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Section III Subspecialty Surgery P517 > Orthopaedic Surgery, C74 P690-720 > Flashcards

Orthopaedic Surgery, C74 P690-720 Flashcards

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1
Q 
ORTHOPAEDIC TERMS
What do the following
abbreviations stand for:
ORIF?
P690
A

Open Reduction Internal Fixation

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2
Q 
ORTHOPAEDIC TERMS
What do the following
abbreviations stand for:
ROM?
P690
A

Range Of Motion

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3
Q 
ORTHOPAEDIC TERMS
What do the following
abbreviations stand for:
FROM?
P690
A

Full Range Of Motion

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4
Q 
ORTHOPAEDIC TERMS
What do the following
abbreviations stand for:
ACL?
P690
A

Anterior Cruciate Ligament

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5
Q 
ORTHOPAEDIC TERMS
What do the following
abbreviations stand for:
PCL?
P690
A

Posterior Cruciate Ligament

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6
Q 
ORTHOPAEDIC TERMS
What do the following
abbreviations stand for:
MCL?
P690
A

Medial Collateral Ligament

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7
Q 
ORTHOPAEDIC TERMS
What do the following
abbreviations stand for:
PWB?
P690
A

Partial Weight Bearing

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8
Q 
ORTHOPAEDIC TERMS
What do the following
abbreviations stand for:
FWB?
P690
A

Full Weight Bearing

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9
Q 
ORTHOPAEDIC TERMS
What do the following
abbreviations stand for:
WBAT?
P690
A

Weight Bearing As Tolerated

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10
Q 
ORTHOPAEDIC TERMS
What do the following
abbreviations stand for:
THA?
P691
A

Total Hip Arthroplasty

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11
Q 
ORTHOPAEDIC TERMS
What do the following
abbreviations stand for:
TKA?
P691
A

Total Knee Arthroplasty

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12
Q 
ORTHOPAEDIC TERMS
What do the following
abbreviations stand for:
THR?
P691
A

Total Hip Replacement

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13
Q 
ORTHOPAEDIC TERMS
What do the following
abbreviations stand for:
TKR?
P691
A

Total Knee Replacement

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14
Q 
ORTHOPAEDIC TERMS
What do the following
abbreviations stand for:
PROM?
P691
A

Passive Range Of Motion

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15
Q 
ORTHOPAEDIC TERMS
What do the following
abbreviations stand for:
AROM?
P691
A

Active Range Of Motion

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16
Q 
ORTHOPAEDIC TERMS
What do the following
abbreviations stand for:
AFO?
P691
A

Ankle Foot Orthotic

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17
Q 
ORTHOPAEDIC TERMS
What do the following
abbreviations stand for:
AVN?
P691
A

AVascular Necrosis

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18
Q

ORTHOPAEDIC TERMS
Define the following terms:
Supination
P691

A

Palm up

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19
Q

ORTHOPAEDIC TERMS
Define the following terms:
Pronation
P691

A

Palm down

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20
Q

ORTHOPAEDIC TERMS
Define the following terms:
Plantarflexion
P691

A

Foot down at ankle joint (plant foot in

ground)

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21
Q

ORTHOPAEDIC TERMS
Define the following terms:
Foot dorsiflexion
P691

A

Foot up at ankle joint

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22
Q

ORTHOPAEDIC TERMS
Define the following terms:
Adduction
P691

A

Movement toward the body

ADDuction = ADD to the body

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23
Q

ORTHOPAEDIC TERMS
Define the following terms:
Abduction
P691

A

Movement away from the body

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24
Q

ORTHOPAEDIC TERMS
Define the following terms:
Inversion
P691

A

Foot sole faces midline

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25
ORTHOPAEDIC TERMS Define the following terms: Eversion P691
Foot sole faces laterally
26
ORTHOPAEDIC TERMS Define the following terms: Volarflexion P691
Hand flexes at wrist joint toward flexor | tendons
27
ORTHOPAEDIC TERMS Define the following terms: Wrist dorsiflexion P691
Hand flexes at wrist joint toward extensor | tendons
28
ORTHOPAEDIC TERMS Define the following terms: Allograft bone P691
Bone from human donor other than | patient
29
ORTHOPAEDIC TERMS Define the following terms: Reduction P692
Maneuver to restore proper alignment to | fracture or joint
30
ORTHOPAEDIC TERMS Define the following terms: Closed reduction P692
Reduction done without surgery | e.g., casts, splints
31
ORTHOPAEDIC TERMS Define the following terms: Open reduction P692
Surgical reduction
32
ORTHOPAEDIC TERMS Define the following terms: Fixation P692
Stabilization of a fracture after reduction by means of surgical placement of hardware that can be external or internal (e.g., pins, plates, screws)
33
ORTHOPAEDIC TERMS Define the following terms: Tibial pin P692 (picture)
Pin placed in the tibia for treating femur or pelvic fractures by applying skeletal traction
34
``` ORTHOPAEDIC TERMS Define the following terms: Unstable fracture or dislocation P692 ```
Fracture or dislocation in which further deformation will occur if reduction is not performed
35
ORTHOPAEDIC TERMS Define the following terms: Varus P693 (picture)
``` 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) ```
36
ORTHOPAEDIC TERMS Define the following terms: Valgus P693 (picture)
Extremity abnormality with apex of defect pointed toward the midline (e.g., genu valgus = knock-kneed)
37
ORTHOPAEDIC TERMS Define the following terms: Dislocation P693
Total loss of congruity and contact | between articular surfaces of a joint
38
ORTHOPAEDIC TERMS Define the following terms: Subluxation P693
Loss of congruity between articular surfaces of a joint; articular contact still remains
39
ORTHOPAEDIC TERMS Define the following terms: Arthroplasty P694
Total joint replacement (most last 10 to | 15 years)
40
ORTHOPAEDIC TERMS Define the following terms: Arthrodesis P694
Joint fusion with removal of articular | surfaces
41
ORTHOPAEDIC TERMS Define the following terms: Osteotomy P694
``` Cutting bone (usually wedge resection) to help realigning of joint surfaces ```
42
ORTHOPAEDIC TERMS Define the following terms: Non-union P694
Failure of fractured bone ends to fuse
43
ORTHOPAEDIC TERMS Define each of the following: Diaphysis P694
Main shaft of long bone
44
``` ORTHOPAEDIC TERMS Define each of the following: Metaphysis P694 ```
Flared end of long bone
45
``` ORTHOPAEDIC TERMS Define each of the following: Physis P694 ```
Growth plate, found only in immature | bone
46
``` TRAUMA GENERAL PRINCIPLES Define extremity examination in fractured extremities. P694 ```
1. Observe entire extremity (e.g., open, angulation, joint disruption) 2. Neurologic (sensation, movement) 3. Vascular (e.g., pulses, cap refill)
47
TRAUMA GENERAL PRINCIPLES Which x-rays should be obtained? P694
``` Two views (also joint above and below fracture) ```
48
TRAUMA GENERAL PRINCIPLES How are fractures described? P694
1. Skin status (open or closed) 2. Bone (by thirds: proximal/middle/ distal) 3. Pattern of fracture (e.g., comminuted) 4. Alignment (displacement, angulation, rotation)
49
``` TRAUMA GENERAL PRINCIPLES How do you define the degree of angulation, displacement, or both? P694 ```
Define lateral/medial/anterior/posterior displacement and angulation of the distal fragment(s) in relation to the proximal bone
50
TRAUMA GENERAL PRINCIPLES Identify each numbered structure: P695 (picture)
1. Diaphysis 2. Metaphysis 3. Physis 4. Epiphysis
51
``` FRACTURES Define the following patterns of fracture: Closed fracture P695 ```
Intact skin over fracture/hematoma
52
``` FRACTURES Define the following patterns of fracture: Open fracture P695 ```
Wound overlying fracture, through which fracture fragments are in continuity with outside environment; high risk of infection (Note: Called “compound fracture” in the past)
53
``` FRACTURES Define the following patterns of fracture: Simple fracture P695 ```
One fracture line, two bone fragments
54
``` FRACTURES Define the following patterns of fracture: Comminuted fracture P695 (picture) ```
Results in more than two bone fragments; | a.k.a. fragmentation
55
``` RACTURES Define the following patterns of fracture: Segmental fracture P696 (picture) ```
Two complete fractures with a “segment” | in between
56
``` RACTURES Define the following patterns of fracture: Transverse fracture P696 (picture) ```
Fracture line perpendicular to long axis | of bone
57
``` RACTURES Define the following patterns of fracture: Oblique fracture P696 (picture) ```
Fracture line creates an oblique angle | with long axis of bone
58
``` RACTURES Define the following patterns of fracture: Spiral fracture P697 (picture) ```
Severe oblique fracture in which fracture plane rotates along the long axis of bone; caused by a twisting injury
59
``` RACTURES Define the following patterns of fracture: Longitudinal fracture P697 ```
Fracture line parallel to long axis of bone
60
``` RACTURES Define the following patterns of fracture: Impacted fracture P697 ```
Fracture resulting from compressive force; end of bone is driven into contiguous metaphyseal region without displacement
61
``` RACTURES Define the following patterns of fracture: Pathologic fracture P697 ```
Fracture through abnormal bone (e.g., | tumor-laden or osteoporotic bone)
62
``` RACTURES Define the following patterns of fracture: Stress fracture P697 ```
Fracture in normal bone from cyclic | loading on bone
63
``` RACTURES Define the following patterns of fracture: Greenstick fracture P697 (picture) ```
Incomplete fracture in which cortex on only one side is disrupted; seen in children
64
``` RACTURES Define the following patterns of fracture: Torus fracture P698 ```
Impaction injury in children in which cortex is buckled but not disrupted (a.k.a. buckle fracture)
65
``` RACTURES Define the following patterns of fracture: Avulsion fracture P698 (picture) ```
Fracture in which tendon is pulled from | bone, carrying with it a bone chip
66
``` RACTURES Define the following patterns of fracture: Periarticular fracture P698 ```
Fracture close to but not involving the joint
67
``` RACTURES Define the following patterns of fracture: Intra-articular fracture P698 ```
``` Fracture through the articular surface of a bone (usually requires ORIF) ```
68
``` RACTURES Define the following specific fractures: Colles’ fracture P698 (picture) ```
Distal radius fracture with dorsal displacement and angulation, usually from falling on an outstretched hand (a common fracture!)
69
``` RACTURES Define the following specific fractures: Smith’s fracture P698 ```
“Reverse Colles’ fracture”—distal radial fracture with volar displacement and angulation, usually from falling on the dorsum of the hand (uncommon)
70
``` RACTURES Define the following specific fractures: Jones’ fracture P699 ```
Fracture at the base of the fifth | metatarsal diaphysis
71
``` RACTURES Define the following specific fractures: Bennett’s fracture P699 (picture) ```
``` Fracture-dislocation of the base of the first metacarpal (thumb) with disruption of the carpometacarpal joint ```
72
``` RACTURES Define the following specific fractures: Boxer’s fracture P699 (picture) ```
Fracture of the metacarpal neck, | “classically” of the small finger
73
``` RACTURES Define the following specific fractures: Nightstick fracture P699 ```
Ulnar fracture
74
``` RACTURES Define the following specific fractures: Clay shoveler’s avulsion fracture P699 ```
Fracture of spinous process of C6–C7
75
``` RACTURES Define the following specific fractures: Hangman’s fracture P699 ```
Fracture of the pedicles of C2
76
``` RACTURES Define the following specific fractures: Transcervical fracture P699 ```
Fracture through the neck of the femur
77
``` RACTURES Define the following specific fractures: Tibial plateau fracture P700 ```
Intra-articular fracture of the proximal tibia | the plateau is the flared proximal end
78
``` RACTURES Define the following specific fractures: Monteggia fracture P700 ```
Fracture of the proximal third of the ulna | with dislocation of the radial head
79
``` RACTURES Define the following specific fractures: Galeazzi fracture P700 ```
Fracture of the radius at the junction of the middle and distal thirds accompanied by disruption of the distal radioulnar joint
80
``` RACTURES Define the following specific fractures: Tibial “plateau” fracture P700 (picture) ```
Proximal tibial fracture
81
``` RACTURES Define the following specific fractures: “Pilon” fracture P700 (picture) ```
Distal tibial fracture
82
``` RACTURES Define the following specific fractures: Pott’s fracture P700 ```
Fracture of distal fibula
83
``` RACTURES Define the following specific fractures: Pott’s disease P700 ```
Tuberculosis of the spine
84
ORTHOPAEDIC TRAUMA What are the major orthopaedic emergencies? P701
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)
85
ORTHOPAEDIC TRAUMA What is the main risk when dealing with an open fracture? P701
Infection
86
ORTHOPAEDIC TRAUMA Which fracture has the highest mortality? P701
``` Pelvic fracture (up to 50% with open pelvic fractures) ```
87
ORTHOPAEDIC TRAUMA What factors determine the extent of injury (3)? P701
``` 1. Age: suggests susceptible point in musculoskeletal system: Child—growth plate Adolescent—ligaments Elderly—metaphyseal bone 2. Direction of forces 3. Magnitude of forces ```
88
``` ORTHOPAEDIC TRAUMA What is the acronym for indications for OPEN reduction? P701 ```
“NO CAST”: Nonunion Open fracture ``` Compromise of blood supply Articular surface malalignment Salter-Harris grade III, IV fracture Trauma patients who need early ambulation ```
89
``` ORTHOPAEDIC TRAUMA Define open fractures by Gustilo-Anderson classification: Grade I? P701 ```
<1-cm laceration
90
``` ORTHOPAEDIC TRAUMA Define open fractures by Gustilo-Anderson classification: Grade II? P701 ```
>1 cm, minimal soft tissue damage
91
``` ORTHOPAEDIC TRAUMA Define open fractures by Gustilo-Anderson classification: Grade IIIA? P702 ```
Open fracture with massive tissue | devitalization/loss, contamination
92
``` ORTHOPAEDIC TRAUMA Define open fractures by Gustilo-Anderson classification: Grade IIIB? P702 ```
Open fracture with massive tissue devitalization/loss and extensive periosteal stripping, contamination, inadequate tissue coverage
93
``` ORTHOPAEDIC TRAUMA Define open fractures by Gustilo-Anderson classification: Grade IIIC? P702 ```
Open fracture with major vascular injury | requiring repair
94
ORTHOPAEDIC TRAUMA What structures are at risk with a humeral fracture? P702
Radial nerve, brachial artery
95
``` ORTHOPAEDIC TRAUMA What must be done when both forearm bones are broken? P702 ```
Because precise movements are needed, open reduction and internal fixation are musts
96
ORTHOPAEDIC TRAUMA How have femoral fractures been repaired traditionally? P702
Traction for 4 to 6 weeks
97
ORTHOPAEDIC TRAUMA What is the newer technique? P702
Intramedullary rod placement
98
ORTHOPAEDIC TRAUMA What are the advantages? P702
Nearly immediate mobility with | decreased morbidity/mortality
99
ORTHOPAEDIC TRAUMA What is the chief concern following tibial fractures? P702
Recognition of associated compartment | syndrome
100
ORTHOPAEDIC TRAUMA What is suggested by pain in the anatomic snuff-box? P702
Fracture of scaphoid bone (a.k.a. | navicular fracture)
101
``` ORTHOPAEDIC TRAUMA What is the most common cause of a “pathologic” fracture in adults? P702 ```
Osteoporosis
102
``` ORTHOPAEDIC TRAUMA COMPARTMENT SYNDROME What is acute compartment syndrome? P703 ```
Increased pressure within an osteofascial compartment that can lead to ischemic necrosis
103
ORTHOPAEDIC TRAUMA COMPARTMENT SYNDROME How is it diagnosed? P703
``` 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) ```
104
ORTHOPAEDIC TRAUMA COMPARTMENT SYNDROME What are the causes? P703
Fractures, vascular compromise, reperfusion injury, compressive dressings; can occur after any musculoskeletal injury
105
``` ORTHOPAEDIC TRAUMA COMPARTMENT SYNDROME What are common causes of forearm compartment syndrome? P703 ```
Supracondylar humerus fracture, brachial artery injury, radius/ulna fracture, crush injury
106
``` ORTHOPAEDIC TRAUMA COMPARTMENT SYNDROME What is Volkmann’s contracture? P703 ```
Final sequela of forearm compartment syndrome; contracture of the forearm flexors from replacement of dead muscle with fibrous tissue
107
``` ORTHOPAEDIC TRAUMA COMPARTMENT SYNDROME What is the most common site of compartment syndrome? P703 ```
Calf (four compartments: anterior, lateral, deep posterior, superficial posterior compartments)
108
``` ORTHOPAEDIC TRAUMA COMPARTMENT SYNDROME What situations should immediately alert one to be on the lookout for a developing compartment syndrome (4)? P703 ```
``` 1. Supracondylar elbow fractures in children 2. Proximal/midshaft tibial fractures 3. Electrical burns 4. Arterial/venous disruption ```
109
``` ORTHOPAEDIC TRAUMA COMPARTMENT SYNDROME What are the symptoms of compartment syndrome? P703 ```
Pain, paresthesias, paralysis
110
``` ORTHOPAEDIC TRAUMA COMPARTMENT SYNDROME What are the signs of compartment syndrome? P703 ```
Pain on passive movement (out of proportion to injury), cyanosis or pallor, hypoesthesia (decreased sensation, decreased two point discrimination), firm compartment
111
``` ORTHOPAEDIC TRAUMA COMPARTMENT SYNDROME Can a patient have a compartment syndrome with a palpable or Dopplerdetectable distal pulse? P704 ```
YES!
112
``` ORTHOPAEDIC TRAUMA COMPARTMENT SYNDROME What are the possible complications of compartment syndrome? P704 ```
Muscle necrosis, nerve damage, | contractures, myoglobinuria
113
``` ORTHOPAEDIC TRAUMA COMPARTMENT SYNDROME What is the initial treatment of the orthopaedic patient developing compartment syndrome? P704 ```
Bivalve and split casts, remove constricting clothes/dressings, place extremity at heart level
114
``` ORTHOPAEDIC TRAUMA COMPARTMENT SYNDROME What is the definitive treatment of compartment syndrome? P704 ```
Fasciotomy within 4 hours (6–8 hours | maximum) if at all possible
115
``` ORTHOPAEDIC TRAUMAMISCELLANEOUS TRAUMA MISCELLANEOUS TRAUMA INJURIES AND COMPLICATIONS Name the motor and sensation tests used to assess the following peripheral nerves: Radial P704 ```
Wrist extension; dorsal web space; | sensation: between thumb and index finger
116
``` ORTHOPAEDIC TRAUMAMISCELLANEOUS TRAUMA MISCELLANEOUS TRAUMA INJURIES AND COMPLICATIONS Name the motor and sensation tests used to assess the following peripheral nerves: Ulnar P704 ```
Little finger abduction; sensation: little | finger-distal ulnar aspect
117
``` ORTHOPAEDIC TRAUMAMISCELLANEOUS TRAUMA MISCELLANEOUS TRAUMA INJURIES AND COMPLICATIONS Name the motor and sensation tests used to assess the following peripheral nerves: Median P704 ```
Thumb opposition or thumb pinch | sensation: index finger-distal radial aspect
118
``` ORTHOPAEDIC TRAUMAMISCELLANEOUS TRAUMA MISCELLANEOUS TRAUMA INJURIES AND COMPLICATIONS Name the motor and sensation tests used to assess the following peripheral nerves: Axillary P704 ```
Arm abduction; sensation: deltoid patch | on lateral aspect of upper arm
119
``` ORTHOPAEDIC TRAUMAMISCELLANEOUS TRAUMA MISCELLANEOUS TRAUMA INJURIES AND COMPLICATIONS Name the motor and sensation tests used to assess the following peripheral nerves: Musculocutaneous P704 ```
Elbow (biceps) flexion; lateral forearm | sensation
120
ORTHOPAEDIC TRAUMAMISCELLANEOUS TRAUMA MISCELLANEOUS TRAUMA INJURIES AND COMPLICATIONS How is a peripheral nerve injury treated? P704
Controversial, although clean lacerations may be repaired primarily; most injuries are followed for 6 to 8 weeks (EMG)
121
ORTHOPAEDIC TRAUMAMISCELLANEOUS TRAUMA MISCELLANEOUS TRAUMA INJURIES AND COMPLICATIONS What fracture is associated with a calcaneus fracture? P704
L-spine fracture (usually from a fall)
122
ORTHOPAEDIC TRAUMAMISCELLANEOUS TRAUMA MISCELLANEOUS TRAUMA INJURIES AND COMPLICATIONS Name the nerves of the brachial plexus. P705
Think: “morning rum” or “A.M. RUM”  Axillary, Median, then Radial, Ulnar, and Musculocutaneous nerves
123
``` ORTHOPAEDIC TRAUMAMISCELLANEOUS TRAUMA MISCELLANEOUS TRAUMA INJURIES AND COMPLICATIONS What are the two indications for operative exploration with a peripheral nerve injury? P705 ```
1. Loss of nerve function after reduction of fracture 2. No EMG signs of nerve regeneration after 8 weeks (nerve graft)
124
``` DISLOCATIONS SHOULDER What is the most common type? P705 ```
95% are anterior (posterior are associated | with seizures or electrical shock)
125
``` DISLOCATIONS SHOULDER Which two structures are at risk? P705 ```
1. Axillary nerve | 2. Axillary artery
126
DISLOCATIONS SHOULDER How is it diagnosed? P705
Indentation of soft tissue beneath | acromion
127
``` DISLOCATIONS SHOULDER What are the three treatment steps? P705 ```
1. Reduction via gradual traction 2. Immobilization for 3 weeks in internal rotation 3. ROM exercises
128
``` DISLOCATIONS ELBOW What is the most common type? P705 ```
Posterior
129
``` DISLOCATIONS ELBOW Which three structures are at risk? P705 ```
1. Brachial artery 2. Ulnar nerve 3. Median nerve
130
DISLOCATIONS ELBOW What is the treatment? P705
Reduce and splint for 7 to 10 days
131
``` DISLOCATIONS HIP When should hip dislocations be reduced? P705 ```
Immediately, to decrease risk of avascular | necrosis; “reduce on the x-ray table!”
132
``` DISLOCATIONS HIP What is the most common cause of a hip dislocation? P705 ```
High velocity trauma (e.g., MVC)
133
``` DISLOCATIONS HIP What is the most common type? P706 ```
Posterior—“dashboard dislocation”— often involves fracture of posterior lip of acetabulum
134
DISLOCATIONS HIP Which structures are at risk? P706
Sciatic nerve; blood supply to femoral | head—avascular necrosis (AVN)
135
DISLOCATIONS HIP What is the treatment? P706
Closed or open reduction
136
DISLOCATIONS KNEE What are the common types? P706
Anterior or posterior
137
DISLOCATIONS KNEE Which structures are at risk? P706
Popliteal artery and vein, peroneal nerve—especially with posterior dislocation, ACL, PCL (Note: need arteriogram)
138
DISLOCATIONS KNEE What is the treatment? P706
Immediate attempt at relocation (do not wait to x-ray), arterial repair, and then ligamentous repair (delayed or primary)
139
``` DISLOCATIONS THE KNEE What are the five ligaments of the knee? P706 (picture) ```
1. Anterior Cruciate Ligament (ACL), 2. Posterior Cruciate Ligament (PCL), 3. Medial Collateral Ligament (MCL), 4. Lateral Collateral Ligament (LCL), 5. Patellar Ligament
140
``` DISLOCATIONS THE KNEE What is the Lachman test for a torn ACL? P707 (picture) ```
Thigh is secured with one hand while the | other hand pulls the tibia anteriorly
141
``` DISLOCATIONS THE KNEE What is the meniscus of the knee? P707 ```
Cartilage surface of the tibia plateau (lateral and medial meniscus); tears are repaired usually by arthroscopy with removal of torn cartilage fragments
142
DISLOCATIONS THE KNEE What is McMurray’s sign? P707
Seen with a medial meniscus tear: medial tenderness of knee with flexion and internal rotation of the knee
143
``` DISLOCATIONS THE KNEE What is the “unhappy triad”? P707 ```
Lateral knee injury resulting in: 1. ACL tear 2. MCL tear 3. Medial meniscus injury
144
DISLOCATIONS THE KNEE What is a “locked knee”? P707
Meniscal tear that displaces and interferes with the knee joint and prevents complete extension
145
``` DISLOCATIONS THE KNEE What is a “bucket-handle tear”? P707 ```
Meniscal tear longitudinally along contour | of normal “C” shape of the meniscus
146
``` DISLOCATIONS THE KNEE In collateral ligament and menisci injuries, which are more common, the medial or the lateral? P707 ```
Medial
147
ACHILLES TENDON RUPTURE What are the signs of an Achilles tendon rupture? P707
``` Severe calf pain, also bruised swollen calf, two ends of ruptured tendon may be felt, patient will have weak plantar flexion from great toe flexors that should be intact; patient often hears a “pop” ```
148
ACHILLES TENDON RUPTURE Name the test for an INTACT Achilles tendon. P708 (picture
Thompson’s test: a squeeze of the gastrocnemius muscle results in plantar flexion of the foot
149
ACHILLES TENDON RUPTURE What is the treatment for an Achilles tendon rupture? P708
Young = surgical repair Elderly = many can be treated with progressive splints
150
ROTATOR CUFF What four muscles form the rotator cuff? P708
Think: “SITS”: 1. Supraspinatus, etc. 2. Infraspinatus 3. Teres minor 4. Subscapularis
151
ROTATOR CUFF When do tears usually occur? P708
Fifth decade
152
ROTATOR CUFF What is the usual history? P708
Intermittent shoulder pain especially with overhead activity, followed by an episode of acute pain corresponding to a tendon tear; weak abduction
153
ROTATOR CUFF What is the treatment? P708
Most tears: symptomatic pain relief Later: if poor muscular function persists, surgical repair is indicated
154
ROTATOR CUFF What is Volkmann’s contracture? P708
Contracture of forearm flexors secondary | to forearm compartment syndrome
155
ROTATOR CUFF What is the usual cause of Volkmann’s contracture? P709
Brachial artery injury, supracondylar humerus fracture, radius/ulnar fracture, crush injury, etc.
156
MISCELLANEOUS Define the following terms: Dupuytren’s contracture P709
Thickening and contracture of palmar | fascia; incidence increases with age
157
MISCELLANEOUS Define the following terms: Charcot’s joint P709
Joint arthritis from peripheral neuropathy
158
MISCELLANEOUS Define the following terms: Tennis elbow P709
Tendonitis of the lateral epicondyle of the humerus; classically seen in tennis players
159
MISCELLANEOUS Define the following terms: Turf toe P709
Hyperextension of the great toe (tear of the tendon of the flexor hallucis brevis); classically seen in football players
160
MISCELLANEOUS Define the following terms: Shin splints P709
Exercise-induced anterior compartment hypertension (compartment syndrome); seen in runners
161
MISCELLANEOUS Define the following terms: Heel spur P709
Plantar fasciitis with abnormal bone growth in the plantar fascia; classically seen in runners and walkers
162
MISCELLANEOUS Define the following terms: Nightstick fracture P709
Ulnar fracture
163
MISCELLANEOUS Define the following terms: Kienbock’s disease P709
Avascular necrosis of the lunate
164
MISCELLANEOUS What is traumatic myositis? P709
Abnormal bone deposit in a muscle after blunt trauma deep muscle contusion (benign)
165
``` MISCELLANEOUS How does a “cast saw” cut the cast but not the underlying skin? P709 ```
``` It is an “oscillating” saw (designed by Dr. Homer Stryker in 1947) that goes back and forth cutting anything hard while moving the skin back and forth without injuring it ```
166
ORTHOPAEDIC INFECTIONS OSTEOMYELITIS What is osteomyelitis? P710
Inflammation/infection of bone marrow | and adjacent bone
167
``` ORTHOPAEDIC INFECTIONS OSTEOMYELITIS What are the most likely causative organisms? P710 ```
``` Neonates: Staphylococcus aureus, gramnegative streptococcus Children: S. aureus, Haemophilus influenzae, streptococci Adults: S. aureus Immunocompromised/drug addicts: S. aureus gram-negative Sickle cell: Salmonella ```
168
``` ORTHOPAEDIC INFECTIONS OSTEOMYELITIS What is the most common organism isolated in osteomyelitis in the general adult population? P710 ```
S. aureus
169
``` ORTHOPAEDIC INFECTIONS OSTEOMYELITIS What is the most common isolated organism in patients with sickle cell disease? P710 ```
Salmonella
170
``` ORTHOPAEDIC INFECTIONS OSTEOMYELITIS What is seen on physical examination? P710 ```
Tenderness, decreased movement, | swelling
171
ORTHOPAEDIC INFECTIONS OSTEOMYELITIS What are the diagnostic steps? P710
History and physical examination, needle aspirate, blood cultures, CBC, ESR, bone scan
172
``` ORTHOPAEDIC INFECTIONS OSTEOMYELITIS What are the treatment options? P710 ```
Antibiotics with or without surgical | drainage
173
ORTHOPAEDIC INFECTIONS OSTEOMYELITIS What is a Marjolin’s ulcer? P710
Squamous cell carcinoma that arises in a | chronic sinus from osteomyelitis
174
ORTHOPAEDIC INFECTIONS SEPTIC ARTHRITIS What is it? P710
Inflammation of a joint beginning as synovitis and ending with destruction of articular cartilage if left untreated
175
``` ORTHOPAEDIC INFECTIONS SEPTIC ARTHRITIS What are the causative agents? P711 ```
Same as in osteomyelitis, except that gonococcus is a common agent in the adult population
176
``` ORTHOPAEDIC INFECTIONS SEPTIC ARTHRITIS What are the findings on physical examination? P711 ```
Joint pain, decreased motion, joint | swelling, joint warm to the touch
177
``` ORTHOPAEDIC INFECTIONS SEPTIC ARTHRITIS What are the diagnostic steps? P711 ```
``` Needle aspirate (look for pus; culture plus Gram stain), x-ray, blood cultures, ESR ```
178
ORTHOPAEDIC INFECTIONS SEPTIC ARTHRITIS What is the treatment? P711
Decompression of the joint via needle aspiration and IV antibiotics; hip, shoulder, and spine must be surgically incised, débrided, and drained
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ORTHOPAEDIC TUMORS What is the most common type in adults? P711
Metastatic!
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ORTHOPAEDIC TUMORS What are the common sources? P711
Breast, lung, prostate, kidney, thyroid, | and multiple myeloma
181
ORTHOPAEDIC TUMORS What is the usual presentation? P711
Bone pain or as a pathologic fracture
182
``` ORTHOPAEDIC TUMORS What is the most common primary malignant bone tumor? P711 ```
Multiple myeloma (45%)
183
``` ORTHOPAEDIC TUMORS What is the differential diagnosis of a possible bone tumor? P711 ```
``` Metastatic disease Primary bone tumors Metabolic disorders (e.g., hyperparathyroidism) Infection ```
184
ORTHOPAEDIC TUMORS What are the benign bone tumors (8)? P711
1. Osteochondroma 2. Enchondroma 3. Unicameral/aneurysmal bone cysts 4. Osteoid osteoma 5. Chondroblastoma 6. Fibroxanthoma 7. Fibrous dysplasia 8. Nonossifying fibroma
185
ORTHOPAEDIC TUMORS What are the malignant bone tumors (7)? P712
1. Multiple myeloma 2. Osteosarcoma 3. Chondrosarcoma 4. Ewing’s sarcoma 5. Giant cell tumor (locally malignant) 6. Malignant melanoma 7. Metastatic
186
``` ORTHOPAEDIC TUMORS Compare benign and malignant bone tumors in terms of: Size P712 ```
Benign—small; 1 cm
187
``` ORTHOPAEDIC TUMORS Compare benign and malignant bone tumors in terms of: Bone reaction P712 ```
Benign—sclerotic bone reaction | Malignant—little reaction
188
``` ORTHOPAEDIC TUMORS Compare benign and malignant bone tumors in terms of: Margins P712 ```
Benign—sharp | Malignant—poorly defined
189
``` ORTHOPAEDIC TUMORS Compare benign and malignant bone tumors in terms of: Invasive P712 ```
Benign—confined to bone Malignant—often extends to surrounding tissues
190
ORTHOPAEDIC TUMORS Are most pediatric bone tumors benign or malignant? P712
80% are benign (most common is | osteochondroma)
191
ORTHOPAEDIC TUMORS Are most adult bone tumors benign or malignant? P712
66% are malignant (most commonly | metastatic)
192
ORTHOPAEDIC TUMORS What are the four diagnostic steps? P712
1. PE/lab tests 2. Radiographs 3. CT scan, technetium scan, or both 4. Biopsy
193
ORTHOPAEDIC TUMORS What are the radiographic signs of malignant tumors? P712
``` Large size Aggressive bone destruction, poorly defined margins Ineffective bone reaction to tumor Extension to soft tissues ```
194
ORTHOPAEDIC TUMORS What are the radiographic signs of benign tumors? P712
``` Small Well circumscribed, sharp margins Effective bone reaction to the tumor (sclerotic periostitis) No extension—confined to bone ```
195
``` ORTHOPAEDIC TUMORS What are some specific radiographic findings of the following: Osteosarcoma? P713 ```
“Sunburst” pattern
196
``` ORTHOPAEDIC TUMORS What are some specific radiographic findings of the following: Fibrous dysplasia P713 ```
Bubbly lytic lesion, “ground glass”
197
``` ORTHOPAEDIC TUMORS What are some specific radiographic findings of the following: Ewing’s sarcoma P713 ```
“Onion skinning”
198
ORTHOPAEDIC TUMORS What is the mainstay of treatment for bone tumours? P713
``` Surgery (excision plus débridement) for both malignant and benign lesions; radiation therapy and chemotherapy as adjuvant therapy for many malignant tumors ```
199
``` ORTHOPAEDIC TUMORS OSTEOSARCOMA What is the usual age at presentation? P713 ```
10 to 20 years
200
``` ORTHOPAEDIC TUMORS OSTEOSARCOMA What is the gender distribution? P713 ```
Male > female
201
``` ORTHOPAEDIC TUMORS OSTEOSARCOMA What is the most common location? P713 ```
≈66% in the distal femur, proximal tibi
202
``` ORTHOPAEDIC TUMORS OSTEOSARCOMA What is the radiographic sine qua non? P713 ```
Bone formation somewhere within tumor
203
ORTHOPAEDIC TUMORS OSTEOSARCOMA What is the treatment? P713
Resection (limb sparing if possible) plus | chemotherapy
204
``` ORTHOPAEDIC TUMORS OSTEOSARCOMA What is the 5-year survival rate? P713 ```
≈70%
205
``` ORTHOPAEDIC TUMORS OSTEOSARCOMA What is the most common site of metastasis? P713 ```
Lungs
206
``` ORTHOPAEDIC TUMORS OSTEOSARCOMA What is the most common benign bone tumor? P713 ```
Osteochondroma; it is cartilaginous in origin and may undergo malignant degeneration
207
ORTHOPAEDIC TUMORS OSTEOSARCOMA What is a chondrosarcoma? P713
Malignant tumor of cartilaginous origin; presents in middle-aged and older patients and is unresponsive to chemotherapy and radiotherapy
208
``` ORTHOPAEDIC TUMORS EWING’S SARCOMA What is the usual presentation? P714 ```
Pain, swelling in involved area
209
``` ORTHOPAEDIC TUMORS EWING’S SARCOMA What is the most common location? P714 ```
Around the knee (distal femur, | proximal tibia)
210
``` ORTHOPAEDIC TUMORS EWING’S SARCOMA What is the usual age at presentation? P714 ```
Evenly spread among those younger than | 20 years of age
211
``` ORTHOPAEDIC TUMORS EWING’S SARCOMA What are the associated radiographic findings? P714 ```
``` Lytic lesion with periosteal reaction termed “onion skinning,” which is calcified layering Central areas of tumor can undergo liquefaction necrosis, which may be confused with purulent infection (particularly in a child with fever, leukocytosis, and bone pain) ```
212
``` ORTHOPAEDIC TUMORS EWING’S SARCOMA What is a memory aid for Ewing’s sarcoma? P714 ```
“TKO Ewing”: Twenty years old or younger Knee joint “Onion skinning”
213
``` ORTHOPAEDIC TUMORS EWING’S SARCOMA What is the 5-year survival rate? P714 ```
50%
214
``` ORTHOPAEDIC TUMORS EWING’S SARCOMA How can Ewing’s sarcoma mimic the appearance of osteomyelitis? P714 ```
Bone cysts
215
``` ORTHOPAEDIC TUMORS EWING’S SARCOMA What is a unicameral bone cyst? P714 ```
Fluid-filled cyst most commonly found in the proximal humerus in children 5 to 15 years of age
216
``` ORTHOPAEDIC TUMORS EWING’S SARCOMA What is the usual presentation? P714 ```
Asymptomatic until pathologic fracture
217
ORTHOPAEDIC TUMORS EWING’S SARCOMA What is the treatment? P714
Steroid injections
218
``` ORTHOPAEDIC TUMORS EWING’S SARCOMA What is an aneurysmal bone cyst? P714 ```
Hemorrhagic lesion that is locally destructive by expansile growth, but does not metastasize
219
``` ORTHOPAEDIC TUMORS EWING’S SARCOMA What is the usual presentation? P715 ```
Pain and swelling; pathologic fractures | are rare
220
ORTHOPAEDIC TUMORS EWING’S SARCOMA What is the treatment? P715
Curettage and bone grafting
221
ARTHRITIS Which arthritides are classified as degenerative? P715
Osteoarthritis | Post-traumatic arthritis
222
ARTHRITIS What signs characterize osteoarthritis? P715
Heberden’s nodes/Bouchard’s nodes Symmetric destruction, usually of the hip, knee, or spine
223
ARTHRITIS What are Bouchard’s nodes? P715
Enlarged PIP joints of the hand from | cartilage/bone growth
224
ARTHRITIS What are Heberden’s nodes? P715
Enlarged DIP joints of the hand from | cartilage/bone growth
225
ARTHRITIS What is post-traumatic arthritis? P715
Usually involves one joint of past trauma
226
``` ARTHRITIS What are the treatment options for degenerative arthritis (3)? P715 ```
1. NSAIDS for acute flare-ups, not for long-term management 2. Local corticosteroid injections 3. Surgery
227
ARTHRITIS What are the characteristics of rheumatoid arthritis? P715
``` Autoimmune reaction in which invasive pannus attacks hyaline articular cartilage; rheumatoid factor (anti-IgG/IgM) in 80% of patients; 3 more common in women; skin nodules (e.g., rheumatoid nodule) ```
228
ARTHRITIS What is pannus? P715
Inflammatory exudate overlying synovial | cells inside the joint
229
``` ARTHRITIS What are the classic hand findings with rheumatoid arthritis? P715 ```
Wrist: radial deviation Fingers: ulnar deviation
230
``` ARTHRITIS What are the surgical management options for joint/bone diseases (3)? P715 ```
1. Arthroplasty 2. Arthrodesis (fusion) 3. Osteotomy
231
``` ARTHRITIS What is the major difference between gout and pseudogout? P716 ```
``` Gout: caused by urate deposition, negative birefringent, needle crystal Pseudogout: caused by calcium pyrophosphate positive birefringent square crystals (Think: Positive Square crystals = PSeudogout) ```
232
ARTHRITIS What is a Charcot’s joint? P716
Arthritic joint from peripheral | neuropathy
233
``` PEDIATRIC ORTHOPAEDICS What are the major differences between pediatric and adult bones? P716 ```
``` Children: increased bone flexibility and bone healing (thus, many fractures are treated closed, whereas an adult would require O.R.I.F.), physis (weak point) ```
234
PEDIATRIC ORTHOPAEDICS What types of fractures are unique to children? P716
Greenstick fracture Torus fracture Fracture through physis
235
PEDIATRIC ORTHOPAEDICS SALTER-HARRIS CLASSIFICATION What does it describe? P716
Fractures in children involving physis
236
``` PEDIATRIC ORTHOPAEDICS SALTER-HARRIS CLASSIFICATION What does it indicate high risk of? P716 ```
Potential growth arrest
237
``` PEDIATRIC ORTHOPAEDICS SALTER-HARRIS CLASSIFICATION Define the following terms: Salter I P716 ```
Through physeal plate only
238
``` PEDIATRIC ORTHOPAEDICS SALTER-HARRIS CLASSIFICATION Define the following terms: Salter II P716 ```
Involves metaphysis and physis
239
``` PEDIATRIC ORTHOPAEDICS SALTER-HARRIS CLASSIFICATION Define the following terms: Salter III P716 ```
Involves physis and epiphysis
240
``` PEDIATRIC ORTHOPAEDICS SALTER-HARRIS CLASSIFICATION Define the following terms: Salter IV P716 ```
Extends from metaphysis through physis, | into epiphysis
241
``` PEDIATRIC ORTHOPAEDICS SALTER-HARRIS CLASSIFICATION Define the following terms: Salter V P716 ```
Axial force crushes physeal plate
242
``` PEDIATRIC ORTHOPAEDICS SALTER-HARRIS CLASSIFICATION Define the following fractures by Salter-Harris grade: (see Picture) P717 (picture) ```
Salter III
243
``` PEDIATRIC ORTHOPAEDICS SALTER-HARRIS CLASSIFICATION Define the following fractures by Salter-Harris grade: (see Picture) P717 (picture) ```
Salter IV
244
``` PEDIATRIC ORTHOPAEDICS SALTER-HARRIS CLASSIFICATION Define the following fractures by Salter-Harris grade: (see Picture) P717 (picture) ```
Salter I
245
``` PEDIATRIC ORTHOPAEDICS SALTER-HARRIS CLASSIFICATION Define the following fractures by Salter-Harris grade: (see Picture) P717 (picture) ```
Salter V
246
``` PEDIATRIC ORTHOPAEDICS SALTER-HARRIS CLASSIFICATION Define the following fractures by Salter-Harris grade: (see Picture) P718 (picture) ```
Salter II
247
``` PEDIATRIC ORTHOPAEDICS SALTER-HARRIS CLASSIFICATION What acronym can help you remember the Salter classifications? P718 (Picture) ```
``` “SALTR”: Separated = type I Above = type II Lower=  type III Through = type IV Ruined = type V ```
248
``` PEDIATRIC ORTHOPAEDICS SALTER-HARRIS CLASSIFICATION What is the simple numerical method for remembering the Salter- Harris classification? P718 (Picture) ```
(N = normal)
249
``` PEDIATRIC ORTHOPAEDICS SALTER-HARRIS CLASSIFICATION Why is the growth plate of concern in childhood fractures? P718 (Picture) ```
``` Growth plate represents the “weak link” in the child’s musculoskeletal system; fractures involving the growth plate of long bones may compromise normal growth, so special attention should be given to them ```
250
``` PEDIATRIC ORTHOPAEDICS SALTER-HARRIS CLASSIFICATION What is a chief concern when oblique/spiral fractures of long bones are seen in children? P719 ```
Child abuse is a possibility; other signs of | abuse should be investigated
251
``` PEDIATRIC ORTHOPAEDICS SALTER-HARRIS CLASSIFICATION What is usually done during reduction of a femoral fracture? P719 ```
``` Small amount of overlap is allowed because increased vascularity from injury may make the affected limb longer if overlap is not present; treatment after reduction is a spica cast ```
252
``` PEDIATRIC ORTHOPAEDICS SALTER-HARRIS CLASSIFICATION What is unique about ligamentous injury in children? P719 ```
Most “ligamentous” injuries are actually | fractures involving the growth plate!
253
``` PEDIATRIC ORTHOPAEDICS SALTER-HARRIS CLASSIFICATION children? What two fractures have a high incidence of associated compartment syndrome? P719 ```
1. Tibial fractures 2. Supracondylar fractures of humerus (Volkmann’s contracture)
254
PEDIATRIC ORTHOPAEDICS CONGENITAL HIP DISLOCATION What is the epidemiology? P719
Female > male, firstborn children, breech Presentation, 1 in 1000 births
255
``` PEDIATRIC ORTHOPAEDICS CONGENITAL HIP DISLOCATION What percentage are bilateral? P719 ```
10%
256
PEDIATRIC ORTHOPAEDICS CONGENITAL HIP DISLOCATION How is the diagnosis made? P719
Barlow’s maneuver, Ortolani’s sign | Radiographic confirmation is required
257
PEDIATRIC ORTHOPAEDICS CONGENITAL HIP DISLOCATION What is Barlow’s maneuver? P719
``` Detects unstable hip: patient is placed in the supine position and attempt is made to push femurs posteriorly with knees at 90 /hip flexed and hip will dislocate (Think: push Back = Barlow) ```
258
PEDIATRIC ORTHOPAEDICS CONGENITAL HIP DISLOCATION What is Ortolani’s sign? P719
“Clunk” produced by relocation of a dislocated femoral head when the examiner abducts the flexed hip and lifts the greater trochanter anteriorly; detects a dislocated hip (Think: Out = Ortolani’s)
259
PEDIATRIC ORTHOPAEDICS CONGENITAL HIP DISLOCATION What is the treatment? P719
Pavlik harness—maintains hip reduction | with hips flexed at 100 to 110
260
PEDIATRIC ORTHOPAEDICS SCOLIOSIS What is the definition? P720
Lateral curvature of a portion of the spine Nonstructural: corrects with positional change Structural: does not correct
261
``` PEDIATRIC ORTHOPAEDICS SCOLIOSIS What are three treatment options? P720 ```
1. Observation 2. Braces (Milwaukee brace) 3. Surgery
262
``` PEDIATRIC ORTHOPAEDICS SCOLIOSIS What are the indications for surgery for scoliosis? P720 ```
Respiratory compromise Rapid progression Curves >40 Failure of brace
263
``` PEDIATRIC ORTHOPAEDICS MISCELLANEOUS Define the following terms: Legg-Calvé-Perthes disease P720 ```
Idiopathic avascular necrosis of femoral | head in children
264
``` PEDIATRIC ORTHOPAEDICS MISCELLANEOUS Define the following terms: Slipped capital femoral epiphysis P720 ```
``` Migration of proximal femoral epiphysis on the metaphysis in children; the proximal femoral epiphysis externally rotates and displaces anteriorly from the capital femoral epiphysis, which stays reduced in the acetabulum (Note: Hip pain in children often presents as knee pain) ```
265
``` PEDIATRIC ORTHOPAEDICS MISCELLANEOUS Define the following terms: Blount’s disease P720 ```
Idiopathic varus bowing of tibia
266
``` PEDIATRIC ORTHOPAEDICS MISCELLANEOUS Define the following terms: Nursemaid’s elbow P720 ```
Dislocation of radial head (from pulling | toddler’s arm)
267
``` PEDIATRIC ORTHOPAEDICS MISCELLANEOUS Define the following terms: Little League elbow P720 ```
Medial epicondylitis
268
``` PEDIATRIC ORTHOPAEDICS MISCELLANEOUS Define the following terms: Osgood-Schlatter’s disease P720 ```
``` Apophysitis of the tibial tubercle resulting from repeated powerful contractions of the quadriceps; seen in adolescents with an open physis Treatment of mild cases: activity restriction Treatment of severe cases: cast ```
269
``` PEDIATRIC ORTHOPAEDICS MISCELLANEOUS What is the most common pediatric bone tumor? P720 ```
Osteochondroma (Remember, 80% of | bone tumors are benign in children)

Section III Subspecialty Surgery P517 (11 decks)

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