Orthopedics--Bannar

Question 1

What is type II collagen found in?

Answer 1

Fibrocartilage.

Question 2

What are the 3 stages of fracture healing? What meds shouldn’t be given in the 1st stage?

Answer 2

Inflammation: don’t use NSAIDs–>10% of fcn back
Reparative: 40% of fcn back
Remodelling: 70% of fcn back

Question 3

When do you use an intramedullary rod?

Answer 3

For diaphyseal fractures to allow early mobilization. Like in the tibia. The hematoma isn’t disrupted. Added mechanical stability. They can stay in there forever. Not a huge effect on hematopoiesis.

Question 4

What are some examples of orthopedic emergencies?

Answer 4

Fractures that are open & include a neurovascular injury
compartment syndrome
dislocations @ the hip, knee, ankle, shoulder, elbow
septic jts
Septic tenosynovitis: infection in flexor tendon sheath

Question 5

A problem with which jt concerns us…could require amputation?

Answer 5

knee jt

b/c of the popliteal artery posteriorly.

Question 6

What is the formula for kinetic energy? How does this apply?

Answer 6

kinetic energy=1/2mass(velocity)^2
**even if it is something simple like a fibular fracture, if it was from 5 floors above…a lot of bad energy transferred. Be worried about everything!

Question 7

When would you order a CT scan?

Answer 7

If you want to get a better 3D pic of something. Intra-articular injuries.

Question 8

What is an example of a bone that has limited healing potential & would be better to replace?

Answer 8

femoral neck. better to replace the femoral neck. esp in old people b/c bed rest leads to serious things. arthroplasty.

Question 9

What is compartment syndrome? What causes the nerve damage & muscle death? What are the common causes?

Answer 9

Serious condition of increased pressure inside a facial compartment

Decreased perfusion leads to nerve damage and muscle death

Most common cause is trauma, fractures, crush injury and increased risk with anticoagulants

Question 10

What are the 5Ps of compartment syndrome?

Answer 10

Pain (early finding)--pain on passive stretch of the muscle in the affected compartment. Anterior compartment syndrome suspected. You flex their toes & if they have increased pain-->be concerned. 
Paresthesia (earlier finding)
Palor (late finding)
Paralysis (late finding)
pulselessness (late finding)

Question 11

T/F High glucose in your joint is bad.

Answer 11

False. Low glucose in your joint is bad. It means microorganisms are snacking on it.

Question 12

What are the things you would be looking for after an arthrocentesis?

Answer 12

Cell count- elevated WBC is bad
Culture- aerobic and anaerobic with gram stain
Crystals- uric acid, calcium pyrophosphate
Chemistry- glucose, protein

Question 13

What is Type I Cartilage found in?

Answer 13

all structural collagen

Question 14

Virchow’s Triad what is it?

Answer 14

Stasis of blood flow: sit still
Endothelial injury: surgery, trauma
Hypercoagulability: hormone replacement

Question 15

Diaphysis is full of _____ bone & the metaphysis is full of ______ bone.

Answer 15

D: cortical bone
M: cancellous

Question 16

Epiphysis is the ____________.

Answer 16

residual cartilage. this is where growth occurs.

Question 17

If you remove the entire meniscus, what happens?

Answer 17

you get arthritis, bone grinds against bone

Question 18

Which nerve do you have to be careful of in an LCL injury?

Answer 18

the common peroneal nerve

Question 19

Which form of diagnostic testing do you use to assess soft tissue injury @ the knee?

Answer 19

MRI

Question 20

A traumatic blood effusion could happen in which types of situations?

Answer 20

ACL tear
Intra-articular fracture
Osteochondral injury
Peripheral meniscal tear

Question 21

Is the inner 1/3 or the peripheral 1/3 of the meniscus more reparable usually? Why?

Answer 21

the peripheral 1/3 b/c it has a blood supply. the inner 1/3 would require a menisectomy

Question 22

Which types of things cause a non-bloody effusion?

Answer 22

articular cartilage, inner portion of the meninscus, extra-articular ligaments (PCL, MCL, LCL)

Question 23

T/F Cartilage has limited healing potential. We want to protect it if possible.

Answer 23

TRUE.

Question 24

What do you really worry about with a knee dislocation?

Answer 24

popliteal artery damage

if you feel equal pulses on both sides, you are probably ok

Question 25

When you are dealing with LCL & PL problems, which nerve do you worry about?

Answer 25

peroneal nerve

Question 26

What is Osgood-Schlatter Disease?

Answer 26

Secondary to repetitive microtrauma

More tension on your muscle & pulling on the tibial tubercle. Common around the growth spurt 10-12 years of age.

This is caused by overuse. Quad stronger & you are getting longer. Growth plate is the weak link.

Question 27

According to the Salter Harris classification, which fracture types have worse outcomes?

Answer 27

Type III, IV, & V

Question 28

When is a Salter fracture really bad?

Answer 28

when it involves a growth plate. Then it needs to be lined up perfectly.

Question 29

Anterior knee pain may not be a knee problem. It could be an issue of referred pain. What are 2 other things you need to consider with this?

Answer 29

hip problem

extra-articular problem

Question 30

What is varus? When is this normal to see?

Answer 30

when the distal appendage is angled toward the midline

this is normal at birth up until 11/2 years & @ 2-3 years valgus dominates

Question 31

What is valgus? When is this normal to see?

Answer 31

when the distal appendage is angled away from the midline

this is normal in a 2-3 year old

Question 32

What are the 3 most important clinical milestones for little ones?

Answer 32

sit up at 6 mo
walk at 1 year
talk at 2 years

Question 33

T/F Genu valgum & genu varus are the abnormal forms of valgus & varus.

Answer 33

True.

Question 34

How should you always talk about angulation?

Answer 34

talk about it in terms of the distal relative to the proximal
also want to know if it is inside the joint or outside the joint

Question 35

What are the 2 things you need for fracture healing? What is the term for not healing?

Answer 35

biology (adequate tissue perfusion) & mechanics (can’t be moving around)
**non union: not healed. malunion: healed in a bad position.

Question 36

T/F It is a bad sign if you can read print thru an arthrocentesis sample.

Answer 36

False. It is a good sign.

Question 37

What would happen if you took out the lateral meniscus v. medial meniscus?

Answer 37

if you took out the lateral meniscus you would have a greater risk of arthritis b/c it covers a greater surface

Question 38

What are the risk factors for a slipped capital femoral epiphysis?

Answer 38

overweight teenage african american male

Question 39

When we are talking about the capsule, the anterior part is tight with what motion? Which motion makes the posterior part tight?

Answer 39

Anterior Part: external rotation

Posterior Part: internal rotation

Question 40

What is the most common muscle torn from the rotator cuff?

Answer 40

supraspinatus

Question 41

What is the most common problem of your shoulder?

Answer 41

anterior dislocation

Question 42

What is the most common tear of the shoulder with trauma?

Answer 42

inferior glenohumeral ligament

Question 43

What are the rotator cuff muscles? What is their innervation?

Answer 43

Rotator Cuff:
S: supraspinatus-->suprascapular nerve
I: infraspinatus-->suprascapular nerve
T: Teres Minor-->Axillary Nerve
S: subscapularis-->Upper & lower sub scapular nerve

Question 44

Why is it hard for a femoral neck fracture to heal?

Answer 44

Femoral neck don’t heal b/c interarticular fracture. Synovial fluid invades. Not easy hematoma formation. Other reasons too.