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Royal College: Emergency Medicine > Orthopedics > Flashcards

Orthopedics Flashcards

This deck covers Chapters 42-51 in Rosens, compromising all of orthopedics and plastic surgery.

1
Q

List 4 indications for consultation with orthopedics

A
  1. Long bone fractures
  2. Joint fracture
  3. Joint violation
  4. Neurovascular compromosie
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2
Q

List 8 different descriptors for a fracture

A
  1. Bone
  2. Location on bone
  3. Open/Closed
  4. Direction of fracture line
  5. Simple/Comminuted
  6. Angulation
  7. Displacement
  8. Type: Avulsion, Compression, Pathologic, Stress
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3
Q

List 6 causes for weakened bones.

A
  1. Cancer
  2. Hyper PTH
  3. Giant Cell Tumour
  4. Echondromata
  5. Cysts
  6. Osteomalacia
  7. Osteogenesis Imperfecta
  8. Scurvy
  9. Rickets
  10. Paget’s
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4
Q

Describe the 5 steps involved with fracture healing

A
  1. Hematoma
  2. Inflammatory
  3. Soft Callus
  4. Hard Callus
  5. Remodeling
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5
Q

Define:

  1. Delayed union
  2. Malunion
  3. Non-union
A
  1. Delayed union - longer than usual healing
  2. Malunion - residual deformity remains
  3. Non-union - failure to unite
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6
Q

List 4 characteristics of nutrient arteries that can help differentiate them from a fracture line.

A
  1. Thin
  2. Angulated through cortex
  3. Only one side of the cortex
  4. Less radiolucent
  5. Sharply marginated
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7
Q

How do you classify and manage open fractures?

A

Gustillo

  • Grade I - <1 cm
  • Ancef 2g IV
  • Grade II - 1-10 cm
  • Ancef 2g IV +/- Gentamycin 5 mg/kg IV
  • Grade IIIA - >10 cm + soft tissue stripping
  • Grade IIIB - >10 cm + periosteal stripping
  • Grade IIIC - >10 cm + vascular injury
  • Ancef 2g IV + Gentamycin 5 mg/kg IV
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8
Q

How much blood loss is associated with these fractures?

  • Radius/Ulna
  • Humerus
  • Tib/Fib
  • Femur
  • Pelvis
A
  • Radius/Ulna
  • 150 cc
  • Humerus
  • 250 cc
  • Tib/Fib
  • 500 cc
  • Femur
  • 1000 cc
  • Pelvis
  • 2000 cc
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9
Q

Define and describe three types of nerve injury.

A
  1. Neuropraxia
    * Stretch inhibiting neurotransmission
  2. Axonotmesis
    * Axon damaged, intact epineurium
  3. Neurotmesis
    * Axon and epineurium damaged
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10
Q

What nerve is commonly injured in these injuries:

  • Distal radius
  • Elbow injury
  • Shoulder dislocation
  • Sacral fracture
  • Acetabular fracture
  • Anterior hip dislocation
  • Posterior hip dislocation
  • Femoral shaft fracture
  • Knee dislocation
  • Lateral tibial plateau fracture
A
  • Distal radius - Median
  • Elbow injury- Median/Ulnar
  • Shoulder dislocation - Axillary
  • Sacral fracture - S1-S5
  • Acetabular fracture - Sciatic
  • Anterior Hip dislocation - Femoral
  • Posterior Hip dislocation - Sciatic
  • Femoral shaft fracture - Femoral nerve
  • Knee dislocation - Tibial/Fibular
  • Lateral tibial plateau fracture - Fibular
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11
Q

What are the 6 P’s of compartment syndrome?

A
  1. Pain (out of proportion/on passive stretch)
  2. Paresthesia
  3. Paralysis
  4. Poikilothermic
  5. Pulseless
  6. Pallor
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12
Q

List 8 causes of compartment syndrome

A
  1. Vascular injury, Coagulation D/O, OAC
  2. Reperfusion
  3. Fracture
  4. Convulsion
  5. Exercise
  6. Burn
  7. Intra-arterial drug injection
  8. Interstitial infusion
  9. Snakebite
  10. DVT
  11. Tight casts
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13
Q

Name 5 anatomic compartments in the lower extremity that are more prone to compartment syndrome?

A

Leg

  1. Anterior (MCC)
  2. Lateral
  3. Deep posterior
  4. Superficial posterior

Thigh

  1. Quadriceps

Buttock

  1. Gluteal
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14
Q

Name 4 anatomic compartments in the upper extremity that are more prone to compartment syndrome?

A

Hand

  1. Interosseous

Forearm

  1. Dorsal
  2. Volar

Arm

  1. Deltoid
  2. Biceps
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15
Q

What pressures are concerning for compartment syndrome?

A

Normal = 0 mmHg

Concern = >30 mmHg or within 30 of MAP/dBP

Tx:

  • Fasciotomy
  • Don’t raise limb above heart
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16
Q

Name the adverse outcome associated with:

  • Open Fracture
  • Injury with Vascular Disruption
  • Pelvic Fracture
  • Hip Dislocation
  • Compartment Syndrome
A
  • Open Fracture
  • Osteomyelitis
  • Injury with Vascular Disruption
  • Amputation
  • Pelvic Fracture
  • Exsanguination
  • Hip Dislocation
  • AVN femoral head
  • Compartment Syndrome
  • Ischemic contracture, amputation, AKI
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17
Q

Name 5 bones prone to AVN

A
  1. Femoral head
  2. Navicular
  3. Talus
  4. Scaphoid
  5. Lunate
  6. Capitate
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18
Q

What are the signs/symptoms of fat embolism syndrome?

A
  • Neuro - confusion, coma, stupor (edema)
  • Cardio - hypotension
  • Resp - ARDS
  • Heme - thrombocytopenia
  • Derm - petechial rash
  • Other - fever, jaundice
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19
Q

What are fracture blisters? Where do they occur? Do they impact management?

A

Tense bullae formed after high-energy injury

Location

  • Usually ankle, elbow, foot, knee

Treatment:

  • Cover with poviodine soaked sterile dressing
  • Requires delay in Sx or approach not over the blister
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20
Q

List 6 complications of fractures and 6 complications of immobility

A

Fractures

  1. Pain
  2. Hemorrhage
  3. Vascular injury
  4. Nerve injury
  5. Compartment syndrome
  6. AVN
  7. Fat embolism syndrome
  8. Reflex dystrophy
  9. Volkmann’s ischemic contracture
  10. Non-union
  11. Malunion

Immobility

  1. Pneumonia
  2. DVT
  3. PE
  4. UTI
  5. Wound infection
  6. Decubitus ulcer
  7. Muscle atrophy
  8. Stress ulcers
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21
Q

List 5 complications of casting

A
  1. Compartment syndrome
  2. Burn
  3. Pressure sore
  4. Pruritic dermatitis
  5. Bacterial/Fungal infection
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22
Q

What is damage control orthopedic surgery?

A

Surgery meant to stop bleeding and aid resuscitation with attempts at definitive repair taken later when more stable

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23
Q

Define subluxation and dislocation

A

Subluxation

  • Partial loss of continuity of a joint surface

Dislocation

  • Complete loss of continuity of a joint surface
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24
Q

Characterize the various degrees of sprains

A

1st Degree

  • Minor tearing/overstretching of some fibers

2nd Degree

  • Partial-thickness tear

3rd Degree

  • Complete thickness tear
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25
Describe the **Ottawa Ankle/Foot Rules** with respect to inclusion criteria, exclusion criteria, and the rule.
**Inclusion** * Adults (validated later in children) * Any mechanism of a blunt ankle injury **Exclusion** * Children * Pregnant * Isolated skin injury * Injury \>10d ago or R/A of the same injury **Rule** * **Ankle** * Pain in the malleolar zone with any one of: * Inability to WB 4 steps on scene AND in ED * Pain along post. 6 cm of the med/lat malleolus * **Foot** * Pain in the midfoot zone with any one of: * Inability to WB 4 steps on scene AND in ED * Pain along the base of the 5th MT * Pain along the navicular
26
Describe the **Ottawa Knee Rules** with respect to inclusion criteria, exclusion criteria, and the rule.
**Inclusion** * Adults (validated later in children) * Any mechanism of blunt knee injury **Exclusion** * Children * Pregnant * Isolated skin injury * Paraplegia * Multi-system trauma **Rule** * Age \>55 * Isolated fibular head pain * Isolated patellar pain * Inability to flex \>90 degrees * Inability to WB 4 steps in ED and initially
27
Characterize the various degrees of strain
**1st Degree** * Minor tear or musculotendinous unit **2nd Degree** * Partial tear **3rd Degree** * Complete tear
28
List 5 risk factors for tendonitis
1. Male 2. Older 3. Obesity 4. Poor flexibility 5. Training error 6. Improper equipment use 7. DM 8. RA 9. SLE 10. Steroids 11. Fluoroquinolones 12. Overuse (occupation)
29
List 4 ultrasound findings of tendonitis
1. Loss of fibrillar echotexture 2. Focal tendon thickening 3. Diffuse thickening 4. Microruptures 5. Focal hypoechoic area 6. Ill-defined borders
30
Identify the following:
**Stener Fracture** * Avulsion of the ulnar corner of the base of the proximal phalanx of the thumb * Can get trapped in the aponeurosis of the adductor pollicis and require surgical release **Treatment** * Thumb spica cast (leave IP joint free) * Plastics OP referral
31
Identify the following:
**Boxer's Fracture** * Fracture of the 4th or 5th metacarpal neck * Closed fist injury **Treatment** * Reduction if \>50-60 degrees angulation * Buddy Tape vs Ulnar Gutter * Plastics OP referral
32
Identify the following:
**Bennett's Fracture** * Oblique 2-part fracture through the base of 1st MC with dislocation of the radial portion * MCC fracture of the thumb **Treatment:** * Thumb spica splint (IP joint free) * Plastics OP referral
33
Identify the following:
**Rolando Fracture** * 3-part intra-articular fracture through the base of the 1st MC * From axial load **Treatment:** * Thumb Spica splint (leave IP free) * Plastics OP referral
34
Identify the following:
**Colle's Fracture** * Dorsal displacement and volar angulation of the distal radius **Treatment** * Reduction * Goals: * 11 degrees volar tilt (lateral) * 11 mm radial styloid height (AP) * \>11 degrees of ulnar slant of radius (AP) * Intra-articular step-off \<2 mm * Splint in radial gutter * Ortho OP referral
35
Identify the following:
**Smith Fracture** * Volar displacement and dorsal angulation * \*Reverse Colle's\* -RARE **Treatment** * Reduction * Goals: * 11 degrees volar tilt (lateral) * 11 mm radial styloid height (AP) * \>11 degrees of ulnar slant of radius (AP) * Intra-articular step-off \<2 mm * Splint in radial gutter vs long arm cast (controversial) * Ortho OP referral
36
Identify the following:
**Barton Fracture** * Intra-articular fracture-dislocation of the distal radius * Carpal displacement * Unstable, often requiring surgery * Can be dorsal or volar, depending on displacement of carpus **Treatment** * Reduce like Colle's * Ortho to see in ED (walking wounded)
37
Identify the following:
**Chauffeur's Fracture** * Solitary fracture of radial styloid **Treatment** * Radial gutter splint * Ortho OP referral
38
What is an Essex-Lopresti fracture?
**Essex-Lopresti Fracture** * Radial Head Fracture * DRUJ injury **Treatment** * Splint immobilize for pain * Ortho to see in ED
39
Identify the following:
**Galeazzi Fracture** * Radial shaft fracture * DRUJ injury * Nerve: AIN frequently injured **Treatment** * Reduction if NVI * Ortho to see in ED
40
Identify the following:
**Monteggia Fracture** * Ulnar fracture * Radial head dislocation * Nerve: PIN frequently injured ​**Treatment** * Reduction if NVI * Ortho to see in ED
41
Provide a memory aid for differentiating Monteggia vs Galeazzi
**MU GR P AIN** (MUGGER PAIN) Monteggia = Ulnar Fracture = PIN Galeazzi = Radius Fracture = AIN
42
Identify the following:
**Nightstick Fracture** * Isolated ulnar shaft fracture * Commonly a defensive injury **Treatment** * Ulnar gutter splint * If displaced \<50% and \<10 degrees of angulation * Ortho OP referral
43
Identify the following:
**Hill-Sachs Fracture** * Impact fracture of the posterolateral humeral head * Associated dislocation **Treatment** * Shoulder reduction * Shoulder Splint * Ortho OP referral
44
Identify the following:
**Bony Bankart Lesion** * Fracture of anterior glenoid (plus labrum) * Associated with shoulder dislocation **Treatment** * Shoulder reduction * Shoulder splint * Ortho OP referral
45
Identify the following:
**March Fracture** * Stress fracture of the metatarsal **Treatment** * Hard soled shoe
46
Identify the following:
**Jones Fracture** * Fracture through the base of the 5th MT, into the intermetatarsal joint * Occurs distal to the peroneus brevis insertion **Treatment** * NWB * Ortho OP referral
47
Identify the following:
**Aviator Fracture** * Vertical fracture through the talar neck with subtalar dislocation * High risk of AVN
48
Identify the following:
**Lisfranc Fracture** * Fracture of the tarsometatarsal joint * Caused by axial load in a plantar flexed foot **Features** * Line from medial 2nd MT to middle cuneiform (AP) * Widening of 1st/2nd MT space (AP) * Fleck sign (avulsion here) * Dorsal displacement of 1st/2nd MT base (Lateral) * Line from medial 4th MT base to medial cuboid (Oblique) * Disruption of the medial column line **Treatment** * Ortho to see in ED
49
Identify the following:
**Maisonneuve Fracture** * Fracture of the proximal ⅓ of the fibula * Associated with deltoid rupture, medial malleolus fracture * Syndesmosis disruption * Nerve injury = common fibular (foot drop) **Treatment** * Ortho to see in ED
50
Identify the following:
**Malgaigne's Fracture** * Fracture of ilium near SI joint w/ symphysis displacement * OR * SI dislocation with both ipsilateral pubic rami fractures * Essential a vertical shear fracture **Treatment** * NWB * Ortho to see in ED
51
Identify the following:
**Dashboard Fracture** * Posterior rim of acetabulum fractured * Knee off dashboard drives femoral head back **Treatment** * Ortho to see in ED
52
Identify the following:
**Pott's Fracture** * Bimalleolar fracture **Treatment** * Ortho to see in ED
53
Identify the following:
**Tillaux Fracture** * Salter-Harris 3 fracture * Medial growth plate ossifies first **Treatment** * U-slab immobilization * Ortho OP referral
54
What is the Weber classification system for ankle fractures?
**Fibular fracture description** * A - Below the syndesmosis * B - At the syndesmosis * C - Above the syndesmosis **Treatment** * A - WBAT in walking boot * B - Stress views, ortho in ED if widening * C - Ortho to see in ED
55
Identify the following:
**Segond Fracture** * Avulsion fracture at the lateral knee * Commonly associated with ACL tear and meniscal injury **Treatment** * Crutches * Ortho OP referral
56
Identify the following:
**Chance Fracture** * Burst fracture of vertebrae, commonly lumbar * Seatbelt injury * Unstable * Commonly associated with intra-abdominal injury **Treatment** * Logroll precautions * Spine to see in ED * CT Abdo/Pelvis
57
Identify the following:
**Clayshoveler's Fracture** * Fracture of the tip of the spinous process of the 6th/7th cervical vertebra * Stable fracture **Treatment** * NSAIDs * Rest * Hard collar * Spine OP referral
58
Identify the following:
**Hangman's Fracture** * Fracture-dislocation of Axis (C2) and Atlas (C1) * Hyperextension during rapid deceleration * Unstable **Treatment** * C-spine collar * Spine to see in ED
59
Identify the following:
**Jefferson's Fracture** * Burst fracture of C1 * Axial load * Unstable **Treatment** * C-spine collar * Spine to see in ED
60
Describe the Lefort fractures and management
**Lefort Fracture** * I - transmaxillary (horizontal above teeth) * II - pyramidal from lateral to teeth to nasofrontal suture * III - craniofacial dislocation, across zygoma and nose through orbits **Treatment** * ABCs * IV ABx due to sinus violation * HOB to 30 degrees * May need to pack anterior nose * Avoid NG, possible skull base fracture
61
Outline the Salter-Harris classification system
**SALTR** * 1 **S**traight-through * 2 **A**bove * 3 be**L**ow * 4 **T**hrough * 5 c**R**ush
62
Identify the following:
**Greenstick Fracture** * Fracture through immature bone * Not through both cortices **Treatment** * Splint * Ortho OP follow-up
63
Identify the following:
**Torus/Buckle Fracture** * See buckle, but not a break in the cortex **Treatment** * Splint * Ortho OP referral
64
List the intrinsic muscles of the hand
**Thenar Group** * Abductor pollicis brevis * Flexor pollicis brevis * Opponens pollicis **Hypothenar Group** * Abductor digiti minimi * Flexor digiti minimi * Opponens digiti minimi **Adductor Pollicis** **Interossei (Palmar x3, Dorsal x4)** **Lumbricals (4)**
65
What are Kanavel's signs? What are they for?
**Kanavel's Signs** Flexor Tenosynovitis 1. Pain along tendon sheath 2. Pain with passive extension 3. Held in flexion 4. Fusiform swelling
66
Describe motor and sensory testing of the hand
**Radial Nerve** * Motor - thumb extension * Sensory - 1st dorsal webspace ​**Median Nerve** * Motor - Opposition of thumb (A-okay) * Sensory - Palmar distal phalanx of D2 **Ulnar Nerve** * Motor - Spread fingers * Sensory - Palmar distal phalanx of D5
67
What degrees of angulation are acceptable for metacarpal shaft AND neck fractures?
**D2/D3** * Shaft 10 degrees * Neck 10 degrees **D4** * Shaft 30 degrees * Neck 30 degrees **D5** * Shaft 40 degrees * Neck 50 degrees
68
How do you diagnose a UCL rupture of the thumb? How do you manage this? What is a Stener lesion?
**Diagnosis** * Valgus stress test (\>35 degrees is abnormal) * U/S or MRI **Treatment** * Thumb spica cast x4 weeks **Stener's Lesion** * Avulsion fragment interposed between adductor pollicis * Needs surgical release
69
What is the Doyle classification? What is it for?
**Doyle Classification - Mallet Finger** * Type I - Closed tendon rupture without avulsion fragment * Type II - Open tendon laceration * Type III - Open tendon laceration with tissue loss * Type IV - Mallet fracture
70
What are 6 indications and 6 contraindications to digit reimplantation?
**Indications** 1. Multiple digits 2. Thumb 3. Wrist and Forearm 4. Sharp 5. Pediatric 6. Distal to FDS insertion **Contraindications** 1. Multiple levels 2. Self-inflicted 3. Proximal to FDS 4. Extreme of age 5. Serious underlying disease 6. Unstable patient
71
What are the anatomic borders of the snuff box?
**Medial Border (Ulnar)** * EPL **Lateral Border (Radial)** * APL **Proximal Border** * Radial styloid
72
What are the normal measurements of the radius? * Radial Inclination * Radial Height * Volar Tilt
* Radial Inclination = 12-24 degrees * Radial Height = 12 mm * Volar Tilt = 12-24 degrees
73
Name a classification system for carpal instability. Describe it.
**Mayfield Classification** * I - Scapholunate Dissociation * \>3 mm gap between the scaphoid and lunate * II - Perilunate dislocation * Lunate articulates with radius, capitate dislocated * III - Perilunate Dislocation + Triquetral Dislocation * Triquetrum overlaps lunate/hamate * IV - Lunate Dislocation * Piece of pie, spilled teacup
74
How do you differentiate a DISI vs VISI midcarpal instability?
1. Locate lunate on lateral view 2. If lunate has dorsal tilt on radius = DISI 3. If lunate has volar tilt on radius = VISI
75
What structure is at risk in midshaft humeral fractures?
**Radial Nerve** Provides innervation to triceps and wrist extensors. Sensation to the dorsum of the hand
76
What structure is at risk with olecranon fracture?
**Ulnar Nerve** Hand intrinsics and ulnar-sided finger/wrist flexors Sensation to ulnar 1.5 fingers
77
What structure is at risk with supracondylar fractures?
**Median Nerve** Innervates radial sided wrist/finger flexors, thenar eminence Sensation to radial side of palm
78
Describe a classification system for supracondylar fractures
**Gartland System** 1. Cortex intact, anterior humeral line off 2. Fracture with anterior cortex displacement 3. Fracture with posterior cortex displacement (+ Anterior)
79
Which neurovascular structures are at risk with posterior elbow dislocations?
Median Nerve Brachial Artery
80
List the sensory and motor components of the brachial plexus
**Brachial Plexus = C5 - T1** * C5 (Deltoid) - Sergeants patch * C6 (Biceps) - Thumb * C7 (Thumb Extensors) - D2 tip * C8 (Finger Flexors) - D5 tip * T1 (Intrinsic Hand) - Medial upper arm
81
List myotomes for the following: * C5-T1 * L2-S1
* C5 - Shoulder abduction * C6 - Elbow flexion * C7 - Elbow/Wrist/Finger extension * C8 - Wrist/Finger flexion * T1 - Finger abduction * L2 - Hip flexion * L3 - Knee extension * L4 - Ankle dorsiflexion * L5 - Great toe extensors * S1 - Plantar flexors
82
List the 3 types of clavicle fracture? How common are they?
**Proximal ⅓ - 5%** * CT if posterior displacement to r/o mediastinal injury **Middle ⅓ - 80%** * \>100% displacement or \>2cm shortening to ortho **Distal ⅓ - 15%** * Ortho OP referral
83
Describe a classification system for AC joint separations. How do you manage each?
**Rockwood Classification** 1. 0-25% 2. 25-50% 3. 50-100% * Sling, Ortho OP referral, Analgesia 4. Posterior 5. \>100% 6. Inferior * OR
84
What are the two most common fractures associated with anterior shoulder dislocations?
**Hill-Sachs** * Occurs in 40% of 1st timers and 80% of recurrent * Ortho OP referral **Bony Bankart** * Ortho OP referral
85
Describe 6 techniques for anterior shoulder reduction
1. **Stimson** * Prone, arm hanging off bed 2. **Traction-Countertraction** * Axial traction with sheet holding body in counter 3. **Milch** * Abduct and pull on arm, push humeral head in 4. **External Rotation** * Adduction with ER 5. **Scapular Manipulation** * Push inferior scapular tip to tilt glenoid into shoulder 6. **Cunningham** * Place hand on your shoulder, massage muscles 7. **Spaso** * Flex arm forward, pull axially, twist in ER 8. **Kocher** * Traction with ER in adduction, then abduct and IR 9. **FARES** * Traction with oscillating AP + abduction
86
Name 3 radiographic signs of posterior shoulder dislocation
1. Lightbulb sign 2. Rim sign 3. Loss of half-moon elliptical overlap of head/glenoid 4. Posterior displacement on axillary
87
List 10 red flags for back pain
1. Fever 2. Trauma 3. Age \>50 4. Steroids 5. Cancer History 6. IVDU 7. Neuro deficit 8. Weight loss 9. Pain \>6 weeks 10. Incontinence 11. Recent bacterial infection 12. Severe pain, despite analgesia
88
Provide 10 causes for thoracic back pain
1. DDD 2. Herniation 3. Diskitis 4. Spinal Hematoma 5. Spinal Abscess 6. AAA 7. Aortic dissection 8. Renal colic 9. Transverse myelitis 10. ACS 11. Pericarditis 12. Pneumonia 13. PE 14. PTX 15. Biliary Colic 16. Pancreatitis 17. PUD
89
Why are the posterior ligaments crucial for pelvic stability? Name three.
Disruption of these ligaments leads to pelvic instability 1. Sacrospinus ligament 2. Iliolumbar ligament 3. Anterior & Posterior SI ligaments 4. Sacrotuberous ligament
90
Name and describe 2 classification systems for pelvic fractures
**Tile's** * A - stable, posterior arch intact * Avulsions, Rami fractures, transverse sacral fractures * B - partially stable, incomplete disruption of posterior arch * Open book, lateral compression * C - Unstable, complete disruption of posterior arch * Vertical shear **Young-Burgess** * AP Compression * Symphysis diastasis \<2.5 cm * Symphysis diastasis \>2.5 cm with sacrospinous and anterior SI ligament disruption * Symphysis diastasis \>2.5 cm with anterior/posterior SI ligament disruption * Lateral Compression * I - Sacral crush on one side * II - Sacral crush with posterior lig. disruption * III - Severe IR of hemipelvis 'Windswept pelvis' * Vertical Shear * Vertical displacement of symphysis and SI joints
91
List where you'd expect an avulsion fracture from the forceful contraction of the following muscles: * Hamstrings * Abdominals * Sartorius * Rectus femoris
* Hamstrings = Ischial tuberosity * Abdominals = Iliac wing * Sartorius = ASIS * Rectus femoris = AIIS
92
List 5 radiographic clues to posterior arch fractures
1. Avulsion of L5 transverse process 2. Avulsion of ischial spine 3. Avulsion of lower lateral lip of the sacrum 4. Displacement of a pubic rami fracture 5. Asymmetry of the sacral foramina
93
Describe the classification of acetabular fractures
**Type A** One column (anterior or posterior) fractured **Type B** Transverse fracture (T-shaped), with a portion of acetabulum attached to the proximal ilium **Type C** Transverse fracture (T-shaped) through both anterior and posterior columns with no portion of the acetabulum attached to the axial skeleton
94
List 8 causes of painful hip without fracture on X-ray
1. Hip fracture 2. Septic arthritis 3. OA 4. Bursitis 5. Tendonitis 6. Transient synovitis 7. Referred back pain 8. Hemarthrosis 9. AVN 10. SCFE 11. Cancer 12. DVT 13. Inguinal hernia
95
Describe 3 ways of detecting subtle hip fractures on x-ray
1. Shenton's Line 2. S and Reverse-S curves 3. Trabecular Pattern
96
List 5 ways to reduce a posterior hip dislocation
**Captain Morgan** * Strap pt down, knee under their's, push foot down **Whistler** * Hand under leg, on opposite knee, push foot down **Stimson** * Prone, legs over end of bed, downward & abduct & ER **Allis** * Stand on bed, hip flexed, pull up **Traction-Countertraction** * Supine, leg over your shoulder, using foot to pull down
97
List 6 risk factors for SCFE
1. Male 2. Obesity 3. Black 4. Radiation/Chemotherapy 5. Renal osteodystrophy 6. Hypothyroidism 7. Neglected septic arthritis
98
List 4 ways to diagnose vascular injury from a knee dislocation
1. ABI 2. U/S 3. CT Angiography 4. Angiogram 5. OR
99
How do you manage a knee dislocation?
* Neurovascular exam * Reduction * Neurovascular exam * OR if vascular compromise * Zimmer
100
What specific measurement can be used for patella alta?
**Insall-Salvati Ratio** Ratio of patella tendon : patellar height If \<0.8, suggests patella baja (quad tendon rupture) If \>1.2, suggests patella alta (patellar tendon rupture)
101
What is the unhappy triad of knee injuries?
1. ACL 2. MCL 3. Medial meniscus
102
What is the terrible triad of elbow injuries?
1. Elbow dislocation 2. Radial head fracture 3. Coronoid fracture
103
List the compartments of the lower leg. Describe the contents and nerve supply of each.
**Anterior** * Deep fibular nerve * Tibialis anterior, Great toe extensor **Lateral** * Superficial fibular nerve * Peroneus longus/brevis **Deep Posterior** * Tibial nerve * TIbialis posterior, great toe flexor **Superficial Posterior** * Sural nerve * Gastrocnemius, soleus
104
List 6 ankle fractures that ortho should see in the ED
1. Weber B 2. Weber C 3. Bimalleolar fracture 4. Trimalleolar fracture 5. Maisonneuve 6. Pilon Fracture 7. Talar fracture 8. Fracture-dislocation 9. Open fracture
105
Identify the following:
**Pilon Fracture** * Axial compression * Intra-articular fracture, very comminuted * Often open **Treatment** * Assessment of neurovascular status * Reduction * Immediate elevation * Ortho to see in ED
106
List 5 injuries associated with Pilon fractures
**Axial load** 1. Compression fracture of spine 2. Acetabular fracture 3. Femoral neck fracture 4. Tibial plateau fracture 5. Calcaneal fracture
107
List 6 things on the DDx for a presumed ankle sprain
1. Ankle sprain 2. Fracture of the base of the 5th MT 3. Fracture of the posterior process of the talus 4. Fracture of the lateral process of the talus 5. Fracture of the anterior process of the calcaneus 6. Midtarsal joint (Lisfranc) injury 7. Peroneal tendon dislocation 8. Lateral collateral ligament sprain
108
How do you calculate Boehler's angle?
Angle between: * Posterior tuberosity --\> Apex of posterior facet * Apex of posterior facet --\> Apex of anterior process Normal = 20 - 40 degrees Abnormal = \<20 degrees
109
List 4 radiographic abnormalities in Lisfranc injuries.
**AP View** 1. Line from medial 2nd MT to middle cuneiform 2. Widening of 1st/2nd MT space 3. Fleck sign (avulsion at 1st/2nd MT base) **Lateral View** 1. Dorsal displacement of 1st/2nd MT base **Oblique View** 1. Line from medial 4th MT base to medial cuboid 2. Disruption of the medial column line

Royal College: Emergency Medicine (25 decks)

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