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Orthopedics > Pimp questions > Flashcards

Pimp questions Flashcards

1
Q

Pathophysiology behind a buckle fracture

A

The junction between the metaphysis and diaphysis is more vascular and porous in kids. It is a weak spot.

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2
Q

Muscles that attach at the pes anserinus

A

SGT FOT Sartorious, Gracilis, Semitendiosus muscles innervated by Femoral, Obturator, and Tibial nerve respectively.

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3
Q

Name the Lateral tubercle of the tibia and what attaches to it.

A

Gerdy’s tubercle, IT band inserts into it.

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4
Q

What is the proximal muscle that is retracted during plating of a distal radius fracture?

A

Pronator muscle

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5
Q

Supinators of the wrist?

A

Biceps muscle, brachioradialis, supinator

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6
Q

Terry Thomas sign

A

An increase in the scapholunate space on an AP radiograph of the wrist (or coronal CT). The increased distance indicates scapholunate dissociation (often with rotary subluxation of the scaphoid) due to ligamentous injury. There is no consensus as to what measurement constitutes widening, but a cut-off of 3 or 4 mm is reasonable in most cases.

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7
Q

What are the layers of the growth plate?

A

reserve zone, proliferative zone, hypertrophic zone, zone of provisional calcification

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8
Q

What layer does the Salter Harris fracture occur?

A

Zone of Hypertrophy

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9
Q

What is the Tip to Apex distance?

A

The sum of the distance from the tip of the lag screw to the apex of the femoral head on the AP and lateral X-rays. (measured in mm) baumgartner paper

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10
Q

Why wait for EMG study after nerve injury?

A

Mullerian degeneration must occur first. This can take 4-6 weeks.

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11
Q

What is a Fabella

A

Ossification in the popliteal fossa

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12
Q

SALTER Harris mnemonic

A

S-Slip through plate Type I A-Above epiphysis Type II L-Lower (below epiphysis) Type III TE-Through Everything Type IV R- Rammed (crushed) Type V

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13
Q

Complication of radial head Fracture?

A

Restricted motion

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14
Q

What is the distal radius colles fracture classification?

A

Frykman Classification

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15
Q

Frykman classification types?

A

type I : transverse metaphyseal fracture. This includes both a Colles and Smith fracture as angulation is not a feature type II : type I + ulnar styloid fracture type III : fracture involves the radiocarpal joint. This includes both a Barton and reverse Barton fractures. type IV : type III + ulnar styloid fracture type V : transverse fracture involves distal radioulnar joint type VI : type V + ulnar styloid fracture type VII : comminuted fracture with involvement of both the radiocarpal and radioulnar joints type VIII : type VII + ulnar styloid fracture

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16
Q

Appropriate size of lag screw?

A

2.5-3x the length of the fracture

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17
Q

Septic joint lab values

A

CRP>5 ESR>30 (this stays elevated longer than CRP) WBC>10 LDH>250 (sensitive for infection)

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18
Q

What to do for open fracture?

A
  1. Trauma survey 2. Early IV antibiotics and tetanus shot 3. direct pressure to control bleeding 4. assess soft tissue damage and neuromuscular exam 5. Move gross debris, place sterile saline soaked dressing on site. 6. Stabilize with splint 7. Surgery with low pressure lavage
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19
Q

What is the Intra capsular Hip fracture classification system?

A

Garden Classification

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20
Q

Garden classification type I

A

I-Incomplete or impacted bone injury w/ valgus angulation of distal component.

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21
Q

What makes an intertrochanteric fracture stable?

A

Intertrochanteric fx is stable when the posteromedial cortex remains intact or has minimal comminution making it possible to obtain and maintain a stable reduction.

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22
Q

What makes an intertrochanteric fracture unstable?

A

Greater comminution of posteromedial cortex Reverse obliquity pattern is unstable b/c of the tendency for medial displacement of femoral shaft (fx extends from medial cortex proximally to lateral cortex distally)

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23
Q

What is a Torus (buckle) fracture?

A

Concave cortex compresses (buckles), convex/tension side: intact

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24
Q

What is a greenstick fracture?

A

Convex/tension side fracture/plastic deformity, concave cortex intact–(reduce if >10 degrees of angulation).

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25
Q

6 lines of pelvis

A

iliopectineal ilioischial teardrop roof (dome) Ant. Wall Post Wall

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26
Q

Normal measurements for the wrist

A
  • 23(22) degrees of radial inclination - 11 mm radial height - 11 degrees of volar tilt
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27
Q

Smith Fracture

A

Volar displacement (apex dorsal)

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28
Q

Barton Fracture

A

fx/dislocation of wrist in which dorsal or volar rim of distal radius is displaced with hand and carpus. Volar is more common.

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29
Q

Chauffeur fracture

A

Radial styloid fracture

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30
Q

Monteggia Fracture

A

Fracture of the proximal ulna accompanied by radial head dislocation classification–Bado (anterior angulation and dislocation most common)

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31
Q

Monteggia Fracture Bado Classification types

A
  1. Ant dislocation of radial head w/ fx of ulnar diaphysis at any level w/ anterior angulation
  2. Post dislocation of radial head w/ fx of ulnar diaphysis w/ posterior angulation.
  3. Lateral dislocation of radial head w/ fx of ulnar metaphysis
  4. Ant dislocation of radial head with both bone fx w/ in proximal third at same level.
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32
Q

Galeazzi/Piedmont Fracture

A

Fracture of the radial diaphysis at the junction of the middle and distal 1/3 with disruption of the DRUJ “A fracture of necessity” because it requires ORIF to achieve a good result Classification- by mechanism

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33
Q

Galeazzi/Piedmont classification types

A

Pronation-Galeazzi-FOOSH with forearm pronation. Direct trauma to the dorsolateral aspect of the wrist. Supination-Reverse Galeazzi-FOOSH with forearm supination. ULNA shaft fx with DRUJ dislocation

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34
Q

olecranon fracture Classification

A

Colton classification undisplaced:

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35
Q

Name the Supracondylar humerus Fx classification system

A

Gartland classification Extension (95%) vs Flexion

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36
Q

Compartments of Forearm

A

3 in total -volar - most commonly affected - dorsal - mobile wad (lateral) rarely involved, muscles - brachioradialis, extensor carpi radialis longus, extensor carpi radialis brevis

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37
Q

Hand compartments

A

10 in total hypothenar thenar adductor pollicis dorsal interosseous (x4) volar (palmar) interosseous (x3)

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38
Q

Radial Head Fx classification

A

Mason Classification I: minimally displaced fx, no mechanical block to rotation, II: marginal fractures with displacement (impact ion, depression, angulation), possible mechanical block to forearm rotation III:comminuted and displaced fx involving entire head, mechanical block to motion IV: (Hotchkiss modification) radial head fx with elbow dislocation.

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39
Q

Extensor compartments of wrist

A

I EPB, APL II ECRB, ECRL III EPL IV E Digitorum, E Indicis V E digiti minimi VI ECU

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40
Q

Boundaries of shoulder quadrangular space

A

Teres minor, major, long head of triceps and humerus.

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41
Q

What structure(s) pass through quadrangular space of shoulder

A

posterior humeral circumflex artery, Axillary nerve.

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42
Q

What are borders of triangular interval

A

Teres major, long and lateral heads of triceps

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43
Q

What structure(s) pass through triangular interval

A

Radial nerve, deep brachial artery

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44
Q

What are borders of triangular space

A

Theres major, minor, long head of triceps

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45
Q

What structure(s) pass through Triangular space?

A

Scapular circumflex artery

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46
Q

Most common entrapment spots of Ulnar nerve in cubital tunnel syndrome?

A
  • b/t two heads of FCU/aponeurosis(most common), arcade of struthers, b/t osborns ligament and MCL,
  • less common: medial intermuscular septum
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47
Q

Supraspinatus innervation?

A

suprascapular nerve

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48
Q

Infraspinatus innervation?

A

Suprascapular nerve

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49
Q

Teres minor innervation

A

axillary nerve

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50
Q

subscapularis innervation

A

upper and lower sub scapular nerves

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51
Q

Name the femoral head Fx classification system?

A

Pipkin classification

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52
Q

Type I pipkin Fx

A

hip dislocation w/ fx of femoral head inferior to fovea capitis

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53
Q

Type II pipkin fx

A

Type I w/ fx superior to fovea capitis

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54
Q

Type III pipkin fx

A

Type I or II w/ fx of the femoral neck

55
Q

Type IV pipkin fx

A

Type I or II w/ fx of the acetabular rim

56
Q

3 types of femoral neck fracture?

A

subcapital, transcervical, basicervical

57
Q

Pauwel femoral neck classification

A

(angle of fx from the horizontal plane? type I: 30 degrees Type II: 50 degrees Type III: 70 degrees

58
Q

Garden classification Type II

A

II-Complete (across whole neck) - undisplaced

59
Q

Garden classification type III

A

III-Complete - partially displaced

60
Q

Garden classification type IV

A

IV- Complete -Totally displaced

61
Q

Evans classification system

A

classifies intertrochanteric fx.

62
Q

Evans classification type I

A

stable (post-medial cortex intact)

63
Q

Evans classification type II

A

unstable (post-medial cortex disrupted)

64
Q

Evans classification type III

A

Reverse obliquity-unstable-(cephalomedullary nail)

65
Q

Tip Apex Distance (TAD)

A

The sum of the distance from the tip of the lag screw to the apex of the femoral head on the AP and lateral X-rays. (measure in mm) - baumgartner paper

66
Q

What is classification system for tibial plateau fx

A

schatzker classification

67
Q

schatzker Type I

A

Lateral plateau, split fx

68
Q

schatzker Type II

A

Lateral plateau, split depression fx

69
Q

schatzker Type III

A

Lateral plateau, depression fx

70
Q

schatzker type IV

A

Meidal plateau fx

71
Q

schatzker type V

A

bicondylar plateau fx

72
Q

schatzker type VI

A

plateau fx with separation of the metaphysics from the diaphysis-comminuted

73
Q

Anterior compartment of leg

A

Tib ant, EHL, EDL, peroneous tertius, deep peroneal n; ant tib artery, vein

74
Q

lateral compartment of leg

A

peroneous longus, peroneus brevis, superficial peroneal nerve

75
Q

supero posterior compartment of leg

A

gastrocemius, soleus, plantaris

76
Q

deep posterior compartment of leg

A

popliteus, FHL, FDL, Tib posterior, Tib nerve, post tib artery, vein, peroneous artery, vein

77
Q

ankle fracture classification system

A

Lauge-Hansen - 4 types with subdivided stages

78
Q

Maisonneuve fracture

A

complete syndesmosis disruption with diastasis and proximal fibula fracture

79
Q

Plafond Fx classification system

A

Ruedi and Allgower

80
Q

plafond fx R&A type I

A

nondisplaced cleavage fx

81
Q

plafond fx R&A type II

A

Displaced fx w/ extension into articular surface

82
Q

Rudi and allgower type III

A

pilon fracture; displaced fx w/ significant articular comminution and metaphysical impaction.

83
Q

Jones Fracture

A

Fx at the metaphyseal/diaphyseal junction of the 5th metatarsal

84
Q

jones avulsion fx

A

base of 5th Metatarsal avulsion fracture

85
Q

Open fracture classification system

A

Gustilo and Anderson classification

86
Q

Gustilo and Anderson classification Type I

A

Clean skin opening, minimal muscle contusion; low energy simple spiral or short oblique fx

87
Q

Gustilo and Anderson classification type II

A

1-10 cm, w/ more extensive soft tissue damage; min to moderate crush component; simp transverse or short oblique fx’s w/ min comminution

88
Q

Gustilo and Anderson classification type IIIA

A

extensive soft tissue laceration,adequate bone coverage;segmental fxs, gunshot injuries, minimal periosteal stripping

89
Q

Gustilo and Anderson classification type IIIB

A

extensive soft tissue injury with periosteal stripping and bone exposure requiring soft tissue flap closure, usually associated with massive contamination

90
Q

Gustilo and Anderson classification type IIIC

A

Large wound with major arterial injury requiring repair

91
Q

what nerve innervates pronator quadratus?

A

Anterior interosseous nerve (branch of median nerve)

92
Q

what nerve causes hip pain referred to knee

A

obturator nerve

93
Q

what nerve innervates tensor fascia lat?

A

inferior gluteal nerve (also the glut max) (sup gluteal-> glut min and med)

94
Q

In acute ACL tear are you more likely to see a medial or lateral meniscal tear?

A

Lateral; (chronic ACL>medial)

95
Q

where is the popliteal artery located at the joint line

A

lateral to the center axis

96
Q

what position does the lower extremity need to be if you are worried about foot drop?

A

Ext at hip, flexion at knee

97
Q

What is at risk in a distal fibula ORIF?

A

Sup peroneal nerve

98
Q

Which tendon in the first compartment has multiple slips?

A

APL

99
Q

what tendon is attached to the pisiform?

A

FCU

100
Q

what is interrupted with dorsal intercalated segment instability (DISI)?

A

Scapholunate ligament

101
Q

What is intersection syndrome?

A

Inflammation at crossing point of 1st and 2nd dorsal compartments @wrist.

102
Q

what provides sensation to top of foot?

A

Sup peroneal nerve

103
Q

why do you put an intraarticular fx (post op) into continuous passive motion (CPM)?

A

the synovial fluid aids in hyaline formation, otherwise they will get fibrous union.

104
Q

Fenestrate

A

to get progenitor cells to stimulate the inflammatory process and heal the area i.e.. lateral epicondylitis we fenestrate the needle into the bone then inject steroid

105
Q

What is PRP?

A

Platlets concentrated from plasma, injected after surgery, platelets full of growth factors to help heal. Best in chronic tendon injuries.

106
Q

Why do we hemi a femoral neck fracture?

A

synovial fluid prevents/impairs the callus formation necessary for bone repair, the blood supply can be disrupted via fx or intracapsular pressure

107
Q

Factors that modify open fracture classification regardless of initial skin defect

A

exposure to: soil, water (pool,lake/stream), fecal matter (barnyard), oral flora (bite), gross contamination on inspection, delay in treatment >12 hours

108
Q

Signs of high energy fracture mechanism

A

segmental fx, bone loss, compartment syndrome, crush mechanism, extensive degloving of subcutaneous fat and skin, requires flap coverage (any size defect)

109
Q

antibiotic coverage for open fractures

A

Type I,II: first gen cephalosporin Type III: add an aminoglycoside Farm injuries: add penicillin and an aminoglycoside give tetanus prophylaxis

110
Q

Low velocity vs high velocity gunshots

A

low velocity 2000 ft/sec includes all military rifles and most hunting rifles shotgun dependent on shot pattern load and distance from target

111
Q

What is affected in boutonnière deformity

A

Central slip rupture over PIP from laceration, traumatic avulsion or capsular distention in RA

112
Q

What occurs in mallet finger deformity

A

Boney avulsion or tendinous disruption of the terminal extensor tendon distal to DIP joint.

113
Q

Type of bone formation in growth plate

A

Enchondral bone formation

114
Q

Layers of growth plate

A

-Reserve zone -Proliferative zone -Hypertrophic zone (Maturation zone, degenerative zone, provisional calcification zone) -Primary spongiosa

115
Q
A
116
Q

Indications for cannulated screw fixation femoral neck fx

A
  • nondisplaced transcervical fx
  • Garden I and II fracture patterns in the physiologically elderly
  • displaced transcervical fx in young patient
117
Q

Indications for sliding hip screw or cephalomedullary nail trans cervical fem neck fx

A
  • basicervical fracture
  • vertical fracture pattern in a young patient
  • biomechanically superior to cannulated screws
  • consider placement of additional cannulated screw above sliding hip screw to prevent rotation
118
Q

Indications for hemiarthroplasty in femoral neck fracture

A
  • controversial
  • debilitated elderly patients
  • metabolic bone disease
119
Q

Indications for total hip arthroplasty in femoral neck fx

A
  • controversial
  • older active patients
  • patients with preexisting hip osteoarthritis
    • more predictable pain relief and better functional outcome than hemiarthroplasty
  • arthroplasty for Garden III and IV in patient > 85 years
120
Q

Indications for sliding hip screw in intertrochanteric hip fx

A

stable intertrochanteric fractures

121
Q

Indications for cephalomedullary nail in intertrochanteric hip fx

A
  • stable fracture patterns
  • unstable fracture patterns
  • reverse obliquity fractures
  • subtrochanteric extension
  • lack of integrity of femoral wall
122
Q

Indications for arthroplasty in intertrochanteric hip fx

A
  • severely comminuted fractures
  • preexisting symptomatic degenerative arthritis
  • osteoporotic bone that is unlikely to hold internal fixation
  • salvage for failed internal fixation
123
Q

Thurston holland fragment

A

Fragment of bone after a Type II or Type IV salter harris fracture

124
Q

Anterior Interosseous nerve innervation

A
125
Q

Anterior interosseous nerve is a branch of what nerve?Branching point?

A
  • Median nerve.
  • Branches from median nerve 4cm distal to medial epicondyle
126
Q

Posterior interosseous nerve motor innervation

A
  • ECRB (often from radial nerve proper, but can be from PIN)
  • Extensor digitorum communis (EDC)
  • Extensor digiti minimi (EDM)
  • Extensor carpi ulnaris (ECU)
  • Supinator
  • Abductor pollicis longus (APL)
  • Extensor pollicus brevis (EPB)
  • Extensor pollicus longus (EPL)
  • Extensor indicis proprius (EIP)
127
Q

Posterior interosseous nerve sensory innervation

A
  • Provides sensory to dorsal wrist capsule
  • NO cutaneous innervation
128
Q
  1. Posterior interosseous nerve is branch of what nerve?
  2. Branching Point?
A
  1. Radial Nerve
  2. Originates from the radial nerve at the radiohumeral joint line
129
Q

Supracondylar fx gartland extension type classification

A

Gartland Extension type

  1. Nondisplaced
  2. Displaced with intact posterior cortex; may be angulated or rotated
  3. Complete displacement; posteromedial or posterolateral
130
Q

Supracondylar fx gartland flexion type classification

A

Gartland flexion type

  1. Nondisplaced
  2. Displaced with intact anterior cortex
  3. Complete displacement; usually anterolateral
131
Q

What tibifibula clear space measurement is abnormal and implies syndesmotic injury?

A

>5mm tibiofibula clear space is abnormal and implies syndesmotic injury

132
Q

What measurement of medial clear space in mortise view of ankle indicates a lateral talar shift

A

Medial clear space of >4-5mm is abnormal and indicates lateral talar shift.

133
Q

what is the tibiofibular overlap distance on AP view that implies syndesmotic injury?

A

Tibiofibula overlap of <10mm on AP view is abnormal and implies syndesmotic injury

134
Q

A lateral talar shift of 1mm or 3mm will result in decreased surface contact by ___ %?

A
  • Lateral talar shift of 1mm will decrease surface contact by 40%
  • Lateral talar shift of 3mm will decrease surface contact by >60%

Orthopedics (5 decks)

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