Ortho Recall Flashcards
(91 cards)
1
Q
WBAT
A
Weight bearing as tolerated
2
Q
Unstable fracture or
dislocation
A
Fracture or dislocation in which further
deformation will occur if reduction is not
performed
3
Q
Varus
A
Extremity abnormality with apex of defect pointed away from midline (e.g., genu varum bowlegged; with valgus, this term can also be used to describe fracture displacement) (Think: knees are very varied apart)
4
Q
Valgus
A
Extremity abnormality with apex of
defect pointed toward the midline
(e.g., genu valgus knock-kneed)
5
Q
Dislocation
A
Total loss of congruity and contact
between articular surfaces of a joint
6
Q
Subluxation
A
Loss of congruity between articular
surfaces of a joint; articular contact still
remains
7
Q
Arthroplasty
A
Total joint replacement (most last 10 to
15 years)
8
Q
Arthrodesis
A
Joint fusion with removal of articular
surfaces
9
Q
Osteotomy
A
Cutting bone (usually wedge resection) to help realigning of joint surfaces
10
Q
Non-union
A
Failure of fractured bone ends to fuse
11
Q
Diaphysis
A
Main shaft of long bone
12
Q
Metaphysis
A
Flared end of long bone
13
Q
Physis
A
Growth plate, found only in immature
bone
14
Q
Define extremity
examination in fractured
extremities.
A
- Observe entire extremity (e.g., open,
angulation, joint disruption) - Neurologic (sensation, movement)
- Vascular (e.g., pulses, cap refill)
15
Q
Which x-rays should be
obtained? (trauma)
A
Two views (also joint above and below fracture)
16
Q
How are fractures
described?
A
- Skin status (open or closed)
- Bone (by thirds: proximal/middle/
distal) - Pattern of fracture (e.g., comminuted)
- Alignment (displacement, angulation,
rotation)
17
Q
How do you define the
degree of angulation,
displacement, or both?
A
Define lateral/medial/anterior/posterior
displacement and angulation of the distal
fragment(s) in relation to the proximal
bone
18
Q
Closed fracture
A
Intact skin over fracture/hematoma
19
Q
Open fracture
A
Wound overlying fracture, through which
fracture fragments are in continuity with
outside environment; high risk of infection
(Note: Called “compound fracture” in
the past)
20
Q
Simple fracture
A
One fracture line, two bone fragments
21
Q
Comminuted fracture
A
Results in more than two bone fragments;
a.k.a. fragmentation
22
Q
Segmental fracture
A
Two complete fractures with a “segment”
in between
23
Q
Transverse fracture
A
Fracture line perpendicular to long axis
of bone
24
Q
Oblique fracture
A
Fracture line creates an oblique angle
with long axis of bone
25
Spiral fracture
Severe oblique fracture in which fracture
plane rotates along the long axis of bone;
caused by a twisting injury
26
Longitudinal fracture
Fracture line parallel to long axis of bone
27
Impacted fracture
Fracture resulting from compressive force;
end of bone is driven into contiguous
metaphyseal region without displacement
28
Pathologic fracture
Fracture through abnormal bone (e.g.,
| tumor-laden or osteoporotic bone)
29
Stress fracture
Fracture in normal bone from cyclic
| loading on bone
30
Greenstick fracture
Incomplete fracture in which cortex on
only one side is disrupted; seen in
children
31
Torus fracture
Impaction injury in children in which
cortex is buckled but not disrupted
(a.k.a. buckle fracture)
32
Avulsion fracture
Fracture in which tendon is pulled from
| bone, carrying with it a bone chip
33
Periarticular fracture
Fracture close to but not involving the joint
34
Intra-articular fracture
```
Fracture through the articular surface of
a bone (usually requires ORIF)
```
35
Colles’ fracture
Distal radius fracture with dorsal
displacement and angulation, usually
from falling on an outstretched hand
(a common fracture!)
36
Smith’s fracture
“Reverse Colles’ fracture”—distal radial
fracture with volar displacement and
angulation, usually from falling on the
dorsum of the hand (uncommon)
37
Jones’ fracture
Fracture at the base of the fifth
| metatarsal diaphysis
38
Bennett’s fracture
```
Fracture-dislocation of the base of the
first metacarpal (thumb) with disruption
of the carpometacarpal joint
```
39
Boxer’s fracture
Fracture of the metacarpal neck,
| “classically” of the small finger
40
Nightstick fracture
Ulnar fracture
41
Clay shoveler’s avulsion
| fracture
Fracture of spinous process of C6–C7
42
Hangman’s fracture
Fracture of the pedicles of C2
43
Transcervical fracture
Fracture through the neck of the femur
44
Tibial plateau fracture
Intra-articular fracture of the proximal tibia
| the plateau is the flared proximal end
45
Monteggia fracture
Fracture of the proximal third of the ulna
| with dislocation of the radial head
46
Galeazzi fracture
Fracture of the radius at the junction of
the middle and distal thirds accompanied
by disruption of the distal radioulnar joint
47
Tibial “plateau” fracture
Proximal tibial fracture
48
“Pilon” fracture
Distal tibial fracture
49
Pott’s fracture
Fracture of distal fibula
50
Pott’s disease
Tuberculosis of the spine
51
What are the major
| orthopaedic emergencies?
1. Open fractures/dislocations
2. Vascular injuries (e.g., knee
dislocation)
3. Compartment syndromes
4. Neural compromise, especially spinal
injury
5. Osteomyelitis/septic arthritis; acute,
i.e., when aspiration is indicated
6. Hip dislocations—require immediate
reduction or patient will develop avascular
necrosis; “reduce on the x-ray table”
7. Exsanguinating pelvic fracture (binder,
external fixator)
52
What is the main risk when
| dealing with an open fracture?
Infection
53
Which fracture has the
| highest mortality
```
Pelvic fracture (up to 50% with open
pelvic fractures)
```
54
What factors determine the
| extent of injury (3)?
```
1. Age: suggests susceptible point in
musculoskeletal system:
Child—growth plate
Adolescent—ligaments
Elderly—metaphyseal bone
2. Direction of forces
3. Magnitude of forces
```
55
What is the acronym for
indications for OPEN
reduction?
```
“NO CAST”:
Nonunion
Open fracture
Compromise of blood supply
Articular surface malalignment
Salter-Harris grade III, IV fracture
Trauma patients who need early
ambulation
```
56
Define open fractures by
Gustilo-Anderson
classification:
Grade I?
1-cm laceration
57
Define open fractures by
Gustilo-Anderson
classification:
Grade II?
1 cm, minimal soft tissue damage
58
Define open fractures by
Gustilo-Anderson
Grade IIIA?
Open fracture with massive tissue
| devitalization/loss, contamination
59
Define open fractures by
Gustilo-Anderson
Grade IIIB?
Open fracture with massive tissue
devitalization/loss and extensive
periosteal stripping, contamination,
inadequate tissue coverage
60
Define open fractures by
Gustilo-Anderson
Grade IIIC?
Open fracture with major vascular injury
| requiring repair
61
What are the five steps in
the initial treatment of an
open fracture?
```
1. Prophylactic antibiotics to include IV
gram-positive anaerobic coverage:
Grade I—cefazolin (Ancef ®)
Grade II or III—cefoxitin/gentamicin
2. Surgical débridement
3. Inoculation against tetanus
4. Lavage wound 6 hours postincident
with high-pressure sterile irrigation
5. Open reduction of fracture and stabilization
(e.g., use of external fixation)
```
62
What structures are at risk
| with a humeral fracture?
Radial nerve, brachial artery
63
What must be done when
both forearm bones are
broken?
Because precise movements are needed,
open reduction and internal fixation are
musts
64
How have femoral fractures
| been repaired traditionally?
Traction for 4 to 6 weeks
65
What is the newer technique?femoral fractures
Intramedullary rod placement
66
What are the advantages?
| Intramedullary rod placement
Nearly immediate mobility with
| decreased morbidity/mortality
67
What is the chief concern
| following tibial fractures?
Recognition of associated compartment
| syndrome
68
What is suggested by pain in
| the anatomic snuff-box?
Fracture of scaphoid bone (a.k.a.
| navicular fracture)`
69
What is the most common
cause of a “pathologic”
fracture in adults?
Osteoporosis
70
What is acute compartment
| syndrome?
Increased pressure within an osteofascial
compartment that can lead to ischemic
necrosis`
71
How is it diagnosed? acute compartment
| syndrome?
```
Clinically, using intracompartmental
pressures is also helpful (especially in
unresponsive patients); fasciotomy is
clearly indicated if pressure in the
compartment is 40 mm Hg (30 to
40 mm Hg is a gray area)
```
72
acute compartment
| syndrome?What are the causes?
Fractures, vascular compromise,
reperfusion injury, compressive dressings;
can occur after any musculoskeletal
injury
73
What are common causes
of forearm compartment
syndrome?
Supracondylar humerus fracture, brachial
artery injury, radius/ulna fracture, crush
injury
74
What is Volkmann’s
| contracture?
Final sequela of forearm compartment
syndrome; contracture of the forearm
flexors from replacement of dead muscle
with fibrous tissue
75
What is the most common
site of compartment
syndrome?
Calf (four compartments: anterior,
lateral, deep posterior, superficial
posterior compartments)
76
```
What situations should
immediately alert one to be
on the lookout for a
developing compartment
syndrome (4)?
```
```
1. Supracondylar elbow fractures in
children
2. Proximal/midshaft tibial fractures
3. Electrical burns
4. Arterial/venous disruption
```
77
What are the symptoms of
| compartment syndrome?
Pain, paresthesias, paralysis
78
What are the signs of
| compartment syndrome?
Pain on passive movement (out of
proportion to injury), cyanosis or pallor,
hypoesthesia (decreased sensation,
decreased two point discrimination), firm
compartment
79
Can a patient have a
compartment syndrome
with a palpable or Dopplerdetectable
distal pulse?
YES!
80
What are the possible
complications of
compartment syndrome?
Muscle necrosis, nerve damage,
| contractures, myoglobinuria
81
What is the initial treatment
of the orthopaedic patient
developing compartment
syndrome?
Bivalve and split casts, remove
constricting clothes/dressings, place
extremity at heart level
82
What is the definitive
treatment of compartment
syndrome?
Fasciotomy within 4 hours (6–8 hours
maximum) if at all possible
MISCELLANEOUS TRAUMA INJURIES AND COMPLICATIONS
83
```
Name the motor and
sensation tests used to assess
the following peripheral
nerves:
Radial
```
Wrist extension; dorsal web space;
| sensation: between thumb and index finger
84
Name the motor and
sensation tests used to assess
the following peripheral
nerves:Ulnar
Little finger abduction; sensation: little
| finger-distal ulnar aspect
85
Name the motor and
sensation tests used to assess
the following peripheral
nerves:Median
Thumb opposition or thumb pinch
| sensation: index finger-distal radial aspect
86
Name the motor and
sensation tests used to assess
the following peripheral
nervesAxillary
Arm abduction; sensation: deltoid patch
| on lateral aspect of upper arm
87
Name the motor and
sensation tests used to assess
the following peripheral
nerves:Musculocutaneous
Elbow (biceps) flexion; lateral forearm
| sensation
88
How is a peripheral nerve
| injury treated?
Controversial, although clean lacerations
may be repaired primarily; most injuries
are followed for 6 to 8 weeks (EMG)
89
What fracture is associated
| with a calcaneus fracture?
L-spine fracture (usually from a fall)
90
Name the nerves of the
| brachial plexus.
Think: “morning rum” or “A.M. RUM”
Axillary, Median, then Radial, Ulnar, and
Musculocutaneous nerves
91
What are the two indications
for operative exploration
with a peripheral nerve
injury?
1. Loss of nerve function after reduction
of fracture
2. No EMG signs of nerve regeneration
after 8 weeks (nerve graft)
