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Flashcards in Bones and Joints Deck (67):
1

Acute osteomyelitis MC seen in ___
Chronic osteomyelitis MC seen in ___

MC organism in osteomyelitis

Acute osteomyelitis MC seen in CHILDREN
Chronic osteomyelitis MC seen in ADULTS

Staph. Aureus

2

Salmonella* osteomyelitis seen in ____

Tx:

Sickle cell disease

Tx: 3rd gen ceph (Cipro) OR Flouroquinolone (Levofloxacin)

3

1. Most sensitive test in early osteomyelitis

2. Gold standard in dx of osteomyelitis

1. MRI

2. Bone Aspiration

4

1. Tx of acute osteomyelitis

2. Tx of chronic osteomyelitis

1. IV abx for 4-6 weeks; 6-8 weeks overall of abx

2. 4 weeks - 24 months of IV and PO abx

5

Tx of acute osteomyelitis from puncture wound

MC organism:

Cipro* or Levofloxacin

Pseudomonas

6

Tx of acute osteomyelitis w/
1. Methicillin sensitive
2. Methicillin Resistant

1. Nafcillin OR Oxacillin;
PCN allergy --> Clindamycin or Vancomycin

2. Vancomycin

7

Osteosarcoma MC in ____
Occur in ____ bones
MC metastasize to ___
X ray shows ____

Adolescents (<20 y/o), 2nd peak in 50-60 y/o
Metaphysis of long bones ( MC in femur*, tibia, humerus)
Metastasize to lung

"hair on end", "sun ray/burst"
Codman's triangle

8

Ewing's Sarcoma MC in ____
Occur in ____ bones
X ray shows ____

Children, Males 5-25 y/o
Diaphysis of long bones, ribs, flat bones (MC in femur, pelvis)

"Onion peel" = lytic lesion w/ layered periosteal reaction

9

Chondrosarcoma MC in ___
X ray shows ___

Adults (40-75 y/o)
3rd MC primary malignancy of bone

Matrix punctate or ring and arch appearance pattern of calcifation

10

Osteochondroma MC in ___
Diagnosis:
Tx:

MC benign bone tumor
Males, 10-20 y/o

Pedunculated, grows away from growth plate*, involves medullary tissue

Observation. Resection if painful, located in pelvis

11

Intracompartmental pressure of _____ is diagnosis of Compartment syndrome

>30-45 mm Hg

12

Primary osteoporosis Type I associated with ____ .
____ bone affected.
MC fracture sites (3)

loss of estrogen in postmenopausal women, testosteron deficiency in men

Trabecular bone

Vertebrae, hip, distal radius

13

Primary osteoporosis Type II associated with ____.
____bone affected.
MC fracture sites (2)

>75 y/o w/ poor calcium absorption

Trabecular and cortical bone

Hip, pelvis

14

Screening DEXA scan recommended for:

Postmenopausal women >65 y/o

Postmenopausal women <65 y/o w/ 1 or more additional RF

RF: alcohol, smoking, low body weight, sedentary, low calcium and vit D intake, corticosteroid use, recurrent falls
Advanced age, Caucasian/Asian, female

15

1st line treatment of osteoporosis

How should it be taken?

Long term use complications

Bisphosphonate

On empty stomach, sit upright for 30-60 min after ingestion

Weakened bones, Jaw necrosis --> monitor closely

16

MC wrist injury
MOI:
Diagnosis:
Complication:
Tx:

Colles Fracture
MOI: FOOSH --> extension fracture --> dorsal displacement of bone fragment
Diagnosis: "dinner fork deformity"
Complication: Extensor pollicus longus tendon rupture
Tx: Sugar tong splint/cast

17

Smith fracture =
Diagnosis:

Flexion fracture --> volar displacement of bone fragment
Dx: Garden Spade Deformity

18

Radial nerve injury causes

wrist drop

19

Colles and Smith fracture may cause injury to ___ nerve, ___ artery

Median nerve, radial artery

20

Median nerve injury causes

Inability of thumb opposition
Numbness/tingling in thumb and 2nd,3rd and 1/2 4th digit

21

Study of choice to diagnose occult hip fracture

MRi

22

IV abx of choice for open fractures

1st and 2nd gen cephalosporins
aminoglycosides

48 hrs after fracture, 48 hrs after surgical procedures

23

Salter Harris Classification

Straight through epiphyseal plate = Type 1
Above epiphyseal plate, involve metaphyseal fragment = Type 2
Lower/beLow, through epiphysis into articular surface = Type 3
Through distal metaphysis, epiphyseal plate and epiphysis = Type 4
c(E)Rush of epiphyseal plate = Type 5

24

Lisfranc fracture

dislocation of tarsometatarsal joint complex

25

Inability to straighten distal finger/flexed @ DIP joint

Mallet (Baseball) Finger = avulsion of extensor tendon

26

MC MOI of shoulder dislocation

Fall on outstretched arm in abduction and extension

27

____ shoulder dislocation more common than ____ shoulder dislocation

Anterior more common than posterior

28

X ray views to determine ant. vs post. shoulder dislocation

Axillary
"Y" view

29

Anterior shoulder dislocation most likely will injure ___ nerve, manifests as ____.

Axillary nerve
Pinprick over deltoid

30

Hill-Sachs lesion =

Humeral head deformities
Seen in recurrent anterior shoulder dislocations

31

Bankart lesion =

Glenoid inferior rim fracture
Seen in anterior shoulder dislocations

32

MC fracture in children

Clavicle fracture (mid 1/3)

33

MOI of acromioclavicular joint dislocation:
Xray:
Ligaments involved:

Direct blow to adducted shoulder
AP w/ weights
Acromioclavicular ligament, coracoclavicular ligament

34

Proximal humerus fracture must r/o ___injury.

Humeral shaft fracture must r/o ____ injury.

Brachial plexus injury. Check deltoid sensation.

Radial nerve --> wrist drop

35

Anterior fat pad in children indicate ____
In adults indicate ___

Children --> supracondylar fx
Adults --> radial head fx

36

____ nerve and ____ artery injury causes Volkmann's ischemic contracture.

Seen in ____

= claw-like deformity from ischemia w/ flexion/contracture of wrist

MEDIAN nerve, BRACHIAL artery

Seen in Supracondylar fractures

37

Kienbock disease

Osteonecrosis of the lunate

38

Dupuytren disease

Tx:

-Palmar aponeurosis, ring, little and middle fingers causing painful nodules, pitting and contractures
-Fixed flexion deformity @ MCP joint

Tx: intra-lesional steroid injection, collagenase injection

39

Carpal tunnel syndrome involves compression of _____.
Symptoms:
Management:

Median nerve

-Parasthesias and pain of palmar 1st 3 and 1/2 of 4th digit ESPECIALLY AT NIGHT
-Thenar muscle wasting
- Weakness in thumb

Volar splint, NSAIDs

40

Boxer's fracture

Tx:

Metacarpal neck of 4th and 5th finger

Tx; 25-30 degrees of angulation --> reduced, ULNAR splint, f/u 1-2 weeks

41

Eikenella corrodens

organism specific to human mouth

42

Gamekeeper's thumb

Tx:

Sprain or tear of ulnar collateral ligament of thumb --> instability of MCP joint, weakness of pinch

Gamekeeper's = chronic
Skier's = acute

Tx: Thumb spica

43

Lateral epicondylitis (a.k.a. ____) = inflammation of tendon insertion of ____ d/t repetitive (pronation/supination) of forearm and excessive wrist (flexion/extension).

"Tennis elbow"
Extensor carpi radialis brevis
Pronation of forearm
Extension of wrist

44

Medial epicondylitis (a.k.a. ____) = inflammation of tendon insertion of ____ worse with ___ activities.

"golfer's elbow" or "baseball elbow"
Pronator teres-flexor carpi radialis
Pulling activities

45

Monteggia Fracture =
____ nerve injury in 17%

Management:

Proximal ULNAR shaft fx w/ anterior radial head dislocation

Radial nerve --> wrist drop

ORIF

46

Galeazzi Fracture =

Management:

Mid-distal RADIAL shaft fracture w/ dislocation of distal radio-ulnar joint

Unstable! ---> ORIF

47

Scaphoid gets blood supply from ___, runs ___ to ___.

Radial artery, distal to proximal
Proximal pole scaphoid has poor blood supply --> avascular necrosis

48

Scaphoid fx management

Long-arm thumb spica cast --> referral to ortho

Displacement of >1 mm --> ORIF

49

De Quervain's Tenosynovitis = stenosing tenosynovitis of ____ and ___.

Clinical manifestation:

Management:

abductor pollicus longus (APL)
Extensor pollicus brevus (EPB)

Pain along radial aspect of wrist, radiating to forearm

Thumb spica splint x 3 weeks, NSAIDs x 10-14 days, steroid injections (no more than 3), PT

50

Finkelstein Test

pain w/ ulnar deviation or thumb extension

Dx of De Quervain's Tenosynovitis

51

Most common level of scoliosis

1. Right thoracic curves @ T7 and T8 (left thoracic curves are rare)
2. Double major: right thoracic, left lumbar

52

Most sensitive test of Scoliosis

Tx:

Adams forward bending test

10-15 degrees: 6-12 month f/u
15-20 degrees: serial AP radiographic f/u Q 3-4 months (large curves) or 6-8 months (smaller curves)
20-40 degrees: bracing
>40 degrees: surgery

53

Scheuermann disease =

Juvenile kyphosis = idiopathic osteochondrosis of thoracic spine

54

Pott disease =

Progressive kyphosis caused by TB of spine

55

Kyphosis =

Tx:

Increased convex curvature of thoracic spine (hump back)

45-60 degrees: observe Q 3-4 months
>60 degrees: Milwaukee brace

56

Legg-Calve_Perthes Disease =

Presentation:

Avascular osteonecrosis of femoral head in CHILDREN d/t ischemia of CAPITAL FEMORAL EPIPHYSIS

PAINLESS limping x weeks, worsen w/ continued activity
Loss of ABDUCTION and INTERNAL rotation

57

Tests to evaluate meniscal tears

McMurray's sign = pop/click while tibia is externally and internally rotated

Apley test

58

Most sensitive test for dx of ACL tear

Lachman test

59

Thompson test

Achilles tendon rupture

60

Morton's Neuroma

Complication of surgical resection

Degeneration/proliferation of plantar digital nerve --> painful mass near tarsal heads

Permanent numbness of affected toes

61

Fleck sign

Fracture @ base of 2nd metatarsal

Pathognomonic for disruption of tarsometatarsal ligament (Lisfranc injury)

62

Jones Fracture = Transverse fx through ____ of ____

diaphysis of 5th metatarsal

63

Pseudojones Fracture = Transverse avulsion fx ____ of ____ d/t ____ w/ ____

Transverse avulsion fx @ BASE of 5th METATARSAL d/t PLANTAR FLEXION w/ INVERSION.

64

Maisonneuve Fracture = Proximal _____ fx d/t rupture of talofibular syndesmosis and interosseus membrane as a result of _____.

Proximal SPIRAL FIBULAR fx d/t rupture of talofibular syndesmosis and interosseus membrane as a result of DISTAL MEDIAL MALEOLAR FX and/or DELTOID LIGAMENT RUPTURE.

65

Ober Test

Pain or resistance to adduction

Dx of Iliotibial Band Syndrome

66

Class of abx that increases risk of tendon rupture

Fluoroquinolones

67

Apophysitis =

inflammation of growth plate