Orthopedics Flashcards
(91 cards)
1
Q
Transverse fracture
A
Right angle to the axis of the bone
2
Q
Spiral fracture
A
Has twisted appearance, also called otrsion
3
Q
Oblique fracture
A
Fracture line between horizontal and vertical direction
4
Q
Comminuted fracture
A
Splintered or crushed
5
Q
Segmental fracture
A
Double
6
Q
Study of choice to diagnose an occult hip fracture
A
MRI
7
Q
Intra-articular fracture
A
Fracture line enters a joint cavity
8
Q
Salter-Harris Classification of fractures
A
Growth (epiphyseal) plate fractures Same Above Lower Through Rammed
9
Q
Buckle fractures (torus)
A
When one side of the cortex buckles as a result of compression injury (FOOSH)
10
Q
Treatment for buckle fracture
A
4-6 weeks in cast
11
Q
Greenstick fractures
A
Occurs in long bones when bowing causes a break in one side of the cortex
12
Q
Most common sites of dislocation
A
Anterior shoulder
Posterior elbow
Posterior hip
13
Q
Treatment for dislocations
A
Closed reduction, immobilization for 24 weeks
If associated fractures, needs ORIF
14
Q
Worrisome r/o injury with anterior glenohumeral shoulder dislocation
A
Axillary nerve injury - pinprick sensation over deltoid
15
Q
Posterior glenohumeral shoulder dislocations are most commonly associated with:
A
Seizures, electric shock, trauma
16
Q
Worrisome r/o injury with humeral shaft gracture
A
Radial nerve injury
May cause wrist drop
17
Q
Most commonly fractured bone in children, adolescents and newborns during birth
A
Clavicle fracture
18
Q
Complications of clavicle fractures
A
Pneumothorax, coracoclavicular ligament disruption, hemothorax, brachial plexus injuries
19
Q
Complications of supracondylar humerus fracture
A
Median nerve and brachial artery injury - volkmann ischemic contracture (claw-like deformity) from ischemia
20
Q
+ fat pad sign
A
Posterior fat pad or displaced anterior fat pad
Radial head fracture
21
Q
Complications of olecranon fractures
A
Ulnar nerve dysfunction
22
Q
Monteggia fracture
A
Proximal ulnar shaft fracture with anterior radial head dislocation
23
Q
Management of monteggia fracture
A
Unstable - ORIF
24
Q
Galeazzi fracture
A
Mid-distal radial shaft fracture with dislocation of distal radioulnar joint
25
Management of Galeazzi fracture
Unstable - ORIF
| Sugar tong splint temporarily
26
Caused from lifting/swinging/pulling a child while forearm is pronated and extended - radial head wedges into the stretched annular ligament
Radial head subluxation (nursemaid's elbow)
27
Management of radial head subluxation (nursemaid's elbow)
Reduction - pressure on radial head with supination and flexion
28
Management of elbow dislocation
Urgent reduction!
| Posterior splint at 90 degrees x 7-10 days
29
Colle's Fracture
Distal radius fracture with dorsal/posterior angulation
30
60% with colle's fracture also have __________ fracture
Ulnar styloid
31
Need a ______________ to diagnose colle's from smiths fracture
Lateral view xr
32
Smith fracture
Reverse colle's fracture
| Ventral/anterior angulation
33
Boxer's fracture
Fracture at neck of 5th metacarpal
34
Management of boxer's fracture
Ulnar gutter splint
35
Management of bite wounds
Augmentin
36
Diagnosis of patellar frx
Sunrise view
37
Worrisome r/o injury with tibial-femoral dislocations
Popliteal artery rupture
38
Insidious onset of localized aching pain, swelling and tenderness at the end of activities. Located in 3rd metatarsal most commonly
Stress (march) fracture
39
Disruption between the articulation of the medial cuneiform and the base of the 2nd metatarsal
Lisfranc injury
40
Management of lisfranc injury
ORIF followed by non-weight bearing cast for 12 weeks
41
Red flags for low back pain (5)
1. Weight loss
2. Over the age of 50
3. History of CA
4. Night time pain
5. Fever
42
What to do if red flags present with low back pain?
Order XR
| If no red flags, treat with NSAID
43
Three major medical conditions to look for with lower back pain
Cauda equina syndrome
CA
Spinal infection (osteomyelitis and spinal epidural abscess)
44
Radiculopathy may be present with __________ (which most commonly affects _____ or _____ root), which will present as pain or numbness radiating to the leg (below leg)
Disk herniation
| L5 or S1 root
45
A ___________ is done to assess herniation (sciatica)
Straight leg raise test
| With pt lying flat, lift leg: a positive test will cause this maneuver to reproduce symptoms
46
Most commonly a result of a metastatic tumor and is actually the initial presentation of cancer in up to 20% of patients
Cauda equina
47
Symptoms of cauda equina
Saddle numbness, weakness, paresthesias, and motor deficits not localized to a single unilateral nerve root. Bladder/bowel dysfunction is a late finding.
48
The ______ is the most common site of metastasis. Therefore, anyone with a history of _________ and __________ should be worked up for metastsis and pathological fracture
Bone
| CA and new onset back pain
49
Epidural abscess will present with _________ and _________
Back pain
| Fever
50
There should be suspicion of an abscess in pts who are (3)
Immunocompromised
Injection drug users
Recent spinal injection or epidural catheter placement
51
Presents as a gradual worsening of low back pain over days. May or may not have any other symptoms
Osteomyelitis
52
Risk factors for back compression fracture
```
History of glucocorticoid use
Over 70 y/o
Trauma
Osteoporosis
Noticeable contusion
```
53
Pts will describe severe back pain and sudden onset of pain with focal tenderness
Compression fracture
54
Diagnostic testing for low back pain
If suspicion for one of the major three medical conditions exists, immediate MRI and referral
Otherwise, NSAIDs
55
Tx for low back pain
```
NSAIDs
PT should be offered
XR if not improved after 4-6 weeks
If no pathology found on MRI, trial of epidural glucocorticoids may be given
Final step is surgery
```
56
Infection in the joint cavity (usually bacterial) - most dangerous form of acute arthritis
septic arthritis
57
Most common organism in septic arthritis
S. aureus MC
N gonorrhoeae
Streptococci, staph epidermidis
58
Signs/symptoms of septic arthritis
1. Joint involvement - single, swollen, warm, painful joint (decreased ROM), tender to palpation
2. Constitutional symptoms: fever, chills, diaphoresis, myalgia, malaise, pain
59
Most common sites of septic arthritis
Knee most common
| Hip > elbow > ankle > wrists
60
Diagnosis of septic arthritis
1. Arthrocentesis - definitive - WBC > 50,000 (PMNs)
| 2. MRI/CT
61
Arthrocentesis WBC Counts:
> 20,000 =
> 2,000 =
< 500 =
Infection
Inflammation
Normal
62
Management of septic arthritis
Arthrotomy with joint drainage
Prompt abx guided by gram stain (2-4 week course)
Gram Positive - Nafcillin, Vanc
Gram Negative - Ceftriaxone, aminoglycosides
63
Acute inflammation of the costochondral, costosternal, or sternoclavicular joints
Costchondritis
64
Pleuritic chest pain, described as an intermittent sharp, stabbing pain that is worse with inspiration, worse with coughing or certain movements of the upper limbs or torso. May radiate to the shoulder
Costochondritis
65
Physical exam with costochondritis
Localized pain and tenderness on palpation
| No palpable edema
66
Causes of bursitis
Direct trauma (can be repetitive motion)
Infectious
Gout
Inflammation
67
Abrupt "goose egg" swelling (boggy, redness)
+/- tender or painless. Limited ROM with flexion
Evaluate for skin breaks to r/o septic
Bursitis (olecranon)
68
Management of olecranon bursitis
```
Rest
NSAIDs
Local steroid injection
Padding
Avoid repetitive motions
```
69
Idiopathic inflammatory condition causing synovitis, bursitis and tenosynovitis, causing pain/stiffness of the proximal joints in pts > 50 y/o
Polymyalgia Rheumatica
70
Most common joints affected by polymyalgia rheumatica
Shoulder
Hip
Neck
71
Polymyalgia rheumatica is closely related to:
Giant cell arteritis
72
Bilateral proximal joint aching/stiffness
Morning stiffness > 30 minutes of the pelvic, neck and shoulder girdle
Creates difficulty combing hair, putting on coat, getting out of chair
Polymyalgia Rheumatica
73
A pt with polymyalgia rheumatica will have ______________ muscle weakness
No severe
74
Diagnosis of polymyalgia rheumatica
Clinical diagnosis
Increased ESR
Anemia (normocytic)
75
Management of polymyalgia rheumatica
Low dose corticosteroids
NSAIDs
Methotrexate
76
Uric acid deposition in the soft tissue, joints and bone
Gout
77
Most commonly due to underexcretion of uric acid
Gout
78
Purine-rich foods that cause rapid changes in uric acid concentrations and therefore gout
Alcohol
Liver
Seafood
Yeasts
79
Medications that are known to cause gout
```
Diuretics (thiazides, loop)
ACEI/ARBs
Pyrazinamide
Ethambutol
Aspirin
```
80
Severe joint pain, erythema, swelling and stiffness
Acute gouty arthritis
81
Collection of solid uric acid in soft tissues (helix of ear, eyelids, achilles tendon). Usually occurs after 10-20 years of chronic hyperuricemia
Tophic deposition
82
Diagnosis of gout
1. Arthrocentesis - negative birefringent needle-shaped urate crystals
2. Radiographs - mouse/rat bite, punched out erosions, +/- tophi
3. Clinical diagnosis
4. Increased ESR and WBC during acute attacks
83
Management of acute gout
NSAIDs drug of choice - indomethacin, naprosyn
Avoid aspirin
Colchicine second line
84
Management of chronic gout (prophylaxis)
Allopurinol
| Febuxostat - safer in pts with renal disease
85
S/E of allopurinol
Taken with meals to prevent gastric irritation
| SJS/TEN
86
Injury to a ligament
Sprain
87
Injury to a tendon
Strain
88
Most common ankle sprain
Inversion of the ankle - causes damage to lateral ligaments
89
Most common ligament affected in ankle sprain
Anterior talofibular ligament
90
Diagnosis of strain/sprain
Clinical diagnosis
| May need to get XR if severe presentation
91
Treatment of strain/sprain
Rest, ice, compression, elevation
NSAIDs used for swelling and pain relief
Range of motion should be started as early as possible
