Flashcards in Orthopedic Surgery Deck (31):
What do you see in congenital hip dysplasia?
Presents as uneven gluteal folds, posterior dislocating hips (with "snapping") in a newborn; dx U/S since hip isn't calcified for X-ray
How does LCP disease present?
Avascular necrosis of the femoral head
Present in a kid with limping, hip pain, and limited hip ROM; dx X-ray, Tx cast + crutches
How does hip dislocation present?
Presents as a chubby kid limping due to groin pain, hip has limited internal rotation; dx X ray, tx pin femoral head back in place
How does a septic hip present?
Presents in toddlers who refuse to move hip following a septic illness; dx hip aspiration under anesthesia, tx perc drain
How does osteomyelitis present in kids?
Presents in kids with severe localized bone pain following a septic illness; dx bone scan since X ray will be false negative, tx antibiotics
What are genu varum and valgus?
genu varum (bowlegs): 3 y/o surgical correction
genu valgus (knock knee) : observation
What is Osgood-Schlatter disease?
Presents in teens with persistent pain over the tibial tubercle, aggravated by quad contraction; tx immobilization in cast
How does club foot present?
Presents as bilateral inverted feet in a newborn
tx serial plaster casts on adducted forefoot --> hindfoot varus --> equinus
How do you treat scoliosis?
Laterally curved spine
Common in teenage girls
Tx spine brace until mature, surgery if severe
How does an osteosarcoma present?
Presents as low-grade knee pain in a 10-25 y/o, X ray shows Codman's triangle and sunburst appearance
How does Ewing sarcoma present?
Presents as low-grade epiphyseal pain in a child, X ray shows onion skinning, due to t(11;22)
How do metastatic bone cancers present?
Usually from breast (lytic) and prostate (blastic), causing bone pain and pathologic fractures
Dx: bone scan
How does multiple myeloma present?
Plasma B cell tumor results in CRAB
bone pain (punched out lesions on Xray)
Dx: urinary Bence-Jones protein
How do you work up fractures?
All require 2 X-rays 90 degrees from each other including joints above and below fractured bone; anticoagulation of choice is fondaparinux + leg compression devices
How do you manage a clavicular fracture?
Typically between mid-to-distal third of clavicle; tx figure of eight device for 4-6 weeks
How does an anterior shoulder dislocation present?
Presents with outward rotated arm + deltoid numbness due to axillary palsy
How does a posterior shoulder dislocation present?
Presents with internally rotated arm held close to body
What is a Colles fracture?
Distal radial fx in osteoporotic women falling on outstretched hand
Tx is reduction + cast
What is a monteggia fracture?
Diaphyseal fx of proximal ulna + radial dislocation, following direct trauma to ulna
What is a Galezzi fracture?
Diaphyseal fracture of distal radius + ulnar dislocation, following direct trauma to radius
How does a scaphoid fracture present?
Presents as wrist pain and tender anatomic snuffbox in a young person falling on outstretched hand; tx thumb spica cast
How does a metacarpal neck fracture present?
Presents as swollen and tender hand after punching a wall; tx splint or plate
How does a hip fracture present?
presents as shortened and externally rotated hip in an osteoporotic woman; tx depends on location of fracture
What is the risk of a femoral neck fracture?
May lead to avascular necrosis of femoral head
Tx prosthetic replacement of head
How do you treat a femoral shaft fracture?
intramedullary rod fixation, high risk of hypovolemic shock and fat embolism
How do knee injuries present?
Unhappy triad: ACL, MCL, and medial meniscus following blow to lateral leg
ACL tear: swelling, pain, positive anterior drawer sign
Meniscal tear: pain, swelling, and clicking of knee with forceful extension
MRI is dx for all
How does a tibial stress fracture present?
Presents as localized tibial pain in a soldier following a long march
tx cast and f/u Xray in 2 weeks
How does an Achilles tendon rupture present?
Presents as "popping noise" in ankle following exertion with pain and swelling
tx cast or surgery
How do you treat an ankle fracture?
Common after falling on inverted or everted foot
How do you manage an open fracture?
Require cleaning and reductino within six hours to prevent ischemia of distal limb