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Ortho Residency > ortho basics > Flashcards

ortho basics Flashcards

(51 cards)

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1
Q

rule of 2s when assessing patient

A

two joints
two views (AP lateral)
two times ( pre post reduction)
two limbs ( for comparison)
two injuries ( calcaneal + spine)

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2
Q

cause of spiral fx

A

torsional force

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3
Q

define translation on xrays

A

displacement of distal segment compared to proximal segment (medial, lateral, anterior, posterior)

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4
Q

define angulation on xrays

A

draw arrow going down, if bone going towards midline = varus if going away from midline = valgus

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5
Q

define length on xrays

A

shortening vs distraction

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6
Q

define rotation on xrays

A

IR vs ER

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7
Q

how to comment on xrays

A

patient details
location (right or left)
bone
part of bone: proximal, middle, distal
type of fx
TALR:
- translation
- angulation
- length
- rotation

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8
Q

early fx complications (local)

A

open fx
compartment syndrome
neurovascular injury
infection
implant failure
soft tissue complications (blisters)

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9
Q

early fx complications (systemic)

A

sepsis
DVT/PE
ARDS
Fat mebolism
haemorhagic shock

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10
Q

late fx complications

A

malunion/nonunion
AVN
osteomyelitis
HO
post traumatic arthritis
CRPS

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11
Q

Gustillo Anderson type 1

A

<1cm, 1st generation cephalosporin for 72 hrs

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12
Q

Gustillo Anderson type 2

A

1-10cm, 1st generation cephalosporin for 72 hrs

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13
Q

Gustillo Anderson type 3A

A

> 10cm, soft tissue converage, 1st generation cephalosporin (pos&neg) + gentamicin (aminoglycoside for neg)

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14
Q

Gustillo Anderson type 3B

A

<10cm, no soft tissue converage, enough soft tissue coverage to close primarily, 1st generation cephalosporin (pos&neg) + gentamicin (aminoglycoside for neg)

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15
Q

Gustillo Anderson type 3C

A

> 10cm,high energy, no soft tissue converage, 1st generation cephalosporin (pos&neg) + gentamicin (aminoglycoside for neg), MAJOR VASCULAR INJURY PRESENT

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16
Q

exceptions to Gustillo-Anderson thatll make a fx 3 immediately

A

farmland/dirty soil/water contamination, exposure to oral flora, shotgun, fx duration > 8hrs

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17
Q

abx role in open fx

A

to prevent osteomyelitis by staph aureus

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18
Q

farmland/soil injury open fx extra treatment?

A

penicillin (anaerobic) to cover clostridium infection

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19
Q

management of open fx (emergency room)

A
  1. ATLS to rule out other life ending injuries
  2. stop haemorhage: direct pressure preferred over tourniquet
  3. give analgesia and tetanus if needed
  4. IV abx <1hr and to continue for 72 hrs
  5. photo
  6. NV assessment, realign limb (splint etc), repeat NV, document
  7. Remove gross contamination and place sterile saline-soaked dressing on wound
  8. imaging if pt stable
  9. prepare pt for OT: NPO, labs, consent
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20
Q

management of open fx (OT)

A
  1. irrigation with NS
  2. debridement within 24 hours
  3. stabilise with ex fix
  4. delayed closure preferred in 72 hours
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21
Q

criteria of fracture related infections (4)

Study These Flashcards
A
  1. fistula/sinus/wound
  2. purulent drainage
  3. two cultures positive
  4. high wbc
22
Q

chance of infection in GA classification

Study These Flashcards
A

closed and type 1: 1-4%
type 2 & 3A: 3-8%
type 3B & C: 10-30%

23
Q

fracture related infection bacteria (early <10 weeks vs late >10 weeks)

Study These Flashcards
A

early: staph aureus, E.coli
late: staph epidermidis

24
Q

fresh water vs salt water open fx abx

Study These Flashcards
A

fresh cipro salty doxy (FC SD)

25
tetanus situation in open fx?
if unknown or no booster in 5 years then give tetanus toxoid if clostridium infection/immunocompromised/no booster in 10 years then tetanus IG
26
how many L to irrigate open fx?
3,6,9L for for Gustillo type 1,2,3
27
why stabilise fx? (3 reasons)
prevent further soft tissue injury maintain alignment reduce pain
28
what is closed reduction?
no direct exposure to bone, traction along axis of bone and reverse MOI under analgesia
29
indications for open reduction over closed
NO CASP: nonunion open fx compromised neurovascular articular fx displaced Salter Harris 3,4,5 Polytrauma
30
non-operative fx management options
brace splint cast slab traction
31
Ex Fix indications (6)
severe open fx (3b+) contaminated fx infected non-unions initial stabilisation (damage control) in polytrauma pelvic fx unstable elbow, elbow, knee dislocations
32
components of ex fix (3)
pin (in bone) rod clamp
33
contraindications to ORIF (5)
active infection/osteomyelitis severe osteoperosis severe communition severe soft tissue injury non-displaced fx
34
ORIF options? (4)
screws: cortical, cancellous, locking nails k wire plates
35
why use splint in fx management? 5
reduce pain facilitate transport of pt allow soft tissue swelling which reduces risk of compartment reduces risk of closed fx becoming open reduces risk of soft tissue and NV damage
36
why use traction in fx?
maintain length, alignemnt, rotation of limb reduces muscle spasms extra note: skeletal traction is done distal to fx
37
pathophysiology of compartment syndrome
increased TISSUE PRESSURE within a FIBROSSEOUS compartment, which exceeds VENOUS and CAPILLARY PERFUSION pressure > muscle ISCHAEMIA and NECROSIS > accumulation of WASTE > LACTIC ACIDOSIS > PAIN and loss of SENSATION due to NERVE IRRITATION
38
intra-compartmental causes of compartment syndrome 5
trauma fx (tibia, supracondylar) Revascularisation injury crush injury haemophilia, venom, tumours, anaphylaxis, DVT
39
extra-compartmental causes of compartment syndrome 3
tight dressing/cast circumfrential burns lithotomy position (well leg compartment syndrome): Prolonged surgical procedures in the lithotomy or the hemilithomy position along with perioperative hypoperfusion lead to ischaemia and increased capillary permeability, followed by a reperfusion injury once the leg is released from the compromising position.
40
most important clinical sign in compartment syndrome + 3 descriptive words
pain 1. out of proportion to injury 2. not relieved by strong analgesics 3. increased by passive extension of compartment
41
how will the limb feel in compartment syndrome
firm and wooden on deep palpation
42
5Ps of acute ischaemia compartment syndrome (late signs)
pain pallor parasthesia pulsenessness paralysis perishingly cold
43
most common early finding of compartment syndrome
loss of 2 point discrimination (not loss of cap refill or pulses)
44
compartment syndrome diagnosis
clinical
45
when to use stryker needle in compartment syndrome
atypical presentation, unconscious pt
46
how to measure intracompartmental pressure (2 ways)
delta P: diff bw diastolic and intra-comparmtental pressure <30 then fasciotomy absolute P >30 then fasciotomy (delta P is better than absolute P) (absolute P is direct intra-comparmtental pressure)
47
compartment syndrome complication
rhabdo, check for CK, RFTs, urinalysis, urine myoglobin
48
compartment syndrome management
remove cast limb placed at level of heart to not decrease arterial flow even more observe one hour, if no improvement then fasciotomy delayed closure with shoelace technique/skin graft/vacuum assisted closure over 72 hrs
49
compartment syndrome untreated comlpication
Volkmann contracture: muscle necrosis and fibrosis
50
compartment syndrome fasciotomy leg thigh forearm ?
leg: double incision laterally and medially to open all 4 comps thigh: lateral incision to open ant and post, adductor rarely requires forearm: volar and dorsal
51
4 Cs to assess muscle for fasciotomy
colour consistency contractility capillary bleeding

Ortho Residency (11 decks)

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