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125 Cards in this Set

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Fractures are classified as complete vs. incomplete and open vs. closed. What is the main difference in Complete and Incomplete fractures?
Complete fractures are broken down into direct and indirect traumas where both cortices of the bone are disrupted (bone fragments separate completely); INCOMPLETE fractures are only seen in children and are broken down into 2 types: Buckle and Greenstick.
Name the two types of incomplete fractures that are seen only in children and describe what causes each of them.
Greenstick - angular force and Buckle (torus) - compression (usually occurs at the metaphysis)
in a greenstick fracture, ngulation of a long bone may cause the bone to break only on the _____ side.
convex
In a complete fracture, both cortices are disrupted. describe the soft tissue injury and amount of bone fragments in a NIGHTSTICK FRACTURE.
minimal soft tissue injury with rare multiple fragments
In a complete fracture, both cortices are disrupted. describe the soft tissue injury and amount of bone fragments in a LOW VELOCITY INJURY.
minimal soft tissue injury and minimal fragments present
In a complete fracture, both cortices are disrupted. describe the soft tissue injury and amount of bone fragments in a HIGH VELOCITY INJURY.
extensive soft tissue damage with significant bony fragments
In a complete fracture, both cortices are disrupted. describe the soft tissue injury and amount of bone fragments in a CRUSH INJURY.
significant soft tissue damage and multiple bony fragments.
name the common complete fracture that occurs in abuse situations.
Spiral Fracture (type of indirect trauma) - rotational force is applied to the bone
name the Complete indirect trauma that results when tendons or ligaments are maximally stretched and disrupt the insertion site.
avulsion fracture
name the complete indirect trauma/fracture that occurs from axial loading.
compression fracture
name the type of fracture that commonly occurs in non-traumatic situations in osteoporotic women.
compression fracture - causes a wedging of the vertebral disc on xray
if a person has a fracture that is protruding through the skin, what is it called and what is the management?
OPEN FRACTURE (aka compound); warrants antibiotics, tetanus prophylaxis, irrigation (OR), debride the tissue
what is the difference in subluxation and dislocation of a joint?
subluxation: the articular surface is partially or incompletely disrupted and will usually spontaneously relocate back to normal; DISLOCATE: joint surface completely out of socket
Name the 5 "P"s of compartment syndrome and how long after a fracture do they generally occur?
1) Pallor 2)Pulselessness(late finding) 3)Pain 4)Paresthesias 5)Poikilothermia(loss of normal thermal regulation); generally occur in the forearm or lower leg and 48-72 hours after the injury
If a fracture is causing neurological deficits, immediate ____ and ____ should be performed.
reduction and splinting
If there is compartment syndrome you begin treatment by immobilizing and elevating. If the intra-compartmental pressure is greater than ____mmHg, they generally require immediate intervention with _______.
30mmHg; fasciotomy
if you have a break in this area of the bone as a child, it could inhibit or disrupt growth.
physis (aka epiphyseal plate)- the cartilaginous zone between the epiphysis and the calcified cartilage (metaphysis)
this part of the bone if formed by endochondral ossification and is called the "shaft" of the bone.
diaphysis
name the carilaginous end of a bone.
epiphysis
name the ossified portion of an epiphysis.
metaphysis
how do acromioclavicular (AC) separations generally occur and how are they diagnosed?
FOOSH (Fall on out-stretched hand); X-rays of shoulder and both clavicles
name the ligaments that are possibly involved in an AC separation.
acromioclavicular joint capsule (ac ligament that attaches the clavicle to the acromion) and the Coracoclavicular Ligament (includes trapezoid and conoid ligaments)
there are 6 types of Acromioclavicular separations. What determines the type assigned to the separation?
measured based on how much ligamentous disruption occured and how high riding the clavicle is
Name the Type of AC Separation. Full tear of both the AC and CC (Coracoclavicular) ligaments with the distal clavicle displaced superiorly on PE and X-ray.
Type III AC Separation
Name the Type of AC Separation. Full tear of the AC ligament; Intact CC ligament; normal anatomic placement of the AC joint; slight displacement of the clavicle may be visulaized on x-ray.
Type II; Treat (tx) the symptoms (analgesics and sling prn)
Name the Type of AC Separation. Partial tear of the AC ligament; CC intact; normal alignment; x-rays are normal.
Type I AC Separation; treat symptoms and use sling prn
Name the Type of AC Separation. Full tear of both AC and CC ligaments; severe clavicular displacement.
Type IV -VI; all managed surgically
How would a person present with a sternoclavicular dislocation?
after direct trauma or FOOSH pt would present with pain over the joint and pain with motion of the affected extremity.
What type of sternoclavicular (SC) dislocation is life-threatening and why?
posterior SC dislocations can compress or lacerate the great vessels in the neck (carotid, jugular)
How do you treat the anterior and posterior SC dislocations?
Anterior: analgesics and sling; Posterior: surgical emergency because of proximity to great vessels
How would you diagnose an SC dislocation?
on PE there would be a slight deformity, pain at site, slight decrease in ROM; plain chest X-RAY (PA and Lateral) with sternal views; if the X-ray is negative, get CT SCAN
Name the most common dislocation seen in the ER.
shoulder dislocation
Of this most common dislocation, what type is more common, anterior or posterior?
95% of shoulder dislocations are ANTERIOR
when treating a shoulder dislocation, what type of examination should be done and if its positive, what should you immediately do?
Neurovascular exam;immediate reduction should be done if there is any deficit
When diagnosing a shoulder dislocation, AP, Lateral, and Axillary views should be done. Which view is key to determing the direction of dislocation?
Axillary view
If a patient has a more common anterior dislocation, how will he/she be holding his/her arm?
affected extremity is held in ABDUCTED AND EXTERNALLY ROTATED position
The uncommon posterior dislocation occurs after what type of actions? How does a patient hold his/her arm?
Posterior - may occur after seizures or lightening strikes; pt. holds arm in adducted and internally rotated position
If the x-ray reveals a posterior dislocation, what does the head of the humerus look like?
lightbulb
When reducing a shoulder dislocation, when should you first consult an orthopedic surgeon?
1) any dislocation with a fracture; 2)A nerve injury; 3) inability to reduce a dislocation
Traction/Counter-traction, Scapular Manipulation and Stimson are all reduction treatment methods for reducing shoulders. What should you do post-reduction?
get repeat x-rays (for your patient and the lawyers)
When reducing a shoulder, it is not uncommon to iatrogenically induce an injury. Name the nerve damaged if the patient experiences loss of sensation over the deltoid.
Axillary Nerve
When reducing a shoulder, it is not uncommon to iatrogenically induce an injury. Name the nerve damaged if the patient loses sensation along the dorsal forearm.
musculocutaneous nerve
Name the injury. There is damage to the posterior humeral head due to repeated anterior dislocations.
Hill Sachs Fracture
Name the injury. There is damage to the anterior humeral head as it hits the glenoid during posterior dislocations.
Reverse Hill Sachs Fracture
when doing a shoulder examination, you should do these common ROM tests.
forward flexion, abduction to 180, external rotation, internal roation (hands behind back)
Name the muscles of the rotator cuff.
SITS - Supraspinatus, Infraspinatus, Teres minor, Subscapularis
what events normally cause rotator cuff injuries?
fall onto the shoulder, heavy lifting, after forceful abduction of the extremity
How will a patient present with a rotator cuff injury?
weak/painful abduction, anterior shoulder pain
how do you diagnose a rotator cuff injury?
PE - isolate each muscle and strength test it (x-rays are not neccessary - this is musculature)
How do you treat a rotator cuff injury?
analgesics, sling for comfort, attention to gentle ROM exercises prevent adhesive capsulitis
this fracture takes alot of force/high velocity and may involve lung and abdominal injuries (which should be ruled out with imaging).
scapular fractures
A proximal humeral fracture is usually seen in elderly patients that have tripped and fallen on FOOSH. They present with pain around shoulder and decreased ROM. This fracture is defined based on injury to the particular anatomic parts. What anatomic parts are possibly involved?
Anatomic neck; surgical neck; greater tuberosity; lesser tuberosity (anatomy lesson: anatomic neck is most superior (below head); surgical neck is below greater and lesser tubercles)
According to Neer's Classifications of proximal humeral fractures, what comprises a 2 part fracture?
one fragment is displaced (totally off the humerous)
if there is a 3part Fracture, how many fragments are there?
2 fragments (usually surgical neck + either greater or lesser tuberosity)
What Type of proximal humeral fracture needs surgical repair?
Four part Fracture (sometimes needs hemi-arthroplsty - where you replace 1/2 of the joint with an artifical substance)
If a patient has a humeral shaft fracture, what should you possibly suspect?
Pathologies (esp. breast CA) and Abuse
What nerve runs along the humeral shaft and is associated with wrist drop (aka "the great extensor nerve"); if its injuried, it requires ORIF?
radial nerve - radial nerve innervates B.E.S.T.: Brachioradialis, Extensors of the fingers and wrist; Supinator; Triceps
What do the following letters stand for, ORIF?
Open Reduction Internal Fixation
Since the presence of a posterior fat pad is abnormal, what does it look like on x-ray and what does it mean?
on x-ray, its a dark area behind the proximal ulna; it means a likely elbox fracture (prox. ulna)
what type of fracture should be suspected if there is pain with pronation/supination?
radial head fracture
on a normal x-ray if you draw a straight line going distal on the anterior border of the humerous it should transect the _____.
capitulum
what is more common in elbow dislocations? anterior or posterior?
Posterior are more common
what nerves and vasculature may be injuried in an elbow dislocation?
median and ulnar nerve; brachial artery
in regard to the elbow, where does the ulnar nerve run and what is it responsible for?
along the medial epicondyle; wrist flexion; sensation of medial palm and pinky and ring finger
If you injure the median nerve, what deficits may you have?
can't pronate forearm, can't flex wrist; get thenar atrophy
Name the fracture. Fracture of mid-ulna with proximal radial dislocation.
Monteggia Fracture - needs ORIF and radial nerve is commonly injuried
Name the fracture. Distal Radial Fracture with diruption of the distal radioulnar joint.
Galeazzi Fracture - ORIF often required
This acronym helps remember the Monteggia vs. Galeazzi Fractures.
MUGER - Monteggia/Mid-Ulnar Galeazzi End Radius
What is the most common carpal fracture? It would be painful to palpate what?
scaphoid; anatomical snuffbox
the majority of scaphoid fractures are negative. Even so, if you have a high clinical suspicion, what should you do?
place them in a thumb-spica splint and repeat x-ray in 10-14 days
Name the fracture. Distal radius fracture displaced posteriorly.
Colles Fracture - occurs when falling forward with extended wrist
Name the fracture. Distal radius fracture displaced anteriorly.
Smith's Fracture - falling forward on flexed wrist
What nerve injury is more common in which wrist fracture (colles vs. smith)?
Median Nerve Injuries are more common in Colles fracture (falling on extended wrist - displaced posteriorly); with both types of fractures, do a closed reduction (setting a bone in a cast - no incision needed)
name the carpal bones.
proximal row = scaphoid, lunate, triquetrum and pisiform; Distal Row= Hamate, capitate, trapezoid, trapezium
If a paint gun blows up on someone's hand (no fingers missing), what do you do?
this INJECTION INJURY is an orthopedic emergency; the toxic/necrotizing substance may cause more damage than known and patient may end up with gangrene and need amputation
Name the Term. Disruption of the extensor tendon from the DIP; needs splinted for 6 weeks and if its not treated will look like a Swan neck (persistnet mallet finger with hyperextension of PIP).
Mallet Finger
Name the Term. Flexion of the PIP with hyperextension of the DIP. needs operative repair.
Boutonniere Deformity
Name the condition. 48 yo Female just started playing tennis. She comes to you with pain in her thumb with tenderness in the anatomical snuffbox. She has a positive Finkelstein Test.
DeQuervain's Tenosynovitis - inflammation of the first dorsal compartment of the hand
What two muscles are in the 1st dorsal compartment of the hand and what is a Finkelstein' Test?
abductor pollicus longus and extensor pollicus brevis; FT: make a fist with the thumb inside (this pulls the thumb and re-creates the symptoms)
This fracture occurs in a high velocity trauma and is classified by the Kane Modification System or Tile Classification. What is the fracture and describe the 2 classificaiton systems?
Pelvic Fracture; Kane System: based on the number of rings in the pelvis that are fractured; Tile System: based on teh direction of the applied force
What do you need to beware of in a pelvic fracture?
potential for significant blood loss (up to 5L)
Name some things that help diagnose a pelvic fracture and how do you manage them?
Dx: blood found at the urethral meatus; rectal tenderness; ultrasound; Management: ATLS (Advanced Trauma Life Support); stabilize with binder; operative fixation/embolization in angiography
How would a patient hold his/her leg if he/she had a femoral neck fracture?
held in abduction and external rotation; patient may be able to walk - treated occasionally with pinning, most require hemiarthroplasty (since the neck is compromised)
How would a patient hold his/her leg if he/she had an intertrochanteric fracture?
the patient would not be able to ambulate and would be holding the leg in an externally rotated position- treated with pinning and rarely hemiarthroplasty
Hip dislocations are true ortho emergencies. What type (posterior or anterior) is more common?
Posterior 90:10
What will happen if you don't reduce this dislocation within 6 hours?
avascular necrosis of the femoral head may occur
what is a complication of reducing a femoral head?
sciatic nerve injury
If a football player is hit in the knee from the side, what is usually damaged?
MAM: MCL(medial collateral lig); ACL (anterior cruciate lig) and Medial Meniscus
Name and describe the tests for ACL.
Lachman's Test (stabilize the femur, hold knee in 20degrees of flexion, create an anterior force to the tibia and feel for laxity relative to the other "normal" knee); ANTERIOR DRAWER TEST: have patient flex hip and knee; Dr. pulls tibia forward - looks for laxity
Treat an ACL tear with ______.
Hinged knee brace
What test do you do for a possible PCL tear?
Posterior Drawer test; Hip and knee flexed; push tibia back
The menisci serve as shock absorbers; How do they get injured?
twisting combined with axial loading
How will a patient present with a meniscial injury?
pain along the joint line; small effusion; clicking when walking
How do you test for mensical injury?
McMurray's Test - pt. supine and hip flexed; rotate tibia medially and laterally - a + test is when you hear a palpable clunk
Name the muscles of the anterior compartment. What does the muscles do?
PEET: Peroneous tertius m; Extensor hallicus longus; Extensor digitorum longus; Tibilais Anterior m; these muscle dorsiflex foot and extend the toes
What are the main nerve and artery supplies to the anterior compartment?
Deep peroneal nerve; anterior tibial artery
Name the muscles of the lateral compartment. name the nerve supply and action of muscles.
Peroneus longus and brevis; Superficial peroneal nerve; foot eversion
eversion and inversion of the foot is based on the _____.
sole of the foot - (ie. eversion - the sole faces away from the midline)
The posterior compartment is broken down into superficial and deep. Name the muscles of the superficial posterior compartment.
gastrocnemius, soleus, and plantaris m (they are the primary muscles for plantar flexion)
The posterior compartment is broken down into superficial and deep. Name the muscles of the deep posterior compartment.
posterior tibial muscle, flexor hallicus longus, flexor digitorum longus (they assist in plantar flexion - like planting your foot on the gas pedal)
List the key examination findings in compartment syndrome.
1)tense compartments; 2) pain out of proportion with exam; 3) loss of sensation; 4) pain with passive and active motion; 5) late findings: loss of pulses, loss of skin color
Name the 5 "P"s of compartment syndrome and how long after a fracture do they generally occur?
1) Pallor 2)Pulselessness(late finding) 3)Pain 4)Paresthesias 5)Poikilothermia(loss of normal thermal regulation); generally occur in the forearm or lower leg and 48-72 hours after the injury; may also occur in burn patients
name (in order of injury frequency) the ankle ligament injuries. what is the normal position of the foot when injured?
ATFL (anterior talofibular ligament) -> calcaneofibular ligament -> posterior talofibular ligament; occurs when a plantar flexed foot is inverted
on the medial side of the ankle, name the 4 parts of the deltoid ligament that may be damaged upon traumatic eversion of foot.
Deltoid Ligament of the Medial Ankle: Posterior TibioTalar part; Tibiocalcaneal part; TibioNavicular Part; Anterior TibioTalar Part
name the syndesmotic ligaments.
Posterior tibiofibular L; interosseous membrane (b/t fibula and tibia); transverse L; and Anterior Tibiofibular L
How would you diagnose an injury to the syndesmotic ligaments?
syndesmotic injury is often called a "high ankle sprain"; do a squeeze test (squeeze tibia and fibula together at the level of the distal gastrocnemius belly); this will send forces along the intermembraneous membrane and the pt will experience pain; ALSO DO an EXTERNAL ROTATION TEST: pt. sitting with knee flexed to 90; externally rotate foot, pain at syndesmosis +
Name the test. When assessing the anterior talofibular ligament and the calcaneofibular ligaments (most commonly injured) do an drawer test that uses inversion rather than anterior pull.
Talar Tilt Test
Name the Ottawa Ankle Rules that determine when a foot should be imaged with x-ray.
X-rays are not necessary: 1) if the pt can walk 4 steps at the scene and 4 steps at the ER; 2)there is no tenderness at either malleolus; 3)there is no tenderness over the distal 6cm of the fibula
If there is bone tenderness over the navicular bone or the base of the metatarsal you should do what?
x-ray
if a person jumps from a 2 story building, what is a possible foot fracture?
calcaneal fracture
what is a associated with a calcaneal fracture in 10-15% of the cases?
lumbar spine fracture
what view of the foot should be taken to assess for a calcaneal fracture?
Harris axial view (knee flexed) -good for visualizing lateral fractures and horizontal fractures
If x-ray is negative and clinical suspicion is high, what should you do?
calculate the Bohler's angle - should be >20; if less= fracture present
what is the difference in a Jones fracture vs. a Pseudo-Jones Fracture?
Jones F= 5th metatarsal diaphysis is fractured (cast and non-weight bearing); Pseudo-Jones Fracture: avulsion fracture of the 5th metatarsal at insertion of the peroneus brevis tendon (walking boot, less serious)
Name the fracture that involves a mid-foot crush trauma. Treated with splint, analgesic, ortho consult.
LisFranc Fracture - commonly 2 metatarsal involved since it is the main stabilizer of the midfoot
______ are commonly seen on the soles of foot with the LisFranc fracture.
ecchymosis (bruise)
Name the Pediatric Classification system that describes fractures of the epiphyseal plate.
Salter-Harris Classification: Types I-V
Name the type. Fractures through the physis and extend proximally through the metaphysis.
Type II
Name the type. Fractures through the physis.
Type I
Name the type. Fractures are crush injuries to the physis and may be subtle on initial x-ray.
Type V
Name the type. Fractures through the physis with extension distally through the epiphysis.
Type III
Name the type. Fractures through metaphysis, physis, and epiphysis.
Type IV
What are the majority of children's fractures under the Salter-Harris Classification?
Type II: 75%; excellent prognosis, usually managed non-operatively
which types almost universally require operative fixation?
Type IV adn V (child may end up with leg discrepancies)