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80 Cards in this Set

  • Front
  • Back
Describe the clinical presentation of coccyx fx's and how they are tx
Sx: px tenderness over sacral region, px during rectal exam. Female > male. Tx: rest, sitz baths, cusions, stool softners, rarely surgery
Discuss the most serious complications of pelvic fx's including mortality and morbidity rates
hemorrhage; retroperitoneal bleeding common cause of death. agressive resuscitation, stabilization. Other complications: GU, rectal, diaphragm and nerve root injury
Discribe Sx, exam and radiographic findings for non-displaced femoral neck fx's and how tx
Sx: moderate px in groin inner thigh, may ambulate. may not be visible on XR. Tx: consult, reduce and stable
Discribe Sx, exam and radiographic findings for displaced femoral neck fx's and how tx
Sx: severe px in groin inner thigh, non-ambulatory. PE: slight external rotation, abduction and shortening. XR obvious. Tx: surgery
What is the most common MOI for a femoral shaft fx. PE, complications and Tx.
MOI: fall, MVC, GSW. PE: shortening, relief px with traction. Complications: neurovascular compromise, infection. Tx: surgery
Explain when CT would be a better imaging technique over MRI for pelvic trauma. When is MRI better?
CT: posterior pelvic arch, acetabulum and assessing hemorrhage, soft tissue. MRI: occult hip fx
Define occlut hip fx and most appropriate imaging technique
Obscure, or doesn't show up with normal XR but still suspicious of fx: MRI
Discuss incidence, MOI and of isolated fibula fx's
Most associated with tibia fx. MOI: isolated = direct blow, proximal = external rotation, distal = internal rotation
What causes an isolated fibula fx
direct blow
What causes a proximal fibula fx
external rotation
what causes a distal fibula fx
internal rotation
Understand the complications associated with tibial fx's and what criteria affect outcome.
Comp: severe injury can result in amputation. Criteria: health of pt, pattern of fx line, # of fragments, fibula intact, soft tissue dammage, contamination, vascular compromise
Whatis the treatment goal for tibial fx's
avoid infection, obtain bone union andrestore function
Describe MOI, Sx, PE, Dx and Tx for achilles tendon ruptures
MOI: forceful plantar flexion. Sx: popping @ time of injury, diff ambulating. PE: dent @ site with palp. Dx: Thomson-Doherty test. Tx: Robert-Jones splint & referral
Explain MOI, Dx, Tx for ruptured gastrocnemius
MOI: forceful plantar flexion w/extended knee, fall. Dx: px plantar flexion, calf tender, swollen or bruised. Tx: immobilize, crutches, ice
Discuss how patella fx's normally present and identify the most common type of fx and tx
Transverse most common, likely displaced. Direct blow. PE: displaced extensor mechanism. Dx: straight leg raise. Tx: Knee immobilizer, ice, elevate, NSAIDS/opioid referral
Explain how a dislocated patella presents and how it can be reduced
PE: displaced laterally over condyle resulting in px and deformity of knee. Tx: reduce by sedation, flex hip, hyperextend knee and slide patella back in place
Describe hx MOI, PE of quadriceps or patella tendon rupture and Tx
Hx: tendonitis or steroids. MOI: fall on flexed knee or forceful contraction of quads. PE: unable to extend, swelling, high-riding patella on XR. Tx: consult surgery
Discuss MOI, PE, Dx and Tx for medial collateral ligament (MCL) sprains and tears.
MOI: abduction, flexion and internal rotation. PE: laxity. Dx: Varus test w/leg extended then flexed 30*. Tx: immob., ice, elev, NSAIDS, gentle ROM
Discuss MOI, PE, Dx and Tx for lateral collateral ligament (LCL) sprains and tears.
MOI: not as common as MCL injuries, adduction, flexion external rotation. PE: laxity. Look for PCL injury. Dx: varus test w/leg extended then 30* flexed. Tx: immob., ice, elev, NSAIDS, gentle ROM
Discuss MOI, PE, Dx, and Tx for anterior cruciate ligament(ACL) tear.
MOI: cutting, squatting twisting. PE: locking on flexion or extension, px, effusion, limited mob., Dx: McMurry's, +Lochman. Tx: Surgery
Discuss MOI, Tx for medial ligament strain
MOI: abduction, flexion and internal rotation. Tx: immob., ice, elev, NSAIDS gentle ROM
Discuss MOI, Tx for lateral ligament strain
MOI: adduction, flexion and external rotation. Tx: immob., ice, elev, NSAIDS, gentle ROM
Outline the Ottawa Ankle Rules for ankle injureis and discuss their utility in medical decision making
>18yo; helps identify if and which radiographs are necessary by dividing foot into zones.
In what "zone" in the Ottawa rules requires ankle radiographs if a pt has px there
malleolar zone with bone tenderness or inability to bear weight
In what "zone" in the Ottawa rules requires foot radiographes if a pt has px there
midfoot zone, bone tenderness or px or unable to bear weight
Discuss the treatment options for uncomplicated ankle fx's
all fx of ankle w/exception of fibular avulsion fx require immob by cast or ORIF and subsequent casting
List types of ankle injuries that require immediate orthopedic consultation
All open fx's, all fx dislocations, all dislocations, all trimalleolar fx, all bimalleolar fx, unstable unimalleolar fx, pediatric salter III, IV, V, maisonneuve fx
Discuss the kind of injuries that can be complicated by avascular necrosis
Bl supply to ft is tenuous. Major fx's of talus and subtalar dislocations are complicated by avascular necrosis. Base of 2nd metatarsal is key-stone of Lisfranc complex and must be Tx with caution
Identify the MOI for calcaneal fx and the associated injuries that often accompany them
MOI: axial load to heel by fall from ht. Associated: vertebral, forearm other lower extremity fx's
Identify MOI of Lisfrance joint injuryies and fx's associated with disruption of the ligament complex. What radiographic findings would help Dx
MOI: high energy, usually tarsal / metatarsal fx or dislocation. Weight bearing XR show gaps between 1st-2nd metatarsals. Tx: surgery
What is a divergent lisfranc injury
metatarsals slayed in both medial and lateral directions usually between 1st and 2nd metatarsals
What is an isolated lisfrance dislocation
1+ metatarsals displaced from the rest
What is a hemolateral lisfranc dislocation
all 5 metatarsals are displaced in same direction either laterally or medially
What are sx of lisfranc injuries
anatomic deformity or variable px with weight bearing, plantar midfoot eccymosis, midfoot instability
What is MOI, PE, Dx and Tx for a nondisplaced metatarsal shaft fracture
MOI: crush or twisting, 5th metatarsal avulsion most common. Can have "march" fx from overuse of 2nd-3rd metatarsal. Dx: XR Tx: ice, immob, elev, analgesia, rigit flat ortho shoe
What is MOI, PE, Dx and Tx for a Jones fracture
MOI: twist, less common but more problematic, occurs transversely at base of 5th metatarsal typically from acute injury. Dx: XR. Tx: nonoperative if min. displaced, surgey for displaced
What is PE, Dx, and Tx for nondisplaced phalangeal fractures
Most commonly 1st phalange or great toe, Dx: XR. Tx: rest, ice, analgesia, hard-soled shoe with buddy tape
What are 3 common kinds of fx's
1. pathological 2. stress 3. salter
List the types of fx's and type of classifications used
Open, closed, fx's: Gustillio's uses a I, II, III type scale to classify open fx's. Type III is subdivided into A,B,C
Define dislocation
articular surfaces are totally out of contact with each other
Define subluxation
articular surfaces only partially out of contact
Define non-articular fx
No joint invovement. minimal chance of degenerative arthritis, no complelling need for early motion
Define intra-articular fx
Joint involvement. good chance of degenerative arthritis, early motion essential.
Define diaphysial fx
mid-shaft, hard cortical bone, may have difficulty healing
Define metaphyseal fx
near end of long bones, spongy cancellous bone, better healing
Define epiphyseal fx
anatomic end of bone (growth plate) fastest healing
Name 5 fx patterns and typical MOI with each
1. transverse: direct blow 2. Oblique: direct or indirect 3. Spiral: twisting 4. Comminuted: more than 2 pieces, extremem direct force 5. Greenstick / buckle: incomplete fx usually in kids
What is a salter I fx
Entire epiphysis
What is a salter II fx
entire epiphysis with a portion of metaphysis
What is a salter III fx
portion of epiphysis
What is a salter IV fx
portion of epiphysis with portion of metaphysis
What is a salter V fx
nothing "broken off" compression injury of epiphyseal plate
What is a long arm ulnar gutter splint used for
injuries to elbow, radial head fx's, nondisplaced supracondylar humeral fx's and reduced dislocation of elbow
What is sugar tong splints used for
fx of wrist or distal forearm.
What is short arm gutter splint used for
fx's of proximal phalnx of ring or little finger, 4th-5th metacarpal, boxer's fx,
What is a thumb spica splint used for
immobilizes wrist and thumb for fx's of scaphoid or thumb metacarpal or proximal phalanx
What is a knee immobilizer used for
fx's of lateral or medial tibial plateau, patella fx, meniscal injuries, ligamentous strains or tears
What is posterior ankle splint used for
ankle sprains, stable fx's,
What is a inflatable ankle stirrup used for
ankle sprains and small avulstion fx's.
What are the 5 "P's" that might indicate comPartment syndrome?
Pain, pallor, paralysis, pulselessness and paresthesias
What does Finklestein's test for
DeQuervain's tenosynovitis: flex and ulnar deviate wrist
What does the Grind test for
1st CMC arthritis: stabilize MCP joint and abduct thumb away from index finger
What does Phalen's test for
carpal tunnel syndrome: compress dorsum of both hands together with wrists flexed at 90*
What does Tinel's sign test for
carpal tunnel: supinated wrist and tap briskly over median nerve
What does Compression test for
carpal tunnel: press firmly over space between flexor carpi radialis nad palmarus longus tendons at distal flexor crease of wrist
What is the thompson test for
achilles rupture: gently squeeze mid calf and look for plantar flexion of foot.
What is the FABER test for
SI joint: flexion abduction and external rotation of hip/leg
What is the straight leg rais SLR test for
radicular pain
What is the Hoover test for
What is the reverse straight leg raise for
femoral nerve and nerve root L2-L4 px
What is McMurry's test for
meniscus injuries
What is acromioclavicular stress test for
rotator cuff:
What is neer test for
What is the painful arc test for
What is the drop arm test for
rotator cuff tears
What is the apprehension test for
shoulder instability: rotator cuff tears
What is speeds test for
biceps tendonitis
What is hawkins test for