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ABSITE > 42 Orthopedics > Flashcards

42 Orthopedics Flashcards

1
Q

osteoblasts vs osteoclasts

A

blasts = synthesize nonmineralized bone cortex … clasts = reabsorb bone

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2
Q

stages of bone healing

A

inflammation —> soft callus formation —> mineralization of the callus —> remodeling of the callus

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3
Q

cartilage receives nutrients from

A

synovial fluid, osmotic

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4
Q

Salter-Harris fracture classifcation and treatment

A

big picture = 1 & 2 are tx w closed reduction, 3-5 cross epiphyseal plate and can impact growth, need ORIF …. 1 = epiphysiolysis of the involved growth plate without assoc fracture …. 2 = additional metaphyseal fracture fragment … 3 = fracture through growth plate and epiphysis … 4 = fracture crosses epiphysis, growth plate (physis), and metaphysis …. 5 = crush of growht plate without a fracture, detected late by asymmetric or premature closure of the growth place

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5
Q

fractures assoc w AVN

A

scaphoid, femoral neck, talus

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6
Q

fractures assoc with nonunion

A

clavicle, 5th metatarsal fracture (Jones’ fracture)

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7
Q

fractures assoc with compartment syndrome

A

supracondylar humerus, tibia

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8
Q

biggest risk factor for nonunion

A

smoking

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9
Q

important lower extremity nerves with function

A

obturator = hip aDduction … superior glutel = hip aBduction …. inferior gluteal = hip extension … femoral = knee extension

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10
Q

number of discs in spine

A

33 … 7 cervical, 12 thoracic, 5 lumbar, 4 coccygeal

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11
Q

lumbar disc herniation: px

A

back pain, sciatica

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12
Q

lumbar disc herniation: pathophys

A

herniated nucleus pulposus

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13
Q

weak hip flexion 2/2 lumbar disc herniation

A

L3 nerve compression, L2-3 disc

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14
Q

weak knee extension (quadriceps), weak patellar reflex 2/2 lumbar disc herniation

A

L4 nerve compression, L3-4 disc

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15
Q

weak dorsiflexion (foot drop), decreased sensation in big toe web space 2/2 lumbar disc herniation

A

L5 nerve compression, L4-5 disc

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16
Q

weak plantar flexion, weak Achilles reflex, decreased sensation in lateral foot 2/2 lumbar disc herniation

A

S1 nerve compression, L5-S1 disc

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17
Q

lumbar disc herniation: nerve root compression and sx

A

affects 1 nerve below disc … L3 nerve compression (L2-3 disc) = weak hip flexion … L4 nerve compression )L3-4 disc) = weak knee extension (quadriceps), weak patellar reflex …. L5 nerve compression (L4-5 disc) = weak dorsiflexion (foot drop), decreased sensation in big toe web space … S1 nerve (L5-S1 disc) = weak plantar flexion, weak Achilles reflex, decreased sensation in lateral foot

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18
Q

lumbar disc herniation: dx

A

MRI for pts with neuro findings

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19
Q

lumbar disc herniation: tx

A

NSAIDs, heat, rest … surgery - for substantial/progressive neurologic defects, refractory cases, severe sciatica, or disc fragments that have herniated into the cord

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20
Q

terminal branches of the brachial plexus: list

A

ulnar, median, radial, axillary, musculocutaneous nerves

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21
Q

ulnar nerve: motor, sensory, injury

A

motor = intrinsic musculature of hand (palmar interossei, palmaris brevis, adductor pollicis, hypothenar eminence), finger abduction (spread fingers), wrist flexion …. sensory = all of the 5th and 1/2 4th fingers, back of the hand …. injury = claw hand

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22
Q

median nerve: motor, sensory, injury

A

motor = thumb apposition (anterior interosseous mucle, OK sign), finger flexors …. sensory = most of palm and 1st 3 and 1/2 4th fingers on palmar side … injury involved in carpal tunnel syndrome

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23
Q

radial nerve: motor, sensory

A

motor = wrist extension, finger extension, thumb extension, triceps, NO hand muscles … sensory = 1st 3 and 1/2 4th fingers on dorsal side

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24
Q

axillary nerve: motor

A

motor to deltoid (abduction)

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25
Q

musculocutaneous nerve: motor

A

biceps, brachialis, coracobrachialis

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26
Q

nerve injury that results in claw hand

A

ulnar nerve (motor = intrinsic musculature of hand (palmar interossei, palmaris brevis, adductor pollicis, hypothenar eminence), finger abduction (spread fingers), wrist flexion …. sensory = all of the 5th and 1/2 4th fingers, back of the hand)

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27
Q

nerve involved in carpal tunnel

A

median nerve (motor = thumb apposition (anterior interosseous mucle, OK sign), finger flexors …. sensory = most of palm and 1st 3 and 1/2 4th fingers on palmar side)

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28
Q

which nerve? - motor = intrinsic musculature of hand (palmar interossei, palmaris brevis, adductor pollicis, hypothenar eminence), finger abduction (spread fingers), wrist flexion …. sensory = all of the 5th and 1/2 4th fingers, back of the hand …. injury = claw hand

A

ulnar (C8-T1)

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29
Q

which nerve? - motor = thumb apposition (anterior interosseous mucle, OK sign), finger flexors …. sensory = most of palm and 1st 3 and 1/2 4th fingers on palmar side … injury involved in carpal tunnel syndrome

A

median (C6-T1)

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30
Q

which nerve? - motor = wrist extension, finger extension, thumb extension, triceps, NO hand muscles … sensory = 1st 3 and 1/2 4th fingers on dorsal side

A

radial (C5-8)

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31
Q

which nerve? - motor to deltoid (abduction)

A

axillary (C5-6)

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32
Q

which nerve? - motor to biceps, brachialis, coracobrachialis

A

musculocutaneous (C5-7)

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33
Q

number of cervical nerves and discs

A

8 nerves, 7 discs

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34
Q

cervical radiculopathy: MC type

A

C7 nerve, C6-7

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35
Q

cervical radiculopathy: nerve compression that results in neck and scalp pain

A

C1, 2, 3, 4 (C1-2, 2-3, 3-4 discs)

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36
Q

cervical radiculopathy: nerve compression that results in weak deltoid and biceps, weak biceps reflex

A

C5 nerve, C4-5 disc

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37
Q

cervical radiculopathy: nerve compression that results in weak deltoid and biceps, weak wrist extensors, weak biceps reflex and bracioradialis reflex

A

C6 nerve, C5-6 disc

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38
Q

cervical radiculopathy: nerve compression that results in weak triceps, weak triceps reflex

A

C7 nerve, C6-7 disc, most common type

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39
Q

cervical radiculopathy: nerve compression that results in weak triceps, weak intrinsic muscle of hand, weak wrist flexion, weak triceps reflex

A

C8 nerve compression, C7-T1 disc …. remember 8 cervical nerves but 7 discs

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40
Q

clavicle fracture tx

A

usually just sling, risk of vascular impingement

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41
Q

shoulder dislocation types, causes, injure what, and tx

A

anterior = 90%, risk of axillary nerve injury, tx w closed reduction … posterior = seizures or electrocution, risk of axillary artery injury, tx w closed reduction

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42
Q

acromioclavicular separation tx

A

sling, risk of brachial plexus and subclavian vessel injury

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43
Q

scapula fracture mgmt

A

sling unless glenoid fossa involved, then need internal fixation

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44
Q

midshaft humeral fracture tx

A

sling almost all of them

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45
Q

supracondylar fracture tx

A

adults —> ORIF … kids nondispaced —> closed reduction … kid displaced —> ORIF

46
Q

Monteggia fracture - describe, tx

A

proximal ulnar fracture w radial head dislocation, tx w ORIF

47
Q

colles fracture - describe, tx

A

fall on outstretched hand, distal radius, tx w closed reduction

48
Q

nursemaid’s elbow - describe, tx

A

subluxation of the radius at the elbow caused by pulling on an extended, pronated arm … tx w closed reduction

49
Q

mgmt of combined radial and ulnar fracture

A

adults tx = ORIF … kids tx = closed reduction

50
Q

scaphoid fracture - describe, tx

A

snuffbox tenderness, can have negative xray … tx = all patients require cast to elbow, may need fixation, risk of AVN

51
Q

Volkmann’s contracture - describe, dx, nerve, tx

A

supracondylar humerus fracture —> occluded anterior interosseous artery —> closed reduction of humerus —> artery opens up —> reperfusion injury, edema, forearm compartment syndrome (flexor compartment most affected) …. sx = forearm pain with passive extension, weakness, tense forearm, hypesthesia … median nerve most affected by swelling … tx w forearm fasciotomies

52
Q

forearm fasciotomies - what to do

A

need to open volar and doral compartments

53
Q

dupuytren’s contracture - assoc with what, describe, tx

A

assoc w DM, etoh … progressive proliferation of the aplmar fascia of hand results in contractures that usually affect the 4th and 5th digits (cannot extend fingers) … tx w NSAIDs, steroid injections, extension of involved fascia for significant contraction

54
Q

carpal tunnel syndrome - describe, tx

A

median nerve compression by transverse carpal ligament … tx = splint, NSAIDs, steroid injections … transverse carpal ligament release if that fails

55
Q

trigger finger - describe, tx

A

tenosynovitis of the flexor tendon that catches at the MCP joint when trying to extend finger …. tx = splint, tendon sheath steroid injections (not the tendon itself), if that fails then release the pulley system at the MCP joint

56
Q

suppurative tenosynovitis - describe, signs, tx

A

infection that spreads along flexor tendon sheaths of digits (can destroy tendon sheath) … 4 classic signs = tendon sheath tenderness, pain with passive motion, swelling along sheath, semi-flexed posture of the involved digit … tx w midaxial longitudinal incision and drainage

57
Q

rotator cuff tears - anatomy, mgmt

A

SITS = supraspinatus, infraspinatus, teres minor, subscapularis … acutely, sling and conservative mgmt … surgical repair if the pts needs to retain a high level of activity or if ADL affected

58
Q

paronychia - describe, tx

A

infection under nail bed, painful, tx = abx, remove nail if purulent

59
Q

felon - describe, tx

A

infection in the terminal joint space of the finger … tx = incision over the tip of the finger along the medial and lateral aspects to prevent necrosis of the finger tip

60
Q

MC dislocation: shoulder vs hip

A

90% anterior shoulder, 90% posterior hip

61
Q

hip dislocation - types, px, injures what, tx

A

posterior = 90%, internal rotation and aDduction of leg, risk of sciatic nerve injury, tx w closed reduction … anterior = external rotation and aBduction of leg, risk of injury to femoral artery, tx w closed reduction

62
Q

tx of isolated anterior ring fracture with minimal ischial displacement

A

weight-bearing as tolerated

63
Q

tx of femoral shaft vs femoral neck fracture

A

shaft = ORIF with intramedullary rod …. neck = ORIF - risk of avascular necrosis if open reduction delayed

64
Q

lateral knee trauma results in what

A

injury to anterior cruciate ligament, posterior cruciate ligament, and medial meniscus injuries

65
Q

ACL injury: physical exam, px, workup, tx

A

+anterior drawer test … p/w knee effusion and pain with pivoting action … MRI confirms dx … tx = surgery with knee instability (reconstruction with patellar tendon or hamstring tendon) o/w PT with leg-strengthening exercises

66
Q

PCL injury: physical, occurrence rate, px, tx

A

+posterior drawer test …. mech less common than ACL injury …. p/w knee pain and joint effusion … tx w conservative therapy initially, surgery for failure of medical mgmt

67
Q

collateral ligaments in knee: how do you injure them? tx? assoc with what?

A

medial collateral ligament / MCL - injure 2/2 lateral blow to knee … LCL - medial blow to knee …. tx = brace for small tear, surgery for large tear … injuries assoc with injury to corresponding meniscus

68
Q

meniscal tear - px, tx

A

joint line tenderness … can tx w arthroscopic repair or debridement

69
Q

posterior knee dislocation - workup

A

need angiogram to r/o popliteal artery injury

70
Q

patellar fracture mgmt

A

long leg cast unless comminuted, then need internal fixation

71
Q

tibial plateau fracture and tib-fib fracture tx

A

ORIF fixation unless open, then need external fixator unless tissue heals

72
Q

plantaris muscle rupture - px

A

pain and mass below popliteal fossa (contracted plantaris) and ankle ecchymosis

73
Q

ankle fracture mgmt

A

most reated with cast and immobilization, bimalleaolar or trimalleolar fractures need ORIF

74
Q

metatarsal fracture mgmt

A

cast immobilization or brace x6 weeks

75
Q

calcaneus fracture mgmt

A

case and immobilization if nondisplaced … ORIF if severe displacement

76
Q

nerve MC injured with lower extremity fasciotomy

A

superficial peroneal nerve - foot eversion

77
Q

footdrop after lithotomy position or after crossing legs for long periods or fibula head fracture

A

common peroneal nerve (foot-drop)

78
Q

common vs peroneal nerve injury: px, commonly 2/2 what injuries

A

common = foot-drop = 2/2 lithotomy position, corssing legs for long periods, fibular head fracture … superficial = foot eversion = 2/2 lower extremity fasciotomy

79
Q

leg compartments: list

A

4 = anterior, lateral, deep posterior, superficial posterior

80
Q

leg compartments: artery, nerve, muscles - anterior compartment

A

anterior tibial artery … deep peroneal nerve … muscles = anterior tibialis, extensor hallicus longus, extensor digitorum longus, communis

81
Q

leg compartments: artery, nerve, muscles - lateral compartment

A

no artery … superficial peroneal nerve … peroneal muscles

82
Q

leg compartments: artery, nerve, muscles - deep posterior compartment

A

posterior tibial artery, peroneal artery …. tibial nerve … muscles = flexor hallicus longus, flexor digitorum longus, posterior tibialis

83
Q

leg compartments: artery, nerve, muscles - superficial posterior compartment

A

no artery … sural nerve … muscles = gastrocnemius, soleus, plantaris

84
Q

anterior vs posterior tibial arteries - run in which compartments

A

anterior artery = anterior compartment … posterior artery = deep posterior compartment

85
Q

compartment syndrome: pathophys

A

most likely to occur in anterior compartment of the leg (get footdrop) after vascular compromise, restoration of blood flow, and subsequent reperfusion injury with swelling of the leg compartment … can also occur 2/2 crush injuries

86
Q

compartment syndrome: px

A

pain with passive motion, swollen exremity … distal pulses may be present (last thing to go) … P >20-30 mmHg abnormal

87
Q

compartment syndrome: dx

A

based on clinical suspicion

88
Q

compartment syndrome: tx

A

fasciotomy

89
Q

pediatric ortho: list common issue

A

osteomyelitis, idiopathic adolescent scoliosis, osgood-schlatter disease, legg-calve-perthes disease, slipped capital femoral epiphysis (SCFE), congenital hip dislocation, clubfoot

90
Q

osteomyelitis: describe, sx, dx, tx

A

can occur in metaphysis of long bones in kids, MC staph … sx = pain, dec use of extremity … dx w MRI, bone bx … tx = I&D, abx

91
Q

idiopathic adolescent scoliosis: px, mgmt

A

prepubertal F, R thoracic curve most common, usually a-sx …. 20-45 degree curves need bracing to slow progression, which can occur w growth spurt …. >45 degree curves or those likely to progress need spinal fusion

92
Q

osgood-schlatter disease: describe, workup, tx

A

tibial tubercle apophysitis, cause by traction injury from the quad in adolescents aged 13-15, MC have pain in front of the knee … x-ray shows irregular shape or fragmenting of the tibial tubercle … tx = activity limitation for mild sx, cast x6 weeks then activity limitation for severe sx

93
Q

legg-calve-perthes disease: describe, sx, imaging, tx

A

AVN of the femoral head, kids 2yo and older, b/l in 10%, can be 2/2 hypercoagulable state …. sx = painful gait limp … xray shows flattening of femoral head … tx = maintain range of motion with limited exercise, femoral head will remodel without sequelae, surgery if femoral head is not covered by the acetabulum

94
Q

SCFE: describe, imaging, tx

A

slipped capital femoral epiphysis, M ages 10-13yo, inc risk of AVN to femoral head, painful gait …. xray show widening and irregularity of the epiphyseal plate .. tx w surgical pinning

95
Q

congenital dislocation of hip: MC in which pts, tx

A

MC in F, tx w Pavlik harness (keep the legs aBducted and the femoral head reduced in the acetabulum)

96
Q

clubfoot tx

A

serial casting

97
Q

describe 2 causes of femoral head AVN in kids

A

boht p/w painful gait …. legg-calve-perthes disease = 2yo and older, xray shows flattening of femoral head, tx w ROM exercise, surgery if femoral head not covered by acetabulum ….. vs …. SCFE = M 10-13yo, inc risk of AVN, xray shows widening and irregularity of epiphyseal plate, tx w surgical pinning

98
Q

bone tumors: MC types

A

met disease - #1 breast, #2 prostate … MC primary = multiple myeloma

99
Q

bone tumors: mgmt of mets

A

internal fixation with impending fracture (>50% of cortical involvement), followed by XRT

100
Q

bone tumors: multiple myeloma - describe, tx

A

MC primary bone tumor, tx = chemo for systemic disease, internal fixation for impending fractures

101
Q

bone tumors: pathologic fractures

A

tx w internal fixation, XRT can be used for pain relief in pts w painful bony mets

102
Q

bone tumors: osteogenic sarcoma

A

MC primary bone sarcoma, usually around the knee, 80% in patients <20yo … xray shows Codman’s triangle (2/2 periosteal reaction) … tx = limb-sparing resection, XRT and doxorubicin-based chemo can be used preop to increase chance of limb sparing resection

103
Q

bone tumors: list benign bone tumors that are treated with curettage +/- bone graft

A

osteoid osteoma, endochondroma (may be able to observe), osteochondroma (resection only if cosmetic defect or causing sx), chondropbalstoma, nonossifying fibroma (may be observed) and fibrodysplasia

104
Q

bone tumors: giant cell tumor of bone - mgmt

A

total resection +/- XRT (benign but 30% risk of recurrence, also has malignant degeneration risk)

105
Q

MC cause of lumbar pain in adolescents (gymnasts)

A

spondylolisthesis

106
Q

spondylolisthesis - describe, tx

A

formed by subluxation or slip of one vertebral body over another … MC in lumbar region … MC cause of lumbar pain in adolescents (gymnasts) … tx = depends on degree of subluxation and sx (ranges from conservative tx to surgical fusion)

107
Q

cervical stenosis mgmt

A

surgical decompression if significant myelopathy present

108
Q

lumbar stenosis mgmt

A

surgical decompression for cases refractory to medical tx

109
Q

torus fracture - describe

A

buckling of metaphyseal cortex seen in kids (i.e. distal radius)

110
Q

open fractures - mgmt

A

need I&D, abx, fracture stabilization, soft tissue coverage

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