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Final Med > orthopedics > Flashcards

orthopedics Flashcards

1
Q

definition of a fracture

A

it is a break in the continuity of the bone or cartilage

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2
Q

what will you observe in your physical examination that would make you suspicious of a fracture?

A

inspection- deformity
palpation - boney tenderness, pain
movement- loss of function, abnormal movement

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3
Q

What is the management of a open fracture

A
  1. ABC
  2. circulation control bleeding with pressure dressing removing any foreign debris
  3. immobilization of the joint and splinting (without reduction unless there is vascular compromise)
  4. irrigation with saline
  5. IV abx prophylaxis third generation cephalosporin (Cefuroxime IV 1.5 g) plus metronidazole
  6. tetanus vaccination
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4
Q

what is the main surgical management of a fracture?

A

reduction and internal fixation

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5
Q

What are the stages of bone healing?

A
  1. heamatoma
  2. procallus
  3. callus
  4. remineralisation
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6
Q

How long does it take for a small bone to heal?

A

2months

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7
Q

How long does it take for a long bone to heal?

A

4 months

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8
Q

What would delay union?

A
  1. age elderly
  2. medications- corticosteroids
  3. hypoxia states
  4. hyperthyroidism
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9
Q

What are the complications of a fracture?

A

1.. infection (open) osetomyelitis
2. heamorhage- most pelvis and femor
3. neuromuscular compromise- sacrum cauda equina
distal radium median N
hip dislocation- sciatic
lateral tibial plateau - perineal
shoulder dislocation- axillary
4. avascular necrosis
5. compartment syndrome

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10
Q

What is a shearing of the nerve called

A

neurotomesis

needs micro surgical repair

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11
Q

What injuries are prone to avascular necrosis

A 
Leg 1. femoral head
 foot 2. talus 
 Hand 3. scaphoid 
4. lunate
5. capitate
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12
Q

What are the three principles of damage control?

A

hypothermia
coagulopathy
acidosis

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13
Q

How do you treat complex pain syndrome?

A

MDT physiotherapy

  1. education
  2. modifying risk factors- counseling
  3. medications- bisphosphonates, gabapentin, TCA
  4. surgical sympathectomy
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14
Q

What is the treatment for compartment syndrome

A

fasciotomy

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15
Q

What are the findings on history and examination that point to compartment syndrome?

A
  1. severe pain disproportionate to the injury

2. passive stretching of the muscle increases the pain

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16
Q

What can you use to help in the diagnosis of compartment syndrome?

A

stryker intracompartmental Pressure monitor

greater than 30 mmhg need for urgent fsciotomy less than 12 hours

17
Q

What are the complications of compartment syndrome?

A

myonecrosis
nerve damage
hyperkalemia

18
Q

What criteria do you use for complex pain syndrome?

A

veldmans criteria

  1. pain during exercise, temp difference, color, volume
  2. symptoms increase after limb use
  3. symptoms in a large area that injury site
19
Q

What are the terms that you would use to describe a fracture?

A
  1. open or closed
  2. exact anatomical location
  3. left or right?
  4. proximal, middle or distal?
  5. direction of the fracture line- transverse, oblique, spiral, comminuted
  6. displacement
  7. angulation
  8. complete or incomplete
  9. avulsion
  10. compression
  11. subluxation
20
Q

How long does it take after an injury for the fracture to be seen on plain film?

A

10- 12 days therefore if clinical evidence than will need to treat as if # and then re x ray in 2 weeks

21
Q

why is splinting important?

A

it decreases pain and increases blood flow

22
Q

What is a Colles’ Fracture?

A

Fracture of the distal radius with dorsal displacement and volar angulation, with or without an ulnar styloid fracture.

23
Q

What is the history in a colles fracture?

A

Falling on an outstretched hand

silver fork deformity

24
Q

Smith fracture history

A

extraarticular fracture with volar angulation of the distal segment

fall on an outstretched hand

25
Q

barton’s #

A

intrarticular with posterior displacement of the distal fragment

26
Q

reverse barton’s

A

intra-articular fracture with anterior displacement of the distal fragment

27
Q

What are the complications of a colle’s fracture?

A

malunion
median nerve palsy and carpal tunnel
osetoarthritis
extensor pollicis longus rupture

28
Q

What is the treatment for colles fracture?

A

closed reduction with cast immobilization

if unstable open reduction and internal fixation

29
Q

What are the treatments for a scaphoid fracture?

A

non-surgical splint for 6 weeks with x ray every two weeks
distal segment short arm cast
proximal short arm or long arm cast
proximal portion of the wrist receives blood supply from the distal retrograde

30
Q

what are the complication of a scaphoid fracture?

A

a vascular necrosis
arthritis
nonunion
delayed union

31
Q

What are the characteristic findings on a x ray for osteoarthritis?

A

Loss of joint space
Osteophytes
Subarticular sclerosis
Subcondral cysts

32
Q

what is the treatment for osteoarthritis

A
  1. education
  2. modifying risk factors
    weight loss, physiotherapy, gentle exercise
  3. medical: NSAIDS, duloxetine, intraarticular steroid injections
  4. surgical: total hip or knee replacement (clinical symptoms)

Final Med (35 decks)

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