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Flashcards in Ortho Deck (31)
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Sprain vs strain

Sprain = ligament. Strain = muscle


Open fracture

Ortho emergency! Irrigate wound, remove debris, stabilize with splint, start ABx/tetanus ppx -> surgery


What is a pathologic fracture?

A fracture that would not have occurred due to the force alone if not for predisposing condition, such as osteoporosis


Most common site for stress fracture?

Metatarsals. Also common are calcaneus and tibia


Salter-Harris classification of fractures involving the epiphysiseal (or growth) plate

I and II have good prognosis for healing. III and IV require surgery. V has poor prognosis with high risk of growth plate arrest


Greenstick fracture

More common in kids, who have "softer" bone than adults


Torus fracture

Buckling of cortex due to compression. Typically in kids in metaphyseal areas. Heals in 2-3 weeks with simple immobilization


Parts of bone

see attached image


Fat embolism syndrome

ARDS syndrome. Confusion, dyspnea, petechial rash on chest/axilla/neck/conjunctiva. Hallmark: arterial hypoxemia with PO2


Anterior shoulder dislocation

Most common type; younger patients, high risk of recurrence. Caused by abduction/external rotation. Presents with inability to adduct/internally rotate, loss of normal rounded shoulder contour. Complications: rotator cuff tear, labral lesions, coracoid fx, Hill-Sachs deformity


What is a Hill-Sachs deformity?

Compression fx of humeral head


Posterior shoulder dislocation

Often precipitated by convulsion, seizure, fall. Caused by internal rotation/adduction. Presents with inability to abduct/externally rotate, prominant coracoid process, flattened anterior aspect of shoulder.


Inferior shoulder dislocation


Complications that occur from any type of shoulder dislocation

Axillary artery injury, venous injury, injury to nerves of brachial plexus, most commonly axillary nerve


How to assess axillary nerve

Deltoid strength. Sensation over lateral upper arm


What pressure in a compartment is indication for fasciotomy (aside from other clinical signs)?

> 30 mm Hg


Volkmann's ischemic contracture

Consequence of failure to fully treat compartment syndrome. Fibrous replacement of necrotic muscle.


Chronic osteomyelitis

Most often seen in LE of diabetic patients. Acute osteo -> walled-off cavity; polymicrobial. Tx options: open drainage of abscess vs. sequestrectomy vs amputation vs debridement + reconstruction; can use depot abx beads in wound as adjunct


Septic bursitis

Infection of superficial bursa, often affecting bunion, olecranon, and prepatellar bursa. Most often Staph aureus. Tx: aspirate bursa + culture. Broad spectrum Abx right away


Osteoid osteoma

Benign bone tumor arising from osteoblasts, usu age 5-25 yo. Most commonly proximal femur. Local tenderness + dull aching pain at site, relieved by NSAIDs. Dx: xray shows localized area of sclerosis with central radiolucent nidus. Tx: symptomatically with NSAIDs. Surgery to remove nidus if med mgmt fails. Excellent prognosis.



Rare benign bone tumor, similar to osteoid osteoma but larger. Most commonly on axial skeleton. Non specific xray. Tx: curettement of lesion, can recur if not adequately excised. Have potential to undergo malignant transformation.



Outgrowth of bone capped by cartilage. Most common benign tumor of bone, usually at metaphysis of long bones of extremities. Xray shows mushroom-like bony prominence. Surgical excision if sx. Very rarely undergo malignant transformation to chondrosarcoma.



Chondroma (mature hyaline cartilage tumor) that grows within bone and expands it. Presentation: asx until pathologic fracture brings attention to it (e.g. Alex's hand fracture). Tx: none if asx. If pathologic fx, allow to heal and then simple excision + bone grafting procedure


Giant cell tumor

Arises from mesenchymal stromal cells supporting the bone marrow; benign tumor. Most commonly around the knee, distal radius, sacrum. Xray: radiolucent lesion, with asymmetric bone destruction; occasional "soap bubble appearance" of thin subperiosteal shell. Tx: curettage + bone grafting, add adjuvant liquid nitrogen to reduce recurrence. Afterwards, monitor CXR q 6 mo for 2-3 years


4 types of malignant primary bone tumors

Osteosarcoma, chondrosarcoma, Ewing's sarcoma, multiple myeloma (most common)



Arises from malignant spindle cell stroma that produces osteoid. Most commonly around knee, prox humerus, rarely mandible. Presentation: pain + tender mass +/- B sx. Xray: poorly defined lesion with bone destruction/formation, may have *sunburst* pattern. Tx: surgery + chemo. Prognosis: 5 year 60%



Low-grade malignant tumor that presents with pain/swelling over months to years. Tx: surgery, do NOT respond to chemo/rads. Better prognosis than osteosarcoma b/c it is slow-growing and metastasizes late.


Ewing's sarcoma

Can occur anywhere in body. Xray: lytic lesions, "onion skin" pattern of periosteum. Tx: surgery + chemo. Most lethal bone tumor.


Most likely site of origin for bone mets

BLT with Kosher Pickle: Breast, Lung, Thyroid, Kidney, Prostate


Most common site of origin for bone mets, peds



What is a shoulder separation?

AC joint ligament tear