Exam 2 Flashcards
(157 cards)
1
Q
3 fused bones of pelvis
A
pubic bone, ilium, ischium
2
Q
iliopectineal line
A
from ilium to pubic bone
3
Q
ilioischial line
A
from ilium to ischium
4
Q
Shenton’s line
A
from femoral neck to obturator ring
5
Q
best way to evaluate SI joint
A
CT or Judet view
6
Q
what do the arcuate lines on the sacrum represent
A
foramina where sacral spinal nerves exit
7
Q
best way to evaluate sacrum
A
CT (obscured by gas and stool)
8
Q
what type of joint is pubic symphysis
A
synchondrosis
9
Q
what attaches to ASIS
A
sartorius
10
Q
what attaches to AIIS
A
rectus femoris
11
Q
3 locations for femoral neck fractures
A
subcapital, transcervical, basicervical
12
Q
what inserts on greater trochanter
A
gluteus medius, gluteis minimus
13
Q
what inserts on lesser trochanter
A
iliopsoas
14
Q
what is the most common location for proximal femur fractures
A
intertrochanteric region
15
Q
what occurs at the metaphysis in peds
A
growing bone matures into adult bone
16
Q
what increases risk for femoral head AVN
A
the closer the fracture is to the femoral head
17
Q
rotation in femur fractures
A
distal fragment tends to externally rotate
18
Q
what does white areas around bone indicate
A
sclerotic, bone is healing
19
Q
insufficiency fracture
A
normal stress on abnormal bone
20
Q
what group more commonly experiences avulsion fractures and why
A
pediatrics; tendons are stronger than bone
21
Q
what is a diastasis
A
pubic symphysis and SI joints are pulled apart
22
Q
when does pelvic diastasis occur
A
vertical shear injury
23
Q
why are pelvic diastasis life-threatening
A
blood loss
24
Q
most common hip dislocation
A
posterior
25
what is a common cause of hip dislocation
MVC
26
what injury is commonly associated with hip dislocation
acetabular fracture
27
what causes an anterior or inferior hip dislocation
externally rotated hip with force along femur
28
common pelvis avulsion sites for peds
ASIS, AIIS
29
pediatric hip on x-ray
lucency around iliac crest and ischia
30
what is an apophysis
a growth plate in an area that doesn't articulate with anything (greater trochanter)
31
best way to view ilium in pediatrics
false profile (60 degree rotation)
32
pathological process of osteoarthritis
damage to cartilage leads to damage to bone (microfractures) allowing synovial fluid to leak in (subchondral cysts) and osteophytes as bone tries to repair itself
33
hallmarks of osteoarthritis on imaging
osteophytes, asymmetric joint space loss, subchondral cysts, subchondral sclerosis
34
pathological process of inflammatory arthritis
inflammatory reaction in synovium leads to erosions that start at the edge of the bone and uniform thinning of cartilage. Increased bloodflow leads to increased osteoclast activity and osteoporosis
35
hallmarks of inflammatory arthritis on imaging
erosions, concentric/symmetric joint space loss, soft tissue swelling, osteoporosis
36
coxa profunda
femoral head pushes into acetabulum and pelvis, causing loss of iliopectineal line. Seen in inflammatory arthritis
37
causes of sacroiliitis
ankylosing spondylitis, IBD, septic joint, RA, psoriatic arthritis, reactive arthritis
38
where does ankylosing spondylitis start
SI joints
39
signs of sacroiliitis on imaging
sclerosis and symmetric SI joint widening
40
most common pediatric fracture
distal forearm
41
SH 1
through the growth plate, can look normal if nondisplaced
42
SH 2
through the growth plate and metaphysis
43
SH 3
through physis, epiphysis, and into joint
44
SH 4
metaphysis, physis, epiphysis
45
SH 5
crush injury to growth plate
46
most common SH fracture
type II
47
treatment for SH fracture
splinting, then casting, usually heals without complications
48
when to call ortho for SH fracture
type 3 and above
49
seq of SH 3
angular deformity due to premature closure of growth plate on one side
50
seq of SH 4
can cause angular deformity or cupping
51
seq of SH 5
premature growth plate closure causing limb length discrepancy
52
Tillaux fracture
ligamentous avulsion of tibia (pediatric version of ankle sprain)
53
what type of SH fracture is a Tillaux
3
54
how to image peds ankle fractures
CT
55
what is a toddler fracture
spiral fracture of tibia from learning to walk
56
what type of SH fracture is a SCFE
displaced type 1
57
imaging for SCFE
AP pelvis frog leg
58
ischium insertion
hamstrings
59
avulsion fracture of lesser trochanter
kickers
60
risk factor for developmental dysplasia of the hip
breech presentation
61
fractures seen in child abuse
metaphyseal corner fractures (avulsion fracture due to flailing limbs), rib fractures, skull fractures
62
how much angulation can a pediatric wrist fx have without needing surgery
45 degrees
63
phase 1 of fracture healing timeline
hematoma, 1 week
64
phase 2 of fracture healing timeline
soft callus (2-3 weeks)
65
phase 3 of fracture healing timeline
hard callus (4-16 weeks)
66
phase 4 fracture healing timeline
remodelling (17 weeks)
67
signs of SCFE
pain to groin, knee, thigh, antalgic gait, external rotation of the foot/hip and shortening
68
osgood schlatter aka
tibial tubercle apophysitis
69
osgood schlatter cause
stress to extensor mechanism (jumping)
70
osgood schlatter presentation
pain to tibial tubercle, worse with activity, pain with extension against resistance, enlarged tibial tubercle
71
osgood schlatter workup
AP/lateral knee radiographs
72
osgood schlatter treatment
NSAIDs, rest, ice, activity modification, sleeves PRN. Or 6 weeks in extension cylinder cast OR ossicle excision
73
common LCP population
males age 4-8
74
LCP presentation
insidious onset of painless limp with intermittent hip/knee/groin/thigh pain
75
LCP imaging
AP lateral pelvis frog leg
76
LCP radiograph findings
medial joint space widening, crescent sign, sclerotic appearance
77
LCP treatment, nonoperative
limit weight-bearing, activity restriction, maintain femoral head until ossification
78
LCP treatment, operative
femoral osteotomy until old enough for hip replacement
79
nursemaids elbow mechanism
sudden longitudinal traction applied to hand with elbow extended and forearm pronated
80
nursemaids elbow pathophys
annular ligament becomes trapped between radial head and capitellum
81
nursemaids elbow presentation
child holding arm flexed and pronated, heard pop, pain over lateral aspect of elbow with supination
82
nursemaids elbow x-ray findings
radius is not in line with capitellum
83
nursemaids elbow reduction
hold arm supinated and apply pressure over radial head and maximally flex arm
84
clubfoot aka
congenital talipes equinovarus
85
most common musculoskeletal birth defect
clubfoot
86
clubfoot CAVE
cavus, adductus, varus, equinus
87
treatment of clubfoot
Ponseti serial casting, new cast q 1-2 weeks
88
causes of acute onset limp in peds
fracture, soft tissue injury, foreign body
89
causes of insidious onset limp in peds
osgood-schlatter, stress fracture, chondromalacia patella, chondritis dessicans
90
diagnosis for osteomyelitis
MRI
91
diagnosis for bone malignancy
MRI
92
symptoms of bone malignancy
pain at night, palpable mass
93
signs of leukemia
neutropenia, decreased platelet count, anemia, night pain
94
x-ray findings for leukemia
moth-ridden bone
95
SI joint infection sign
positive FABER (flexion, abduction, external rotation)
96
classic sign for septic arthritis
won't bear weight
97
septic arthritis diagnosis
ultrasound and joint aspiration
98
SI joint infection diagnosis
MRI
99
psoas abscess sign
psoas sign (pain with hip flexion)
100
Barlow
adduct the hip while applying posterior force
101
Ortolani
abduct the hip while applying anterior force
102
sign of hip joint effusion
hip flexed, abducted, externally rotated
103
when does bone malignancy occur
peds over 10
104
3 types of femoroacetabular impingement
pincer, cam, combined
105
pincer impingement
extra bone grows over the normal rim of the acetabulum, so the labrum gets crushed under the more prominent acetabulum. More common in middle-aged women
106
cam impingement
femoral head isn't round and doesn't rotate well within the acetabulum and grinds the cartilage. young, athletic men
107
mechanism of hip impingement
repeated overloading of structures, labral degeneration, osteoarthritis
108
symptoms of hip impingement
groin pain worsened by hip flexion, difficulty sitting, limping, mechanical symptoms, gluteal or trochanteric pain
109
test for hip impingement
Fadir test (flex the hip and internally rotate)
110
treatment for hip impingement
activity modification, NSAIDs, PT, hip replacement
111
trochanteric bursitis presentation
lateral hip/thigh pain, point tenderness over bursa over greater trochanter with bogginess, erythema, crepitus
112
trochanteric bursitis mechanism
tight IT band, overexertion, trauma
113
trochanteric bursitis treatment
NSAIDs, IT band stretching, PT, injections
114
IT band syndrome presentation
pain over greater trochanter distal to lateral knee
115
IT band syndrome mechanism
repetitive use
116
IT band syndrome treatment
RICE, PT, massage, injections
117
test for IT Band syndrome
Obers test (put leg behind off side of bed)
118
AVN symptoms
asymptomatic, deep groin pain, eventual joint collapse
119
AVN treatment pre-collapse
core decompression, vascularized fibular graft
120
femoral neck stress fracture mechanism
repetitive loading of bone with microfractures and no opportunity to heal
121
femoral neck stress fracture symptoms
insidious onset, improves with rest, benign physical exam
122
radiograph findings of femoral neck stress fracture
may find linear lucency if late
123
imaging for femoral neck stress fracture
MRI
124
treatment for femoral neck stress fracture
NWB or percutaneous screw fixation if severe
125
Maisonneuve fracture
fracture of fibula with ankle sprain
126
fracture with highest risk of femoral head AVN
femoral neck, closer to the femoral head
127
artery compromised in femoral neck fracture
medial circumflex
128
artery potentially compromised in intertrochanteric fracture
lateral circumflex
129
anterior dislocation of knee causes what
possible popliteal artery compromise
130
bones of ankle
tibia, fibula, talus
131
achilles tendon attachment
calcaneus
132
talus articulates with
navicular
133
calcaneus articulates with
cuboid
134
navicular articulates with
cuneiforms
135
what fracture is associated with inversion
lateral talus
136
attachment of peroneus tendon
base of 5th metatarsal
137
extensor complex components
quad muscles/tendon, patella, patellar tendon, tibia
138
acl
prevents tibia from sliding anteriorly relative to the femur
139
test for acl injury
lachman, anterior drawer
140
pcl
prevents tibia from sliding posteriorly relative to femur
141
pcl injury mechanism
direct impact to tibia or forced hyperextension
142
test for LCL injury
varus
143
test for MCL injury
valgus
144
what is attached to MCL
medial meniscus
145
treatment for MCL
hinge knee brace
146
terrible triad
ACL, MCL, medial meniscus
147
test for meniscus
McMurray
148
knee tendon rupture sign
cannot extend knee against gravity and cannot resist flexion
149
treatment for knee tendon rupture
urgent surgical repair, NWB, immobilize knee in extension
150
quad tendon rupture mechanism
sudden heavy load on partially flexed knee
151
patella dislocation mechanism
rapid change of direction, usually displaces laterally
152
patella dislocation treatment
PT, RICE, NSAIDs, braces, possible MPFL reconstruction
153
patella dislocation test
patellar apprehension sign, J tracking
154
when is surgery indicated for tibial plateau fractures
more than 3 mm displacement
155
knee dislocation meaning
femur and tibia have dislocated
156
ottawa ankle rules
pain near malleoli AND age over 55, unable walk 4 steps, bone tenderness at posterior edge of either malleolus
157
when to get ankle-brachial index
knee dislocations
