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