Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/114

Click to flip

114 Cards in this Set

  • Front
  • Back
Orthopedic Surgery Lecs 1-2- Intro and General Management of Fractures
Orthopedic Surgery Lecs 1-2- Intro and General Management of Fractures
3 "Structural" Fnctns of Bones?
Framework for body
Levers for Skeletal Muscles
Protection for Viscera
1 "Physiologic" Fnctns of Bones?
Storage of Ca & Phosphorus
When osteoblasts become embedded in the calcified matrix they then become what?
osteocytes
What types of cells are responsible for bone resorption?
osteclasts
2 types of bones and their morphological structure?
Cancellous - Spongy
Cortical - Compact
Bone lengthening takes place via what process?

Bone widening takes plce via what process?
Endochondral Ossification

Intramembranous Ossification
What is Wolff's Law?
Bone is deposited in the sites subjected to stress and is resorbed from sites where there is little stress
What are the 4 zones of the epiphyseal growth plate?
Zone of:
Germinal Cells
Young proliferating cartilage
Hypertrophic Cartilage
Calcifying Cartilage
What Type of Joint:
1) Held together by fibrous tissue?

2) Held together by cartilage and is seen in the skull?

3) Held together by cartilage that's obliterated by bone?

4) Held together by Cartilgae and is b/t the pubic bones?

5) Has Hyaline cartilage w/ a capsule and fluid?
1) Syndesmosis

2) Synchondrosis

3) Synostosis

4) Symphysis

5) Synovial
Define a fracture?
Break in the continuity of the bone
Fractures are ___ ____ injuries w/ _______
Fractures are SOFT TISSUE injuries w/ UNDERLYING BONE INVOLVEMENT
3 Most basic classifications of a fracture? (AKA: if you call him @ 3:00 in the AM, describe the fracture in these 3 terms)
What bone?
What part?
Fracture type?
Fracture:
Initial care consists of 2 things?

Along with splinting you can do what other 4 things? (RICES)
Correct malalignment
Splinting

Rest, Ice, Compression, Elevation, Splint
Fracture healing involves the formation of what?

When aligning the bone, be careful w/ "distraction." What is "distraction?
A Callous

Pulling the ends of the break apart too far --> slower healing
Do the following heal fast or slow:
Sub-Q bones like the clavicle?

Metaphyseal Fractures?

Open Fractures?

Spiral Fractures?
Long

Fast

Slow

Faster
Physician's Role In Fractures:

Physician Attempts to prevent _____ and NOT Prevent
Deformity
Natural Healing of the fracture
Does bone "healing" leave a scar?
No!
3 Benefits of a closed reduction?
No stripping of the periosteum
Dec Risk of Infxn
No Scar
3 Fnctns of a cast?
Immobilize
Allow Ambulation
Maintain Reduction
Post-Fracture Care:

Ice & _____

Observe for what?

You want to get what happening early?
Elevation

Compartment Syndrome:
Pain on passive stretching,
Sensory loss,
Tenseness of involved compartment,
Pain out of proportion,
Elbow injuries, high tibial fracts, metatarsal fracs

Early Motion!
X-rays may lag behind true "clinical" bone union by how long?
several weekls
When rehabing, you must keep the joint _____
mobile
Fractures in kids are almost always treated how?
Closed
Are sprains common or rare in kids?
RARE
2 Types of epiphyses in an epiphyseal plate? Where are they? Contribute to what?
Traction Epiphysis; Iliac Crest & Trochanters; Contour

Pressure Epiphysis: Ends of Long Bones; Longitudinal Growth
4 Zones in fractures?
Zone of:
Germinal cells
Proliferation
Hypertrophic Cartilge
Provisional Calcification
4 FRACTURE TYPES IN KIDS -->
LOTS OFCOMPLICATIONS!?!?
Supracondylar Frac of Humerus
Lat Condylar Frac of Humerus
Epiphyseal Fracs III, IV, V
Fradial head and neck Fracs
With above kids fractures, what should you do?
REFER!
FRACTURE TYPES IN ADULTS -->
LOTS OFCOMPLICATIONS!?!?

Bone Bones of Forearm
Displaced Single Forearm Bone
Displaced Malleolar Fracture
Displace Bimalleolar Fracture
Supracondylar or Intracondylar humerus
Displaced Olecranon
Displaced Radial Head
Fractured upper tibia
FRACTURE TYPES IN ADULTS -->
LOTS OFCOMPLICATIONS!?!?

Bone Bones of Forearm
Displaced Single Forearm Bone
Displaced Malleolar Fracture
Displace Bimalleolar Fracture
Supracondylar or Intracondylar humerus
Displaced Olecranon
Displaced Radial Head
Fractured upper tibia
KNOW THE SALTER-HARRIS CLASSIFICATION for PROGNOSIS of a FRACTURE
KNOW THE SALTER-HARRIS CLASSIFICATION for PROGNOSIS of a FRACTURE
4 Fracture type swhich should always be referred?
All open fracs
Intra-articular fracs
All femur fracs
Mostfractures of both bones of lower leg in adults
Orthopedic Surgery Lecs 3-4: The Hip & Thigh
Orthopedic Surgery Lecs 3-4: The Hip & Thigh
1) Immediate tx of Muscle Strain involves what?
1) CTL of pain and swelling w/ RICE (Rest, Ice, Compression, Elevation)
What are apophyseal avulsion injuries?
Injuries to muscle attachments -->
separation of the muscle from its attachment
Greater than 1cm Ischial avulsion OR 1-2 cm lesser trochanter avulsion may require what to prevent what?
May require surgery to prevent wewakness
FYI: A Contusion is a ____
Bruise
A contusion resulting from a "direct blow" to the iliac crest is called what?
An iliac crest "hip pointer"
3 s/s of an iliac crest "hip pointer?"
Tenderness, Ecchymosis, Muscle Spasm
Tx for iliac crest "hip pointer"?
Compression w/ ice
How does a person get a proximal thigh contusion?
When their muscle gets compressed b/t an external force and the underlying bone
What is the tx goal with a proximal thigh contusion?

Tx for prox thigh contusion?
Prevent lossof ROM and myositis ossificans

RICE in flexion w/ limited wt bearing until pt has pain-free ROM -->
stretching and strengthening exercises
What is myositis ossificans?

When should you tx MO?
When a deep contusion is "misinterpreted" by the body -->
contusion healing as a "fractuer-true ossification"

only when painful or when it interferes w/ ROM
Hip dislocation usually results from what 2 things?

In which direction does a hip usually dislocate?

How will a pt w/a posterior hip dislocation present?
High energy-MVA or contact sports

Posteriorly

w/ leg flexed, internally rotated and ADducted
Hip dislocation is assoc w/ what 4 complications?
Osteonecrosis
Neurovascular Injury
Post-Traumatic Arthritis
Associated Fractures (Femoral Head and Acetabulum)
What is a "labral tear"?

Pt will present w/ what type of pain?
Tear in the labrum of the hip

Groin pain
Stress Fractures:

Stress fractures are often seen in military recruits and athletes, it will often be seen in a triad of what 3 things in FEMALE athletes?

A missed Dx can lead to what 2 complications?

Pt will present w/ _____ pain upon axial loading, heel strike or single leg hop.
Triad of eating disorder, irregular menses AND stress fractures

Displacement and osteonecrosis

Groin pain
2 Types of stress fractures?

Which type is more stable?

Which type is less stable and tends to displace?

What is indicate to prevent displacement and osteonecrosis?
Compression Stress Fxs & Tension Stress Fxs

Compression Stress Fx

Tension Stress Fx

Surgery
Osteitis Pubis

Osteitis Pubis is the result of what?

c/o pain in _____ that radiates around hip and is exacerbated with kicking, jumping & running
Repetitive stress @ insertion of adductors and rectus abdominus

pubic region
Snapping Hip Syndrome

What are 2 types of Snapping hip syndrome?
External Variety SHS & Internal Variety SHS
SHS External Variety can be result of what 3 pathologies?

Often seen in who?

Dx w/ what test?
IT Band, Greater Troch Probs, Bursitis

Women w/ wider ips and runners on banked surfaces

Ober's
SHS Internal Variety

Result of dysfnctn of what?
Iliopsoas tendon
Slipped Capital Femoral Epiphysis

1) Common in what 3 groups of ppl?

2) YOU MUST r/o what?

3) May present w/ knee pain but ROTATION of _____ causes pain?

4) Pt will present in what position?

5) Tx?
1) Adolescents, AA, Obese

2) Hypothyroidism

3) Hip

4) flexed hip that externally rotates

5) Closed reduction and percutaneous screws
1) With a CAM impingement the pt develops a _____ alongthe superior lateral neck jnctn?

2) CAM Impingement may be due to what?

3) Pain in groing and Dec ROM may be reproduced by _____

4) Tx?

5) If due to DJD, you made need what?
1) Bump

2) Slipped Capital Femoral Epiphysis OR DJD

3) ABduction or flexion w/ internal rotation

4) Maintain flexibility, Injections to dec inflamm. Arthroscopic resection of bump.

THA
Gluteus Medius Tear

1) Gluteus medius tear will lead to ____ hip pain that is tender to palpation over the ____.

2) Motion in this direction will be restricted?
1) lateral; greater trochanter

2) ABduction
Osteoarthritis of the hip:

1) Pt c/o what?

2) May also have pain in what 2 areas?

3) What 2 signs / Tests will be positive?

4) 2 Surgical options?
A) You would only use the arthodesis when?
1) stiffness upon walking that improves w/ "warm up period" then gradually worsens as day progresses

2) thigh or knee pain

3) Trendelengerg's Sign and Patrick Febrere

4) Total Hip Arthroplasty and arthodesis
A) If THA is CI
1) Avascular necrosis of the hip usually only involves what?

2) 2 things you want to do in PE?

3) What's the Tx goal?
1) Femoral Head

2) ROM, Patrick Fabrere

3) To prevent femoral head collapse
Bursitis

1) 2 Types hip bursitis?
1) Greater trochanteric bursitis
Ischial tuberosity bursitis
Nerve Entrapment

1) Upper lumbar nerves supply sensation to where?

2) Lower lumbar and sacral nerves refer pain to where?

3) Pudendal nerve cyclistsm is result of what?

4) Meralgia Paresthetica is the result of entrapment of what nerve?

5) Tx these with?
1) Anterior Thigh

2) Buttocks and post thigh

3) Compression from a seat

4) Lateral Femoral cutaneous nerve

5) Steroid Injection
1) Fractures of the hip are almost alwaus assoc w/ what?

2) In Elderly women, what is the MC cause of hip fractures?
1) Trauma

2) Osteoperosis
TEST QUESTION!!!!!!!!!!!!!!!!!!!!!!!!

Females who fall and break hip:

1) If age 65-69 their chance of dying in 1 yr increases by how much?

2) If age 70-80, their chance of dying in 1 yr increases by how much?

3) If 80 + their chance of dying in 1 yr increases by how much?
1) 5X

2) 3X

3) 2X
Hip fractures usually lead to how much blood loss?
2-3 units
The MAJOR complication of hip fracture is what?
DVT
1) What are the 2 major types of hip fractures?
1) Intracapsular: Femoral Neck or Subcapital

Intertrochanteric
Lecs 7-8: Foot & Ankle
Lecs 7-8: Foot & Ankle
1) The ankle is what type of joint?

2) The ankle joint is composed of what 3 bones?

3) Talus is what shape?

4) Which part of Talus is wider?
1) Synovial Joint

2) Tibia, Fibula, Talus

3) Rhomboid

4) Anterior part of talus is wider
1) Ankle sprains are usually in what direction?

2) Which 2 ligaments usually have damage?
1) Lateral inversion injury

2) ATF (ant talo-fibular) and IFC
The Ottawa Ankle Rules tell you what?
When you should get an ankle X-ray
The Ottawa Ankle Rules say that you should get an x-ray if you have Ankle Pain + 1 of the following 3:

_____


_____


______
tender along distal 6 cm of post tibia or tip of medial malleolus

tender alon distal 6 cm of post fibula or lat malleolus

can't bear wt for 4 steps
Ankle Sprain

To differentiate fracture from strain, what should you do?

What test(s) should you perform?
palpate the mealleoli and ligs

Ant Drawer and squeeze test (for high ankle sprain)
Ankle Injury

1 "interesting" tx?
Contrast baths (cold --> walk --> warm --> walk --> cold...repeat)
Ankle dislocation is usually assoc w/ what?


What determines tx for dislocated ankle?

Although rare, a serious complication of total talor dislocation is what?

For a total talor dislocation, what must you do IMMEDIATELY?
Fx

Whether or not Fx is present

AVN (Avascular Necrosis)

Reduce
What is Cuboid Syndrome?
Cuboid is plantar flexed
What is MC nerve entrapment of foot?

What nerve?

If tarsal tunnel syndrome accompanied by chronic burning pain, what should you also consider?

What sign will be positive for what nerve?
Tarsal Tunnel Syndrome

Posterior Tibial

Diabetic NEuropathy and RSD

Tinel's; Post tibial nerve
Superficial peroneal nerve entrapment may mimic what other cond'n?
Compartment Syndrome
Jogger's foot is entrapment of what nerve? where?
Plantar nerve @ master knot of Henry
What is morton's Neuroma?

Where is it?
Perineurial fibrosis of the common digital nerve

3rd Intermetatarsal space
Achilles Tendonitis

1) Positive or negative Thompsons?

2) Assoc w/ what deformity?
1) Negative (Duh! It's just tendonitis)

2) Haglund's Deformity
Achilles Rupture

1) What part of the gait cycle is not possible?

2) What test will be positive?

3) Active ppl, such as athletes, should have what Tx?
1) Toe off

2) Thompson's

3) Surgery
What is plantar fasciitis?

When is pain the worst?

Pain is NOT caused by what?
Pain in plant part of heel and medial longitudinal arch

Early AM when first waking up

Calcaneal "heel" spur
Bunion

What is a bunion?

Seen in ppl who's ____ are too narrow

Although shoe modification is the best first step, what is the surgical procedure that can be done?
Lateral Deviation fo great toe @ MP Jt

shoes

Distal Osteotomy (Hallux Valgus Angle < 30degrees, IM angle < 14) or Proximal Osteotomy (Hallux Valgus Angle > 30 degrees, IM angle > 14)
What is a bunionette?
Deformity of 5th MP jt
What is Hallux Rigidus?

ROM will be decresed in which direction?
Degenerative Joint Dz of 1st MP joint of foot

Dorsiflexion
Hammertoe

What is hammertoe?

If it can be passively corrected it is considered what?

If it CANNOT be passively corrected it is considered what?
Deformity of lesser toe of which there is flexion of the PIP and ext of MP Jts

Fixed

Flexible
Frieberg's Dz:

What is Friebderg's Dz?
Avascular NEcrosis of 2nd Metatarsal HEad
Ankle Fxs:

Any displacement into the articulation of the ankle mortise needs to be reduced to the ______


Any widening of the mortise needs to be reduced to normal and stabilized with a _____ syndesmotic screw
anatomic position

Tibiofibular
WHEN IT COMES TO A DISPLACED ANKLE FX, YOU MUST OBTAIN HOW MANY VIEWS ON X-RAY?

Most cases of a dispalced ankle fx require what?
3 Views

ORIF
1 common complication of a talus fx is what?

When you have a fracture of the calcaneus you should always do a urinarlysis to check for hematuria, why?

ALWAYS X-RAY _________ IN A CALCANEAL FX BC OF AN INCREASED CHANCE OF COMPRESSION FX?
Avascular Necrosis

Increased risk of kidney contusion

Lumbar Spine
Metatarsal Fx are usualyl result of compression injury @ what location?
On top of foot
Subluxation of Radial Head

1) Result of what action?

2) How do kids present?
1) Pulling on child's arm (like when swinging them by the hands) when the arm is extended and pronated

2) Holds arm against their body, flexed and pronated @ elbow (like in a sling)
In what type of Fx do you need to beware of the Lis Franc and Tarso-Metatarsal Jts?
Metatarsal Fx
What are 5 Congenital Deletions
Streeter's Dysplasia: Amniotic bands / rings around the UE
Congenital Amputations: Born without UE
Aplasia & Hypoplasia: UE That didn't form
Phocomelia: Develop "hands" but not proximal limbs
Mal-rotation of a digit
AND
Displaced Prox phalanx of big toe
AND
Intra-Articular Fx of prox phalanx of big toe are both fractures of the _____ that req ORIF?

For fx of the phalanges, is much tx needed, apart from buddy taping?
Phalanges

No
congenital Elevation of Scapula
Sprengle's Deformity
Congenital Absence of clavicle

1) Usually unilat or BL?

2) Hypermobility of _____
1) Bilat

2) Shoulders
Congenital Radidal-Ulcar Synostosis

Failure of what 2 bones to separate?

Cannot perform what 2 actions?
Radius and Ulna

Pronation and supination
Trigger Thumb

Trigger thumb --> Inability to perform what action?

How to tx?
Extend Interphalangeal Joint of thumb (Like kid "Shooting" with a finger gun)

Release of A1 Pulley
What is Syndactyly?

What is Polydactyly?
Fused / Webbed Digits

Extra Fingers
Congenital Dislocation of Radial Head

The elbow will have what deformity?

Restriction of mvt in which 2 directions?
Varus (normally elbow is valgus)

Supination and Pronation
Fracture of the Radial Head

1) Requires what Type of procedure that you USUALLY DO NOT do in a child?

2) You Must Recognize this _______
1) ORIF

2) EARLY
Subluxation of Radial Head

1) Pt will have tederness over the ____ and resistance to _____

2) X-Rays are normalyl _____

3) When you place thumb over radial head and supinate and flex elbow with other hand, you will feel a click which means that you have done what?

4) Which ligament has to "slip" back into normal position?
1) Radial Head; attempted supination

2) Negative

3) Reduced it

4) Annular Ligament
If a radial head subluxation recurs after its been reduced, it may require what?
Immobiliation for 2-3 wks in a long arm cast
2 Types of Supracondylar Fracs of Humerus?
Non-Displaced
Displaced
If it's a displaced supracondylar fracture of the humerus, is it an emergency?
YES! - It can lead to Volkman's Contracture! (Claw Hand!)
Fx of UE

1) Remember, sprains in kids are what?

2) MC Fx in kids?
1) Rare

2) Colles Fx
Lec 9: Pediatric UE
Lec 9: Pediatric UE
Lec 10-11: The Spine
Lec 10-11: The Spine
THE CARDS FOR THIS LECS ARE BASED OFF OF WHAT HE SAID WILL DEF BE TEST QUES, SO KNOW THESE!!!!
THE CARDS FOR THIS LECS ARE BASED OFF OF WHAT HE SAID WILL DEF BE TEST QUES, SO KNOW THESE!!!!
In a potential Cervical Fx Situation, what is the 1st test you should order?
A LATERAL C-SPINE THAT SHOWS ALL 7 Cervical vertvebrae from occiput down to and including top of T1
3 Atypical Vertebrae in the C-Spine?
C1, C2, C7
The Vertebral discs get their blood supply from where?
From the bony vertebral body! (They don't have their own blood supply!)
Spinal stenosis is ______ or ______ narrowing of the _____

Spinal Stenosis Usually gets worse with _____

Spinal Stenosis is assoc w/ ____ onset of neurogenic ______ and occasionally neurogenic ______
Congenital; Acquired; Spinal Canal

age

Insidious; Claudication; Leg Pain
Spinal Stenosis - Clinical Sx

1) Low back pain and leg pain will get worse w/ what?

2) Low back pain and leg pain will get better w/ what?

3) 3 Leg Sx of Spinal Stenosis?

4) How is pseudoclaudication different from vascular claudication?
1) Spine extension when walking, standing, supine

2) Flexion of the spine (Sitting, Stooping, bending forward

3) Weakness, Pain, Pseudoclaudication

4) Pseudoclaudication reovers quickly with sitting or spinal flexion
With spinal stenossi Sx can be reproduced by walking on a ______, in a typical ______


Can more than one nerve root be involved in spinal stenosis?
treadmill; nerve root pattern


Yes