PCOM Flashcards
1
Q
Classification for Chondral & Osteochondral Injuries to knee
A
Outerbridge Classification
Grade 0= normal
Grade 1 = cartilage w/ softening and swelling
Grade 2 = partial thickness defect w/ fissures on surface that don’t reach subchondral bone or exceed 1.5 cm in diameter
Grade 3 = Fissuring to the level of subchondral bon in an area w/ a diameter more than 1.5 cm
Grade 4 = exposed subchondral bone
2
Q
Order of motion in MUA for shoulder (mnemonic)
A
FEAR
Flexion
Extension
Abduction
Rotation
3
Q
Bipolar vs. Unipolar implant in a hip hemiarthroplasty
A
unipolar - concentric: neck of prosthesis comes out of center of head)
bipolar - eccentric: neck of prosthesis doesn’t necessarily come out of the center
4
Q
Classification of distal Radius Fx
A
Frykman I: extrarticular fx of distal radius II: w/ associated ulnar styloid III: involves radiocarpal joint IV: w/ associated ulnar styloid V: involves DRUJ VI: w/ associated ulnar styloid VII: involves radoiocarpal joint AND DRUJ VIII w/ associated ulnar styloid
5
Q
Things to consider in distal radial fracture
A
open vs. closed displacement angulation comminution loss of radial length
6
Q
Smith vs Colles fracture
A
Colles: distal radius fracture, dorsal angulation (apex volar), dorsal displacement, radial shift, radial shortening, “dinner fork deformity”
Smith: reverse colles - volar angulation (apex dorsal) “garden spade”
7
Q
What are the 4 compartments in the leg?
A
Anterior
Lateral
Superficial posterior
Deep posterior
8
Q
Contents of anterior compartment of leg?
A
N: deep peroneal nerve
A: ant tibial artery
M: tibialis anterior, EHL, EDL, peroneus tertius
9
Q
Contents of lateral compartment of leg?
A
N: superficial fibular nerve
M:peroneus longus, peroneus brevis
10
Q
Contents of superficial posterior leg?
A
N: sural nerve
M: gastroc, soleus, plantaris
11
Q
Contents of deep posterior leg?
A
N: tibial
A: post tibial artery
M: Tibialis posterior, FHL, FDL, popliteus
12
Q
What are the three compartments of the thigh?
A
Anterior, medial, posterior
13
Q
Contents of anterior thigh
A
quadriceps mm (rectus femoris, vastus lateralis, vastus intermedius, vastus medialis)
14
Q
contents of posterior thigh
A
biceps femoris
semitendinosis
semimembranosis
sciatic nerve
15
Q
contents of medial thigh
A
adductor magnus adductor longus adductor brevis gracilis pectineus obturator externus femoral vessels
16
Q
What are the compartments of the forearm?
A
anterior
- superficial
- middle
- deep
Posterior
- superficial
- deep
17
Q
Contents of anterior superficial compartment of forearm
A
pronator teres
FCR
FCU
palmaris longus
18
Q
contents of anterior middle compartment of forearm
A
flexor digitorum superficialis
19
Q
contents of anterior deep compartment of forearm
A
flexor digitorum profundus
flexor pollicis longus
pronator quadratus
20
Q
contents of posterior superficial compartment of forearm
A
anconeus extensor digitorum [communis] extensor digiti minimi extensor carpi ulnaris **** look up extensor carpi radials
21
Q
contents of posterior deep compartment of forearm
A
supinator
extensor pollicus longus
extensor pollicus brevis
extensor indicis proprius
22
Q
what are the 10 compartments of the hand
A
thenar hypothenar adductor pollicus dorsal interosseus x 4 palmar interosseus x 3
23
Q
contents of the thenar compartment of hand
A
abductor pollicus
flexor pollicus brevis
oponens pollicis
ALL FOR ONE
24
Q
contents of the hypothenar compartment of hand
A
opponens digiti minimi
flexor digiti minimi
abductor digiti minimi
ONE FOR ALL
25
how many layers of the foot are there?
4ish (4 beneath the plantar fascia)
```
Plantar fascia
1
-abductor hallicus
-flexor digitorum brevis
-abductor digiti minimi
2
- quadratus plantae
- lumbricals
-FHL and FDL tendons
3
-flexor hallicus brevis
-adductor hallicus
- flexor digiti minimi brevis
4
-planter interossei
-dorsal interossei
-peroneus longus tendon
-tibialis posterior tendon
```
26
What are the 7 compartments of the foot?
```
medial
lateral
superficial central
deep central
adductor
interosseus 1-2
interosseus 2-3, 3-4, 4-5
```
27
contents of medial compartment of foot
abductor hallucis
flexor hallucis brevis
FHL tendon
28
contents of lateral compartment of foot
abductor digiti minimi
| flexor digiti minimi
29
contents of superficial central compartment of foot
flexor digitorum brevis
lumbricals
FDL tendons
30
contents of deep central compartment of foot
quadratus plantae
| posterior tibial neurovascular bundle
31
contents of adductor compartment of foot
adductor hallucis
32
contents of first interosseus compartment of foot vs second, third, and fourth interosseus compartment
interosseus 1-2 = dorsal interosseus muscle
interosseus 2-3, 3-4, 4-5 = dorsal & plantar interosseus muscles
33
Schatzker Classification of Tibial plateau fractures
1: split fx lateral condyle
2: split & depression fx lateral condyle
3: depression fx lateral condyle
4: split fx medial condyle
5: bicondylar split
6: plateau fx w/ separation of diaphysis from metaphysis
most common: schatzker 2
34
MC associated injury with tibial plate fx? second most common?
lateral meniscus tear
MCL tear
*bonus: arterial disruption is most commonly seen with schatzker 4. the mechanism of injury for arterial disruption is shearing forces that occur during dislocation.
35
Salter Harris Classification
```
*pediatrics
I: transphyseal
II: transphyseal, exits the metaphysis
III: transphyseal, exits epiphysis
IV: transphyseal, through metaphysics and epiphysis
V: crushed physis
```
36
Salter Harris prognosis
```
*pediatrics
I: good
II: ?
III: ?
IV: poor
V: poor
```
37
5 P's of compartment syndrome
```
pain w/ passive movement (or out of proportion??)
pallor
pulselessness
parasthesia
paralysis
```
-poikilothermic???
38
Rotator cuff muscles (mnemonic)
```
SITS
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
```
39
Actions of Rotator cuff muscles
Supraspinatus - abduction
infraspinatus - ext rotation
teres minor - ext rotation
Subscap - int rotation
infra and minor - the words sound like smaller or lesser, meaning they need to work together for one action -> both of them do external rotation
40
Two classifications of femoral neck fxs are?
Garden and Pauwel
41
Garden classification
Femoral neck
Garden 1 - non displaced, incomplete, valgus impacted
Garden 2 - non displaced, complete (non displaced on AP & lat)
Garden 3 - partially displaced, complete*** look up
Garden 4 - completely displaced
42
Treatment of femoral neck fx based on Garden classification
```
Garden 1 (non displaced, incomplete, valgus impacted)
- 3 cancellous screws to prevent displacement
```
```
Garden 2 (non displaced, complete)
- 3 cancellous screws
```
```
Garden 3 (partially displaced, complete)
- hemi vs total hip arthroplasty
```
```
Garden 4 (completely displaced)
- hemi vs total hip arthroplasty
```
43
Pauwel Classification
Femoral Neck Fractures
Pauwel 1: <30 deg angle
Pauwel 2: 30-50 deg angle
Pauwel 3: >70 deg angle
*** look this up for clarification
44
Terrible triad of the elbow
posterior dislocation
radial head fx
fx of coronoid process
45
measurements/ lines that you evaluate in distal radius
```
radial inclination
- normal = 23
radial height
- normal = 12
volar tilt
- normal= 11
```
46
What is Double Crush Syndrome?
multi level lesions along a peripheral nerve can occur. Presence of more pro lesion seems to render distal nerve trunk more vulnerable to compression
in carpal tunnel study - surgical release of double crush groups had poorer outcomes.
both entrapments may require treatment for optimal results.
47
What are the 3 stages of Carpal tunnel syndrome
Based on severity
Stage 1 - numbness, pain and tingling. mostly at night, + relief w/ shaking hand
Stage 2 - symptoms also during day w/ prolonged positions/ repetitive hand movements. + weakness (pt reports dropping things)
Stage 3 - atrophy, shrinking of muscles. tingling may no longer be present d/t severe nerve damage
48
Describe Bowstring Test for Sciatica
Pt supine. knee flexed 90 and placed on examiner's shoulder. Examiner places fingers in popliteal space behind knee, apply pressure
+ test = tingling burning sensation in hip and buttocks
49
What does SLAC stand for?
Scaphoid Lunate Advanced Collapse
50
Describe what SLAC is
a condition of progressive instability --> advanced arthritis of radoiocarpal and mid carpal joints.
degenerative arthritis seen in chronic dissociation btwn scaphoid and lunate
51
Describe the pathoanatomy of SLAC
chronic SL ligament injury --> dorsal intercalated segmental instability (DISI).
The scapholunate ligament no longer restrains articulation between the two bones --> scaphoid flexed and lunate extended
- scapholunate angle >70
- lunate extended >10 deg past neutral
Resultant SCAPHOID FLEXION and LUNATE EXTENSION --> abnormal distribution of forces across mid carpal and radoiocarpal joints & malalignment of concentric joint surfaces
Initially affects radioscaphoid joint and progresses to capitolunate joint.
52
This classification describes predicatable progression of degenerative changes from radial styloid to the entire scaphoid facet and finally to the unstable capitulant joint, as the capitate subluxates dorsally on the lunate.
what is the key finding ?
Watson classification
key finding: radiolunate joint is spared (unlike other forms of wrist arthritis) b/c there is a concentric articulation between the lunate and the spheroid lunate fossa of the distal radius.
53
Describe the Watson stages
Stage 1 - arthritis btwn scaphoid and radial styloid
Stage 2 - between scaphoid and entire scaphoid facet of radius
Stage 3 - between capitate and lunate
*radiolunate joint spared
54
What is the peek-a-boo sign
heel pad seen easily from front w/ pt standing and feet pointing straight ahead.
Normally heel pad isn't visible on medial side of the foot when viewed from the front b/c of valgus positioning of the normal heel (places heel pad behind normal hind foot)
55
What 12 things should be in an op note?
1. preop dx
2. postop dx
3. procedure
4. surgeon
5. assistant
6. EBL/ TBL
7. Anesthesia
8. fluids - IV, foley ouput
9. Drains
10. complications
11. condition
12. Disposition; to pacu
56
What 7 things do you need for preop?
1. consent
2. NPO @ midnight
3. IVF
4. hold anticoag
5. abx
6. add to OR schedule
7. med/ cardio clearance
57
what 7 things should you KNOW about pts?
1. activity - wb status
2. analgesia - pain meds
3. abx
4. anticoag
5. hgb and INR
6. cultures
7. studies - MRI, CT, pending
58
Admit orders
```
A. admit to - my name, admitting and referring doc, needs, competent
D. diagnosis - list w/ primary
C - condition and code status
V - vital signs, frequency
A. Allergies and rxns
N. nursing orders
D. diet
A. activity, level, fall risk
L. labs
I. IV fluids, maintenance 30 cc/ kg/ 24 hr, oral when possible
S. special, DVT ppx
M. meds, all prehospital meds
```
D. discharge planning, goals, discharge criteria
59
What is a barton fx?
fx/ dislocation with dorsal or volar rim of distal radius
*distinguished from colles or smith by intraarticular involvement.
60
Acceptable distal radius reductions
- radial length: w/in 2-3 mm of contralat wrist (MOST IMPORTANT)
- palmar tilt: neutral to 10 deg volar tilt (dorsal angulation)
- intraarticular step off: <2mm
- radial inclination: <5 degree loss
61
how is carpal alignment measured?
intersection of 2 lines in lateral XR:
parallel thru middle of radial shaft and parallel to capitate
should intersect with carpus
62
Describe the displacing forces in a proximal humerus fx
prox humerus retroverted 35-40 degrees relative to epicondylar axis
Greater Tuberosity: disp sup and post by supraspinatus and ext rotators
Lesser Tuberosity: disp medially by subscapularis
Shaft: disp medially by pec minor
Prox segment: abducted by deltoid
63
What is the bluod supply to the proximal humerus
ANT and post humeral circumflex artery. via interosseus arcuate artery
64
what lies in the quadrangular space that can be damaged in pro humerus injury
axillary nerve. test sensation over deltoid
65
What classification is used for proximal humerus fx? What are the 4 parts?
```
Neer classification
greater tuberosity
lesser tuberosity
humeral shaft
humeral head
```
66
What is considered a part in the near classification of proximal humerus fx?
if displaced > 1cm or 45 deg angulation
67
Describe Neer classification for proximal humerus fx's.
Type 1: 1 part, no displaced fragments w/ any # fx lines
Type 2: 2 part fx: anatomic neck, surgical neck, greater tuberosity, lesser tuberosity
Type 3: 3 part fx: surgical neck w/ greater tuberosity, surgical neck w/ lesser tuberosity
Type 4: 4 part fx: all 4 displaced
Fx: dislocation
68
what kind of ex's of the articular surface occur in the shoulder joint?
impression fx
hill- sachs
Reverse hill sachs (w/ post dislocation)
69
In prox humerus fx when do you perform ORIF
GT gets ORIF if displaced 5mm
| LT gets ORIF only if fragment locks int rotation
70
what nerve is injured with damage to acetabulum?
sciatic nerve injury, peroneal division
71
what line represents the ant column of the acetabulum?
iliopubic: iliac crest to pubic symphysis. has ant wall acetabulum
72
what line represents the posterior column of acetabulum
ilioischial: superior gluteal notch to ischial tuberosity, has post wall acetabulum and acetabular dome
73
what is the corona mortis
vascular communication btwn ext iliac or deep inf epigastric and obturator 10-15% of pst *****
74
what is the blood supply to the femoral head?
ascending branch of medial circumflex, is deep to quadrates femoris
75
where does the sup gluteal NV bundle exit?
greater sciatic notch
76
eval in acetabular fx
EVAL - major trauma, check sciatic nerve (esp post column injury) and femoral A&N (ant column)
77
Describe imaging of pelvis when evaluating acetabulum
AP:
iliopectineal line (ant column)
ilioischial line (post column)
medial teardrop
Judet:
iliac oblique - 45 degree ext rotation. shows post column ilioischial line) and ant wall)
obturator oblique - 45 degree int rotation. shows ant column (iliopectineal line) and post wall
78
What is the classification of acetabulum fx?
Judet- Letournal
79
What are the elementary Judet letournal fxs?
```
Post wall
Post column
ant wall
ant column
Transverse
- transtectal
- juxtatectal
- infratectal
```
80
what are the associated Judet letournal fxs?
```
T shaped
post column and post wall
Transvers and post wall
ant column + post hemitransverse
both column
```
81
describe the 3 types of transverse acetabular fxs
transtectal - through acetab dome
juxtatectal - through jxn of acetab dome and fossa acetabuli
infratectal - through fossa acetabuli
