Pimp questions Flashcards
(134 cards)
1
Q
Pathophysiology behind a buckle fracture
A
The junction between the metaphysis and diaphysis is more vascular and porous in kids. It is a weak spot.
2
Q
Muscles that attach at the pes anserinus
A
SGT FOT Sartorious, Gracilis, Semitendiosus muscles innervated by Femoral, Obturator, and Tibial nerve respectively.
3
Q
Name the Lateral tubercle of the tibia and what attaches to it.
A
Gerdy’s tubercle, IT band inserts into it.
4
Q
What is the proximal muscle that is retracted during plating of a distal radius fracture?
A
Pronator muscle
5
Q
Supinators of the wrist?
A
Biceps muscle, brachioradialis, supinator
6
Q
Terry Thomas sign
A
An increase in the scapholunate space on an AP radiograph of the wrist (or coronal CT). The increased distance indicates scapholunate dissociation (often with rotary subluxation of the scaphoid) due to ligamentous injury. There is no consensus as to what measurement constitutes widening, but a cut-off of 3 or 4 mm is reasonable in most cases.
7
Q
What are the layers of the growth plate?
A
reserve zone, proliferative zone, hypertrophic zone, zone of provisional calcification
8
Q
What layer does the Salter Harris fracture occur?
A
Zone of Hypertrophy
9
Q
What is the Tip to Apex distance?
A
The sum of the distance from the tip of the lag screw to the apex of the femoral head on the AP and lateral X-rays. (measured in mm) baumgartner paper
10
Q
Why wait for EMG study after nerve injury?
A
Mullerian degeneration must occur first. This can take 4-6 weeks.
11
Q
What is a Fabella
A
Ossification in the popliteal fossa
12
Q
SALTER Harris mnemonic
A
S-Slip through plate Type I A-Above epiphysis Type II L-Lower (below epiphysis) Type III TE-Through Everything Type IV R- Rammed (crushed) Type V
13
Q
Complication of radial head Fracture?
A
Restricted motion
14
Q
What is the distal radius colles fracture classification?
A
Frykman Classification
15
Q
Frykman classification types?
A
type I : transverse metaphyseal fracture. This includes both a Colles and Smith fracture as angulation is not a feature type II : type I + ulnar styloid fracture type III : fracture involves the radiocarpal joint. This includes both a Barton and reverse Barton fractures. type IV : type III + ulnar styloid fracture type V : transverse fracture involves distal radioulnar joint type VI : type V + ulnar styloid fracture type VII : comminuted fracture with involvement of both the radiocarpal and radioulnar joints type VIII : type VII + ulnar styloid fracture
16
Q
Appropriate size of lag screw?
A
2.5-3x the length of the fracture
17
Q
Septic joint lab values
A
CRP>5 ESR>30 (this stays elevated longer than CRP) WBC>10 LDH>250 (sensitive for infection)
18
Q
What to do for open fracture?
A
- Trauma survey 2. Early IV antibiotics and tetanus shot 3. direct pressure to control bleeding 4. assess soft tissue damage and neuromuscular exam 5. Move gross debris, place sterile saline soaked dressing on site. 6. Stabilize with splint 7. Surgery with low pressure lavage
19
Q
What is the Intra capsular Hip fracture classification system?
A
Garden Classification
20
Q
Garden classification type I
A
I-Incomplete or impacted bone injury w/ valgus angulation of distal component.
21
Q
What makes an intertrochanteric fracture stable?
A
Intertrochanteric fx is stable when the posteromedial cortex remains intact or has minimal comminution making it possible to obtain and maintain a stable reduction.
22
Q
What makes an intertrochanteric fracture unstable?
A
Greater comminution of posteromedial cortex Reverse obliquity pattern is unstable b/c of the tendency for medial displacement of femoral shaft (fx extends from medial cortex proximally to lateral cortex distally)
23
Q
What is a Torus (buckle) fracture?
A
Concave cortex compresses (buckles), convex/tension side: intact
24
Q
What is a greenstick fracture?
A
Convex/tension side fracture/plastic deformity, concave cortex intact–(reduce if >10 degrees of angulation).
25
6 lines of pelvis
iliopectineal ilioischial teardrop roof (dome) Ant. Wall Post Wall
26
Normal measurements for the wrist
- 23(22) degrees of radial inclination - 11 mm radial height - 11 degrees of volar tilt
27
Smith Fracture
Volar displacement (apex dorsal)
28
Barton Fracture
fx/dislocation of wrist in which dorsal or volar rim of distal radius is displaced with hand and carpus. Volar is more common.
29
Chauffeur fracture
Radial styloid fracture
30
Monteggia Fracture
Fracture of the proximal ulna accompanied by radial head dislocation classification--Bado (anterior angulation and dislocation most common)
31
Monteggia Fracture Bado Classification types
1. Ant dislocation of radial head w/ fx of ulnar diaphysis at any level w/ anterior angulation
2. Post dislocation of radial head w/ fx of ulnar diaphysis w/ posterior angulation.
3. Lateral dislocation of radial head w/ fx of ulnar metaphysis
4. Ant dislocation of radial head with both bone fx w/ in proximal third at same level.
32
Galeazzi/Piedmont Fracture
Fracture of the radial diaphysis at the junction of the middle and distal 1/3 with disruption of the DRUJ "A fracture of necessity" because it requires ORIF to achieve a good result Classification- by mechanism
33
Galeazzi/Piedmont classification types
Pronation-Galeazzi-FOOSH with forearm pronation. Direct trauma to the dorsolateral aspect of the wrist. Supination-Reverse Galeazzi-FOOSH with forearm supination. ULNA shaft fx with DRUJ dislocation
34
olecranon fracture Classification
Colton classification undisplaced:
35
Name the Supracondylar humerus Fx classification system
Gartland classification Extension (95%) vs Flexion
36
Compartments of Forearm
3 in total -volar - most commonly affected - dorsal - mobile wad (lateral) rarely involved, muscles - brachioradialis, extensor carpi radialis longus, extensor carpi radialis brevis
37
Hand compartments
10 in total hypothenar thenar adductor pollicis dorsal interosseous (x4) volar (palmar) interosseous (x3)
38
Radial Head Fx classification
Mason Classification I: minimally displaced fx, no mechanical block to rotation, II: marginal fractures with displacement (impact ion, depression, angulation), possible mechanical block to forearm rotation III:comminuted and displaced fx involving entire head, mechanical block to motion IV: (Hotchkiss modification) radial head fx with elbow dislocation.
39
Extensor compartments of wrist
I EPB, APL II ECRB, ECRL III EPL IV E Digitorum, E Indicis V E digiti minimi VI ECU
40
Boundaries of shoulder quadrangular space
Teres minor, major, long head of triceps and humerus.
41
What structure(s) pass through quadrangular space of shoulder
posterior humeral circumflex artery, Axillary nerve.
42
What are borders of triangular interval
Teres major, long and lateral heads of triceps
43
What structure(s) pass through triangular interval
Radial nerve, deep brachial artery
44
What are borders of triangular space
Theres major, minor, long head of triceps
45
What structure(s) pass through Triangular space?
Scapular circumflex artery
46
Most common entrapment spots of Ulnar nerve in cubital tunnel syndrome?
* b/t two heads of FCU/aponeurosis(most common), arcade of struthers, b/t osborns ligament and MCL,
* less common: medial intermuscular septum
47
Supraspinatus innervation?
suprascapular nerve
48
Infraspinatus innervation?
Suprascapular nerve
49
Teres minor innervation
axillary nerve
50
subscapularis innervation
upper and lower sub scapular nerves
51
Name the femoral head Fx classification system?
Pipkin classification
52
Type I pipkin Fx
hip dislocation w/ fx of femoral head inferior to fovea capitis
53
Type II pipkin fx
Type I w/ fx superior to fovea capitis
54
Type III pipkin fx
Type I or II w/ fx of the femoral neck
55
Type IV pipkin fx
Type I or II w/ fx of the acetabular rim
56
3 types of femoral neck fracture?
subcapital, transcervical, basicervical
57
Pauwel femoral neck classification
(angle of fx from the horizontal plane? type I: 30 degrees Type II: 50 degrees Type III: 70 degrees
58
Garden classification Type II
II-Complete (across whole neck) - undisplaced
59
Garden classification type III
III-Complete - partially displaced
60
Garden classification type IV
IV- Complete -Totally displaced
61
Evans classification system
classifies intertrochanteric fx.
62
Evans classification type I
stable (post-medial cortex intact)
63
Evans classification type II
unstable (post-medial cortex disrupted)
64
Evans classification type III
Reverse obliquity-unstable-(cephalomedullary nail)
65
Tip Apex Distance (TAD)
The sum of the distance from the tip of the lag screw to the apex of the femoral head on the AP and lateral X-rays. (measure in mm) - baumgartner paper
66
What is classification system for tibial plateau fx
schatzker classification
67
schatzker Type I
Lateral plateau, split fx
68
schatzker Type II
Lateral plateau, split depression fx
69
schatzker Type III
Lateral plateau, depression fx
70
schatzker type IV
Meidal plateau fx
71
schatzker type V
bicondylar plateau fx
72
schatzker type VI
plateau fx with separation of the metaphysics from the diaphysis-comminuted
73
Anterior compartment of leg
Tib ant, EHL, EDL, peroneous tertius, deep peroneal n; ant tib artery, vein
74
lateral compartment of leg
peroneous longus, peroneus brevis, superficial peroneal nerve
75
supero posterior compartment of leg
gastrocemius, soleus, plantaris
76
deep posterior compartment of leg
popliteus, FHL, FDL, Tib posterior, Tib nerve, post tib artery, vein, peroneous artery, vein
77
ankle fracture classification system
Lauge-Hansen - 4 types with subdivided stages
78
Maisonneuve fracture
complete syndesmosis disruption with diastasis and proximal fibula fracture
79
Plafond Fx classification system
Ruedi and Allgower
80
plafond fx R&A type I
nondisplaced cleavage fx
81
plafond fx R&A type II
Displaced fx w/ extension into articular surface
82
Rudi and allgower type III
pilon fracture; displaced fx w/ significant articular comminution and metaphysical impaction.
83
Jones Fracture
Fx at the metaphyseal/diaphyseal junction of the 5th metatarsal
84
jones avulsion fx
base of 5th Metatarsal avulsion fracture
85
Open fracture classification system
Gustilo and Anderson classification
86
Gustilo and Anderson classification Type I
Clean skin opening, minimal muscle contusion; low energy simple spiral or short oblique fx
87
Gustilo and Anderson classification type II
1-10 cm, w/ more extensive soft tissue damage; min to moderate crush component; simp transverse or short oblique fx's w/ min comminution
88
Gustilo and Anderson classification type IIIA
extensive soft tissue laceration,adequate bone coverage;segmental fxs, gunshot injuries, minimal periosteal stripping
89
Gustilo and Anderson classification type IIIB
extensive soft tissue injury with periosteal stripping and bone exposure requiring soft tissue flap closure, usually associated with massive contamination
90
Gustilo and Anderson classification type IIIC
Large wound with major arterial injury requiring repair
91
what nerve innervates pronator quadratus?
Anterior interosseous nerve (branch of median nerve)
92
what nerve causes hip pain referred to knee
obturator nerve
93
what nerve innervates tensor fascia lat?
inferior gluteal nerve (also the glut max) (sup gluteal-\> glut min and med)
94
In acute ACL tear are you more likely to see a medial or lateral meniscal tear?
Lateral; (chronic ACL\>medial)
95
where is the popliteal artery located at the joint line
lateral to the center axis
96
what position does the lower extremity need to be if you are worried about foot drop?
Ext at hip, flexion at knee
97
What is at risk in a distal fibula ORIF?
Sup peroneal nerve
98
Which tendon in the first compartment has multiple slips?
APL
99
what tendon is attached to the pisiform?
FCU
100
what is interrupted with dorsal intercalated segment instability (DISI)?
Scapholunate ligament
101
What is intersection syndrome?
Inflammation at crossing point of 1st and 2nd dorsal compartments @wrist.
102
what provides sensation to top of foot?
Sup peroneal nerve
103
why do you put an intraarticular fx (post op) into continuous passive motion (CPM)?
the synovial fluid aids in hyaline formation, otherwise they will get fibrous union.
104
Fenestrate
to get progenitor cells to stimulate the inflammatory process and heal the area i.e.. lateral epicondylitis we fenestrate the needle into the bone then inject steroid
105
What is PRP?
Platlets concentrated from plasma, injected after surgery, platelets full of growth factors to help heal. Best in chronic tendon injuries.
106
Why do we hemi a femoral neck fracture?
synovial fluid prevents/impairs the callus formation necessary for bone repair, the blood supply can be disrupted via fx or intracapsular pressure
107
Factors that modify open fracture classification regardless of initial skin defect
exposure to: soil, water (pool,lake/stream), fecal matter (barnyard), oral flora (bite), gross contamination on inspection, delay in treatment \>12 hours
108
Signs of high energy fracture mechanism
segmental fx, bone loss, compartment syndrome, crush mechanism, extensive degloving of subcutaneous fat and skin, requires flap coverage (any size defect)
109
antibiotic coverage for open fractures
Type I,II: first gen cephalosporin Type III: add an aminoglycoside Farm injuries: add penicillin and an aminoglycoside give tetanus prophylaxis
110
Low velocity vs high velocity gunshots
low velocity 2000 ft/sec includes all military rifles and most hunting rifles shotgun dependent on shot pattern load and distance from target
111
What is affected in boutonnière deformity
Central slip rupture over PIP from laceration, traumatic avulsion or capsular distention in RA
112
What occurs in mallet finger deformity
Boney avulsion or tendinous disruption of the terminal extensor tendon distal to DIP joint.
113
Type of bone formation in growth plate
Enchondral bone formation
114
Layers of growth plate
-Reserve zone -Proliferative zone -Hypertrophic zone (Maturation zone, degenerative zone, provisional calcification zone) -Primary spongiosa
115
116
Indications for cannulated screw fixation femoral neck fx
* nondisplaced transcervical fx
* Garden I and II fracture patterns in the physiologically elderly
* displaced transcervical fx in young patient
117
Indications for sliding hip screw or cephalomedullary nail trans cervical fem neck fx
* basicervical fracture
* vertical fracture pattern in a young patient
* biomechanically superior to cannulated screws
* consider placement of additional cannulated screw above sliding hip screw to prevent rotation
118
Indications for hemiarthroplasty in femoral neck fracture
* controversial
* debilitated elderly patients
* metabolic bone disease
119
Indications for total hip arthroplasty in femoral neck fx
* controversial
* older active patients
* patients with preexisting hip osteoarthritis
* more predictable pain relief and better functional outcome than hemiarthroplasty
* arthroplasty for Garden III and IV in patient \> 85 years
120
Indications for sliding hip screw in intertrochanteric hip fx
stable intertrochanteric fractures
121
Indications for cephalomedullary nail in intertrochanteric hip fx
* stable fracture patterns
* unstable fracture patterns
* reverse obliquity fractures
* subtrochanteric extension
* lack of integrity of femoral wall
122
Indications for arthroplasty in intertrochanteric hip fx
* severely comminuted fractures
* preexisting symptomatic degenerative arthritis
* osteoporotic bone that is unlikely to hold internal fixation
* salvage for failed internal fixation
123
Thurston holland fragment
Fragment of bone after a Type II or Type IV salter harris fracture
124
Anterior Interosseous nerve innervation
125
Anterior interosseous nerve is a branch of what nerve?Branching point?
* Median nerve.
* Branches from median nerve 4cm distal to medial epicondyle
126
Posterior interosseous nerve motor innervation
* ECRB (often from radial nerve proper, but can be from PIN)
* Extensor digitorum communis (EDC)
* Extensor digiti minimi (EDM)
* Extensor carpi ulnaris (ECU)
* Supinator
* Abductor pollicis longus (APL)
* Extensor pollicus brevis (EPB)
* Extensor pollicus longus (EPL)
* Extensor indicis proprius (EIP)
127
Posterior interosseous nerve sensory innervation
* Provides sensory to dorsal wrist capsule
* NO cutaneous innervation
128
1. Posterior interosseous nerve is branch of what nerve?
2. Branching Point?
1. Radial Nerve
2. Originates from the radial nerve at the radiohumeral joint line
129
Supracondylar fx gartland extension type classification
Gartland Extension type
1. Nondisplaced
2. Displaced with intact posterior cortex; may be angulated or rotated
3. Complete displacement; posteromedial or posterolateral
130
Supracondylar fx gartland flexion type classification
Gartland flexion type
1. Nondisplaced
2. Displaced with intact anterior cortex
3. Complete displacement; usually anterolateral
131
What tibifibula clear space measurement is abnormal and implies syndesmotic injury?
\>5mm tibiofibula clear space is abnormal and implies syndesmotic injury
132
What measurement of medial clear space in mortise view of ankle indicates a lateral talar shift
Medial clear space of \>4-5mm is abnormal and indicates lateral talar shift.
133
what is the tibiofibular overlap distance on AP view that implies syndesmotic injury?
Tibiofibula overlap of \<10mm on AP view is abnormal and implies syndesmotic injury
134
A lateral talar shift of 1mm or 3mm will result in decreased surface contact by ___ %?
* Lateral talar shift of 1mm will decrease surface contact by 40%
* Lateral talar shift of 3mm will decrease surface contact by \>60%
