Orthopedic Surgery - Part 2 Flashcards
(204 cards)
1
Q
What are the two main types of pelvic fractures?
A
Superior/inferior pubic rami fx (not fatal)
High-energy fx (can be fatal)
2
Q
What is the usual cause of superior/inferior pubic rami fx?
A
Fall on butt (Elderly)
3
Q
How are superior/inferior pubic rami fractures treated?
A
Non surgical
Pain control (may require hospitalization)
WBAT
4
Q
What is the one factor of superior/inferior pubic rami fractures that should be looked for as they can be a major complication?
A
Extension of fx into acetabulum
5
Q
What percentage of high energy pelvic fractures have other injuries?
A
85%
6
Q
What are two common complications of high energy fractures?
A
Hemorrhage, urogenital injruy
7
Q
What does an L5 transverse process fx suggest?
A
Instability because of disassociation of pelvis and spine
8
Q
What is an open book pelvic fracture?
A
Separating of symphysis pubis. Can result in separation of SI joint
9
Q
What is the MOI for an open book fracture?
A
AP compression
10
Q
How many units of blood are typically needed for open book pelvic fractures?
A
6-15 units
11
Q
What is a vertical shear pelvic fracture?
A
Open pubic symphysis, separated SI joint, fractured rami
12
Q
What should be checked before foley insertion?
A
Ureteral bleeding
13
Q
What IV access should be placed with pelvic fractures?
A
Large bore IV x 2
14
Q
If AP pelvic xray is positive for pelvic fracture what other imaging should be ordered?
A
Inlet/Outlet XR and CT scan
15
Q
What images are part of trauma imaging?
A
C-spine, abdominal, pelvic films
16
Q
How should MAST trousers be removed to prevent distributive shock?
A
Deflate slowly and monitor vitals carefully
17
Q
Should bleeding in pelvis or elsewhere be stopped first?
A
Elsewhere
18
Q
Of there is no abdominal bleeding what can be placed to stabilize the pelvis until surgery?
A
Abdominal binder or external fixator
19
Q
When should abdominal binder/external fixator be removed?
A
Not until ready to administer definitive care
20
Q
How do you treat continued hemoinstability?
A
Transfusion followed by angiography
21
Q
What will males experience following ORIF of a pelvic fracture?
A
Significant scrotal swelling
22
Q
What is the MOI for clavicle fractures?
A
Fall on shoulder
23
Q
Where are clavicles most commonly fractured?
A
Midshaft (80%)
24
Q
What clavicle fracture has the highest risk of nerve and vessel trauma?
A
Medial border
25
What is the treatment for closed clavicle fracture?
Sling or figure 8 for 6-12 weeks
26
What movements should a patient with a clavicle fracture avoid?
Forward flexion, abduction, and external rotation of the shoulder joint
27
What is the MOI for a separated shoulder?
Fall on the tip of the shoulder
28
What is a separated shoulder?
Disruption of acromioclavicular joint
29
How are grade I and grade II separated shoulders treated?
Sling, NSAID, PT
30
How are grade III separated shoulders treated?
Surgically if it is an athlete or in a high demand job
31
How do you treat an anterior sternoclavicualr joint dislocation?
Conservatively
32
How do you treat a posterior sternoclavicular joint dislocation?
Surgically, high vascular area
33
What is the MOI for a scapular fracture?
Significant direct trauma
34
How often are scapular fractures associated with other injuries and what other injuries occur?
80% in clavicle, ribs, pulmonary contusion, pneumothorax, brachial plexus injury
35
What imaging should be ordered for a scapula fracture?
```
Chest (look for pneumothorax)
3V shoulder (Look at glenoid)
```
36
What is the treatment for scapula fractures?
Non surgical with the exception of glenoid involvement
37
What percent of displacement is acceptable before surgery is necessary in proximal humerus fractures?
50%
38
How is a proximal humerus fracture plus an associated rotator cuff tear managed?
Wait until the fracture is healed, the address RC tear
39
How does an anterior/inferior shoulder dislocation present?
Pt holds arm at side with arm down and in front
| "empty socket sign"
40
What is the MOI for a shoulder dislocation?
FOOSH
41
If a patient has a severe seizure what imaging should be done?
Shoulder x-ray for posterior dislocation
42
How does a patient present with a posterior dislocation?
Cannot externally rotate
43
What imaging should be ordered for a shoulder dislocation?
3 view pre and post reduction x-ray
44
What is a Hill-Sachs lesion?
Chipped head of humerus following shoulder dislocation
45
What is a Bankart Lesion?
Chipped glenoid from shoulder dislocation
46
How are shoulder dislocations treated?
Reduction and immobilization, referral to ortho, PT
47
What percentage of patients re-dislocate their shoulder if they have a Bankart lesion?
80%
48
What is the treatment of shoulder dislocations with a Bankart lesion?
Surgery
49
What does the SITS pneumonic mean for rotator cuff muscles?
Supraspinatus, Infraspinatus, Teres minor, Subscapularis
50
What tests are sensitive for RC tear?
Empty can and Drop arm
51
What tests are sensitive for impingement of the rotator cuff?
Hawkins, Neers
52
How many Xray views should ALWAYS be ordered for shoulders?
3
53
What x-ray findings will be present with shoulder impingement?
Impinging osteophytes at AC joint
54
What imaging should be ordered to evaluate for tear or degree of impingement?
MRI
55
How are rotator cuff tears treated?
NSAIDS, PT, rest, ice, cortisone injection
56
How are persistent impingements treated?
Arthroscopic subacromial decompression
57
Where is the most common humerus fracture?
Midshaft
58
What nerve is easily damaged with humerus fracture?
Radial
59
How do you check if the radial nerve is intact?
Thumbs up
60
How is a closed humerus fracture treated?
Coaptation splint or humeral fracture brace
61
When is ORIF indicated for humerus fracture?
Open fx, vascular injuries, gross displacement, significant comminution
62
What is the MOI for a supracondylar humerus fx?
FOOSH + hyperextension of elbow
63
What could also be injured with supracondylar humerus fx?
Brachial artery
64
What is a Volkmann's ischemic contracture?
Brachial artery gets injured - becomes spastic and spontaneously closes off
65
What should be monitored often to detect a Volkmanns ischemic contracture?
Radial pulse
66
What are the two signs on xray that indicate a supracondylar fracture?
Anterior sail or posterior fat pad
67
How are supracondylar fractures treated in children?
Cast, closed reduction + cast, CRPP, ORIF
68
How are supracondylar fractures treated in adults?
Usually ORIF
69
What is the most common elbow dislocation?
Posterior lateral
70
How does a pt with elbow dislocation present?
Elbow extended, arm abducted, forearm supinated
71
How is an elbow dislocation reduced?
Correct med/lat deformity first then flex elbow at 90 degree with distal traction
72
How is an elbow dislocation treated?
Reduce, splint posterior elbow at 90 degrees, refer to ortho
73
What is a nursemaids elbow and what is the MOI?
Subluxation of radial head caused by excessive longitudinal traction
74
What ligament can be affected by a nursemaids elbow?
Annular
75
How is a nursemaids elbow reduced?
Fully supinate and flex forearm
76
What should forearm fracture films include?
Elbow and wrist
77
How are forearm fractures treated?
reduce and long arm cast or ORIF especially in adults
78
What injury is commonly coincides with radius and ulna fracture?
Radial head dislocation
79
What is the MOI of a radial fracture?
FOOSH
80
What is a Collie's fracture?
Dorsal angulation radius fracture
81
What is a Smith's fracture?
Volar angulation radius fracture
82
How many degrees of angulation of a radial fracture is acceptable in children?
15%
83
What is the treatment for an angulated/displaced radial fracture in adults?
ORIF
84
What is the major complication of a scaphoid fracture?
AVN
85
What is the physical exam sign of a scaphoid fracture?
Pain at the anatomic snuffbox
86
What xray is ordered for a scaphoid fracture?
Carpal series
87
What imaging is ordered to evaluate the severity of a scaphoid fracture?
MRI/CT
88
How is a scaphoid fracture treated?
Splint, cast, with immobilization of the thumb, wrist, and elbow
89
How large of a displacement requires ORIF?
1 mm or more
90
What is the diagnostic appearance for AVN of the scaphoid on xray?
Ground glass appearance or increased bone density early on
91
What is a boxer's fx?
5th MC fx
92
How does a boxer's fx present?
Loss of prominence of knuckle with pain
93
What is the most common fx of the phalanges?
distal
94
When should a fingernail be removed in association with a distal phalanx fracture?
If 50% or greater involvement
95
What is the MOI of a Mallet injury?
Downward blow to distal phalanx in extension
96
What is a Mallet injury?
Avulsion of distal extensor tendon from base of distal phalanx
97
How will a mallet injury present?
Inability to extend at DIP
98
How is a Mallet injury treated?
Splint in extension, refer to hand surgeon
99
What is a Jersey injury?
Avulsion of distal flexor tendon
100
How is a jersey injury treated?
splint in neutral, surgery
101
What is the most common finger dislocation?
DIP
102
How is a finger dislocation treated?
Reduction with pain control or not, splint, refer to hand specialist
103
Difficulty in reduction of a finger dislocation is an indication of what?
A caught central slip. May need surgery
104
What is the most common mononeuropathy?
Carpal tunnel
105
What is carpal tunnel?
Compression of medial nerve under the transverse carpal ligament
106
What are the clinical features of carpal tunnel syndrome?
Night pain, numbness, weakness, paresthesias, sparing the 5th digit, thenar atrophy in late
107
What PE tests are sensitive for carpal tunnel syndrome?
Tinnels and Phalens
108
What is the gold standard diagnostic tool for diagnosis of carpal tunnel?
EMG
109
What is the treatment for carpal tunnel?
```
Activity modification
NSAIDS
Volar splint (especially at night)
Steroid injection
Surgery for decompression
```
110
What is the MOI for an acetabular fracture?
Blow to greater trochanter
Hip dislocation - posterior wall
Rami Fx - Medial wal or posterior wall
111
What imaging should be ordered if there is a suspicion of an acetabular fracture?
CT
112
What nerve can be injured with an acetabular fracture?
Sciatic
113
When is surgery indicated for an acetabular fracture?
If unstable or displaced
114
What is the most common MOI for a dislocated hip?
Blow to flexed knee (MVA- dashboard)
115
How does a posterior (90% of hip dislocations) dislocated hip present?
Hip flexed, internally rotated, adducted
116
How does an anterior dislocated hip present?
Externally rotate, abducted, mildly flexed
117
How is a dislocated hip treated?
Orthopedic emergency
| Reduction
118
Patients can experience AVN of the femoral head if hip is dislocated for how long?
12 hrs
119
What xray should be ordered for a dislocated hip?
Shoot thru lateral
120
How is a posterior hip dislocation reduced?
Pt supine, one person stabilizes the pelvis, another pulls in-line traction with simultaneous flexion, abduction and rotation
121
What is a hip fx until proven otherwise?
Hip pain
122
How does a patient with a hip fracture present?
Leg shortened, eternal rotation
123
What imaging should be ordered for a hip fracture?
Xray or CT for occult
124
What can be given before surgery to help with pain?
Buck's traction 5-10 lbs
125
A hip fracture is a surgical emergency in what demographic and why?
young because of AVN
126
Are hip fractures surgical in elderly?
If they are stable
127
Who commonly experiences a stress fx of the femoral neck?
```
Distance runner
eating disorder
amenorrhea
Osteoporosis
Vitamin D/PTH
```
128
What risks are associated with a femur fracture?
Hemorrhage, compartment syndrome
129
A spiral fx of a non-weight-bearing child is what?
Child abuse
130
What must a femur fx x-ray include?
Hip and knee
131
Hip fractures in children under 6 are treated how?
Cast (Spica)
132
How is a hip fx treated in adults
Surgery
133
What is the MOI for a patellar fracture?
Fall on bent knee
134
What is crucial in evaluating a patellar fracture to r/o quad tendon rupture?
Straight leg test
135
What imaging is necessary for a patellar fracture?
xray
| CT if surgical
136
What are the two surgical treatments for a patellar fracture?
ORIF vs patellectomy
137
What is a knee dislocation?
Complete dislocation of tibia from femur
138
Why is a knee dislocation an orthopedic emergency?
High risk of popliteal artery/nerve injury. can lead to amputation or death
139
What are common complications of a knee dislocation?
```
Artery/nerve injury
High rate of chronic function loss
Multi ligament disruption
High risk of OA in future
Compartment syndrome
Rare return to sports
```
140
When should a dislocated knee be xrayed?
Pre and post reduction
141
What should be ordered for a dislocated knee for surgery planning?
MRI
142
What is the MOI of a patella dislocation?
Direct blow or twist
143
How is a patella dislocation reduced?
Extend knee
144
How is a patella dislocation treated?
Knee immobilizer and refer to ortho
145
What injury associated with a patellar dislocation is found on MRI?
Medial patellafemoral ligament injury
146
What is the MOI of a meniscal injury?
Rotational force of femur on tibia
147
Is a medial or lateral meniscal injury more common?
Medial
148
What will PE reveal about meniscal injury?
Inability to extend because of locking
| +McMurry's, +Apley's
149
What is the gold standard for meniscal injuries?
MRI
150
What is the treatment for meniscal injury?
arthroscopy
151
What is the MOI for a cruciate ligament injury?
pivot/twisting
152
Is ACL or PCL injury more common?
ACL
153
What are the the sx of cruciate ligament injury?
A "pop" with instability and effusion (3-4 hrs later)
154
What PE signs indicate cruciate ligament injury?
Lachman's (most sensitive) and anterior drawer (posterior drawer for PCL)
155
What is the gold standard imaging for cruciate ligament injury?
MRI
156
What other imaging should be ordered for cruciate ligament injury?
XR to rule out fracture, especially lateral tibial plateau with ACL
157
What is the treatment for cruciate ligament injury?
Surgery (6-9 mo recovery)
158
What is the MOI for a collateral ligament?
Direct blow causing med or lat force
159
What knee deformity indicates MCL injury
Valgus
160
What knee deformity indicates LCL injury
Varus
161
What is the tx for a collateral ligament injury?
PT, brace, RICE, NSAIDS, surgery is rare
162
What is Osgood-Schlatter disease?
Apophysitis of the tibial tubercle due to trauma or overuse
163
In what age group is Osgood-Schlatter seen?
8-15 y/o
164
What are the presenting sx of Osgood-Schlatter?
Anterior knee pain at tubercle
165
What imaging should be ordered for OS and what will they show?
Lateral XR that may show fragmentation/avulsion
166
What is the treatment for OS?
Activity modification, RICE, PT, NSAIDS
167
What are the complications of a tibial plateau fx?
Ligament/Meniscal injury, foot drop due to peronal nerve injury
168
What type of tibial plateau fx is more common in the elderly?
Depressed Fx
169
What type of tibial plateau fx is more common in the young?
Split fx
170
Are most tibial plateau fractures medial or lateral?
Lateral
171
What is the most common long bone fracture?
Tibia/fibula
172
What are common complications of tib/fib fractures?
compartment syndrome
173
Who commonly gets tibial and fibula stress fractures?
runners, dancers, military
174
What is the tx for most tib/fib fractures?
Surgery
175
What is the treatment for toddlers with tib/fib fractures and stress fractures?
Casting
176
Where do most fractures associated with ankle dislocations occur?
foot, proximal tib/fib
177
What xray should be ordered for an ankle fracture/dislocation?
3V ankle, dont miss the posterior
178
What are the majority of ankle strains due to?
Inversion
179
What ligament is most commonly affected with ankle sprains?
Anterior talofibular
180
What is the set of guidelines called that helps determine of a patient with ankle pain needs an xray?
Ottowa Ankle
181
What is the treatment for an ankle sprain?
RICE
NSAID
WBAT
PT
182
How long does it take to recover from an ankle sprain?
3-4 months
183
The fracture of what bone in the foot is an orthopedic emergency due to possible AVN?
Talus fracture
184
What is the MOI of a talus fx?
Fall with hyperflexed foot
185
When should a talus fracture be displaced?
When it's non-displaced
186
When should a talus fracture be operated on?
When it is displaced
187
What is the MOI for a calcaneal fx?
Fall from a height
188
What injuries are commonly associated with calcaneal fractures?
Bilateral
Spine Fx
Leg fx
189
What imaging should be ordered for a calcaneal fracture?
3V foot + Os calcis views
190
What imaging should be ordered along with xrays for a calcaneal fracture?
CT. Xray seriously underestimates the severity of the injury
191
What structure should be evaluated with a calcaneal fracture?
Achilles tendon
192
What is the treatment for a calcaneal fracture?
ORIF or closed
193
What is the MOI of a metatarsal fx?
Direct trauma, twist
194
What imaging should be ordered for metatarsal fracture?
xray
195
What is the treatment for a metatarsal fracture?
NWB/ closed reduction if not displaced
196
What is a Jones injury?
Inversion injury with fx at diaphyseal junction of the 5th MT
197
How is a jones injury treated?
NWB, surgery
198
What is a Lisfranc Injury?
Fracture/ligament rupture between base of second metatarsal and medial cuneiform
199
What is the MOI of a lisfranc injury?
Extreme plantarflexion
200
What imaging is ordered for a lisfranc injury?
3V XR of foot, consider stress views, CT or MRI
201
What is the treatment for a Lisfranc injury?
Surgery
202
What treatment is ordered for phalangeal foot fx?
XR entire foot to evaluate for associated injury
203
Which toe is most important to have perfect alignment?
1st toe b/c of balance and painful OA
204
What is the treatment for a phalangeal fx of the foot?
Hard sole shoe and buddy taping
