Ortho Flashcards
(161 cards)
1
Q
Spondylolisthesis
A
slip or listehsis
vertebral body slips in relation to one below it
defect in junction of lamina with pedical (pars intra-articularis) spondylolysis
deminished lumbar lordosis
step off
px with extension
2
Q
Valgus
A
knock knee, legs inward
3
Q
Varus
A
bowlegged
4
Q
Monteggia’s fracture
A
fracture of prox third of the ulna with dislocation of the prox head of the radius
5
Q
Dupuytren’s contracture
A
palmar fibromatosis (thickening of the palmer fascia) Males>40 note a tendon problem starts with painless nodule contracture/cord is late problem May also have peyronie's of penis
6
Q
Boutonnières deformity
A
DIP Hyperextended
PIP flexed
loss of central tendon, volar subluxation of lateral bands
7
Q
Paronychia
A
infection of soft tissue around nail
Staph (acute)
candida albicans (chronic)
trauma induced (manicure/hangnail)
8
Q
DeQuervain’s syndrome
A
Inflamed 1st dorsal tendon compartment
9
Q
Gamekeeper’s thumb
A
UCL tear at MCP joint of thumb
10
Q
Hallux valgus
A
medial deviation of the first metatarsal and lateral deviation and/or rotation of the hallux, with or without medial soft-tissue enlargement of the first metatarsal head., bunion
11
Q
Lisfranc fracture
A
Lisfranc injury, also known as Lisfranc fracture, is an injury of the foot in which one or more of the metatarsal bones are displaced from the tarsus.
foot is in high heel position when comes down…
12
Q
Mallet toe
A
Mallet toe is a deformity of the toe that can cause pain and disability in the affected person. It is similar to hammertoe; in both conditions, the toe bends downward, causing it to resemble a mallet or hammer.
13
Q
Pott’s disease
A
TB of the spine
destruction of vertebral bodies
xray shows vertebral osteolysis or compression fx
tx = rest, anti-TB meds
14
Q
Cauda equine syndrome
A
Compression of Cauda Equina roots
? large midline disc herniation
C/o incontinence, severe leg px, numbness, diff walking
Emergent MRI >Surgery
15
Q
Swollen flex tendon catches on A-1 pulley
A
Trigger finger
16
Q
What test is done for DeQuervain’s Tenosynovitis?
A
Finklestein’s test
17
Q
deformity characterized by:
flexed DIP
Hyperexteded PIP
A
Swan Neck Deformity
18
Q
Swan Neck Deformity
A
Loss of terminal ext tendon
19
Q
Define volar
A
relating to palm of hand or sole of foot
20
Q
Tests for flexor tendon lacerations
A
Profundus test
sublimus test
21
Q
results from a direct blow to extended digit
A
mallet finger
22
Q
Tx of mallet finger
A
extension splint 8 weeks (avulsion likely)
23
Q
GameKeeper’s thumb
A
Ulnar collateral ligament tear at the MCP of the thumb
aka skier’s thumb
24
Q
interarticular fx base of thumb
A
Bennett’s fx (unstable)
25
FOOSH
Fall on outstretched hand
26
tilt of the colles fracture
dorsal tilt
27
Tx of scaphoid fx
spica splint 8-12 wks
28
scapholunate dislocation
4-5 mm widening
| Terry Thomas or David Letterman sign
29
Human bite organism
Staph aureus or Eikenella
30
Rx for Human bite
Augmentin 7-10 days
31
Cat/Dog bite organism
```
Alpha Strep
pasturella multicoda (cats)
```
32
Rx Cat/Dog bite
Augmentin 7-10 days
| DO NOT CLOSE PUNCTURE WOUNDS
33
complication of penetrating trauma or puncture to hand
Deep Space Infection (thenar space)
| 2% of all hand infections
34
Flexor Tenosynovitis
Flexor tendon sheath infection
10% of all hand infections
penetrating trauma
staph or strep is usual organism
35
Kanaval's signs (4 signs)
Semi-flexed posture of digit
fusiform swelling
tenderness, erythema along tendon
severe pain with passive motion (extension)
36
Tx flexor tenosynovitis
urgent surgical drainage
irrigation catheter flush
IV antibiotics for at least 24 hours then oral 7-10 days
37
Deep pulp infection
Felon
38
Felon Tx
X-ray to r/o fb
| surgical drainage,
39
Paronychia Tx
early-nail trimming, soaks, antibiotics
| late-partial nail removal, drain abcess
40
OA nodes at DIP
Heberdens nodes (85%)
41
OA nodes at PIP
Brouchard's nodes (45%)
42
Nerve compression: Median Nerve
Carpal tunnel
Pronator syndrome
anterior interosseous syndrome
43
Nerve compression: Ulnar nerve
guyon's canal, cubital tunnel
44
Nerve Compression: Radial Nerve
Post. Interosseous nerve compression
| radial tunnel
45
Carpal Tunnel Syndrome: physical exam
thenar atrophy
loss of 2 point discrimination
tests: Tinel's, Phalen's, compression
Electrodiagnostic studies (gold standard)
46
Tx of Dupuytren's
```
excise cords surgically >30 degrees
inject collagenase (xiaflex)
```
47
Lederhosen's disease
plantar fibramatosis (similar to dupuytren's but of foot)
48
Peyronie's disease
(penile contracture)
49
Pseudoarthrosis
failure of bone healing causing a "false joint" consisting of soft tissue
50
Nerve injury recovery times:
Contusion
Crush
Contusion : 2-3mo
| Crush: 2 cm/mo
51
radial nerve > spiral fracture to humerus> ______
Wrist drop
52
Peroneal nerve > fracture to fibular neck > ______
foot drop
53
Ultimate goals of Fx Tx
1. Alignment of bones (angular and rotational)
2. Restoration of proper length
3. Restoration of apposition of the bone ends
4. Adequate immobilization
54
acceptable angular deformity in child reduction of fx
15-20 degrees that is close to a joint and in same plane of motion
55
Top Ten principles of setting fx
1. comparison xrays
2. xrays in two planes
3. look for an injury in another bone
4. correct a both angular and rotational misalignment
5. take stress xrays
6. Do not be satisfied with one dx (always look for another injury.
7. Reduce the fx ASAP
8. evaluate for joint instability and tendon function
9. usefulness of extremity (not just xray)
10. Irreducibility may signify soft tissue interposition
56
Fracture healing overlap stages
Inflammation
Repair
Remodeling
57
Volkman's Ischemic Contracture
acute ischemia and necrosis of muscle fibers of the flexor group of muscles in the forearm. especially the FDP and FPL. the muscles become fibrotic and shortened
58
time... delayed union or delayed healing
fracture not healed after 16-20 weeks.
59
time... non-union fracture
not healed after 60 or absence of evidence of progression of callus formation over 3 mo
60
osteonecrosis
fracture that results in compromised blood supply to bone and ultimately results in bone death
61
bones at risk for osteonecrosis
talus
scaphoid
femoral head
62
compartment syndrome P's
```
Pain!!
Pallor
paresthesias
Paralysis
Pressure
Pulselessness
Poikilothermia
```
63
Compartment Syndrome: direct measurement of pressure in mmHg
< or equal to 30 mmHg
64
Volkmann's Ischemic Contracture is a result of
Untreated arterial injury
| compartment syndrome secondary to swelling in a tight cast.
65
Reflex Sympathetic Dystrophy- AKA
Complex regional Pain syndrome
66
Pathology of Reflex Sympathetic Dystrophy
Disturbance of the sympathetic nervous system which leads to intense pain and vasomotor symptoms.
EXTREME sensitivity to light touch
Pain out of proportion to injury (can't have clothes touch it)
extremity is swollen, warm and excessive perspiration may occur
67
Reflex sympathetic dystrophy: clinical features
```
Joint motion restricted
area becomes cool
atrophy (skin and muscle)
skin (dry, shiny and glossy)
stiffness and intractable pain
anxiety and depression
```
68
Principles of treatment, fracture in children
1. Mild angular deformities in the plane of motion frequently correct themselves with growth
2. rational misalignment does not currect itself
3. apposition and mild shortening are of less importance in young children
4. remodeling is greater when fractures closer to the physis.
5. physical therapy after the fracture has headled is usually unnecessary and may even be unwise.
6. A tender growth plate after an inury usually means that a fracture is present, even though a fracture may not be apparent on x-ray.
7. nonunion is almost impossible in children
8. malposition may not be correctable after 7-10 days.
69
slater-Harris Classification
```
S-Separation>Type 1
A-Above>Type 2
L-Lower>Type III
T-Through>Type IV
R-Ram>Type V
```
70
Thurstan Holland fragment
small metaphyseal triangular portion of bone carried with physis in type II and IV Salter-Harris Fx.
71
SCFE fx
Slipped capital femoral epiphysis
72
Distal Tibia Ossific nucleus:
| ages appears and closes
Appears => 2-3yo
Fuses: Girls => 15yo
Boys => 17 yo
Fuses central to meadial and then lateral over 18 mo
73
Ages for elbow occification
6 mo - 2 years capitellum
5 - 9 years med epicondyle
7 - 13 years trochlea
8-13 years lat epicondyle
74
Kocher criteria
```
septic hip
Fever (greater that 38.5 degree C)
Not-weight bearing
ESR (greater than 40 mm/hr)
WBC count (greater than 12,000)
```
Modified to include:
CRP
Prospective study of 53 pts???
75
Labs for septic hip
Blood cultures
CRP
ESR
CBC with differential
76
Definitive Dx for septic hip
```
Joint aspiration
(cloudy appearance, WBC b/t 80-200k
```
77
TX Septic hip
I&D
IV abx followed by oral abx
serial CRPs
78
nerve roots of cervical spine exit _____
above corresponding pedicle
79
never roots of the thoracic and lumbar spine exit _____
below the corresponding pedicle
80
cafe au lait spots are associated with
neurofibromatosis
81
Normal range of motion of c-spine
flexion:50
extension: 60
rotation: 80
lateral bend: 45
82
Motor examination for cervial nerve roots
```
C5: deltoid, shoulder abduction
C6: biceps-elbow felsion
ECR: wrist extension
C7: Tricpes-Elbow extension
FCR-wrist flexion
C8: FDP- flexion middle finger
T1: Hand Interossei-Spread Fingers
```
83
Reflex examination
Biceps C5,C6
Brachioradialis C5,C6
Triceps C7
84
congenitial torticollis most common position
Lateral flexion and rotation
85
congenital torticollis causes
birth trauma SCM muscle damage
| breech or difficult forceps delivery
86
torticollis
cervical dystonia
87
cervical strain vs sprain
strain - muscle or tendon
| sprain - ligament
88
Spurling's test
perform for nerve root compression (c-spine)
| patient in slight extension and lateral flexion, apply axial force
89
Hoffman's sign
Myelopathy cervical spine
| flick middle finger will have involuntary contraction of the thumb and index finger IP joints
90
Ankle Clonus
Myelopathy
| 5 beats or more abnormal
91
Babinski reflex
Myelopathy
| + when hallux dorsiflexes and other toes fan out
92
Hangman's fx
facture of pars interarticularis pedicle of C2
93
Jefferson Fx
Burst of C1-diving accidents
94
Chance fx
lapbelt injury
thoracolumbar junction
include abdominal injuries
95
3 columns of spine
Anterior:ALL (ligament) and anterior 2/3 of body and disc
Middle Column: Posterior 1/3 of body and disc to include PLL (ligament)
Posterior: everything posterior to the PLL
96
Types of Thoracic outlet syndrome
Neurogenic: compression of lower bachial plexus usually by tissue band that connects C7 to 1st rib
Vascular:
Subclavian artery compression: color changes, claudication or vague px in arm.
Subclavian vein: swelling of arm, distension of veins or px in arm or hand. (may be thrombus)
97
Adson test
test for subclavian artery compression by cervical rib or tightening anterior and midle scalene muscles (TOS)
passively extend, abduct and externally rotate arm while palpating radial pulse
take deep breath and hold in
extend neck and rotate head towards affected side
+ = loss of radial pulse
98
Rpps pr East Test
sit up with good posture
shoulders abducted to 90 and externally rotated (stick em up)
open and close fist for 1 min
+ if reproduces symptoms
TOS test
99
L4 neurologic level
sensory top of leg
reflex: patellar
weak quad
100
L5 Neuologic level
sensory top of foot
reflex: none
can stand on heels
difficulty pulling big toe up
101
S1 neurologic level
sensory bottom of foot
relfex ahillies
can't stand on toes
102
spinal stenosis treatment
lumbar epidural steroid injections
NSAIDS
Surgical Decompression
Refer: bladder/bowel incontinence or failed conservative treatment
103
Nerve roots motor L4-S1
L4: quadriceps
L5 EHL (big toe)
S1 Ankle pantar flexion
104
Nerve roots Reflex L4-S1
L4: knee jerk
L5: none
S1: Achilles
105
Nerve roots sensation L4-S1
L4: Anterior thigh
L5: Shin, top and medical foot
S1: Calf, lat foot
106
Kyphoplasty
fixes compression fx
107
"Hip Px"
Buttock= referred back pain
Groin=true hip joint pain (arthritis)
Lateral=trochanteric bursitis
108
Talipes Equinovarus
Congenital defority of hindfoot equinus, forefoot adduction and varus
commonly associated wtih spina bifida, arthrogryposis, myelodysplasia
r/o hip dyspasia and torticollis
109
Congenitial club foot
Cavus
adductus
varus
equinus
110
galeazzi sign
The Galeazzi test, also known as the Allis sign, is used to assess for hip dislocation, primarily in order to test for developmental dysplasia of the hip.It is performed by flexing an infant's knees when they are lying down so that the feet touch the surface and the ankles touch the buttocks.
111
Ortalani and Barlow tests
check for hip dysphagia posterior hip dislocation
112
pavlic harness
bace for hip dysplagia less than 6 mo
113
Osteomyelitis
```
generally secodnary to hematogenous spread
s. aureus most common
sudden onset of fever, systemic illness
slower onset in adolescents
bone destruction on x-ray
```
114
transient synovitis
```
most common cause of lower ext pain
children 3-8 yrs
rapid onset hip pain
limited ROM
limping or inability to bear weight
frequent preceding viral illness
DDX: septic arthritis
```
115
Legg-Calve-Perthes Dx
4-12 yo
| a childhood hip disorder initiated by a disruption of blood flow to the head of the femur. avascular necrosis
116
SCFE
slipped capital femoral epiphysis
displaces posterior and medially
high rate of AVN
antalgic gait, hip pain, obligate external rotation
117
How to think more important than you know (12 things)...
```
Toxins
Tumors
Trauma
infection
inflammation/immunologic
metabolic
endocronologic
hematologic
vascular
neurologic
congenital
psychologic
```
118
trigger thumb
nodular enlargment of flexor tendon that becomes locked at A1 pulley
119
erb's palsy vs klumpke's Palsy
Erb's:
most common
C5-C6
Position (waiter's tip)
Klumpke's
C8-T1
Hand paralysis but shoulder/elbow maintained
120
ligaments that reinforce hip capsule
ilio, ischio and pubofemoral ligaments
121
Steroid/EtOH use can cause what in the hip?
AVN
122
thomas test
hip flexor test
123
trendelenburg test
gluteus medius injury
124
Patrick's Faber test
Hip for Limited ROM patient on back, leg at 90, foot folded over top of other leg. (looks like a 4)
125
FAIR test
piriformis syndrome, on back, leg at 90 degree across other leg way out past bed, (like granny sleeping)
126
labs for hip pain
CBC, ESR, CRP, rheumatoid factor
| joint aspiration: cell count, gram stain, culture
127
Myocitis Ossificans
formation of bone tissue inside muscle tissue after a traumatic injury to the area
128
injury tot eh acetabular labrum and cartilage
FAI, femoral acetabular impingement... hip impingement
129
pain over lateral hip described as deep (C sign)
hip impingment
catching locking and clicking
decreased flexion and internal rotation
130
FADIR and FADIR test
Flexion, adduction, and internal rotation
| Patient over back, hip and knee flexed, knee over midline
131
two types of hip impingement
Pincer and Cam
132
sign of AVN
progressive pain to groin, lateral hip or buttock, lip and LOM... dragging leg behind, antalgic gait
133
crescent sign-hip
well defined sclerotic region beneath articular surface representing subchondral fracture
134
meniscus blood supply
peripheral 1/3 only
135
McMurray's test
for medial and lateral meniscal tears
136
Apley test
patient prone, knee 90 degree with axial load
137
primary and anterior stabilizer of the knee
ACL
138
Lachman's test
ACL test, more sensitive, knee at 30 degrees, anterior and posterior translation of tibia
139
Pivot shift test
Knee fully extended
valgus and upward force applied to knee
tibia subluxes anteriorly on femur
140
collateral ligament tears:
Valgus force?
Varus force?
```
valgus = MCL
Varus = LCL
```
141
patellar fx
extensor mechanism usually intact if two main fragments < 6 mm apart
Immobilize in extension 6 weeks
142
chondromalacia patellae
Patellofemoral pain syndrome, most common anterior knee problem, worse with sitting with knee flexed or going down stairs.
143
foot anatomy refresher, # of bones
26 bones, 34 joints
144
haglund's deformity
deformity of calcaneus
145
most ankle sprains involve what MOI
lateral ligament complexes as a result of plantar flexion and inversion
146
anterior drawer test of the ankle is for what?
anterior talofibular ligament
147
talar tilt test
INVERSION stress on ankle at 90 degrees
tests stability of calcaneofibular and anterior talofibular ligaments
tests stability of the ATF...
148
Deltoid ligament stability-ankle
evert foot stress used to assess tear of deltoid ligament
149
squeeze test-ankle
provocative test for syndesmotic injury
150
Ottawa Ankle rules
Determines the need for xrays in patients with an ankle injury
Pain in the malleolar zone and any of the following:
1. Bone tenderness along the dist 6 cm of the posterior edge of the fibular or tip of the lateral malleolus.
2. Bone tenderness along the distal 6 cm of th eposterior edge of the tibia or tip of the medial malleolus.
3. inability to bear weight for more than 4 steps both immediately and in the ED
151
chronic osteomyelitis antibiotic therapy
IV antibiotics for 2-6 weeks with transition to oral antibiotics for total treatment of 4-8 weeks
152
acute osteomyelitis
beta-lactam antibiotics
| if MRSA is suspected, then IV vancomycin
153
antibiotic to use in diabetic foot infections or PCN allergy. (osteomyelitis)
fluoroquinilone
154
treatment for jones fracture
strict non-weight bearing for 6-8 weeks
| walking boot for additional 2-4 weeks
155
Morton's neuroma
perineural firosis of the plantar nerve where lateral and plantar branches communicate.
Located between the 3rd web space
156
"Walking on a marble" or "wrinkle in sock"
Morton's neuroma
157
arthritis of the MTP joint
hallux rigidus - most common sight of arthritis in the foot.
158
normal hallux valgus angle
< 15 degrees
159
toe deformity with flexion at DIP
Mallet toe
160
toe deformity with flexion of PIP
Hammer toe
161
toe deformity with flexion of both PIP and DIP
claw toe
