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Flashcards in Ortho Deck (56)
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1

Partial disruption of a joint, in which some degree of contact between the articular surfaces remains.

Subluxation

2

Complete disruption of a joint, such that the articular surfaces of the bones that comprise the joint are no longer in contact with one another.

Dislocation

3

A tearing injury to muscle fibers resulting from excessive tension or overuse.

Strain

4

A tearing injury to one or more ligaments of a joint, which occurs when the joint is forced beyond the limits of its normal planes of motion.

Sprain

5

"Fatigue" fractures from repetitive forces before the bone and supporting tissues have had time to adjust/accommodate to such forces

Stress fracture

6

Radiographs for stress fractures

often negative until weeks later - diagnose by presumption + point tenderness and swelling

7

Salter fractures aka

epiphyseal fractures - growth plate fractures in children

8

3 phases of fracture healing

inflammatory
reparative
remodeling

9

3 orthopedic emergencies - broad categories

1. Open fracture
2. Subluxation / dislocation
3. Neurovascular injury

10

Potential major complication of open fracture

osteomyelitis

11

Urgency of reducing a dislocation / subluxation based on:

1. Neuro / circular compromise - neurovascular bundle "kinked"

2. Longer it's dislocated, harder it is to reduce and less stable it will be (due to edema, muscle spasm, tissue changes)

12

Serious complication specific to hip dislocation

Avascular necrosis of femoral head

13

Why avascular necrosis of femoral head can occur in hip dislocation

Much of blood supply to femoral head is delivered through vessels that emerge from the acetabulum

14

Sling supplement to splint is useful for injuries to ___ and ___ because ____

wrist and forearm; because optimal immobilization includes joint above and below injury

15

On physical exam, patients with disruption of sternoclavicular joint or fracture of the humeral shaft may complain only of ___

shoulder pain

16

Common examples of fractures which may not appear on radiograph until 7-10 days post trauma

Fractures of scaphoid

Nondisplaced fracture of radial head

Stress fracture of metatarsal

17

"Fat pad sign" on elbow of adult often indicates

Radio head or neck fracture - most common cause of elbow joint effusions in adults

18

"Fat pad sign" on elbow of children often indicates

Supracondylar fracture - most common cause of elbow joint effusions in children

19

Clue in history to indicate posterior sternoclavicular dislocation

Shoulder pain + dysphagia

20

Mechanism: bilateral compression of shoulders, via MVA or "pile on" in football often results in ___

anterior (more common) or posterior (mediastinal structures at risk) sternoclavicular dislocation

21

Mechanism: direct blow to medial clavicle often results in ___

posterior sternoclavicular dislocation

22

Mechanism: fall, landing on apex of shoulder

acromioclavicular separation

23

Mechanism: direct blow to anterior shoulder; fall on outsretched arm; seizure or electroconvulsive muscular activity

posterior dislocation of shoulder

24

Mechanism: Sudden traction force to toddler's arm

Subluxed radial head

**sometimes causes pseudoparalysis of arm and therefore can be misdiagnosed as brachial plexus injury**

25

Mechanism: fall, landing on outstretched arm or with elbow under body

Fracture of the radial head (may be occult on x ray)

26

Mechanism: Forced dorsiflexion of wrist

Colles fracture
Fracture of scaphoid
Lunate dislocation

27

Mechanism: striking knee against dashboard in MVA

Posterior dislocation of hip

28

Mechanism: landing flat on feet from a height

Calcaneus fracture
Tibial plateau fracture
Acetabular fracture
Vertebral compression fracture - lumbar

29

Mechanism: ankle inversion force

Fracture of any 3 of malleoli
Disruption of anterior tibiofibular ligament with proximal fibular fracture

30

Mechanism: Inversion or medial or lateral stress to the forefoot; axial load on the metatarsal heads with the ankle plantarflexed

Midfoot dislocation (Lisfranc injury)

31

One of the most common hip disorders in adolescents; often presents with hip pain but can present with groin pain, isolated thigh or knee pain.

Slipped capital femoral epiphysis Leg is externally rotated with an antalgic gait

32

What is "broken off" in Salter Harris Type I

entire epiphysis

33

What is "broken off" in salter Harris Type II

entire epiphysis along with portion of metaphysis

34

What is "broken off" in salter harris type III

portion of epiphysis

35

What is "broken off" in salter harris type IV

a portion of epiphysis along with a portion of metaphysis

36

What is "broken off" in salter harris type V

Compression injury of epiphyseal plate

37

Diagnosis of Type 1 Salter Harris

Presumptive - often not radiographically lucent
Based on tender and swelling at region of physis

38

Diagnosis of Type V Salter Harris

Often not radiographically apparent
qPresumptive with significant "axial loading" force coupled with significant tenderness in physis region

39

Open fracture antibiotic prophylaxis options

Cefazolin or Cipro
+ Gentamicin for > 10cm wound

+ Consider using Penicillin, metronidazole, or clindamycin if significant contamination with soil is present

40

When to consult ortho

Compartment syndrome
Dislocation with fracture
Circulatory compromise
Open fracture

41

Immobilization technique for shoulder dislocation, acromioclavicular separation, clavicle fracture, humeral neck fracture

Shoulder immobilizer - like a sling, but better

42

Immobilization technique used for a variety of upper-extremity injuries, in conjunction with other immobilization techniques; may be used alone for nondisplaced or clinically suspected fracture of the radial head.

Sling

43

Immobilization technique used for reduced elbow dislocation, displaced radial head fracture, supracondylar humeral fracture

Long-arm gutter

(arm in sling position - elbow flexed at 90, palm facing abdomen)

44

Immobilization technique used for wrist or forearm fracture

Sugar tong splint
** often supplemented w sling **

(arm in sling position - elbow flexed at 90, palm facing abdomen

45

Immobilization technique used for 4th - 5th ray metacarpal or proximal phalanx fracture

Ulnar short arm gutter splint

The metacarpophalangeal joints and interphalangeal joints are positioned in gentle flexion

46

Immobilization technique used for 2nd or 3rd ray metacarpal or proximal phalanx fracture

Radial shrot arm gutter splint

The metacarpophalangeal joints and interphalangeal joints are positioned in gentle flexion

47

Immobilization technique used for scaphoid fracture or thumb metacarpal/proximal phalanx fracture

thumb spica

48

Immobilization technique used for:
Fracture or reduced subluxation of patella
Knee dislocation, postreduction (temporary)
Tibial plateau fracture
Knee ligament injury
Suspected meniscal tear (provided the knee can be fully extended)

Knee immobilizer

*Use of an immobilizer for more than a few days in the elderly or for more than a week or two in young patients may result in painful stiffness of the knee joint. For that reason, orthopedic follow-up should occur within approximately 7 days.*

49

Immobilization technique used for:
Ankle dislocation or fracture-dislocation

Unstable ankle fracture (high distal fibular fracture or medial and/or posterior malleolar fracture)

Widened medial mortise (indicates disruption of stabilizing medial structures)

Metatarsal fracture (alternative immobilization dressings may be used)

Posterior ankle mold
* consider adjunctive use of ankle sugar-tong for unstable ankles*

While the dressing is setting, the ankle should be maintained in a position as close as possible to neutral dorsiflexion—that is, at 90 degrees to the leg. T

50

Immobilization technique used for:
Simple ankle sprain

Stable lateral malleolus fracture (below the superior border of the talus) without other ankle involvement (no medial swelling or tenderness, posterior malleolus intact)

Ankle stirrup

51

Immobilization technique used for:
Toe fracture

Some metatarsal fractures

Hard-soled shoe

52

Immobilization technique used for:
Some toe or foot contusions or fractures where weightbearing is allowed

Short-leg walking boot

53

When to get xray for neck pain

3-view cervical spine films in
- chronic, weeks to months neck pain (+/- trauma)
- history of malignancy or remote neck surgery
- neck pain and preexisting spinal disorders

54

When to get MRI for neck pain

MRI is indicated for patients with chronic neck pain with neurologic signs or symptoms regardless of the plain radiographic findings.5 MRI is also indicated when plain radiographs reveal bone or disk margin destruction, if there is cervical instability, and (with intravenous contrast) if epidural abscess or malignancy is suspected

55

Symptoms of acute cervical disk prolapse

neck pain, headache, pain distributed to the shoulder and along the medial scapular border, dermatome pain, and dysesthesia in the spinal root distribution to the shoulder and arm

56

What serious condition should be considered with neck pain in patients taking anticoagluants or bleeding disorder

Cervical spin epidural hematoma