Ortho

Question 1

Sprain vs strain

Answer 1

Sprain = ligament. Strain = muscle

Question 2

Open fracture

Answer 2

Ortho emergency! Irrigate wound, remove debris, stabilize with splint, start ABx/tetanus ppx -> surgery

Question 3

What is a pathologic fracture?

Answer 3

A fracture that would not have occurred due to the force alone if not for predisposing condition, such as osteoporosis

Question 4

Most common site for stress fracture?

Answer 4

Metatarsals. Also common are calcaneus and tibia

Question 5

Salter-Harris classification of fractures involving the epiphysiseal (or growth) plate

Answer 5

I and II have good prognosis for healing. III and IV require surgery. V has poor prognosis with high risk of growth plate arrest

Question 6

Greenstick fracture

Answer 6

More common in kids, who have “softer” bone than adults

Question 7

Torus fracture

Answer 7

Buckling of cortex due to compression. Typically in kids in metaphyseal areas. Heals in 2-3 weeks with simple immobilization

Question 8

Parts of bone

Answer 8

see attached image

Question 9

Fat embolism syndrome

Answer 9

ARDS syndrome. Confusion, dyspnea, petechial rash on chest/axilla/neck/conjunctiva. Hallmark: arterial hypoxemia with PO2

Question 10

Anterior shoulder dislocation

Answer 10

Most common type; younger patients, high risk of recurrence. Caused by abduction/external rotation. Presents with inability to adduct/internally rotate, loss of normal rounded shoulder contour. Complications: rotator cuff tear, labral lesions, coracoid fx, Hill-Sachs deformity

Question 11

What is a Hill-Sachs deformity?

Answer 11

Compression fx of humeral head

Question 12

Posterior shoulder dislocation

Answer 12

Often precipitated by convulsion, seizure, fall. Caused by internal rotation/adduction. Presents with inability to abduct/externally rotate, prominant coracoid process, flattened anterior aspect of shoulder.

Question 13

Inferior shoulder dislocation

Question 14

Complications that occur from any type of shoulder dislocation

Answer 14

Axillary artery injury, venous injury, injury to nerves of brachial plexus, most commonly axillary nerve

Question 15

How to assess axillary nerve

Answer 15

Deltoid strength. Sensation over lateral upper arm

Question 16

What pressure in a compartment is indication for fasciotomy (aside from other clinical signs)?

Answer 16

> 30 mm Hg

Question 17

Volkmann’s ischemic contracture

Answer 17

Consequence of failure to fully treat compartment syndrome. Fibrous replacement of necrotic muscle.

Question 18

Chronic osteomyelitis

Answer 18

Most often seen in LE of diabetic patients. Acute osteo -> walled-off cavity; polymicrobial. Tx options: open drainage of abscess vs. sequestrectomy vs amputation vs debridement + reconstruction; can use depot abx beads in wound as adjunct

Question 19

Septic bursitis

Answer 19

Infection of superficial bursa, often affecting bunion, olecranon, and prepatellar bursa. Most often Staph aureus. Tx: aspirate bursa + culture. Broad spectrum Abx right away

Question 20

Osteoid osteoma

Answer 20

Benign bone tumor arising from osteoblasts, usu age 5-25 yo. Most commonly proximal femur. Local tenderness + dull aching pain at site, relieved by NSAIDs. Dx: xray shows localized area of sclerosis with central radiolucent nidus. Tx: symptomatically with NSAIDs. Surgery to remove nidus if med mgmt fails. Excellent prognosis.

Question 21

Osteoblastoma

Answer 21

Rare benign bone tumor, similar to osteoid osteoma but larger. Most commonly on axial skeleton. Non specific xray. Tx: curettement of lesion, can recur if not adequately excised. Have potential to undergo malignant transformation.

Question 22

Osteochondroma

Answer 22

Outgrowth of bone capped by cartilage. Most common benign tumor of bone, usually at metaphysis of long bones of extremities. Xray shows mushroom-like bony prominence. Surgical excision if sx. Very rarely undergo malignant transformation to chondrosarcoma.

Question 23

Enchondroma

Answer 23

Chondroma (mature hyaline cartilage tumor) that grows within bone and expands it. Presentation: asx until pathologic fracture brings attention to it (e.g. Alex’s hand fracture). Tx: none if asx. If pathologic fx, allow to heal and then simple excision + bone grafting procedure

Question 24

Giant cell tumor

Answer 24

Arises from mesenchymal stromal cells supporting the bone marrow; benign tumor. Most commonly around the knee, distal radius, sacrum. Xray: radiolucent lesion, with asymmetric bone destruction; occasional “soap bubble appearance” of thin subperiosteal shell. Tx: curettage + bone grafting, add adjuvant liquid nitrogen to reduce recurrence. Afterwards, monitor CXR q 6 mo for 2-3 years

Question 25

4 types of malignant primary bone tumors

Answer 25

Osteosarcoma, chondrosarcoma, Ewing’s sarcoma, multiple myeloma (most common)

Question 26

Osteosarcoma

Answer 26

Arises from malignant spindle cell stroma that produces osteoid. Most commonly around knee, prox humerus, rarely mandible. Presentation: pain + tender mass +/- B sx. Xray: poorly defined lesion with bone destruction/formation, may have *sunburst* pattern. Tx: surgery + chemo. Prognosis: 5 year 60%

Question 27

Chondrosarcoma

Answer 27

Low-grade malignant tumor that presents with pain/swelling over months to years. Tx: surgery, do NOT respond to chemo/rads. Better prognosis than osteosarcoma b/c it is slow-growing and metastasizes late.

Question 28

Ewing’s sarcoma

Answer 28

Can occur anywhere in body. Xray: lytic lesions, “onion skin” pattern of periosteum. Tx: surgery + chemo. Most lethal bone tumor.

Question 29

Most likely site of origin for bone mets

Answer 29

BLT with Kosher Pickle: Breast, Lung, Thyroid, Kidney, Prostate

Question 30

Most common site of origin for bone mets, peds

Answer 30

Neuroblastoma

Question 31

What is a shoulder separation?

Answer 31

AC joint ligament tear