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Flashcards in Orthopedic Surgery 1 & 2 Deck (41):

What are the important things to evaluate with a fracture (Fx)?

- open or closed
- identify the bone
- location and pattern of fx (transverse, oblique, comminuted; break in more than one location...)
- displacement/angulation


How do you treat NONdisplaced CLOSED fractures?

- placed in a splint or cast for definitive treatment.
*monitor soft tissue swelling.


How do you treat DISPLACED CLOSED fractures?

- reduced to anatomic position and may be treated in cast or may need surgery.


What are OPEN fractures?

- a break in the skin and underlying soft tissue leading directly into or communicating with the fx and its hematoma.
*do NOT use term "compound" fx.


**** What is the Gustilo system of classification? (TEST QUESTION)

- emphasis on size of skin injury (minor or major soft tissue involvement) in OPEN fxs, used for prognosis.
*the higher you go on the scale, the more likely for bone deformities or infection.


What are TYPE 1 OPEN fractures?

- INSIDE-OUT injury
- clean wound
- minimal soft tissue damage
- no significant periosteal stripping


What are TYPE 2 OPEN fractures?

- OUTSIDE-IN (can bring bacteria in) mechanism
- moderate soft tissue damage
- higher energy injury
- some necrotic muscle, some periosteal stripping


What are TYPE 3A OPEN fractures?

- OUTSIDE-IN injury
- high energy
- extensive muscle devitalization
- bone coverage with existing soft tissue is not problematic.


What are TYPE 3B OPEN fractures?

- OUTSIDE-IN injury
- high energy
- extensive muscle devitalization
- requires a local flap or free flap for bone coverage and soft tissue closure.
- periosteal stripping


What is a TYPE 3C OPEN fracture?

- Type 3B with major vascular injury requiring repair.
- increased risk of amputation.


**** What is the most important thing to remember with OPEN fractures? (TEST QUESTION)

- Type 1 and 2= 1st generation cephalosporin.
- Type 3= add aminoglycoside.
- severely contaminated or farm-type injuries= add penicillin.
*always check tetanus status.


What is important to remember in regard to films?

- get films of the joint ABOVE and BELOW the fracture.


What is a hemiarthroplasty?

- procedure which replaces one half of the femur or humerus whilst leaving the other half intact when the blood supply has been disrupted by a fracture.


How could you treat a closed right midshaft transverse humerus fracture?

- hanging arm cast -OR-
- intramedullary Rod with screws proximal and distal to the rod to prevent the bone from rotating around the rod (think of it like a shish kabob).


What is a Monteggia fracture?

- fracture of the proximal third of the ulna with dislocation of the head of the radius.
*treat with plat and screws


What makes pediatric fractures different from adult fractures?

- growth plates
*this is why pediatric cases are more commonly treated with closed reductions (casting) vs. surgery, to reduce the risk of growth plate disturbance with surgery.


How do we treat a femoral head fracture?

- stabilize with plates and screws
- replace with titanium head (hemiarthroplasty with cerclage wire); usually for elderly.


How do you treat a patellar fracture?

- tension band wire= converts a displacing force into a compression force


What is normal knee flexion ROM?

- about 180 degrees


When do fibular fractures need to be repaired?

- when they are more distal around the ankle due to stability requirements.


How do you treat a severely infected metal prosthetic?

- replace with antibiotic infused cement balls, which are implanted for 6 weeks along with IV antibiotics, and then if cultures are negative, replace with new implant.


**** A 30-year old male in a MVA has a closed comminuted fracture of the proximal tibia. He was admitted to the hospital and is schedule for surgery in a day or so. He is complaining of severe pain and is asking for narcotics. His leg is swollen, tense, and the pain is substantially worse with flexion. What is the next step in treatment? (TEST QUESTION)

- Go to the OR for an emergent fasciotomy


**** A 20-year old gymnast is out and slips. She is now experiencing ankle pain. The next day she visits the PCP with a swollen ankle and in pain. What diagnostic study should be ordered? (TEST QUESTION)

- X-ray


**** Which of the follow is NOT an orthopedic surgery emergency? (TEST QUESTION)
a) An open fracture
b) Compartment syndrome
c) septic join
d) cauda equina syndrome
e) Acute anterior tertiary ligament tear/rupture

- e) Acute anterior tertiary ligament tear/rupture


**** A 40-year old male laborer is experiencing back pain that radiates to the right leg has a positive SLR and a positive contralateral SLR. This has been present for a few weeks and is getting worse. He is experiencing tenderness at the lumbar spine, sciatic scoliosis, and a diminished patellar reflex. You suspect sciatica. Which nerve root is affected? (TEST QUESTION)

- L4


**** In evaluating a patient who is experiencing LBP with leg pain. What is a useful study? (TEST QUESTION)



**** Salter-Harris classification refers to? (TEST QUESTION)

- Pediatric fractures


**** Is OMM a of value for treatment for LBP? (TEST QUESTION)



**** Fractures are classified by. . . ? (TEST QUESTION)
A) Complexity of fracture pattern
B) Injury to soft tissue
C) Injury to neurovascular structures
D) All of the above

- D) All of the above


**** True or False: The natural history of back pain is poorly known. (TEST QUESTION)



**** What is the primary indication for joint surgery? (TEST QUESTION)

- Relief of pain


**** True or False: Cauda Equina Syndrome can be treated non-operatively with bed rest, traction, and medications. (TEST QUESTION)



**** In the diagnosis of compartment syndrome. Which of the following clinical findings is false? (TEST QUESTION)
A) Pain out of proportion
B) Increased need for narcotics
C) Palpably tense compartment
D) Pain with passive stretch
E) Elevation of the leg improves the condition

- E) Elevation of the leg improves the condition


**** What is important when describing a fracture to another physician? (TEST QUESTION)
A) Location of fracture
B) Open or closed fracture
C) Whether there is angulation or dislocation of the fracture
D) All of the above

- D) All of the above


**** True or False: 90% of patients w/LBP have pain in the butt and back, 10% also have leg pain. (TEST QUESTION)



**** Which of the following are tension tests? (TEST QUESTION)
B) Sitting Root Test
C) Contralateral SLR
D) All of the above

- D) All of the above


**** Do most patients with LBP require surgery? (TEST QUESTION)



**** 26 y/o male comes into your office complaining of back pain that shoots down the right leg. Exam reveals decreased sensation in L4 dermatome distribution with a positive straight-leg raising test. What reflex do you suspect to be diminished? (TE

- patellar reflex due to disc herniation between L3/4.


**** What should your initial treatment for an open grade 2 tibial fracture consist of? (TEST QUESTION)

- debridement, ABX (cephalosporin +/- aminoglycoside)


**** 6 y/o male comes into ED with wrist fracture. Should you treat this young boy the same way you treated his father a few years ago? (TEST QUESTION)

- NO because this child still has his growth plates.


**** Is an external fixator used for definitive or temporary treatment? (TEST QUESTION)