Intro to orthopedic Surgery

Question 1

Wolff’s Law

Answer 1

Bone is deposited in sites subjected to stress and is resorbed from sites where there is little stress

Question 2

Bone Growth/remodeling

Length

Answer 2

Endochondral ossification
articular cartilage
epiphysial plate cartilage

Question 3

Bone Growth/Remodeling

Width

Answer 3

intramembranous ossification in the deeper layers of the periosteum osteoblasts

simultaneous osteoclastic resorption in endosteum

Question 4

Sydesmosis

Answer 4

bones joined by fibrous connective tissue

Question 5

Synchondrosis

Answer 5

held together by boney plates (bound by layer of cartilage)

Question 6

Synostosis

Answer 6

bone replaces ligamentous tissue (fusion of adjacent bones)

Question 7

Symphysis

Answer 7

hyaline cartilage - no synovial membranes

Question 8

Synovial

Answer 8

Hyaline cartilage + capsule of fibrous tissue between

synovial fluid present

Question 9

Avulsion fracture

Answer 9

Bone pulls off

Question 10

Closed fracture

Answer 10

Not open to outside environment

Question 11

Comminuted fracture

Answer 11

many pieces

Question 12

Displaced fracture

Answer 12

parts no longer in close proximation

Question 13

Epiphyseal Fracture

Answer 13

through the epiphysis (ONLY IN CHILDREN)

Question 14

Fatigue Fracture

Answer 14

Caused by constant stress

think of bending clothes hanger back and forth - eventually it breaks

New army recruit = Marching fracture

Question 15

Greenstick fracture

Answer 15

CHILDREN

Bone splinters on one side and stays together on the other

Question 16

Impacted fracture

Answer 16

Bone shoved into itself

Question 17

Intraarticular fracture

Answer 17

fractures into the articular surface - must me put back together perfectly to prevent arthritis

Question 18

Occult fracture

Answer 18

Hidden (found on MRI or Bone Scan )

Question 19

Open

Answer 19

Communicating with outside

Question 20

Pathologic

Answer 20

going through weak bone (ex: tumor)

Question 21

Torus

Answer 21

CHILDREN

Buckle Fracture

Question 22

Nonunion

Answer 22

bone doesnt heal (requires surgery to clean it out)

Question 23

Subluxation

Answer 23

snaps over to the side

Question 24

Fractures do not _____ the ____

Answer 24

Fractures do not DISLOCATE they DISPLACE (shorten, angulate, rotate, etc)

Question 25

Initial Fracture care

Answer 25

Correct significant misalignment Splinting RICE Neurocirculatory monitoring

Question 26

When splinting which joints should be immobilized

Answer 26

the joint above and the joint below the fracture

Question 27

Describe the healing of bone

Answer 27

Healing starts instantly Hematoma forms then calous forms (builds bridge) osteoclasts come in and clean up eventually callous smooths back out into original bone

Question 28

Benefits of closed reduction

Answer 28

1: Avoids stripping of periosteum(where blood supply is) 2: Decreases chance of infection 3: No scar

Question 29

Indicatiosn for open reduction (ORIF)

Answer 29

Intra-articular fractures Irreducible fractures Unstable fractures Early Mobilization Certain Physeal Fractures

Question 30

most common fracture of childhood

Answer 30

Colle's Fracture

Question 31

Compartment Syndrome Symptoms

Answer 31

Pain in passive stretching Sensort loss Tenseness of involved compartment (swelling) ** only have 4-6 hours to recognize the signs

Question 32

Most common sites of compartment Syndrome

Answer 32

Metatarsals Forearms Legs (tibial fractures)

Question 33

Fracture Aftecare

Answer 33

1: Ice and Elevation 2: observe for compartment syndrome 3: Early motion

Question 34

Frequency of x-rays with fractures

Answer 34

weekly for 2-3 weeks

Question 35

How do fractures differ in children compared to adults

Answer 35

1: Less complicated 2: Almost always treated closed 3: Nonunion is rare

Question 36

Fractures in children are almost always treated _____

Answer 36

closed

Question 37

Principles of treatment for fractures in children

Answer 37

PT is not usually necessary Sprains are rare in children Nonunion is almost impossible Malposition may not be correctable after 7-10 days

Question 38

Two types of epiphyses

Answer 38

Traction epiphysis Pressure epiphysis

Question 39

Traction epiphysis

Answer 39

contribute to contour but little to longitudinal growth iliac crest and trochanters

Question 40

Pressure epiphysis

Answer 40

contribute to longitudinal growth occur at ends of long bones

Question 41

Most common type of Salter Harris Fracture

Answer 41

Type II

Question 42

weakest zone/layer

Answer 42

zone III (zone of hypertrophy)

Question 43

Epiphyseal Zones

Answer 43

Germinal (next to joint) Proliferation Hypertrophy Provisional calcification

Question 44

Epiphyseal Fractures

Answer 44

Through the weakest zone (III) Usually transverse

Question 45

When to refer fractures in children:

Answer 45

Suprcondylar fractures of humerus Lateral condylar fractures of humerus Epiphyseal fractures III, IV, V Radial Head and neck fractures

Question 46

When to refer fractures in adults

Answer 46

Both bones of forearm or displaced single forearm bone Displaced malleolar or bimalleolar fracture Supracondylar or intracondylar humerus Displaced olecranon fracture Displaced radial head Fractured upper tibia

Question 47

fractures to ALWAYS refer

Answer 47

all open fractures intra-articular fractures all femur fractures most fractures of both bones of lower leg in adults Pathologic fractures

Question 48

Causes of Pathologic Fractures

Answer 48

Metastatic Tumors Cystic lesions Infection Paget's disease

Question 49

Common locations of fatigue fractures

Answer 49

``` Metatarsal March Fractures Femoral neck (refer) Calcaneus Tibia Fibula ```

Question 50

Best way to diagnose Fatigue Fractures

Answer 50

MRI X-rays are negative early (not positive until 2-4 weeks)