Ortho pearls

Question 1

What are 15 Buckley indications to operate or consult in orthopedics

Answer 1

1. open fracture
2. neurovascular compromise
3. failure to reduce joint/bone
4. failure to maintain reduction/alignment of joint/bone
5. major trauma/polytrauma
6. infection - septic joint, infected hardware
7. intra-articular step >2 mm
8. bilateral fractures
9. pediatric elbow
10. floating joint
11. patients with compliance issues
12. to save a life (or functional life) ie. hip fractures in elderly
13. complex injuries
14. obese patients
15. cosmetic results

Question 2

What are 4 stages of bone healing

Answer 2

1. inflammatory (hematoma)
2. soft callus
3. hard callus
4. remodelling

Question 3

What is the goal in all ankle fractures

Answer 3

Keep the tibia over and in line with the talus

Question 4

What are 2 things you must not miss in acute knee injuries

Answer 4

Extensor mechanism disruption

Knee dislocation

Question 5

What are ddx considerations in bony pain?

Answer 5

fracture
traumatic soft tissue injury
osteoid osteoma
metastatic lesion
chrondoblastoma
Ewing's sarcoma
osteonecrosis
leukemia
lymphoma
tendons/ligament inflammation

Question 6

What are 3 routes of infection in osteomyelitis?

Answer 6

hematogenous
direct innoculation
contiguous

Question 7

What features of the synovial membrane allow for infection?

Answer 7

Lacks a basement membrane which allows for bacteria to easily penetration into articular cartilage, bone, and prosthetic devices

Question 8

What is the involucrum?

Answer 8

Layer of new bone growth outside the sequestra

Question 9

What is the sequestra?

Answer 9

In osteomyelitis, decreased blood supply can lead to areas of necrotic bone (hallmark of chronic osteomyelitis)

Question 10

What are 5 risk factors for osteomyelitis?

Answer 10

diabetes mellitus
immunosuppression
sickle cell disease
HIV
alcoholism/IVDU
pre-existing joint disease (trauma, RA, gout)
post-surgical

Question 11

What is the gold standard for diagnosis of osteomyelitis?

Answer 11

bone biopsy/culture

diagnostic in 87% of cases

Question 12

What are Xray findings of osteomyelitis?

Answer 12

lucent areas of cortical bone destruction
periosteal reaction (children >adults)
findings lag behind clinical picture up to 2 weeks

Question 13

How do Xray / bone scan / CT / MRI compare for diagnosing osteomyelitis?

Answer 13

Xray: 90% abnormal by 28 days,

Question 14

Why do babies get septic arthritis with osteo?

Answer 14

Lack of physis separating epiphysis from metaphysis, direct spread

Question 15

What are 3 complications from vertebral osteomyelitis?

Answer 15

epidural abscess
psoas abscess
retropharyngeal abscess

Question 16

What are the 4 Kochner’s criteria for septic arthritis?

Answer 16

Non weight bearing
ESR >40
WBC >12
Temp >38.5

Question 17

What is the traditional cut-off for synovial fluid and septic arthritis?

Answer 17

> 50,000 cells/mm3