Orthopedics--Bannar Flashcards
What is type II collagen found in?
Fibrocartilage.
What are the 3 stages of fracture healing? What meds shouldn’t be given in the 1st stage?
Inflammation: don’t use NSAIDs–>10% of fcn back
Reparative: 40% of fcn back
Remodelling: 70% of fcn back
When do you use an intramedullary rod?
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.
What are some examples of orthopedic emergencies?
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
A problem with which jt concerns us…could require amputation?
knee jt
b/c of the popliteal artery posteriorly.
What is the formula for kinetic energy? How does this apply?
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!
When would you order a CT scan?
If you want to get a better 3D pic of something. Intra-articular injuries.
What is an example of a bone that has limited healing potential & would be better to replace?
femoral neck. better to replace the femoral neck. esp in old people b/c bed rest leads to serious things. arthroplasty.
What is compartment syndrome? What causes the nerve damage & muscle death? What are the common causes?
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
What are the 5Ps of compartment syndrome?
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)
T/F High glucose in your joint is bad.
False. Low glucose in your joint is bad. It means microorganisms are snacking on it.
What are the things you would be looking for after an arthrocentesis?
Cell count- elevated WBC is bad
Culture- aerobic and anaerobic with gram stain
Crystals- uric acid, calcium pyrophosphate
Chemistry- glucose, protein
What is Type I Cartilage found in?
all structural collagen
Virchow’s Triad what is it?
Stasis of blood flow: sit still
Endothelial injury: surgery, trauma
Hypercoagulability: hormone replacement
Diaphysis is full of _____ bone & the metaphysis is full of ______ bone.
D: cortical bone
M: cancellous
Epiphysis is the ____________.
residual cartilage. this is where growth occurs.
If you remove the entire meniscus, what happens?
you get arthritis, bone grinds against bone
Which nerve do you have to be careful of in an LCL injury?
the common peroneal nerve
Which form of diagnostic testing do you use to assess soft tissue injury @ the knee?
MRI
A traumatic blood effusion could happen in which types of situations?
ACL tear
Intra-articular fracture
Osteochondral injury
Peripheral meniscal tear
Is the inner 1/3 or the peripheral 1/3 of the meniscus more reparable usually? Why?
the peripheral 1/3 b/c it has a blood supply. the inner 1/3 would require a menisectomy
Which types of things cause a non-bloody effusion?
articular cartilage, inner portion of the meninscus, extra-articular ligaments (PCL, MCL, LCL)
T/F Cartilage has limited healing potential. We want to protect it if possible.
TRUE.
What do you really worry about with a knee dislocation?
popliteal artery damage
if you feel equal pulses on both sides, you are probably ok
When you are dealing with LCL & PL problems, which nerve do you worry about?
peroneal nerve
What is Osgood-Schlatter Disease?
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.
According to the Salter Harris classification, which fracture types have worse outcomes?
Type III, IV, & V
When is a Salter fracture really bad?
when it involves a growth plate. Then it needs to be lined up perfectly.
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?
hip problem
extra-articular problem
What is varus? When is this normal to see?
when the distal appendage is angled toward the midline
this is normal at birth up until 11/2 years & @ 2-3 years valgus dominates
What is valgus? When is this normal to see?
when the distal appendage is angled away from the midline
this is normal in a 2-3 year old
What are the 3 most important clinical milestones for little ones?
sit up at 6 mo
walk at 1 year
talk at 2 years
T/F Genu valgum & genu varus are the abnormal forms of valgus & varus.
True.
How should you always talk about angulation?
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
What are the 2 things you need for fracture healing? What is the term for not healing?
biology (adequate tissue perfusion) & mechanics (can’t be moving around)
**non union: not healed. malunion: healed in a bad position.
T/F It is a bad sign if you can read print thru an arthrocentesis sample.
False. It is a good sign.
What would happen if you took out the lateral meniscus v. medial meniscus?
if you took out the lateral meniscus you would have a greater risk of arthritis b/c it covers a greater surface
What are the risk factors for a slipped capital femoral epiphysis?
overweight teenage african american male
When we are talking about the capsule, the anterior part is tight with what motion? Which motion makes the posterior part tight?
Anterior Part: external rotation
Posterior Part: internal rotation
What is the most common muscle torn from the rotator cuff?
supraspinatus
What is the most common problem of your shoulder?
anterior dislocation
What is the most common tear of the shoulder with trauma?
inferior glenohumeral ligament
What are the rotator cuff muscles? What is their innervation?
Rotator Cuff: S: supraspinatus-->suprascapular nerve I: infraspinatus-->suprascapular nerve T: Teres Minor-->Axillary Nerve S: subscapularis-->Upper & lower sub scapular nerve
Why is it hard for a femoral neck fracture to heal?
Femoral neck don’t heal b/c interarticular fracture. Synovial fluid invades. Not easy hematoma formation. Other reasons too.
