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Flashcards in ORTHO Deck (72):
1

Is everything in ortho able to diagnose with xrays?

No… duh

2

Where does a clavicle fracture typically occur?

Distal 1/3

3

What physical exam finding is of the biggest concern with a clavicle fracture?

Look at the skin! If you see tenting it will convert into an open fracture

And make sure they don’t hurt at the sternoclavicular joint

And no neuro findings!

4

How do you treat a clavicle fracture?

Should immobilizer & sleep upright if need be

5

What’s it called when there is shortening?

Beynnett

6

What are the grades of an AC joint separation?

Grade 1-3

7

How do you treat an AC separation?

sling

8

Who do most commonly see humeral head fractures in and what MOI?

elderly with FOOSH

9

How do we treat humeral head fractures?

Typically conservative

10

If you find a scapula injury, what do you need to think?

There is most likely other trauma

11

What should we never say after an xray?

Don't say: "Everything is okay". Say: "I do not see obvious bony injury BUT we can’t see soft issue injury"

12

What’s the MOI for a shoulder dislocation?

Abd & Ext rotation

13

What will you see on PE with a shoulder dislocation?

Sulcus sign that you can place your thumb into it

14

What should we rule out with a shoulder dislocation?

Fracture & neuromuscular and a Hill-Sachs deformity

15

What would cause a posterior dislocation in an unconscious patient?

Seizure and Electrocution

16

What’s a good pain medication for shoulder dislocations?

Fentanyl (since it wears off quickly)

17

What should we ask about in history for shoulder dislocations?

Ask about prior dislocations & how long it has been out for & which hand is dominant

18

If a patient has a hill-sachs deformity, how difficult is it to relocate?

VERY (will often need full sedation)

19

What image would prove shoulder relocation?

Y (with humeral head touching all 3 views)

20

Once the shoulder is reduced, what do you do?

post reduction films, recheck neurovascular, and tell them to avoid abd/ext rot

21

Limited flexion ROM (can’t go past 90 degrees) is key in what diagnosis?

Rotator cuff injury

22

how do you treat a RTC tear?

Sling → send to ortho

23

What are the common elbow fractures?

Supercondylar (bad)

Radial head

Olecranon

24

If you see a distal humeral fracture in a child – what do you do?

REFER!!!! It’s a supracondylar fracture that is so likely to produce long term effects

25

A sail sign is for what?

Proximal radial head fracture

26

When do we see a posterior fat pad in the elbow?

Only when there is an injury; again proximal radial head fracture

27

What type of splint for a proximal radial head fracture?

Long arm

28

Which way does an elbow dislocate?

Posterior

29

After an elbow reduction, what do you do?

Are they neuromuscular intact -
have radiologist or ortho confirm that there’s no radial head fx

30

How do you reduce an elbow?

Countertraction, then pull out and flex forward

31

What’s special about the scaphoid?

Limited blood supply → high rate of non-unions

32

When do you need to handle a wrist injury rather than splinting and sending to ortho later?

Severely angulated or displaced

33

What splint for a distal radius?

volar

34

Any time you find a fracture in a two-bone structure what must you do?

Either crazy palpate or image higher up

35

What fractures in the wrist/forearm do you not want to miss?

Monteggia or Galiazzi

36

What does a positive finkelstein’s test?

DeQuervan’s

37

What does a positive tinel’s test?

Carpal tunnel

38

How do you treat carpal tunnel?

Splint day & night

39

If a patient has a hyperextension injury of the thumb – what diagnosis?

Gamekeeper’s Thumb

40

What must you test for gamekeeper’s?

MCL injury

41

If a grandma fell and her hip hurts and she won’t walk – what does that mean? What should you do?

There is most definitely something wrong → most likely an acetabular fracture

CT hip

42

What hip fracture is stable and the person can walk in on it?

Ramus or pelvic ring fractures

43

If you break higher up in the crest portion of the hip – will they walk on it?

Nope

44

What should you look for on PE in a pelvic fracture?

Crepitus, instability, weight bear, and rotation

45

Shortened and internally rotated hip is what?

Dislocation

46

What should you press onto to rule out significant injury in a pelvic injury?

Iliac crests – if you not crepitus → get trauma

47

What parts of body can you bleed into?

Head, chest, pelvis, and femur

48

Where is an open book fracture?

Pubic symphysis

49

What do you need to make sure or with a pelvic fracture (downtown)?

Make sure there’s no tear in their urethra → no blood present

50

What happens to hip fracture patients?

They get admitted

51

What classification system can we use for hip fractures?

Garden classification

52

If a patient cannot walk on their hip and their leg is externally rotated – what diagnosis is most likely?

Hip fracture

53

Who would most commonly dislocate their hip?

total hip patients

54

Which way do most hips dislocate?

Posterior

55

How do you manage a femur fraction in the ED?

Traction splint (Hare) → Surgical fixation is always necessary

56

If you have a patient with a suspected femur fracture, what must you remember?

Rule out any other injuries!!!

57

If there is some type of neurovascular compromise in a femur fracture, what must you do?

Pull traction

58

If you see a kid with a femur fracture – what must you suspect?

Child abuse

59

If a patient presents with a plant and twist mechanism with minimal pain?

ACL

60

PE findings of ACL tear?

+ Anterior drawer & + Lachman’s

61

PE findings for meniscal tear?

joint line tenderness & + Valgus

62

What is the meniscus connected to?

MCL

63

IF you have a true knee dislocation – what do you do?

DO NOT DO ANYTHING WITH IT! Call ortho for EMERGENT consult

Why? Because of the popliteal artery, and you assume neurovascular accident

64

We should ALWAYS check AROM in the knee – what are we ruling out?

Quad or patellar tendon rupture

65

What is difficult about tibial plateau fractures?

easy to miss & often don’t heal well

66

What must you always note on ankle xray?

Is the mortise intact

67

Which ankle injury is most common?

Lateral malleolus

68

If there is an ankle fracture what MUST you check, in order to rule out what?

DOCUMENT NO PROXIMAL TIBIAL TENDERNESS

In order to rule out a maisoneuve injury

69

If you have a bi or tri-malleolar fracture what happen to the mortise joint?

It is unstable

70

A positive Thompson test is for what?

Achilles rupture

71

How do you splint an Achilles tendon rupture?

Full plantar flexion

72

If you have a calcaneal fracture in the right side – what must you rule out?

ALWAYS x-ray the other foot

ALWAYS examine the spine!