Orthopedic Surgery - Part 1

Question 1

What x-ray should be ordered for fractures?

Answer 1

Plain radiograph with at least 2 views at 90 degrees from one another (AP and Lat)

Question 2

How soon should open fractures go into the OR?

Answer 2

Within 4-8 hours (ideally less than 6)

Question 3

What abx are given for open fractures?

Answer 3

1st generation cephalosporin (add aminoglycoside for lg wounds or soft tissue injury)

Question 4

What abx should be given for farm injuries?

Answer 4

Penicillin

Question 5

What organism should be considered for “through the shoe injuries”?

Answer 5

Pseudomonas

Question 6

What five features should be included when describing a fracture?

Answer 6

Open vs Closed
Type
Displacement
Angulation
Location

Question 7

What is an open type 1 fracture?

Answer 7

Low energy MOI
Less than 1 cm in length
Are usually transverse or short oblique

Question 8

What is an open type II fracture?

Answer 8

Greater energy
Wound more than 1 cm long
Typically with comminution and minimal to moderate crushing

Question 9

What is an open type III fracture?

Answer 9

Wound greater than 10 cm
Significant comminution and extensive soft tissue injury
High energy
Grossly contaminated

Question 10

What is an open type III A fracture?

Answer 10

Adequate bone coverage of remaining skin (wont need a graft)

Question 11

What is an open type III B fracture?

Answer 11

Bone exposure that requires a flap or graft

Question 12

What is an open type III C fracture?

Answer 12

Circulatory compromise requiring vascular repair or reconstruction to reperfusion of the limb

Question 13

What is a torus fracture?

Answer 13

A “bulge” in the cortex of the bone does not go all the way through, seen in children

Question 14

What is a greenstick fracture?

Answer 14

A break in one cortex, seen in children

Question 15

What is a transverse fracture?

Answer 15

A break through the bone horizontally

Question 16

What is an oblique fracture?

Answer 16

The fracture runs at an oblique angle to the long axis of the bone

Question 17

What is a spiral fracture?

Answer 17

Wraps in a spiral along the long axis of the bone

Question 18

A spiral fracture of the femur in a non-weight bearing child is indicative of what?

Answer 18

Child abuse

Question 19

What is a comminuted fracture?

Answer 19

A bone broken into many pieces (shattered)

Question 20

What is a segmental fracture?

Answer 20

A fracture above, one below, and a middle piece broken out

Question 21

What is an avulsion?

Answer 21

A piece of bone is pulled off by a ligament or tendon

Question 22

What is an impacted bone?

Answer 22

Bone fragments are driven into one another

Question 23

Salter harris pneumonic:

Answer 23

S = separated
A = above
L = lower
T = through
ER = Everything's ruined

Question 24

What is a non-displaced fracture?

Answer 24

The two ends of bone are not displaced from one another

Question 25

What is a displaced fracture?

Answer 25

Bone ends are separated

Question 26

What is angulation?

Answer 26

Relation of long axis of fragments in relation to each other described by the direction the distal fragment points and amount of angle

Question 27

How long can muscles and nerves survive ischemic conditions without irreversible damage?

Answer 27

4 hours

Question 28

At what point does nerve and muscle ischemia become permanent?

Answer 28

8 hours

Question 29

What are the 5 p's of compartment syndrome?

Answer 29

``` Pulselessness (Late finding, bad sign) Paresthesias (Late finding, bad sign) Paralysis Pallor Pain ``` Do serial exams

Question 30

What is the diagnostic exam technique of compartment syndrome?

Answer 30

Severe pain with PROM of the muscles of the affected compartment that is out of proportion

Question 31

How is compartment syndrome treated?

Answer 31

Fasciotomy

Question 32

How are amputations treated?

Answer 32

Stop bleeding | Wrap amputated segment in sterile gauze and soak in lactated ringer's, place in plastic bag, and place on ice

Question 33

What is Virchow's triad for DVT?

Answer 33

Stasis Intimal injury Hypercoaguability

Question 34

What two features gives high clinical suspicion for DVT?

Answer 34

Calf pain + risk factors

Question 35

What physical exam signs signify DVT

Answer 35

Homan's sign Palpable cords Tenderness Edema

Question 36

Gold stander for diagnosis of DVT

Answer 36

Venography

Question 37

Best test for DVT

Answer 37

Venous doppler US

Question 38

What are the signs and symptoms of PE?

Answer 38

Pleuritic chest pain, Tachypnea, Tachycardia, EKG R BBB | EKG S1Q3T3

Question 39

Treatment for PE?

Answer 39

IV heparin

Question 40

What is Necrotizing fasciitis?

Answer 40

Infection along fascial planes by group A strep (or sometimes clostridia)

Question 41

How is necrotizing fasciitis treated?

Answer 41

Debridement ahead of the infection, IV abx, high risk of amputation

Question 42

What is the most common hand infection?

Answer 42

Paronychia, infection at the nail fold

Question 43

How is paronychia treated?

Answer 43

Abx, I&D prn

Question 44

What is the infection of the nail pulp at the tip of the finger?

Answer 44

Felon

Question 45

How is a felon treated?

Answer 45

Abx, I&D

Question 46

What is kanavel signs and what do they indicate?

Answer 46

Tenderness along tendon sheath proximally, finger is held flexed with pain on passive extension. Sausage digit. Indicative of Flexor Tenosynovitis

Question 47

When does a dog/human/cat bite become a surgical emergency?

Answer 47

When it is intra-articular

Question 48

What is the most common intra-articular human bite?

Answer 48

3rd and 4th metacarpal from punch to face "fight bite"

Question 49

What is the treatment for a fight bite?

Answer 49

Intra-articular I&D

Question 50

What antibiotic is given for a fight bite and for which organisms?

Answer 50

Augmentin for strep viridians, S aureus, Eikenella

Question 51

What organisms are most common in dog bites?

Answer 51

S viridians> Pasturella multicocida > s aureus

Question 52

What abx are given for dog bites?

Answer 52

Augmentin

Question 53

What are the most common organisms in a cat bite?

Answer 53

Pasteurella>S. aureus

Question 54

What abx are given for cat bites?

Answer 54

Augmentin

Question 55

When can a cervical collar be removed in a trauma pt?

Answer 55

When C-spine XR from occiput to T1 are neg in ap, lat, and odontoid views. Should be awake, sober, alert, have full ROM without pain or neuro deficits

Question 56

When should an x-ray of entire spine be considered?

Answer 56

If there is an altered LOC

Question 57

Which XR view should be checked for alignment and soft tissue swelling?

Answer 57

Lateral

Question 58

What is a Jefferson's fx?

Answer 58

Fx of C1 ring

Question 59

What is a hangman's fx?

Answer 59

Fx of C2 isthmus

Question 60

What is a clay-shovelers fx?

Answer 60

C6-T1 Spinous process avulsion

Question 61

What is the anterior column of the spine?

Answer 61

Anterior longitudinal ligament and anterior vertebral body

Question 62

What is the middle column of the spine?

Answer 62

Posterior vertebral body and posterior longitudinal ligament

Question 63

What is the posterior column of the spine?

Answer 63

Posterior longitudinal ligament to spinous processes

Question 64

What is a compression fracture of the spine?

Answer 64

Failure of the anterior column with preservation of the middle column

Question 65

What is a burst fx of the spine?

Answer 65

Fx of anterior and middle column with axial load with or without posterior column involvement (more likely to be unstable)

Question 66

At what spinal level does the spinal cord end?

Answer 66

L2

Question 67

A burst fracture at L1-L2 can lead to what?

Answer 67

Bladder/bowel dysfunction

Question 68

What are signs of a coccyx fx?

Answer 68

Pain with rectal exam and defication

Question 69

How are coccyx fxs treated?

Answer 69

Stool softener, donut pad, time

Question 70

What should be given for any neuro deficit with a spine fx?

Answer 70

IV Methylprednisolone

Question 71

What should always be checked with a spinal fracture?

Answer 71

Rectal exam, reflexes, and perianal sensation

Question 72

When is methylprednisolone contraindicated?

Answer 72

Pregnancy <13 Open spine surgery Uncontrolled DM

Question 73

What causes cauda equina syndrome?

Answer 73

multilevel LS root compression through trauma, hematoma, infection, post surgical

Question 74

What are the signs and symptoms of cauda equina syndrome?

Answer 74

Saddle anesthesia, bilateral radiculitis, LE numbness, weakness, hyporeflexia, loss of bowel/bladder fxn