Ortho & Sports Med

Question 1

Presentation of femoral neck fracture

Answer 1

Severe hip pain
Inability to bear weight
Age ≥65
Shortenend, externally rotated
Painful ROM

Question 2

X-ray findings femoral neck fracture

Answer 2

Shortening of the neck of cortical contour

Disruption

Question 3

Achilles tendinopathy risk factors

Answer 3

Athletic activity, increase in regiment
Systemic disorders: psoriasis, ankylosis spondylitis
Medications: glucocorticoids, fluoroquinelones

Question 4

Presentation of Achilles tendinopathy

Answer 4

Swelling and tenderness
Pain (burning sensation)
2-6cm proximal to the posterior calcaneus.

Question 5

Thompson test

Answer 5

with patient prone and feet off the end of the table, squeeze the calf muscles; absence of plantar flexion indicates tendon rupture (positive Thompson)

Question 6

Sever disease (calcínela apophysitis)

Answer 6

Posterior heel pain and tenderness within 2cm of insertion of the Achilles’ tendon. Seen in children and adolescents who run of jump because the apophysis is most susceptible to stress during periods of rapid growth.

Question 7

Enthesitis

Answer 7

Inflammatory disorder characterized by local pain, tenderness and swelling at the insertion of a tendon or ligament associated with back pain/ stiffness.

Relatively specific finding for ankylosing spondylitis or other spondyloarthropathies.

Question 8

Subcutaneous calcaneal bursitis

Answer 8

Pain and tenderness at the calcaneal prominence (at insertion point).
Swelling warmth and erythema.

Question 9

Assessment clavicle fracture

Answer 9

Asses for Hard and soft signs of arterial injury. Hard signs require immediate surgical intervention. Soft signs require capsular imaging.

Uncomplicated fractures (no neruovasular involvement) can be slinger or figure eight bandage.

Question 10

Anatomical features of clavicle fracture that increase risk

Answer 10

Middle third of the clavicle overlies the brachial plexus and the subclavian artery and vein in the thoracic outlet. Require carful neurovascular assessment

Distal third: require open reduction and internal fixation to prevent nonunion

Question 11

Hard Signs of traumatic arterial injury

Answer 11

Distal limb ischemia (paralysis, pallor, cool extremities)
Absent/ Feeble distal pulse
Active hemorrhage, 
Radially expanding hematoma 
Bruit/ thrill at site of injury

Question 12

Soft signs of traumatic arterial injury

Answer 12

Diminished distal pulses 
Unexplained hypotension
Stable hematoma 
Documented hemorrhage at time of injury
Associated neurological deficit

Question 13

Initial evaluation of severe extremity injury

Answer 13

Hemorrhage control
Radiography of skeletal injuries
Evaluation of neurovascular bundle.
Vascular assessment( hard and soft signs)

Question 14

Assessment of Hard signs of arterial injury

Answer 14

Surgical exploration and repair

Question 15

Assessment of Soft signs of arterial injury

Answer 15

Injured extremity index (similar to ABI; <0.9 is abnormal)
CT or canvantional angio
Duplex Doppler

Question 16

Common risk with supracondylar fracture of the humerus

Answer 16

Most common results in posterior displacement of the distal humerus fragment which can cause entrapment of the median nerve and brachial artery located anterior to the humerus.

Question 17

Signs of complicated supreacondylar fracture of the humorous

Answer 17

Diminished distal perfusion (brachial artery)

Weak “OK” signs; inability to approximate thumb and index (mean nerve injury)

Question 18

Supracondylar fracture that occurs on flexed below impact

Answer 18

Causes anterior displacements of the distal humerus fragment (rare) which can impinge on the ulnar nerve located posterior to the medial epicondyle

Question 19

Metaphysical corner fracture

Answer 19

Result from forcible pulling or twisting of an extremity. Red flag for child abuse

Question 20

Next step in suspected child abuse

Answer 20

1. perfume skeletal surgery to look for additional occult fractures
2. Fundoscopy (retinal hemorrhage) and CT head