Ortho Flashcards

Question

Nommer les zones du fingertips

Answer 1

The radius has three articular surfaces at the wrist—radiocarpal joint, DRUJ, and an interface with the triangular fibrocartilage complex (TFCC), also known as the articular disk.

Answer 2

Radial: court extenseur du pouce et abd du pouce ulnaire: long extenseur du pouce

Answer 3

The pisiform is unique in the carpus because it is the only sesamoid-like bone and attaches to the FCU tendon, articulating on its dorsal surface with the triquetrum. Although pisiform injuries are rare, occurring in less than 1% of all carpal fractures, given the important role of forming the lateral wall of Guyon’s canal, ulnar arterial damage and neurapraxias may be associated.

Answer 4

Signe de Terry Tomas (gap \> 2-3 mm) et signet ring sign ( anneau créé par scaphoid)

Answer 5

Semi-lunaire aligné avec le radius mais capitatum luxé dorsalement A stage III injury appears identical to a stage II injury but includes a dislocation of the triquetrum that is seen best on the PA view, with overlap of the triquetrum on the lunate or hamate. This injury may be associated with a volar triquetral fracture.

Answer 6

PA: semi-lunaire apparait triangulaire, piece of pie sign latéral: lunaire luxé en antérieur, spilled cuptea sign

Answer 7

Hutchinson’s fracture, or chauffeur’s fracture, is an intraarticular fracture of the radial styloid. Tx: sugar tong splint - possible fixation chirurgicale selon stabilité et si atteinte ligaments périlunaires

Answer 8

Acute dislocation of the DRUJ can occur as an isolated injury, which is rare, or in association with a fracture to the distal radius (Colles’ fracture), radial diaphysis (Galeazzi’s fracture), or radial head (Essex-Lopresti injury) This forcible rotation of the wrist causes disruption of the TFCC, the major stabilizer of the DRUJ, and may result in an associated avulsion fracture of the ulnar styloid. With a dorsal dislocation of the ulna, the ulnar styloid appears more prominent than on the unaffected side, and significant pain and limitation of movement are noted on supination of the wrist. With a volar dislocation of the ulna, there is loss of the normal ulnar styloid prominence, with pain and limitation of movement on pronation. These characteristic clinical findings should alert the emergency clinician to the possibility of DRUJ disruption and prompt the appropriate investigations to confirm the presence or absence of injury.

Answer 9

Contient 9 tendons (4 FDS, 4 FDP, long fléchisseur pouce) + nerf médian conditions systémiques: grossesse, ménopause, rheumatoid arthritis, hypothyroidism, diabetes mellitus, renal failure, congestive heart failure, acromegaly, and collagen vascular diseases.

Answer 10

clinically manifests with pain on the radial side of the wrist, approximately 4 to 8 cm proximal to the site of de Quervain’s disease. Pathophysiologically, intersection syndrome occurs secondary to inflammation where the muscle bellies of the APL and EPB cross over the muscle bellies of the extensor carpi radialis longus and brevis proximal to the retinaculum. Mêmes tendons pour DeQuervain

Answer 11

The Essex-Lopresti lesion, or longitudinal radioulnar disassociation, refers to an unstable forearm as a result of a triad of injuries to the radial head, disruption of the interosseous membrane, and violation of the DRUJ. Référence en ortho

Answer 12

Tx non conservateur dans plus de 80% des cas Hanging cast ou sugar tong Attention R/O atteinte nerf radial

Answer 13

Surtout 5-10a, extension (98%) ou flexion In children with extension-type supracondylar fractures, the arm is held at the side and has a characteristic S-shaped configuration, whereas with flexion-type supracondylar fractures, the forearm is supported with the opposite hand with the elbow flexed to 90 degrees. There may be anterior angulation of the sharp distal end of the proximal fragment into the antecubital fossa, which could injure the brachial artery and median nerve The anterior interosseous nerve is the most commonly injured, followed by the radial, median, and ulnar nerves. Most deficits seen at the time of injury are neurapraxias that resolve with conservative management. Sauf si flexion: nerf ulnaire + fréquent Gartland classification Type I: Minimal or no displacement Type II: Displacement of the fracture but with the posterior cortex intact Type IIA: No rotational component Type IIB: Some rotational component Type III: Displaced, no cortical contact Type IIIA: No rotation of the fracture Type IIIB: Rotation present En extension: Type 1: immobilisation coude 80deg, mobilisation après 3 sem type 2: conservateur vs fixation percut En lfexion: In type I fracture, the periosteum is minimally displaced. These injuries do not need to be immobilized in extension. The elbow can be comfortably flexed and should be immobilized in a splint as with extension injuries. Type II and III injuries should be referred to an orthopedist immediately. Type II injuries are manipulated into extension and then either in a long arm cast or with percutaneous pins. Type III injuries are treated with closed reduction and percutaneous pinning but will require open reduction if closed reduction fails

Answer 14

Latéral + fréquent Fixation SOP si déplacement sup 2 mm condyle latéral: immobilisation coude extension, supination condyle médial: coude extension, pronation, poignet flexion

Answer 15

For epicondylar fractures, if the fracture fragment is minimally displaced (\<5 mm), treatment with a posterior splint is appropriate. To minimize distraction of the fragment by the forearm flexors, the elbow and wrist are flexed with the forearm pronated. Fx épicondyle latérale: très très rare

Answer 16

Attention nerf ulnaire Si fx non déplacée, immobilisation 45-90 deg flexion 3 sem Si déplacement de plus de 2mm ou déplacement en flexion - SOP

Answer 17

Radial head fractures are classified into four types: type I, undisplaced fractures; type II, marginal fractures (involving \<30% of the articular surface) with more than 2 mm displacement, including impaction or angulation; type III, comminuted fractures of the entire radial head; and type IV, any of the previous types with elbow dislocation Tx types 1-2, exercises mobilisation après 2-3 jours. Référence en spécialité si ROM diminuée 3-4: ortho

Answer 18

Attention nerf médian et artère brachiale Réduction luxation postérieure: supination, flexion 30deg, traction en ligne, si non réussi, appliquer pression inférieure avec traction Immobilisation avec attelle postérieure - éval ortho - mobilisation précoce si pas d'instabilité

Answer 19

Rupture proximale du long chef - flexion demeure ok, car court chef compense, svt âge moyen, sportifs Rupture distale a/n insertion au radius, associé à tendinite/IRC/DB/ atteinte inflammatoire, faiblesse flexion et supination

Answer 20

- atteinte neurovasculaire, étirement de la peau, interposition tiss mous - Consultation en 72 hrs pour fx latérale type 2 - Fx comminutives ou déplacées du tiers moyen (plus de 18 mm raccourcissement) FR non union: tabac, femme, âge avancé

Answer 21

A grade I injury is a mild sprain of the sternoclavicular and costoclavicular ligaments.(immobilisation avec attelle, mobilisation rapide) A grade II injury is associated with subluxation of the joint (anterior or posterior) secondary to disruption of the sternoclavicular ligament and capsule. ( immobilisation avec attelle, ortho, hab 4-6 sem) Complete rupture of the sternoclavicular and costoclavicular ligaments results in a grade III injury (dislocation) - ortho, réduction fermée vs ouverte Luxation postérieure : urgence, réduction en SOP préférable

Answer 22

Rockwood: 1. entorse 2. AC 3. AC + CC puis PSI (postérieur, supérieur, inférieur) distance coracoclaviculaire normale 11 à 13 mm Tx : type 1-2, immobilisation avec attelle, reprise mvt lorsque dlr diminuée 1,2 sem The management of type III injuries is variable, although most favor initial nonoperative management.4 Selected patients who are young, are serious athletes, have severe displacement (more than 2 cm), and perform repetitive overhead activities may be candidates for surgical intervention. Treatment of type III injuries in the ED should consist of sling immobilization and sports medicine or orthopedic referral. Type IV, V, and VI injuries require early surgical treatment

Answer 23

Lightbulb au RX Réduction avec rotation interne et traction latérale ou Stimson Immobilisation en rotation interne ou externe si possible

Answer 24

Hill Sach: fx par impaction a/n aspect postéro-latéral tête humérale

Answer 25

- Sous acromiale - Sous glénoidienne - souspineux

Answer 26

Stimson: position ventrale, accrocher poids 10-15 livres au bras luxé, réduction après 20-30 minutes Traction-contre traction: traction / contretraction avec bras en abduction Rotation externe: amener bras en adduction, flexion coude 90deg, puis rotation externe lente (pas de traction Cunningham: Adduct the affected arm to the body and place elbow in full flexion resting against operator’s shoulder. Operator then provides traction by placing their wrist on patient’s forearm while asking the patient to shrug shoulders superiorly and posteriorly. The operator adds massage down through the trapezius, deltoid, and the biceps muscles. This technique is targeted to relax muscles causing a dynamic obstruction. Milch: amener bras en rotation externe et abd, si pas de réduction à 90 deg abd et 90deg rotation externe, appliquer traction sur humérus avec pression latérale et supérieure sur tête humérale FARES: A variation of the Milch technique called FARES (FAst, REliable, and Safe). Move the limb anteriorly and posteriorly in small oscillating movements while continuing to apply traction and start slowly abducting the limb. Once the limb is abducted to 90 degrees, externally rotate the limb at the shoulder, with ongoing traction and oscillating anterior/ posterior movements. Continue to slowly abduct the limb past this position. Clunk! Reduction is usually achieved once the limb is abducted to 120 degrees. Manipulation scapula: Apply traction (manual or hanging weights), and then manipulate the scapula by rotating the inferior tip medially and stabilizing the superior and medial edges with the opposite hand.

Answer 27

Fracture Bankart - Hill Sach Récidive luxation Lésion nerf axillaire Rupture coiffe rotateur Instabilité épaule

Answer 28

Luxatio Erecta Bras bloqué en abd 110-160deg, au RX - humérus parallèle à l'épine de la scapula Réduction par traction-contretraction Complications Fx tubérosité, lésion labrale, lésion nerf axillaire, thrombose/lacération artère axillaire, déchirure coiffe rotateurs

Answer 29

Dissociation complète du MS Au RX, déplacement latéral \> 1 cm de la scapula p/r côté opposé Associated osseous injuries include acromioclavicular separation, displaced fractures of the clavicle, and dislocations of the SCJ. Vascular lesions (subclavian, axillary, or brachial vessels) have been reported in 64% to 100% of patients and severe neurologic injuries in 94%.

Answer 30

The normal distance from the superior aspect of the humerus to the undersurface of the acromion ranges from 7 to 14 mm. A distance of less than 6 mm is highly suggestive of a complete tear.

Answer 31

Yergason et speed

Answer 32

The normal distance from the superior aspect of the humerus to the undersurface of the acromion ranges from 7 to 14 mm. A distance of less than 6 mm is highly suggestive of a complete tear.

Answer 33

History of malignancy Fever with localized back pain Back pain with history of intravenous (IV) drug use, recent tattoo, or bacterial source New neurologic deficit (especially loss of bowel or bladder function or saddle anesthesia) Direct trauma Worsening pain after spinal surgery Sudden onset of back pain in patients on anticoagulants Recent spinal procedure, such as epidural injection

Answer 34

Type A: Stable, posterior arch intact; includes avulsion fractures, isolated iliac wing fracture, pubic rami fractures, minimally displaced ring fracture, and transverse fractures of the sacrum or coccyx. Type B: Partially stable, incomplete disruption of the posterior arch; includes anteroposterior injuries (“open-book” fracture) and lateral compression injuries; may be unilateral or bilateral; these injuries are rotationally unstable but vertically stable. Type C: Unstable, complete disruption of the posterior arch; includes iliac, sacroiliac, and vertical sacral injuries that result from vertical shearing forces; may be unilateral or bilateral. These injuries are both rotationally and vertically unstable.

Answer 35

Anteroposterior Compression I. Symphysis diastasis \<2.5 cm II. Symphysis diastasis \>2.5 cm, sacrospinous and anterior sacroiliac ligament disruption, results in rotational instability III. Symphysis diastasis \>2.5 cm, with complete disruption of the anterior and posterior sacroiliac ligament, results in complete rotational and vertical instability Lateral Compression I. Sacral crush injury on ipsilateral side II. Sacral crush injury with disruption of posterior sacroiliac ligaments; iliac wing fracture may be present (crescent fracture); rotationally unstable III. Severe internal rotation of ipsilateral hemipelvis with external rotation of contralateral side (“windswept” pelvis), rotationally unstable Vertical Shear Vertical displacement of symphysis and sacroiliac joints resulting in complete rotational and vertical instability Combined Mechanisms Any combination of the aforementioned mechanisms

Answer 36

Simple transverse fractures at or below S4 are treated conservatively. Above S4, neurologic injuries are common, necessitating careful clinical evaluation and surgery when neurologic compromise is present.

Answer 37

Avulsion of L5 transverse process\* Avulsion of ischial spine\* Avulsion of lower lateral lip of the sacrum (sacrotuberous ligament)\* Displacement at the site of a pubic ramus fracture Asymmetry or lack of definition of bone cortex at superior aspect of the sacral foramina

Answer 38

Fracture transverse: n'implique pas " pelvic ring" mais fx verticale oui

Answer 39

chronic corticosteroid therapy, chronic alcoholism, hemoglobinopathy (eg, sickle cell anemia), dysbarism, and chronic pancreatitis. AVN is an emerging complication associated with human immunodeficiency virus (HIV) infection

Answer 40

Treatment of stress fractures of the femoral neck is based on involvement of the compressive or tensile aspect. Compressive-side fractures (médial) involving less than half of the cortex are inherently stable and can be treated conservatively with partial weight bearing with crutches. Tension-side fractures (latéral) and compressive-side fractures involving more than half the cortex are considered unstable and at risk for displacement. These fractures should be treated operatively with screw fixation.

Answer 41

Ligne Shenton Position du petit trochanter ( luxation post/rotation interne/troch non visible) Grosseur de la tête fémorale (luxation postérieure, apparait plus petite, plus grosse si luxation antérieure)

Answer 42

Allis (réduction postérieure et obturateur) To perform the Allis technique for reduction of posterior hip dislocation: 1. Place the patient in the supine position, with the pelvis stabilized by an assistant. 2. With the knee flexed, apply steady traction in line with the deformity. 3. Slowly bring the hip to 90 degrees of flexion while applying steady upward traction and gentle rotation. 4. Ask the assistant to push the greater trochanter forward toward the acetabulum. 5. Once reduction has been achieved, bring the hip to the extended position while maintaining traction. Stimson: To perform Stimson’s technique for reduction of posterior hip dislocation: 1. Place the patient in a prone position, with the leg hanging over the edge of the bed. The hip and knee are flexed at 90 degrees. 2. Ask an assistant to stabilize the pelvis. 3. Apply steady downward traction in line with the femur. 4. Gently rotate the femoral head while the assistant pushes the greater trochanter anteriorly toward the acetabulum. 5. Once reduction has been achieved, bring the hip to the extended position while maintaining traction Captain Morgan 1. With the patient supine on the stretcher in its lowest position, secure the pelvis to the stretcher with a bed sheet or strap. Place the strap over the ischial wings and pubic symphysis. This prevents you from lifting the patient off the bed and is more effective than having an assistant try to secure the pelvis. 2. Stand at the side of the bed and place one foot up on the bed (like Captain Morgan standing on a rum barrel). If you need additional height, consider using a stable cardiopulmonary resuscitation (CPR) stool. 3. Place the patient’s ipsilateral leg over your leg so that your knee is resting in his or her popliteal fossa. 4. While holding the ankle in position with slight downward pressure, lift up with both legs to apply traction on the femur and reduce the hip. 5. If traction alone does not work, use your hands to internally and externally rotate the leg to achieve the reduction Whistler 1. Start with the patient lying supine on the bed, and secure the patient’s hips to the bed, as for the Captain Morgan technique. 2. Bend the contralateral leg so that the patient’s knee is flexed 90 degrees and the foot is on the bed. 3. Bend the ipsilateral leg to the same position. 4. Place your arm under the ipsilateral knee and rest it on top of the contralateral knee. 5. Now rotate your body so that you are perpendicular to the patient and looking at his or her feet. This should cause you to squat a little. 6. While holding the patient’s ipsilateral ankle with your other hand, slowly lift up with your legs, while keeping your arm straight and strong. This puts traction on the femur and should reduce the dislocation. 7. If reduction is not achieved with traction alone, use your hand that is on the ankle to internally or externally rotate the leg to achieve the reduction. Traction-contre traction avec pt en décubitus dorsal ( 1 strap autour genou, 1 autour aine/crête iliaque)

Answer 43

To perform the technique for reduction of pubic dislocation: 1. Place the patient in the supine position. 2. Apply longitudinal traction in line with the deformity. 3. Hyperextend and internally rotate the hip while an assistant applies downward pressure on the femoral head.

Answer 44

Sartorius Semi-tendineux Gracilis

Answer 45

TVP Thrombose artérielle Pseudoanévrysme Ossification hétérotopique compartiment (généralement précoce)

Answer 46

The avulsion occurs at the site of attachment of the lateral capsular ligament. Most Segond fractures are caused by sports injuries; the mechanism is almost always knee flexion with excessive internal rotation and varus stress.

Answer 47

Fosse intercondylienne antérieure: attache LCA et parties antérieure ménisques Fosse post: attache LCP et parties post ménisques Donc rupture LCA avec fx antérieure épine intercondylienne

Answer 48

The disorder is found mainly in adolescents and results in partial or total separation of a segment of articular cartilage and subchondral bone from the underlying bone. Atteint souvent la partie latérale du condyle médial

Answer 49

Patella alta (haute) may be sought on the lateral radiograph with use of a ratio of patellar length to patellar tendon length (Insall-Salvati ratio). If this ratio is less than 0.8, patella alta is present.

Answer 50

The popliteus is a small flat muscle that originates on the lateral femoral condyle and inserts on the posteromedial tibia, capsule, and lateral meniscus. It passes beneath the lateral head of the gastrocnemius Functionally, it prevents external rotation of the tibia and withdraws the lateral meniscus during flexion to prevent impingement between the femur and tibia. A third function, along with the quadriceps and PCL, is to stabilize the knee by preventing forward displacement of the femur on the tibia. The Webb test is performed with the patient supine and knee flexed to 90 degrees. The leg is rotated internally, and the patient is asked to resist the examiner’s attempt to rotate the leg externally. Reproduction of symptoms suggests the diagnosis.

Answer 51

The anterior compartment contains the tibialis anterior, long toe extensor muscles, anterior tibial artery, and deep peroneal nerve, which supplies sensation to the first web space of the foot. The lateral compartment contains two muscles that evert the foot, the peroneus longus and brevis, and the superficial peroneal nerve, which supplies sensation to the dorsum of the foot. The superficial posterior compartment contains the gastrocnemius, plantaris, and soleus muscles and sural nerve, which supplies the lateral side of the foot and distal calf. The deep posterior compartment contains the tibialis posterior muscle, long toe flexor muscles, posterior tibial and peroneal arteries, and tibial nerve, which supplies sensation to the plantar aspect of the foot.

Answer 52

This injury involves a medial ankle disruption (deltoid ligament tear or medial malleolar fracture), with complete tearing of the syndesmotic ligament joining the tibia and fibula and fracture of the proximal fibula. Consequently, the fibula floats free relative to the tibia, resulting in an unstable ankle mortise, for which surgical fixation is required. The possibility of this injury indicates the need for examination of the proximal fibula in all medial ankle injuries.

Answer 53

reduction of an anterolateral dislocation can be accomplished in the ED by flexing the knee to 90 degrees, everting the ankle, and applying direct pressure to the head of the fibula. Orthopedic referral and immobilization of the knee for a minimum of 3 to 6 weeks are necessary after reduction. If closed reduction fails, the patient may require open reduction, with repair of the torn capsule ligaments and pinning.

Answer 54

The plantaris is a small variable muscle that originates at the lateral condyle of the femur and passes beneath the soleus to insert on the Achilles tendon. It is a feeble flexor of the knee and plantar flexor of the ankle joint, with little functional significance. Attelle si douleur sévère, canne si moins sévère

Answer 55

The flexor retinaculum tethers the tendons of the tibialis posterior, digitorum longus, and flexor hallucis muscles behind the medial malleolus. The peroneal retinaculum and tendon sheath tether the peroneus longus and brevis tendons behind the lateral malleolus. The extensor retinaculum tethers the tendons of the tibialis anterior, extensor digitorum longus, extensor hallucis longus, and peroneus tertius over the anterior aspect of the ankle. Posteriorly, in the midline, lie the Achilles and plantaris tendons

Answer 56

Syndesmose A = clear space Syndesmose B = overlap

Answer 57

Weber A fractures involve inversion-adduction forces. Weber B fractures involve abduction forces. Weber C fractures involve eversion-abduction forces

Answer 58

**Unimalleolar fractures** Displaced medial malleolar fracture Medial malleolar fracture with lateral collateral ligament rupture Displaced lateral malleolar fracture Lateral malleolar fracture with deltoid ligament rupture Lateral malleolar fracture with widened medial clear space Unimalleolar fracture with syndesmotic diastasis Fibula fracture at or proximal to the tibiotalar joint line Displaced posterior malleolar fracture Posterior malleolar fracture involving \>25% of articular surface **All intraarticular fractures with an articular surface step deformity** **All bimalleolar fractures** **All trimalleolar fractures** **All intraarticular fractures with step deformity** **All open fractures** **All pilon fractures**

Answer 59

Danis Weber A isolé (pas dlr en médial) : immobilisation 6-8 sem, pas MEC 3 sem Weber C: atteinte médiale et syndesmose fréquente - ortho pour SOP Weber B: 50% atteinte syndesmose, évaluation par ortho Fx isolée malléole interne: pas MEC 3 sem - total 6-8 sem Malléole postérieure Treatment usually consists of casting for 6 weeks for nondisplaced fractures in which no associated injury or ankle instability is present CT is generally used to ensure anatomic reduction prior to conservative management. Fractures involving more than 25% of the tibial surface usually require open reduction and internal fixation (ORIF); however, this is an area of controversy, and displaced posterior malleolar fractures require orthopedics consultation. Fx trimalléolaires: ortho/SOP Fx bimalléolaires: controverse, éval ortho

Answer 60

Even in cases of complete Achilles tendon rupture, weak plantar flexion may still be possible because of the actions of the tibialis posterior, toe flexors, and peroneal muscles

Answer 61

Éversion et inversion a/n subtalaire Add/Abd a/n midtarse

Answer 62

Head: Their mechanism is a compressive force applied on a plantar-flexed foot and transmitted up through the talonavicular joint Neck: dorsiflexion forcée - c.f. classification hawkins

Answer 63

Neck: Type 1 fractures, which are nondisplaced, are the only talar neck fractures amenable to nonoperative treatment, which initially consists of 6 weeks of nonweightbearing in a cast. Close outpatient orthopedic follow-up is essential.40 Hawkins types 2 to 4 fractures or talar neck fractures with any displacement are managed surgically Head + body: controversé, consultation ortho

Answer 64

An osteochondral lesion should be considered in any patient with acute ligamentous ankle injury accompanied by gross edema and an effusion visible on plain radiographs. However, most osteochondral lesions are not diagnosed at the time of injury but present as persistent pain and effusions

Answer 65

Rupture ligament talo-calcanéum et talo-naviculaire. Luxation médiale plus fréquente (p/r ant/post/lat)

Answer 66

Anteroposterior View Loss of alignment of the medial border of the second metatarsal with the middle cuneiform Presence of a fleck sign from avulsion of the Lisfranc ligament Diastasis \> 2 mm between base of the first and second metatarsals Compared to the uninjured foot: difference \> 1 mm between base of the first and second metatarsals Oblique View Loss of alignment between the medial border of the fourth metatarsal and medial border of the cuboid Lateral View Loss of alignment between the plantar aspect of the fifth metatarsal and the medial cuneiform Loss of dorsal alignment of tarsals with their respective metatarsals

Answer 67

most undisplaced metatarsal shaft fractures of the second through fifth metatarsals are treated with a below-knee walking cast or boot for 2 to 4 weeks. Although not strictly necessary, pain may necessitate a period of nonweightbearing. Nondisplaced first metatarsal fractures should be treated with casting for 4 to 6 weeks.61 The patient should be nonweightbearing for at least the first 3 weeks, if not the entire period Reduction should be considered in any metatarsal shaft fracture with more than 3 mm of displacement or 10 degrees of angulation. Closed reduction, with toe traps and countertraction at the ankle, is often successful. Non–weight-bearing casting for 4 to 6 weeks should follow The indications for open reduction are controversial but generally include the presence of compartment syndrome, unstable fractures, open fractures, fractures that have failed closed reduction, and multiple fractures (fx déplacées 4e et 5e méta svt chirurgicales) Tête / Col: plus svt déplacées et instables - chx + fréquente, si non déplacées, immobilisation 4-6 sem Base 1 à 4: rare, penser à Lisfranc. Si non déplacé - immobilisation, déplacé Fixation

Answer 68

Zone 1: fx par avulsion bande latérale de l'aponévrose plantaire. Tx non chirurgical, botte de marche 3 sem Zone 2 (Jones) minimalement 15 mm de l'extrémité proximale. Immobilisation 3 mois vs chx selon ortho Zone 3: svt secondaire fx stress, immobilisation prolongée vs chx selon ortho

Answer 69

Non déplacées : buddy taping Déplacées: réduction et buddy taping Si déplacement persistant/rotation : fixation SOP Fx intraarticulaires 1er orteil - svt fixation Luxation MTP: réduction puis immobilisation avec botte de marche ou buddy taping avec attelle d'aluminium pour 3 sem Luxation IP: si 1er orteil - botte marche 3 sem, si autres oreils buddy taping seulement

Answer 70

High-risk stress fractures often occur in bones with a vulnerable vascular supply. In the lower extremity, high-risk stress fractures include the femoral neck, anterior tibia, medial malleolus, navicular, proximal fifth metatarsal, and sesamoid bones. Immobilisation requise et parfois chirurgie

Answer 71

Historical Information Recent significant trauma History of cancer Anticoagulant use Intravenous drug use History of prolonged glucocorticoid use History of osteoporosis History of abdominal aortic aneurysm Patient \> 50 yr Unrelenting night or rest pain Unexplained weight loss Recent bacterial infection Immunocompromised status Failure to improve after 6 wk of conservative therapy Physical Examination Abnormal vital signs—hypotension, hypertension, tachycardia, fever Unequal blood pressure readings in the upper extremities Murmur of aortic insufficiency Pulse deficit or circulatory compromise of the lower extremities Pulsatile abdominal mass Urinary retention Urinary or stool incontinence Loss of rectal sphincter tone Severe or progressive neurologic deficit Focal lower extremity weakness New ataxia or difficulty walking

Answer 72

DORST—distraction, overreaction, regional disturbances, simulation tests, tenderness)

Answer 73

hard: pied moite/froid, absence pouls, hématome expansif, hémorragie pulsatile soft: paresthésie, asymétrie pouls

Answer 74

R = A/B: A(tendon rotule) / B (rotule) inf 0.8: patella basse sup 1.2 patella haute

Answer 75

NAV tête 2-3-4e méta

Ortho Flashcards

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