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Ortho Flashcards

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1
Q

What is the difference in onset of pain with a ligament tear vs meniscus tear?

A 
Ligament = sudden onset
Meniscal = gradual onset
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2
Q

Wounds in a recent ortho surgery is what until proven otherwise?

A

Deep space/joint infection

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3
Q

What are the minimum views needed for an x-ray of an injury?

A

Minimum two views at 90 degrees from each other

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4
Q

What is the most commonly missed fracture on x-rays?

A

The second one

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5
Q

What is the clinical significance of a: comminuted fx?

A

Harder to hold together

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6
Q

What is the clinical significance of a: fx in which a joint is involved?

A

Must be maintained in anatomic position otherwise increase risk of arthritis

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7
Q

What is the clinical significance of a: shifted fx?

A

Tore a lot of soft tissue-less stable

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8
Q

What is the clinical significance of an oblique/spiral fx?

A

More likely to shift/slide

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9
Q

What is the treatment for a buckle fracture?

A

Self limited-give something for comfort and protection

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10
Q

Does good position mean a stable fx?

A

No

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11
Q

What is the principle on whether to mold a cast in flexion or extension?

A

If the fx is reduced, want to antagonize movement of the fx, otherwise it will try to shift back to where it originally was

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12
Q

What are the four characteristics of a bad fx?

A
  • Shifted
  • Comminuted
  • joint involved
  • oblique/spiral fx
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13
Q

What is a colles fx?

A

extra articular fx of the distal radius, with distal fragment dorsally displaced

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14
Q

What a smith’s fx?

A

Extra articular fx of the distal radius, with the distal fragment displaced volarly

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15
Q

Which is more stable: a smith or colles fx? Why?

A

Colles is more stable since the flexors move the distal radius volarly with a smith’s fx

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16
Q

What is a Barton’s fx? Which is more unstable: a volar or dorsal displacement? Why?

A
  • An intra-articular fracture of the distal radius with dislocation of the radiocarpal joint.
  • Volar displacement less stable, since flexors pull on the bone more
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17
Q

What is a Chauffeur’s (Hutchinson’s) fx?

A

Fx of the distal radial styloid

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18
Q

In how many week should a scaphoid fx be apparent?

A

4 weeks, although can be sooner

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19
Q

How can you place the hand to better appreciate a scaphoid fx?

A

Wrist in ulnar deivation

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20
Q

Is a more proximal or distal fx to the scaphoid more concerning?

A

Proximal

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21
Q

What is the complication from a scapholunate dislocation?

A

Arthritis several years later

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22
Q

What discharge instructions should you give to someone who has a scapholunate dislocation?

A

Must not return to impact sport that caused it

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23
Q

What is the “terry thomas” sign?

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A

Gap of over 3 mm in scaphoid and lunate in a scapholunate discloation

24
Q

What is the “spilled tea cup” sign?

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A

Lunate dislocation

25
What is the classic presentation of a lunate dislocation?
FOOSH injury with subsequent swelling over the volar aspect of the wrist
26
What is the general management for a lunate dislocation?
Reduce and refer (to OR)
27
What is a perilunate dislocation?
All of the carpal bones are displaced, except the lunate
28
What is the line of bones that should connect in the wrist, starting distally, and ending in the radius? (4)
Metacarpal Capitate Lunate Radius
29
What is the general management of a perilunate dislocation?
Reduce and refer for probable operative management
30
What are Gilula's arcs?
Three arcs - Proximal aspect of the proximal carpals - Distal aspect of the proximal carpals - Proximal aspect of the distal carpals
31
What is the most proximal carpal bone on the radial side of the hand? Ulnar?
``` Radial = Scaphoid Ulnar = lunate ```
32
What is the bone that sits above and between the lunate and the scaphoid?
Capitate
33
What is the bone just lateral to the scaphoid?
Trapezium
34
What is the bone just medial to the lunate?
Triquetrum
35
What is the distal carpal bone that sits just proximal to the 1st through 5th metacarpals?
``` 1 = Trapezium 2 = Trapezoid 3 = Capitate 4 = Hamate 5 = Pisiform/triquetrum ```
36
What is the treatment for a triquetrum fx?
Splint and refer (usually heal well on their own in 6-8 weeks)
37
What is the "piano key" sign?
Pushing down on the ulnar styloid when broken feels like a piano key
38
How can you tell if you have a radial-ulna ligament tear?
Pronate and supinate while stabilizing the radial head and ulnar head respectively-- if laxity, may have it
39
What is the stress view for a scapholunate dislocation?
Make a fist
40
What is the hamate view on x-ray?
X-ray shot parallel to the metacarpals hand when it is fully extended at the wrist
41
What is the proper splint position for a hook of the hamate fx?
ulnar gutter with wrist extension, with flexion at the MCPs, but extension at the PIPs and DIPs.
42
Why is a native hip dislocation an orthopedic emergency, while a prosthetic hip dislocation is not?
Risk of femoral head necrosis with native hip
43
How many hours do you have to reduce a dislocated hip before avascular necrosis sets in?
6 hours
44
What must always be visualized with a prosthetic joint on x-ray? Why?
- The ends of the prosthesis with two views at 90 degrees | - Can have periprosthetic fractures
45
What type of hip fracture is most likely to cause vascular disruption?
Subcapital
46
What is the risk of bisphosphonates in terms of fractures?
Increased susceptibility 2/2 laying down irregular bone
47
What is the presentation of IT band syndrome?
- Lateral knee pain worse with walking/running | - Usually occurs in runners
48
What is the pressure number to remember for diagnosing compartment syndrome? How are these used (2)?
- within 30 mmHg of DBO | - Over 30 mmHG
49
Which is more likely to have abnormalities in CRP, ESR, WBC: acute or chronic osteomyelitis?
Acute
50
What is the difference between wet and dry gangrene?
``` Wet = infectious Dry = Ishemic ```
51
Heliotrope rash + elevated CK + MSK pain = ?
Dermatomyositis
52
What are the components of the CRAB mnemonic for multiple myeloma?
- hyperCalcemia - Renal failure - Anemia - Bone lesions
53
What are the four typical features of OA on plain films?
- Joint space narrowing - Subchondral sclerosis - Osteophytes - Subchondral cysts
54
What must always be high on the differential for a patient with RA that comes in with joint pain?
Septic arthritis (usually on immunosuppression)
55
Which affects distal hand joints and which proximal: RA vs OA
``` RA = proximal OA = distal ```
56
Which are positively birefringent and which are negative : gout vs pseudogout?
``` Pseudogout = Positive Gout = negative ```

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