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Flashcards in PCOM Deck (81):
1

Classification for Chondral & Osteochondral Injuries to knee

Outerbridge Classification

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

2

Order of motion in MUA for shoulder (mnemonic)

FEAR

Flexion
Extension
Abduction
Rotation

3

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

4

Classification of distal Radius Fx

Frykman
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

5

Things to consider in distal radial fracture

open vs. closed
displacement
angulation
comminution
loss of radial length

6

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"

7

What are the 4 compartments in the leg?

Anterior
Lateral
Superficial posterior
Deep posterior

8

Contents of anterior compartment of leg?

N: deep peroneal nerve
A: ant tibial artery
M: tibialis anterior, EHL, EDL, peroneus tertius

9

Contents of lateral compartment of leg?

N: superficial fibular nerve
M:peroneus longus, peroneus brevis

10

Contents of superficial posterior leg?

N: sural nerve
M: gastroc, soleus, plantaris

11

Contents of deep posterior leg?

N: tibial
A: post tibial artery
M: Tibialis posterior, FHL, FDL, popliteus

12

What are the three compartments of the thigh?

Anterior, medial, posterior

13

Contents of anterior thigh

quadriceps mm
(rectus femoris, vastus lateralis, vastus intermedius, vastus medialis)

14

contents of posterior thigh

biceps femoris
semitendinosis
semimembranosis
sciatic nerve

15

contents of medial thigh

adductor magnus
adductor longus
adductor brevis
gracilis
pectineus
obturator externus
femoral vessels

16

What are the compartments of the forearm?

anterior
- superficial
- middle
- deep

Posterior
- superficial
- deep

17

Contents of anterior superficial compartment of forearm

pronator teres
FCR
FCU
palmaris longus

18

contents of anterior middle compartment of forearm

flexor digitorum superficialis

19

contents of anterior deep compartment of forearm

flexor digitorum profundus
flexor pollicis longus
pronator quadratus

20

contents of posterior superficial compartment of forearm

anconeus
extensor digitorum [communis]
extensor digiti minimi
extensor carpi ulnaris
**** look up extensor carpi radials

21

contents of posterior deep compartment of forearm

supinator
extensor pollicus longus
extensor pollicus brevis
extensor indicis proprius

22

what are the 10 compartments of the hand

thenar
hypothenar
adductor pollicus
dorsal interosseus x 4
palmar interosseus x 3

23

contents of the thenar compartment of hand

abductor pollicus
flexor pollicus brevis
oponens pollicis

ALL FOR ONE

24

contents of the hypothenar compartment of hand

opponens digiti minimi
flexor digiti minimi
abductor digiti minimi

ONE FOR ALL

25

how many layers of the foot are there?

4ish (4 beneath the plantar fascia)

Plantar fascia
1
-abductor hallicus
-flexor digitorum brevis
-abductor digiti minimi
2
- quadratus plantae
- lumbricals
-FHL and FDL tendons
3
-flexor hallicus brevis
-adductor hallicus
- flexor digiti minimi brevis
4
-planter interossei
-dorsal interossei
-peroneus longus tendon
-tibialis posterior tendon

26

What are the 7 compartments of the foot?

medial
lateral
superficial central
deep central
adductor
interosseus 1-2
interosseus 2-3, 3-4, 4-5

27

contents of medial compartment of foot

abductor hallucis
flexor hallucis brevis
FHL tendon

28

contents of lateral compartment of foot

abductor digiti minimi
flexor digiti minimi

29

contents of superficial central compartment of foot

flexor digitorum brevis
lumbricals
FDL tendons

30

contents of deep central compartment of foot

quadratus plantae
posterior tibial neurovascular bundle

31

contents of adductor compartment of foot

adductor hallucis

32

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

33

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

34

MC associated injury with tibial plate fx? second most common?

lateral meniscus tear
MCL 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.

35

Salter Harris Classification

*pediatrics
I: transphyseal
II: transphyseal, exits the metaphysis
III: transphyseal, exits epiphysis
IV: transphyseal, through metaphysics and epiphysis
V: crushed physis

36

Salter Harris prognosis

*pediatrics
I: good
II: ?
III: ?
IV: poor
V: poor

37

5 P's of compartment syndrome

pain w/ passive movement (or out of proportion??)
pallor
pulselessness
parasthesia
paralysis

-poikilothermic???

38

Rotator cuff muscles (mnemonic)

SITS
Supraspinatus
Infraspinatus
Teres minor
Subscapularis

39

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

40

Two classifications of femoral neck fxs are?

Garden and Pauwel

41

Garden classification

Femoral neck

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

42

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

43

Pauwel Classification

Femoral Neck Fractures

Pauwel 1: <30 deg angle
Pauwel 2: 30-50 deg angle
Pauwel 3: >70 deg angle

*** look this up for clarification

44

Terrible triad of the elbow

posterior dislocation
radial head fx
fx of coronoid process

45

measurements/ lines that you evaluate in distal radius

radial inclination
- normal = 23
radial height
- normal = 12
volar tilt
- normal= 11

46

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.

47

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

48

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

49

What does SLAC stand for?

Scaphoid Lunate Advanced Collapse

50

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

51

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.

52

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 ?

Watson classification

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.

53

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

54

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)

55

What 12 things should be in an op note?

1. preop dx
2. postop dx
3. procedure
4. surgeon
5. assistant
6. EBL/ TBL
7. Anesthesia
8. fluids - IV, foley ouput
9. Drains
10. complications
11. condition
12. Disposition; to pacu

56

What 7 things do you need for preop?

1. consent
2. NPO @ midnight
3. IVF
4. hold anticoag
5. abx
6. add to OR schedule
7. med/ cardio clearance

57

what 7 things should you KNOW about pts?

1. activity - wb status
2. analgesia - pain meds
3. abx
4. anticoag
5. hgb and INR
6. cultures
7. studies - MRI, CT, pending

58

Admit orders

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
D. diet
A. activity, level, fall risk
L. labs
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

59

What is a barton fx?

fx/ dislocation with dorsal or volar rim of distal radius

*distinguished from colles or smith by intraarticular involvement.

60

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

61

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

62

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

63

What is the bluod supply to the proximal humerus

ANT and post humeral circumflex artery. via interosseus arcuate artery

64

what lies in the quadrangular space that can be damaged in pro humerus injury

axillary nerve. test sensation over deltoid

65

What classification is used for proximal humerus fx? What are the 4 parts?

Neer classification
greater tuberosity
lesser tuberosity
humeral shaft
humeral head

66

What is considered a part in the near classification of proximal humerus fx?

if displaced > 1cm or 45 deg angulation

67

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
Fx: dislocation

68

what kind of ex's of the articular surface occur in the shoulder joint?

impression fx
hill- sachs
Reverse hill sachs (w/ post dislocation)

69

In prox humerus fx when do you perform ORIF

GT gets ORIF if displaced 5mm
LT gets ORIF only if fragment locks int rotation

70

what nerve is injured with damage to acetabulum?

sciatic nerve injury, peroneal division

71

what line represents the ant column of the acetabulum?

iliopubic: iliac crest to pubic symphysis. has ant wall acetabulum

72

what line represents the posterior column of acetabulum

ilioischial: superior gluteal notch to ischial tuberosity, has post wall acetabulum and acetabular dome

73

what is the corona mortis

vascular communication btwn ext iliac or deep inf epigastric and obturator 10-15% of pst *****

74

what is the blood supply to the femoral head?

ascending branch of medial circumflex, is deep to quadrates femoris

75

where does the sup gluteal NV bundle exit?

greater sciatic notch

76

eval in acetabular fx

EVAL - major trauma, check sciatic nerve (esp post column injury) and femoral A&N (ant column)

77

Describe imaging of pelvis when evaluating acetabulum

AP:
iliopectineal line (ant column)
ilioischial line (post column)
medial teardrop

Judet:
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

78

What is the classification of acetabulum fx?

Judet- Letournal

79

What are the elementary Judet letournal fxs?

Post wall
Post column
ant wall
ant column
Transverse
- transtectal
- juxtatectal
- infratectal

80

what are the associated Judet letournal fxs?

T shaped
post column and post wall
Transvers and post wall
ant column + post hemitransverse
both column

81

describe the 3 types of transverse acetabular fxs

transtectal - through acetab dome

juxtatectal - through jxn of acetab dome and fossa acetabuli

infratectal - through fossa acetabuli