Flashcards in PCOM Deck (81):
Classification for Chondral & Osteochondral Injuries to knee
Grade 0= normal
Grade 1 = cartilage w/ softening and swelling
Grade 2 = partial thickness defect w/ fissures on surface that don't reach subchondral bone or exceed 1.5 cm in diameter
Grade 3 = Fissuring to the level of subchondral bon in an area w/ a diameter more than 1.5 cm
Grade 4 = exposed subchondral bone
Order of motion in MUA for shoulder (mnemonic)
Bipolar vs. Unipolar implant in a hip hemiarthroplasty
unipolar - concentric: neck of prosthesis comes out of center of head)
bipolar - eccentric: neck of prosthesis doesn't necessarily come out of the center
Classification of distal Radius Fx
I: extrarticular fx of distal radius
II: w/ associated ulnar styloid
III: involves radiocarpal joint
IV: w/ associated ulnar styloid
V: involves DRUJ
VI: w/ associated ulnar styloid
VII: involves radoiocarpal joint AND DRUJ
VIII w/ associated ulnar styloid
Things to consider in distal radial fracture
open vs. closed
loss of radial length
Smith vs Colles fracture
Colles: distal radius fracture, dorsal angulation (apex volar), dorsal displacement, radial shift, radial shortening, "dinner fork deformity"
Smith: reverse colles - volar angulation (apex dorsal) "garden spade"
What are the 4 compartments in the leg?
Contents of anterior compartment of leg?
N: deep peroneal nerve
A: ant tibial artery
M: tibialis anterior, EHL, EDL, peroneus tertius
Contents of lateral compartment of leg?
N: superficial fibular nerve
M:peroneus longus, peroneus brevis
Contents of superficial posterior leg?
N: sural nerve
M: gastroc, soleus, plantaris
Contents of deep posterior leg?
A: post tibial artery
M: Tibialis posterior, FHL, FDL, popliteus
What are the three compartments of the thigh?
Anterior, medial, posterior
Contents of anterior thigh
(rectus femoris, vastus lateralis, vastus intermedius, vastus medialis)
contents of posterior thigh
contents of medial thigh
What are the compartments of the forearm?
Contents of anterior superficial compartment of forearm
contents of anterior middle compartment of forearm
flexor digitorum superficialis
contents of anterior deep compartment of forearm
flexor digitorum profundus
flexor pollicis longus
contents of posterior superficial compartment of forearm
extensor digitorum [communis]
extensor digiti minimi
extensor carpi ulnaris
**** look up extensor carpi radials
contents of posterior deep compartment of forearm
extensor pollicus longus
extensor pollicus brevis
extensor indicis proprius
what are the 10 compartments of the hand
dorsal interosseus x 4
palmar interosseus x 3
contents of the thenar compartment of hand
flexor pollicus brevis
ALL FOR ONE
contents of the hypothenar compartment of hand
opponens digiti minimi
flexor digiti minimi
abductor digiti minimi
ONE FOR ALL
how many layers of the foot are there?
4ish (4 beneath the plantar fascia)
-flexor digitorum brevis
-abductor digiti minimi
- quadratus plantae
-FHL and FDL tendons
-flexor hallicus brevis
- flexor digiti minimi brevis
-peroneus longus tendon
-tibialis posterior tendon
What are the 7 compartments of the foot?
interosseus 2-3, 3-4, 4-5
contents of medial compartment of foot
flexor hallucis brevis
contents of lateral compartment of foot
abductor digiti minimi
flexor digiti minimi
contents of superficial central compartment of foot
flexor digitorum brevis
contents of deep central compartment of foot
posterior tibial neurovascular bundle
contents of adductor compartment of foot
contents of first interosseus compartment of foot vs second, third, and fourth interosseus compartment
interosseus 1-2 = dorsal interosseus muscle
interosseus 2-3, 3-4, 4-5 = dorsal & plantar interosseus muscles
Schatzker Classification of Tibial plateau fractures
1: split fx lateral condyle
2: split & depression fx lateral condyle
3: depression fx lateral condyle
4: split fx medial condyle
5: bicondylar split
6: plateau fx w/ separation of diaphysis from metaphysis
most common: schatzker 2
MC associated injury with tibial plate fx? second most common?
lateral meniscus tear
*bonus: arterial disruption is most commonly seen with schatzker 4. the mechanism of injury for arterial disruption is shearing forces that occur during dislocation.
Salter Harris Classification
II: transphyseal, exits the metaphysis
III: transphyseal, exits epiphysis
IV: transphyseal, through metaphysics and epiphysis
V: crushed physis
Salter Harris prognosis
5 P's of compartment syndrome
pain w/ passive movement (or out of proportion??)
Rotator cuff muscles (mnemonic)
Actions of Rotator cuff muscles
Supraspinatus - abduction
infraspinatus - ext rotation
teres minor - ext rotation
Subscap - int rotation
infra and minor - the words sound like smaller or lesser, meaning they need to work together for one action -> both of them do external rotation
Two classifications of femoral neck fxs are?
Garden and Pauwel
Garden 1 - non displaced, incomplete, valgus impacted
Garden 2 - non displaced, complete (non displaced on AP & lat)
Garden 3 - partially displaced, complete*** look up
Garden 4 - completely displaced
Treatment of femoral neck fx based on Garden classification
Garden 1 (non displaced, incomplete, valgus impacted)
- 3 cancellous screws to prevent displacement
Garden 2 (non displaced, complete)
- 3 cancellous screws
Garden 3 (partially displaced, complete)
- hemi vs total hip arthroplasty
Garden 4 (completely displaced)
- hemi vs total hip arthroplasty
Femoral Neck Fractures
Pauwel 1: <30 deg angle
Pauwel 2: 30-50 deg angle
Pauwel 3: >70 deg angle
*** look this up for clarification
Terrible triad of the elbow
radial head fx
fx of coronoid process
measurements/ lines that you evaluate in distal radius
- normal = 23
- normal = 12
- normal= 11
What is Double Crush Syndrome?
multi level lesions along a peripheral nerve can occur. Presence of more pro lesion seems to render distal nerve trunk more vulnerable to compression
in carpal tunnel study - surgical release of double crush groups had poorer outcomes.
both entrapments may require treatment for optimal results.
What are the 3 stages of Carpal tunnel syndrome
Based on severity
Stage 1 - numbness, pain and tingling. mostly at night, + relief w/ shaking hand
Stage 2 - symptoms also during day w/ prolonged positions/ repetitive hand movements. + weakness (pt reports dropping things)
Stage 3 - atrophy, shrinking of muscles. tingling may no longer be present d/t severe nerve damage
Describe Bowstring Test for Sciatica
Pt supine. knee flexed 90 and placed on examiner's shoulder. Examiner places fingers in popliteal space behind knee, apply pressure
+ test = tingling burning sensation in hip and buttocks
What does SLAC stand for?
Scaphoid Lunate Advanced Collapse
Describe what SLAC is
a condition of progressive instability --> advanced arthritis of radoiocarpal and mid carpal joints.
degenerative arthritis seen in chronic dissociation btwn scaphoid and lunate
Describe the pathoanatomy of SLAC
chronic SL ligament injury --> dorsal intercalated segmental instability (DISI).
The scapholunate ligament no longer restrains articulation between the two bones --> scaphoid flexed and lunate extended
- scapholunate angle >70
- lunate extended >10 deg past neutral
Resultant SCAPHOID FLEXION and LUNATE EXTENSION --> abnormal distribution of forces across mid carpal and radoiocarpal joints & malalignment of concentric joint surfaces
Initially affects radioscaphoid joint and progresses to capitolunate joint.
This classification describes predicatable progression of degenerative changes from radial styloid to the entire scaphoid facet and finally to the unstable capitulant joint, as the capitate subluxates dorsally on the lunate.
what is the key finding ?
key finding: radiolunate joint is spared (unlike other forms of wrist arthritis) b/c there is a concentric articulation between the lunate and the spheroid lunate fossa of the distal radius.
Describe the Watson stages
Stage 1 - arthritis btwn scaphoid and radial styloid
Stage 2 - between scaphoid and entire scaphoid facet of radius
Stage 3 - between capitate and lunate
*radiolunate joint spared
What is the peek-a-boo sign
heel pad seen easily from front w/ pt standing and feet pointing straight ahead.
Normally heel pad isn't visible on medial side of the foot when viewed from the front b/c of valgus positioning of the normal heel (places heel pad behind normal hind foot)
What 12 things should be in an op note?
1. preop dx
2. postop dx
6. EBL/ TBL
8. fluids - IV, foley ouput
12. Disposition; to pacu
What 7 things do you need for preop?
2. NPO @ midnight
4. hold anticoag
6. add to OR schedule
7. med/ cardio clearance
what 7 things should you KNOW about pts?
1. activity - wb status
2. analgesia - pain meds
5. hgb and INR
7. studies - MRI, CT, pending
A. admit to - my name, admitting and referring doc, needs, competent
D. diagnosis - list w/ primary
C - condition and code status
V - vital signs, frequency
A. Allergies and rxns
N. nursing orders
A. activity, level, fall risk
I. IV fluids, maintenance 30 cc/ kg/ 24 hr, oral when possible
S. special, DVT ppx
M. meds, all prehospital meds
D. discharge planning, goals, discharge criteria
What is a barton fx?
fx/ dislocation with dorsal or volar rim of distal radius
*distinguished from colles or smith by intraarticular involvement.
Acceptable distal radius reductions
- radial length: w/in 2-3 mm of contralat wrist (MOST IMPORTANT)
- palmar tilt: neutral to 10 deg volar tilt (dorsal angulation)
- intraarticular step off: <2mm
- radial inclination: <5 degree loss
how is carpal alignment measured?
intersection of 2 lines in lateral XR:
parallel thru middle of radial shaft and parallel to capitate
should intersect with carpus
Describe the displacing forces in a proximal humerus fx
prox humerus retroverted 35-40 degrees relative to epicondylar axis
Greater Tuberosity: disp sup and post by supraspinatus and ext rotators
Lesser Tuberosity: disp medially by subscapularis
Shaft: disp medially by pec minor
Prox segment: abducted by deltoid
What is the bluod supply to the proximal humerus
ANT and post humeral circumflex artery. via interosseus arcuate artery
what lies in the quadrangular space that can be damaged in pro humerus injury
axillary nerve. test sensation over deltoid
What classification is used for proximal humerus fx? What are the 4 parts?
What is considered a part in the near classification of proximal humerus fx?
if displaced > 1cm or 45 deg angulation
Describe Neer classification for proximal humerus fx's.
Type 1: 1 part, no displaced fragments w/ any # fx lines
Type 2: 2 part fx: anatomic neck, surgical neck, greater tuberosity, lesser tuberosity
Type 3: 3 part fx: surgical neck w/ greater tuberosity, surgical neck w/ lesser tuberosity
Type 4: 4 part fx: all 4 displaced
what kind of ex's of the articular surface occur in the shoulder joint?
Reverse hill sachs (w/ post dislocation)
In prox humerus fx when do you perform ORIF
GT gets ORIF if displaced 5mm
LT gets ORIF only if fragment locks int rotation
what nerve is injured with damage to acetabulum?
sciatic nerve injury, peroneal division
what line represents the ant column of the acetabulum?
iliopubic: iliac crest to pubic symphysis. has ant wall acetabulum
what line represents the posterior column of acetabulum
ilioischial: superior gluteal notch to ischial tuberosity, has post wall acetabulum and acetabular dome
what is the corona mortis
vascular communication btwn ext iliac or deep inf epigastric and obturator 10-15% of pst *****
what is the blood supply to the femoral head?
ascending branch of medial circumflex, is deep to quadrates femoris
where does the sup gluteal NV bundle exit?
greater sciatic notch
eval in acetabular fx
EVAL - major trauma, check sciatic nerve (esp post column injury) and femoral A&N (ant column)
Describe imaging of pelvis when evaluating acetabulum
iliopectineal line (ant column)
ilioischial line (post column)
iliac oblique - 45 degree ext rotation. shows post column ilioischial line) and ant wall)
obturator oblique - 45 degree int rotation. shows ant column (iliopectineal line) and post wall
What is the classification of acetabulum fx?
What are the elementary Judet letournal fxs?
what are the associated Judet letournal fxs?
post column and post wall
Transvers and post wall
ant column + post hemitransverse