus: buckle fracture, cortex intact

Question 23

What distinguishes a Tillaux fracture from a Triplane fracture?

Answer 23

The lack of a fracture component in the coronal plane (evaluated with lateral x-ray or CT) distinguishes a Tillaux fracture from a triplanar fracture.