General Principles of Orthopedics Flashcards
(63 cards)
1
Q
Cortical bone
A
- “Hard” outer surface
- Provides skeletal support
- Site of attachment for tendon & ligaments
2
Q
Cancellous Bone
A
- “spongy”/trabecular bone found at ends of long bones, pelvis, ribs, skull & vertebrae
- porous
- Includes red & yellow bone marrow
3
Q
Where is Cancellous Bone found?
A
Long bones Pelvis Ribs Skull Vertebrae
4
Q
Where is red bone marrow found?
A
Adults–axial skeleton
5
Q
Where is yellow bone marrow found?
A
Adults–appendicular skeleton
6
Q
Metaphysis
A
Transition zone
7
Q
Diaphysis
A
Shaft
8
Q
Epiphysis
A
Location of growth plate
9
Q
Tendon
A
Connect muscle to bone
10
Q
Ligaments
A
Attach bone to bone
11
Q
Parts of axial skeleton
A
Bones of head and trunkk Skull Ossicles of middle ear Hyoid bone Rib cage Sternum & vertebral column
12
Q
Parts of appendicular skeleton
A
Pectoral girdles (clavicle and scapulae) Arms and forearms Hands Pelvis Thighs/leg Feet/ankles
13
Q
Bone Remodeling Cycle
A
- Resorption
- Reversal
- Formation
14
Q
What is key for diagnosis of fx/msck injury?
A
HISTORY
15
Q
Acute & Chronic duration
A
Acute <6 wks
Chronic >6wks
16
Q
Traumatic vs Atraumatic
A
Traumatic = acute; injury related Atraumatic = degenerative; overuse
17
Q
How do fracture lines appear on imaging?
A
BLACKER, more sharply angles & jagged than other lucencies in bone
18
Q
What other structures can mimic an acute fx on imaging?
A
Sesamoid bones
Accessory ossicles
Unhealed fx
19
Q
Definition Fracture
A
Loss of continuity of structure of bone
20
Q
Closed fx
A
fx not exposed to environment
**ALL FX HAVE SOME DEGREE OF SOFT TISSUE INJURY
21
Q
Open fx
A
break in skin & underlying soft tissue
22
Q
What is the length of time recommended for surgical tx of open fx?
A
6hrs
23
Q
Fracture Healing Phases
A
- Inflammatory phase (hematoma and granulation tissue form)
- Reparative phase (callus formation)
- Bone remodeling (final phase of healing)
24
Q
What healing phase is a hematoma and granulation tissue seen in?
A
Inflammatory phase
25
What healing phase is a callus seen in?
Reparative phase
26
What healing phase shows compact bone replacing spongy bone
Bone remodeling--final phase
27
Delayed union?
fx taking longer to heal than usually required
28
Malunion?
fx is healing in mechanically & cosmetically UNACCEPTABLE way
29
Nonunion?
Fx will most likely NOT heal
30
Principle of splinting
- Immobilize affected extremity/area
- Prevent further injury
- Pain control
31
Rules of immobilization
- MUST immobilize joint above & below injury
- Wrap from distal to proximal to minimize tapping of blood distal to injury
- Eval distal circulation, motor function & sensation BEFORE & AFTER splinting
32
Length of splinting
Temporary
| 1-5 days
33
What do you always want to evaluate BEFORE & AFTER splintign?
circulation
motor function
sensation
34
Casting principles
- Maintain position to provide bone healing
- prevent displacement of fx
- protect from further injury
35
Length of cast
4-6wks
| usually change at 3wks if no movement of fx
36
Would you put an unstable wrist fx in a short arm cast?
NO.
Unstable wrist fx --> LONG ARM CAST
Stable wrist fx --> SHORT arm cast
37
What fx goes in a long arm cast?
Forarm fx
| Unstable wrist fx
38
What fx goes into a spica cast?
Scaphoid fx
| Radial styloid fx
39
What fx goes into a long leg cast?
Tib/fib fx
| Quad tendon repair
40
What fx goes into a short leg cast?
Anything below the knee
| Foot, ankle, achille's, Sever's syndrome
41
What is a closed reduction?
- reduce bone to near anatomic position
- "recreate the fracture" to align
- must be STABLE fx
- no incision in the skin
42
ORIF (open reduction internal fixation)?
- Reduce and hold unstable fx
- Acts as internal splint
- Allows for correction of deformity
- requires surgery
43
Would you use an ORIF for a stable fx?
NO. used for UNSTABLE fx
44
What do ORIF IM Rod prevent?
anterior/posterior movement of bone
45
What do ORIF IM screws prevent?
prevent bone from rotating around rod
46
When would you do an Ex-Fix?
- when major non-lifesaving procedures must be avoided
- bridge to definitive internal fixation
- if pt in OR for life-saving procedure, should be applied in concert
47
What type of injury MSCK injury involves stretching/tearing of ligaments?
Sprain (most common in ankle)
48
Mechanism of injury of sprain
inversion
| eversion
49
What type MSCK injury involve injury to muscle or muscle and tendon?
Strain
50
Mechanism of injury of strain?
overextension
over stretching
muscle over use
51
Sx strain
Pain
muscle spasms/weakness
swelling
cramping
52
Tx Sprain/Strain
```
RICE (rest, ice, compression, elevation)
Splinting
NSAID
Early ROM
PT
```
53
What do you want to evaluate before & after a reduction?
neurovascular status
54
How do you describe a fx fragment in a relation to another fragment?
describe the relationship of the DISTAL fx fragment relative to the PROXIMAL fragment
55
Tendonitis
Inflammation/irritation of tendon
causes pain & tenderness at or just outside of joint
Most common: shoulders, elbows, wrists, knees
56
Tx tendonitis
```
Rest
Ice cube massages
BRACE
NSAIDs (naproxen)
PT
Cortisone (not 1st line)
```
57
Tendon Rupture--Contributions
Steroid injection into tendon
Fluoroquinolone
Body habitus
Trauma
58
Tx Tendon Rupture
```
Splint/immobilize
Ice
NSAIDs
Repair/reconstruction
Early ROM
PT
```
59
Ligament Rupture
Common sport injury (skiing, soccer, football)
| Results from VALGUS stress or direct fall onto joint
60
Valgus stress or varus stress for ligament rupture?
VALGUS stress
61
1st line ortho pain mgmt?
ACETAMINOPHEN
| 350-650mg q4-6hrs
62
Can you get topical analgesics OTC for othro pain mgmt?
No. Prescription only
63
What should you warn pt about when using NSAIDs?
| When should they expect it to work?
- Take w/ food
- Analgesic effect seen within 1-2hrs
- Anti-inflammatory effect after 2-4wks of continuous use
