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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
Q

Describe the Ottawa Ankle/Foot Rules with respect to inclusion criteria, exclusion criteria, and the rule.

A

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
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26
Q

Describe the Ottawa Knee Rules with respect to inclusion criteria, exclusion criteria, and the rule.

A

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
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27
Q

Characterize the various degrees of strain

A

1st Degree

  • Minor tear or musculotendinous unit

2nd Degree

  • Partial tear

3rd Degree

  • Complete tear
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28
Q

List 5 risk factors for tendonitis

A
  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)
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29
Q

List 4 ultrasound findings of tendonitis

A
  1. Loss of fibrillar echotexture
  2. Focal tendon thickening
  3. Diffuse thickening
  4. Microruptures
  5. Focal hypoechoic area
  6. Ill-defined borders
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30
Q

Identify the following:

A

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
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31
Q

Identify the following:

A

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
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32
Q

Identify the following:

A

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
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33
Q

Identify the following:

A

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
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34
Q

Identify the following:

A

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
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35
Q

Identify the following:

A

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
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36
Q

Identify the following:

A

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)
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37
Q

Identify the following:

A

Chauffeur’s Fracture

  • Solitary fracture of radial styloid

Treatment

  • Radial gutter splint
  • Ortho OP referral
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38
Q

What is an Essex-Lopresti fracture?

A

Essex-Lopresti Fracture

  • Radial Head Fracture
  • DRUJ injury

Treatment

  • Splint immobilize for pain
  • Ortho to see in ED
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39
Q

Identify the following:

A

Galeazzi Fracture

  • Radial shaft fracture
  • DRUJ injury
  • Nerve: AIN frequently injured

Treatment

  • Reduction if NVI
  • Ortho to see in ED
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40
Q

Identify the following:

A

Monteggia Fracture

  • Ulnar fracture
  • Radial head dislocation
  • Nerve: PIN frequently injured

​Treatment

  • Reduction if NVI
  • Ortho to see in ED
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41
Q

Provide a memory aid for differentiating Monteggia vs Galeazzi

A

MU GR P AIN

(MUGGER PAIN)

Monteggia = Ulnar Fracture = PIN

Galeazzi = Radius Fracture = AIN

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42
Q

Identify the following:

A

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
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43
Q

Identify the following:

A

Hill-Sachs Fracture

  • Impact fracture of the posterolateral humeral head
  • Associated dislocation

Treatment

  • Shoulder reduction
  • Shoulder Splint
  • Ortho OP referral
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44
Q

Identify the following:

A

Bony Bankart Lesion

  • Fracture of anterior glenoid (plus labrum)
  • Associated with shoulder dislocation

Treatment

  • Shoulder reduction
  • Shoulder splint
  • Ortho OP referral
45
Q

Identify the following:

A

March Fracture

  • Stress fracture of the metatarsal

Treatment

  • Hard soled shoe
46
Q

Identify the following:

A

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
Q

Identify the following:

A

Aviator Fracture

  • Vertical fracture through the talar neck with subtalar dislocation
  • High risk of AVN
48
Q

Identify the following:

A

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
Q

Identify the following:

A

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
Q

Identify the following:

A

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
Q

Identify the following:

A

Dashboard Fracture

  • Posterior rim of acetabulum fractured
  • Knee off dashboard drives femoral head back

Treatment

  • Ortho to see in ED
52
Q

Identify the following:

A

Pott’s Fracture

  • Bimalleolar fracture

Treatment

  • Ortho to see in ED
53
Q

Identify the following:

A

Tillaux Fracture

  • Salter-Harris 3 fracture
  • Medial growth plate ossifies first

Treatment

  • U-slab immobilization
  • Ortho OP referral
54
Q

What is the Weber classification system for ankle fractures?

A

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
Q

Identify the following:

A

Segond Fracture

  • Avulsion fracture at the lateral knee
  • Commonly associated with ACL tear and meniscal injury

Treatment

  • Crutches
  • Ortho OP referral
56
Q

Identify the following:

A

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
Q

Identify the following:

A

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
Q

Identify the following:

A

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
Q

Identify the following:

A

Jefferson’s Fracture

  • Burst fracture of C1
  • Axial load
  • Unstable

Treatment

  • C-spine collar
  • Spine to see in ED
60
Q

Describe the Lefort fractures and management

A

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
Q

Outline the Salter-Harris classification system

A

SALTR

  • 1 Straight-through
  • 2 Above
  • 3 beLow
  • 4 Through
  • 5 cRush
62
Q

Identify the following:

A

Greenstick Fracture

  • Fracture through immature bone
  • Not through both cortices

Treatment

  • Splint
  • Ortho OP follow-up
63
Q

Identify the following:

A

Torus/Buckle Fracture

  • See buckle, but not a break in the cortex

Treatment

  • Splint
  • Ortho OP referral
64
Q

List the intrinsic muscles of the hand

A

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
Q

What are Kanavel’s signs? What are they for?

A

Kanavel’s Signs

Flexor Tenosynovitis

  1. Pain along tendon sheath
  2. Pain with passive extension
  3. Held in flexion
  4. Fusiform swelling
66
Q

Describe motor and sensory testing of the hand

A

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
Q

What degrees of angulation are acceptable for metacarpal shaft AND neck fractures?

A

D2/D3

  • Shaft 10 degrees
  • Neck 10 degrees

D4

  • Shaft 30 degrees
  • Neck 30 degrees

D5

  • Shaft 40 degrees
  • Neck 50 degrees
68
Q

How do you diagnose a UCL rupture of the thumb? How do you manage this? What is a Stener lesion?

A

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
Q

What is the Doyle classification? What is it for?

A

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
Q

What are 6 indications and 6 contraindications to digit reimplantation?

A

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
Q

What are the anatomic borders of the snuff box?

A

Medial Border (Ulnar)

  • EPL

Lateral Border (Radial)

  • APL

Proximal Border

  • Radial styloid
72
Q

What are the normal measurements of the radius?

  • Radial Inclination
  • Radial Height
  • Volar Tilt
A
  • Radial Inclination = 12-24 degrees
  • Radial Height = 12 mm
  • Volar Tilt = 12-24 degrees
73
Q

Name a classification system for carpal instability. Describe it.

A

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
Q

How do you differentiate a DISI vs VISI midcarpal instability?

A
  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
Q

What structure is at risk in midshaft humeral fractures?

A

Radial Nerve

Provides innervation to triceps and wrist extensors.

Sensation to the dorsum of the hand

76
Q

What structure is at risk with olecranon fracture?

A

Ulnar Nerve

Hand intrinsics and ulnar-sided finger/wrist flexors

Sensation to ulnar 1.5 fingers

77
Q

What structure is at risk with supracondylar fractures?

A

Median Nerve

Innervates radial sided wrist/finger flexors, thenar eminence

Sensation to radial side of palm

78
Q

Describe a classification system for supracondylar fractures

A

Gartland System

  1. Cortex intact, anterior humeral line off
  2. Fracture with anterior cortex displacement
  3. Fracture with posterior cortex displacement (+ Anterior)
79
Q

Which neurovascular structures are at risk with posterior elbow dislocations?

A

Median Nerve

Brachial Artery

80
Q

List the sensory and motor components of the brachial plexus

A

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
Q

List myotomes for the following:

  • C5-T1
  • L2-S1
A
  • 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
Q

List the 3 types of clavicle fracture? How common are they?

A

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
Q

Describe a classification system for AC joint separations.

How do you manage each?

A

Rockwood Classification

  1. 0-25%
  2. 25-50%
  3. 50-100%
    * Sling, Ortho OP referral, Analgesia
  4. Posterior
  5. >100%
  6. Inferior
    * OR
84
Q

What are the two most common fractures associated with anterior shoulder dislocations?

A

Hill-Sachs

  • Occurs in 40% of 1st timers and 80% of recurrent
  • Ortho OP referral

Bony Bankart

  • Ortho OP referral
85
Q

Describe 6 techniques for anterior shoulder reduction

A
  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
Q

Name 3 radiographic signs of posterior shoulder dislocation

A
  1. Lightbulb sign
  2. Rim sign
  3. Loss of half-moon elliptical overlap of head/glenoid
  4. Posterior displacement on axillary
87
Q

List 10 red flags for back pain

A
  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
Q

Provide 10 causes for thoracic back pain

A
  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
Q

Why are the posterior ligaments crucial for pelvic stability?

Name three.

A

Disruption of these ligaments leads to pelvic instability

  1. Sacrospinus ligament
  2. Iliolumbar ligament
  3. Anterior & Posterior SI ligaments
  4. Sacrotuberous ligament
90
Q

Name and describe 2 classification systems for pelvic fractures

A

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
Q

List where you’d expect an avulsion fracture from the forceful contraction of the following muscles:

  • Hamstrings
  • Abdominals
  • Sartorius
  • Rectus femoris
A
  • Hamstrings = Ischial tuberosity
  • Abdominals = Iliac wing
  • Sartorius = ASIS
  • Rectus femoris = AIIS
92
Q

List 5 radiographic clues to posterior arch fractures

A
  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
Q

Describe the classification of acetabular fractures

A

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
Q

List 8 causes of painful hip without fracture on X-ray

A
  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
Q

Describe 3 ways of detecting subtle hip fractures on x-ray

A
  1. Shenton’s Line
  2. S and Reverse-S curves
  3. Trabecular Pattern
96
Q

List 5 ways to reduce a posterior hip dislocation

A

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
Q

List 6 risk factors for SCFE

A
  1. Male
  2. Obesity
  3. Black
  4. Radiation/Chemotherapy
  5. Renal osteodystrophy
  6. Hypothyroidism
  7. Neglected septic arthritis
98
Q

List 4 ways to diagnose vascular injury from a knee dislocation

A
  1. ABI
  2. U/S
  3. CT Angiography
  4. Angiogram
  5. OR
99
Q

How do you manage a knee dislocation?

A
  • Neurovascular exam
  • Reduction
  • Neurovascular exam
  • OR if vascular compromise
  • Zimmer
100
Q

What specific measurement can be used for patella alta?

A

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
Q

What is the unhappy triad of knee injuries?

A
  1. ACL
  2. MCL
  3. Medial meniscus
102
Q

What is the terrible triad of elbow injuries?

A
  1. Elbow dislocation
  2. Radial head fracture
  3. Coronoid fracture
103
Q

List the compartments of the lower leg.

Describe the contents and nerve supply of each.

A

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
Q

List 6 ankle fractures that ortho should see in the ED

A
  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
Q

Identify the following:

A

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
Q

List 5 injuries associated with Pilon fractures

A

Axial load

  1. Compression fracture of spine
  2. Acetabular fracture
  3. Femoral neck fracture
  4. Tibial plateau fracture
  5. Calcaneal fracture
107
Q

List 6 things on the DDx for a presumed ankle sprain

A
  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
Q

How do you calculate Boehler’s angle?

A

Angle between:

  • Posterior tuberosity –> Apex of posterior facet
  • Apex of posterior facet –> Apex of anterior process

Normal = 20 - 40 degrees

Abnormal = <20 degrees

109
Q

List 4 radiographic abnormalities in Lisfranc injuries.

A

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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