geriatric orthopedics

Question 1

those with increased risk of fall… (in terms of hip,knee, gait, age)

Answer 1

hip Increased flexion
knee: Decreased flexion in pre-swing, Decrease power in pre-swing
Gait: slow + Stride-to-stride variability
age: Frequency doubles every decade after 50

Question 2

Decreased ________ function and loss of ______responses increase chance of falls

Answer 2

proprioceptive, protective

Question 3

usual mechanism of hip fracture

Answer 3

Usually the femoral neck from twisting injury or the intertrochanteric region from fall on the greater trochanter

Question 4

Elderly , Fall or sometimes mild trauma
Pain with walking and standing
Pain can radiate to the knee
what are we assuming…?

Answer 4

hip fx

Question 5

PE hip fracture: pain where? changes in leg?

Answer 5

Pain in groin not laterally
May have externally rotated and shortened leg
If complaining of knee pain CHECK THE HIP!!!

Question 6

imaging for hip fx: who gets imaging? why?

Answer 6

Chest x-ray if (+) for fracture: - OR clearance and possible fat embolism
CT/MRI for those who have history and exam consistent for fracture but negative plain films

Question 7

3 types of hip fx surgery txts

Answer 7

1. Open reduction internal fixation (ORIF): Nondisplaced or minimally displaced fx of femoral neck
2. Hip Replacement: Displaced neck fractures
   Have a high rate of vascular necrosis
3. Compression screw and side plate: Intertrochanteric fractures

Question 8

why do we need people up and walking after hip surgery?

Answer 8

prevent blood clots

Question 9

MOI:Falling on outstretched hand (FOOSH!)

what is the fracture?

Answer 9

Colle’s fracture
Distal radius fracture fragment is tilted dorsally
“dinner fork”

Question 10

MOI:Falling on dorsum of hand

what is the fracture?

Answer 10

smith’s fracture

Distal segment is tilted volarly

Question 11

txt for wrist fractures- accuracy of reduction correlates w/ what?

Answer 11

functional result

Question 12

txt: displaced wrist fractures

Answer 12

Internal or external fixation

Question 13

txt: minimally or nondisplaced

Answer 13

DONT need OR
Sugar tong splint 2-3 weeks then…
Short arm cast additional 2-3 weeks then…
Removable splint for 3 weeks

Question 14

who gets vertebral compression fractures? what part of the spine is it usually?

Answer 14

elderly; Secondary to osteoporosis
Typically lower thoracic or upper lumbar (areas of most flexion of spine)
* Minimal trauma

Question 15

what is a pathological fracture?

Answer 15

one secondary to a Dz process

Question 16

what can compression fracture result in? painful?

Answer 16

Exaggerated thoracic kyphosis: “Dowager’s hump”

Caused by compression fractures and vertebral collapse; Can be very painful

Question 17

compression spine fracture: conservative txt

Answer 17

Short-term pain medication and rest

Early mobilization and short term bracing

Question 18

compression spine fracture: surgical txt - what indicates this txt?

Answer 18

for instability or neurological impairment

Question 19

compression spine fracture: surgical txt. what is it? what can it improve?

Answer 19

Vertebroplasty/Kyphoplasty (percutaneously injecting cement into vertebral body to restore height)
Improve posture and pain

Question 20

most common 2-part humerus fracture is where?

Answer 20

2-part is at surgical neck

Question 21

PE of humerus fracture? (4)

Answer 21

Ecchymosis+ Swelling
Severe pain with movement (not so bad without movement)
Ask about numbness, tingling,
Check for pale extremities, radial pulse, capillary refill

Question 22

Dx test common upper arm fractures:

Answer 22

Trauma series shoulder - minimum 3 views! …
AP
Axillary lateral view
Transscapular “Y” view
** Have to be sure not to miss a dislocation – do not accept suboptimal x-rays

Question 23

common fracture txt: what kind of fractures would constitute a sling? what about prosthesis?

Answer 23

Usually for simple 2-part fractures at surgical neck sling is appropriate
For displaced 4-part fractures prosthesis secondary to disrupted blood supply