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310 Cards in this Set
- Front
- Back
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What are the three primary signs and symptoms of orthopedic disease/injuries?
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pain, stiffness, i nstability
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What is Finkelstein's test?
What does it test for? |
Pt grasps thumb in the palm of their hand and the provider ulnar deviates the thumb and hand. Look for pain along extensor and abductor pollicis
deQeurvains synovitis |
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What is Tinel's Sign?
What does it test for? |
examiner tap the velar aspect of the wrist over the median nerve of medial elbow over the ulnar nerve. This reproduces paresthesias over nerve distributions.
Carpel tunnel |
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What is Phalen's sign?
What does it test for? |
involves flexing the wrist maximally and holding it for at least 1 min. will reproduce numbness and tingling along median nerve distribution
carpel tunnel |
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Athrodesis is....
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surgical prices that promotes bone growth across joints
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Closed fractures are....
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fractures of a bone in which the surrounding skin remains intact
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Closed reduction is....
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normal bone/joint relationship is restored with our the necessity of an incision
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Open fracture is...
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fracture of a bone that communicates with the air through a disruption in the skin
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Open reduction is...
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normal bone/joint relationship is restored through a surgical approach
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What is acute compartment syndrome?
Conisered a medical emergency because.... |
bleeding into a closed muscle compartment to the extent that perfusion of muscle and nerve tissue decreases to a level inadequate to sustain the viability of the tissues;
necrosis of muscle and nerve tissue can occur within 4-8 hours |
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What are the areas most commonly affected by compartment syndrome?
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volar aspect of the forearm and the anterior compartment of the leg
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What 4 things can happen from untreated compartment syndrome?
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tissue necrosis, secondary muscle paralysis, muscle contracutre and sensory impairment
(Volkmann's ischemic contracture: Claw hand or foot) |
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What are the characteristic '3 P's' associated with compartment syndrome?
What else may be experienced? |
Pain, parethesia, paralysis;
intractable pain and sensory hypoesthesia distal to involved compartment |
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What is the most important physical sign of compartment syndrome?
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extreme pain on stretching the long muscles that run through that compartment
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______ is usually present in compartment syndrome.
If a pt is wearing a cast or splint and you suspect CS, you need to..... |
edema;
remove it!! |
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How do you dx compartment syndrome?
(diastolic pressure)-(intra-compartmental pressure) should be less than or equal to _______. |
manometric measurement of intra-compartmental pressure
20 mmHg |
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Pulselessness indicates ______ and NOT compartment sydnrome
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arterial injury
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What is the treatment for compartment syndrome?
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surgical fasciotomy of affected compartment until edema subsides along with elevation (but not excessive elevation)
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Why do you want to avoid excessive elevation in treating compartment syndrome?
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it can reduce the hydrostatic pressure and may lower arterial pressure enough to decrease compartment perfusion
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What are the typical presenting complaints of bone tumors?
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mild pain and persistent swelling over the affected area
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Chronic pain that prevents pt from sleeping can be characteristic of both ____ and ____ bone tumors as well as a lot of other conditions/tumors.
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malignant and benign
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Fever, malaise, weakenss and other constitutional symptoms can occur with _________ (which type of bone tumor)?
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ewings sarcoma
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Weakness and anemia often accompany ____ (which type of born tumor/condition)?
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multiple myeloma
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More often than not, bone tumors present or have __________
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pathological fractures
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When diagnosing bone tumors, the physical exam should focus on identifying....
In pts over 40, careful exam of _____ and _____ can help rule out primary cancer. |
masses, boney tenderness, joint involvement, reduced ROM, limping or deformities;
prostate; breasts |
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What can ID lytic/blastic lesions and contained/extended lesions?
What are the three views used? |
Plain film radiography;
AP, lateral and oblique |
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_____ studies can help determine if there are other lesions besides the primary one
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Radioisotope
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What is the best way to ID boney changes and lesions elsewhere such as the chest, abdomen, etc that may be present with bone tumors?
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CT!
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If looking for metastasis of bone tumors, want to use...
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radioisotopes or bone scans
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MRI scans are helpful in delineating _______ and _____ involvement (from bone tumors) as well as......
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soft tissue lesions, marrow involvement;
staging lesions |
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What is the definitive dx procedure for ID'ing bone tumors?
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biopsy
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How do you treat benign bone tumors/lesions?
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observation and followup. Surgery needed if lesion is lg or risk of pathological fracture
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How do you treat malignant bone tumors/lesions?
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surgery with radiation and chemo depending on tumor type and staging
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Cumulative trauma disorder is.......
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an umbrella term that encompasses specific terms such as carpel tunnel syndrome, epicondylitis, flexor tendinitis, and generalized myofascial pain
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CTD can be caused or aggravated by _____ or ________of a specific body part. Other aggravating factors include ____, _____ or _____
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repetitive motion; sustained exertion;
vibration, cold, awkward postures |
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Symptoms associated with CTD are usually _____ in onset without a history of ________.
Typical complaints include: (3) Symptoms tend to be difficult to _____ and often the site of pathology is not where....... |
insidious; trauma;
pain, fatigue, numbness; pinpoint to a specific area; the pain is felt |
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Positive Phalen's test and weakness in the opponens muscle indicate:
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carpel tunnel
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Positive Finkelstein's test with local tenderness and swelling=
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deQuervains tenosynovitis
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Tinel's sign at the medial elbow and numbness at the ulnar side of the fingers indicates.....
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ulnar nerve entrapement
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Callus on a bone that is seen on X ray is an indication of....
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a fracture that is healing
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Initial treatment of CTD disorders includes ______. Want to avoid ____.
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RICE (rest, ice, compression, elevation)
narcotics |
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Stress fractures are....
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microscopic fractures often not initially detected by X ray
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Torus fractures occur mostly in ___ bone and shows a __________ with no visible _______.
It buckles but doesn't ____. |
young;
buckling of the affected bone cortex; fracture break |
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Greenstick fractures are just like torus fractures except.....
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there will be a break in one side of the bone (and just bending of the other)
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Intra-articular fractures are fractures that cross the ______ and involve the _______
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articular cartilage; joint
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Displaced fractures are expressed in ____ or ____ in the direction of the displacement of the distal fragment
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mm, cm
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Nondisplaced fractures have no.....
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displacement/are still aligned
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Angulated fractures are expressed in degrees of the direction of the _____
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apex
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Comminuted fractures have ....
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more than 1 piece of bone at the fracture site
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Compression fractures are _____ or _______
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impacted; compressed
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Linear fractures are ______ fractures along the axis of the bone
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straight line
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Segmental fractures are....
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two or more fractures in a single bone
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Oblique fractures have fractures at a _____ across the bone.
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angle
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Spiral fractures are fractures that _____ don't he axis of the bone.
Seen a lot in kids and want to think about _____! |
twist;
child abuse |
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Transverse fractures are fractures that go...
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straight across a bone
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What are the 4 common symptoms and signs of fractures?
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swelling, tenderness, pain and deformity
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Stress fractures will usually cause pain on ____ and have ____ swelling
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weight bearing; mild
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Non-displaced fractures will have ____ and ____ but no _____
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pain; swelling; angulation
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If you suspect a fracture, what must you check?
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pulses and muscle/nerve function proximal and distal to the fracture site
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How do you dx a fracture?
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X rays (except stress fractures)
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What is the principle goal of fracture treatment?
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union, especially in wt bearing bones; preserve function of joints; restoring alignment; preserving bone length
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What is the first step in treatment of a fracture?
Second step? |
reduction;
fixation |
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What three things do you need to take into consideration when treating fractures?
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compartment syndrome, infection, nonunion
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Intra-articular injections are typically used in treatment of _________
Some can be absorbed _____. Don't want to give more than ____ per joint per year because they can.... |
chronic inflammatory diseases;
systemically; 2; erode the joint |
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What is the most common dz that you treat with intra-articular injections?
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RA
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Intra-articular injections can be very helpful with pts with ______ who have comorbid conditions and/or allergies that prohibit use of systemic meds.
This is only short term and you need to...... |
gout;
address the disease process itself |
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Which two tendons do you NOT want to inject intra-articular steroids into?
This is because if there is already pain in these tendons, it may indicate _____ and the steroids can... |
patella and achilles;
tears; make them worse or cause them to rupture |
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Improper use of injections includes: (4)
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to tx acute trauma;
Injection directly into tendon or nerve; injection into an injected joint, tendon or bursa, multiple injections in conditions other than RA |
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Osteoporosis is a skeletal disorder characterized by....
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compromised bone strength predisposing to an increased risk of fractures (pathological)
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Bone strength = bone _____ + bone _____
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density; quality
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Bone density=
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grams of mineral/area (volume)
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Bone quality includes: (4)
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architecture, turnover, damage accumulation and mineralization
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Osteopenia is defined as...
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lower than normal bone density (BMD) but not low enough to be considered osteoporosis
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What is the preferred diagnostic test for determining bone mineral density?
This measures bone density at the ___ or ____ and gives very precise results while emitting very low radiation |
dual energy X ray absorptiometry (DEXA scan);
hip or spine |
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What is another test that can determine BMD but emits much more radiation?
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quantitative CT scan
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DEXA scan results are given in ___ scores and ____ scores.
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T; Z
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T scores compare your BMD with....
Z scores compare your BMD with... |
healthy young women;
other people at your age, gender and race |
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Normal BMD is within ______ of the young adult mean.
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+/- 1SD
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Osteopenia BMD is between _______ below the young adult mean
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- 1.5 to 2.5
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Osteoporosis BMD is more than ____ below the young adult mean
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-2.5
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Severe osteoporosis is defined as a BMD below ______ and ________ has occurred.
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-2.5; one or more broken bones
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N-telopeptide measures ......
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bone turnover
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Which medications increased the risk of osteoporosis?
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heparin; dilantin, phenobarbitol (anticonvulsants); corticosteroids
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Corticosteroid use in young people can cause ____
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AVN
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There are rarely sx of osteoporosis before fractures occur but the following three things are associated with OP.
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cracking (stress on long bones), overt fractures, and compression (vertebral collapse)
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Ultimate goal for tx of Osteoporosis is.....
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prevention of fractures by increasing or maintaining BMD and strength
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Early detection and timely tx of people with decreased BMD can...
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substantially decrease the risk of fractures= first line treatment is prevetion
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What are three things you can do to help prevent osteoporosis?
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make sure to have adequate nutritional intake and calcium intake, VitD supplements if necessary and exercise
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What are some lifestyle changes recommended to all pts with OPenia and OPorosis?
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stop smoking, curtail excessive alcohol consumption, exercise, balanced diet with adequate calcium and vit D
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You do not want to exceed ____mg/day of calcium because it won't be _____
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2000; absorbed
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How much calcium should you give kids less than 10? teenagers?
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800; 1200
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How much calcium should you give pregnant and nursing mothers?
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1200-1500
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How much calcium should you give men, premeno women and postmeno women on E?
Postmeno women not on E? |
1000; 1500
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Calcium carbonate salt tablets: 1250 mg of caltrate, Os-Cal and Tums contain ____ . _____ and _____ mg of calcium respectively
It is best to divide doses into ___ or ___ dosing because .... If these cannot be tolerated due to side effects ____ can be tried; |
600; 500; 500;
BID; TID; the intestines may not be able to absorb all 500 at one time; calcium citrate (citracal) |
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What re some side effects of calcium carbonate?
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indigestion, constipation
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How much Vit D should men and women over 71 get?
Women in all other age groups? Infants under 12 mo of age? |
800; 600; 400
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Antiresorptive agents function to decrease....
They include ..... |
removal of calcium from bones;
bisphosphonates |
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What are the 4 bisphosphonates commonly used for treatment of OP?
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alendronate, risedronate, ibandronate, zolendronate
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Which two bisphosphonates require oral dosage only?
Which can be given through IV or oral doses? Which is IV only? |
alenronate, risendronate;
ibandronate; zolendronate |
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Bisphosphonates should be taken on a ___ stomach with at least 8 oz of _____
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emtpy; water
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Selective estrogen receptor modulators act like ___ on the bone but has _____ effects on the uterus.
Does have the side effects of ____ and ____ like estrogen Very effective in preventing ______ in postmeno women with OP. _________ is approved for tx of OPorosis NOT OPenia |
estrogen; antiestrogen;
DVT; PE; spinal fractures; Raloxifene |
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Calcitonin is a hormone approved that can be dosed ___, _____ or _____
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IM, subcue, intranasally
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Teriparatide is a synthetic version of human _____ which helps regulate calcium metabolism
Administered ______ |
PTH; subcue
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Denosumab is an _____ that blocks a chemical messenger that plays a role in promoting bone thinning
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IV infusible Ab
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____ scans should not be done for followup in pts with OPorosis instead, should monitor patients ____ and ____, _____ and ______
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DEXA;
signs; symptoms; side effects; labs |
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Men can be affected by OPorosis most likely due to...
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a decrease in serum testosterone
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Paget's disease is a chronic condition of bone characterized by....
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disorder of the normal bone remodeling process
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Because of the asynchronous bone remodeling in Paget's disease, bone that is formed is abnormally ______, not as ___ and is _____ and prone to ______
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enlarged; dense; brittle; fractures
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Paget's disease is also known as ________
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osteitis deformans
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Paget's disease affects mostly _______, men ____ than women.
Extremely rare form can affect kids= |
adults; more;
juvenile paget's disease |
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What is the cause of Paget's disease?
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unknown
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It is felt that people with genetic defect may need a ___ trigger to start Paget's disease because ______ has been identified within the bone cels of pts
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viral; paramyxovirus nucleocapsid
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Typically there are no symptoms with Paget's disease unless there is ___ or ___ pain due to significant ____, _____ or _____
Disease is usually discovered incidentally when...... |
bone; joint; deformity, fracture, arthritis;
X-raying for other reasons; |
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What are the bones most commonly affected by Paget's disease?
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spine, femur, pelvis, skull, clavicle, humerus
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Enlarged bones in Paget's disease can.........causing pain.
Bowing of the legs can occur involving the knee and hip joints leading to ____,___ ,____, and ____ What can occur when skull bones are affected? Very widespread disease can lead to....... |
encroach on and pinch nerves;
arthritis; limping; pain and stiffness; headache, loss of vision and hearing; CHF |
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What is the best scan to show the extent of Paget's disease?
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Bone scan
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______ is frequently elevated in pts with Paget's disease
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serum alkaline phosphatase (enzyme from bone metabolism)
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SAP becomes a marker used to_____________ once dz is diagnosed.
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monitor effectiveness of treatment
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Goal of the treatment of Paget's disease is directed at....
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controlling disease activity and managing its complications
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Mild/quiet Paget's disease (no sx) treatment includes:
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nothing
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What is the mainstay of treatment for Paget's disease?
What can also be used? |
Oral or injectable bishosphonate drugs
calcitonin and plicamycin |
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Antineoplastic drugs have been used to treat ____ in Paget's disease.
Ex. of drug= |
hypercalcemia;
Plicamycin |
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Flat foot is the loss of the.....
Is normal in children up to _____ due to the presence of _________. What are the two types? |
medial longitudinal arch;
2; longitudinal fat pad; flexible; rigid |
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Flexible flat foot is a ___ disorder that is seen in both adults and children. Often ______.
Heels will be _____ with weight on the ______. Symptoms include ___, ____ and______ . Treatment= |
benign; hereditary;
everted; big toe; pain, burning, easy fatigability (vary); none/controversial. Usually go away with age |
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Rigid flat food is not passively _____ and is present with or without __________.
Associated with tarsal coalitions such as _____________. Results in a loss of______ in the hind foot causing protective spasm in _____ muscles. Symptoms include a ____ onset, usually early _______, ____ and ______ common, heel usually _____. Treatment can include... |
correctable; weight-bearing;
congenital cartilaginous bridges; motion; peroneal; gradual; adolescence; stiffness and painful limp; everted; sx in early cases, rest, heat, NSAIDs, surgery in some cases |
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Forefoot includes the ________ of the foot to the ________
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metatarsals to the palanyx's
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Midfoot includes......
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the small bones of the foot (cuneiform, navicular)
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Hindfoot includes the ______ and _______
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talus, calcaneous
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Posterior tibial tendinopathy isa spectrum of overuse disorders and includes: (3)
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clubfoot, calcaneovalgus, and kohler's disease
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Clubfoot is a ____ deformity present at birth. Commonly _____ with the exact cause unknown
Clinical features include ____ of the ankle and forefoot (limited _____ bending), ____ of the heel and _____ of the forefoot. Tx= early ___________ for _____ and _____ |
fixed; bilateral;
equinus; upward; varus; adduction; ortho referral; manipulation and casting |
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Calcaneovalgus is the most common _____ foot disorder. Characterized be excessive ____ and _____ of the foot.
Cause is ____ and is not a fixed disorder= easily _______ but caution against ________ Clinical features include ____ of ligaments at birth and ______so profound that the toes can....... Treatment for mild cases= ________. For advanced cases =____________ |
neonatal; eversion; dorsiflexion;
unknown; correctable; overcorrecting; laxity; dorsiflexion; touch the anterior tibia |
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Kohler's disease is the necrosis of the _____ bone usually secondary to _____ (_______);
Onset usually around age ___ with the initial complaint being a ________. Also, local ____, _____ and _____ frequently seen. |
navicular; ischemia (AVN);
5; painful limp; pain, tenderness, and swelling over navicular bone |
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85% of all ankle sprains involve the _______ ligament which is part of the ______ ligament complex.
More severe injuries can involve the ________ ligament and rarely the ________ is involved. |
anterior talofibular; lateral;
calcaneofibular; posterior talofibular |
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Clinical features of an ankle sprain include a hx of a ____ followed by ____ and _____. Will also have ___ and ____ at the site of injury.
Need to R/O ________ |
'pop'; pain and swelling; hemorrhage and local tenderness
bony tenderness |
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After an ankle sprain, need to determine stability through which two tests?
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anterior drawer test and talar tilt test
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The anterior drawer test is the most reliable and least painful way to test for _______.
Positive test indicates ____ and _____ rupture. *Need to compare to the other side to determine.... |
ankle sprains;
ATF and CF; if the movement is present in only one ankle. IF present in both, may just indicate a pt with laxed ligaments |
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Treatment of ankle sprains, regardless of severity includes......
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RICE, crutches, rehab (4-6 weeks or longer)
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Tarsal tunnel syndrome is....
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nerve entrapment by compression of posterior tibial nerve beneath the flexor retinaculum
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Clinical features of tarsal tunnel syndrome include......
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vague symptoms, burning pain, numbness and tingling in sole of foot
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What is the treatment for tarsal tunnel syndrome?
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medial heel wedge or heel seat; surgical tx with mixed results
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Tarsal tunnel syndrome is similar to ________.
If you test the nerve and muscle involvement through EMG above and below the flexor retinaculum, in nerve impingement....... If diabetic neuropathy, there ...... |
carpal tunnel syndrome;
there will be a difference; will not be a difference and will be more widespread numbness |
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Subluxation of peroneal tendons are caused by.....
Treatment includes.... |
a sudden forceful dorsiflexion of the foot with contracted peroneal muscles (trying to plantar flex) resulting in a tear in the retinaculum behind the lateral malleolus.
reduction and immobilization in short-leg walking cast; chronic cases may require surgery |
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Hallux varus is the ____ deviation of the great toe at the MTP.
More common in ___ Treatment= |
medial;
kids; passive stretching exercises, proper shoe wear |
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Hallus rigidus is usually secondary to traumatic ________, most common in the ___-____ decade of life.
Have pain with _____ movement in the MTP joint of the great toe Can be confused with _____ Clinical feature is gradually increasing ___ and ____ often precipitated by a ______ Treatment= |
osteoarthritis; 3rd-4th;
restricted; gout; pain and stiffness; minor injury; rest, moist heat, anti-inflammatories |
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Talar Dome fractures are characterized by a small area of ____ on the articular surface of the talus.
Cause is usually _____ and it results in restriction of ________. Dx via ____ and treatment is prolonged _____________ |
necrotic bone;
traumatic; ankle movement; XRay; non-weight bearing status |
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Plantar Fascia extends from the ____ to the _______.
Etiology of plantar fasciitis is usually ______. Clinical features include pain beneath the ____, pain worse with ...... or after ....... PE shows local point tenderness in the area of ________________. Treatment can include...... |
calcaneous; proximal phalanges;
overuse; calcaneous, first steps in morning; long inactive periods; medial tubercle of calcareous; NSAIDs, taping, heel cups/orthotics, tender point injection with steroid/lidocaine (helpful) |
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Plantar fibromatosis is fibrous tissue proliferation of the ______. Is similar to ________ but rarely causes a ____ .
Begins as a _____ subdue nodule that slowly enlarges and becomes ______. Tx: |
plantar fascia; Dupuytren's contracture; contracture;
painless; tender; surgery needed when wt bearing becomes painful |
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Achilles tendinitis is the ______ of the achilles tendon. Cause by.....
Characterized by ___, ____, ____ and _____. Treatment includes.... |
inflammation;
overuse of calf muscles (athletes commonly); pain, local tenderness, swelling and crepitus; rest, head, gentle stretching, small heel lift, NO injections, NSAIDS questionable |
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There are ___ bursa near the insertion of the achilles tendon. If become inflamed, treat with ____ and ______. Can do injections into the bursa but need to make sure to avoid the _____.
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2; heat, heel elevation; tendon
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Calcaneal apophysitis, AKA ________, is a low grade inflammatory reaction at the insertion of the _____ with.........
Similar to ______ of the knee Clinical features: often _____, local ____, ____and ______. Passive stretching of ____ reproduces pain. Tx= |
Sever's dz; Achilles tendon; sclerosis of calcaneal growth plate;
Osgood-Schlatter; bilateral; pain, tenderness, swelling; heel; NSAIDs, local heat, avoidance of activity (goes away when pt is done growing) |
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Achilles tendon rupture is a disorder preceded by a hx of gradual ________. Associated with some medications (______ esp in kids). Ruptures usually occur ___-___ cm above insertion
Clinical features: occurs during ___, pt hears a _____. Post injury, pt will walk ______ and will be unable to stand on the ___ of the foot. ____ and _____ are common. Majority but not all _____ is lost. Dx through _______ test. Tx= |
degeneration; quinolones; 2-3;
activity; 'pop'; flat-footed; ball; tenderness; hemorrhage; plantarflexion; Thompson squeeze prompt referral to ortho, delay can compromise outcome. Needs immediate surgical repair |
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Plantaris tendon lies ____ to the heel cord in the calf. Rupture is classically dx as a sudden ___________ with no associated loss of calf strength (plantar flexion)
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medial; sharp pain in the calf
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Morton's neuroma is a common cause of _____ in the forefoot. Results from _______ of plantar nerve divisions. Secondary to ______ Trauma.
Females affected ____than males. _____ can increase the risk. Clinical features include severe ____ pain which is worse with activity, most commonly located in the ____ web space and also have associated _____ in affected toes. Tx= |
pain; perineural fibrosis; repetitive;
more than; tight shoes; burning; 3rd; numbness; NSAIDs, physcial separation of affected metatarsal needs and removal of neuroma |
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Metatarsalgia is pain ........with no obvious cause.
Symptoms include ____ or ____ pain that is worse with activity and relieved by rest. ______ develop under the affected areas. Treatment: |
beneath metatarsal heads;
burning or cramping; calluses; balance wt-bearing pressure away from heads |
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MTP synovitis is ____ syovitis of unknown etiology. More common in the ____ toe.
Chronic use of _____ shoes may be a risk factor. Exam will show ____ and ____ of affected joint. Treatment= |
painful; 2nd;
high heeled; swelling; tenderness; NSAIDs, shoe modification, steroid injection |
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Hallux valgus is a ____ deviation of the great toe at the MTP joint.
_____ and _____ are presenting complaints. treatment= |
lateral;
pain; deformity; pressure relief over resulting bunion, shoe modification |
|
|
Scoliosis is the _____ deviation associated with ____ of the spine
|
lateral; rotation
|
|
|
Which type of scoliosis is the type most commonly seen in practice?
|
adolescent idiopathic scoliosis
|
|
|
Scoliosis is ____ common in females compared to males.
|
more
|
|
|
Curves less than ___ degrees are considered normal human variation (in regards to scoliosis).
|
10
|
|
|
At what point of curvature do you treat scoliosis?
|
20
|
|
|
What is normal variation at maturity of leg lengths?
|
1.5 cm
|
|
|
If diagnosis is made before menarche, ____% will bet worse due to the pt growing.
|
53
|
|
|
A nonoperative treatment for scoliosis is _______.
This only keeps the curve from ...........and doesn't....... |
bracing.
getting worse; reverse existing curves |
|
|
Which brace is typically used to treat scoliosis?
|
TLSO (thoracic, lumbar, sacral orthosis)
|
|
|
Braces as a treatment for scoliosis are effective in ___% of patients and helps them.....
Definition of success= Have better success with... |
85; avoid surgery;
max curve reached is 40 degrees smaller curves |
|
|
Curves below ___ Degrees at maturity rarely get worse.
|
40
|
|
|
Want to surgically fix curves of _____ if the pt is still growing and _____ if they are done growing
|
40-50; 50
|
|
|
What is a surgical treatment for scoliosis?
|
posterior spinal fusion via steel rods and bone grafts
|
|
|
What is the better option for the surgical treatment of scoliosis, but more expensive?
|
posterior spinal fusion using screws
|
|
|
A limp is defined as...
|
asymmetrical gait
|
|
|
What are some causes of a limp?
|
joint, bone deformities, neuro control, pain
|
|
|
If someone is limping or walking funny, want to watch their upper limbs because...
|
if the problem is a neuro problem, they will usually have abnormalities in the upper limbs too
|
|
|
What are the best bets for a limping child between the ages of 1-3?
|
developmental dysplasia of the hip and congenital dislocation of the hip
|
|
|
Developmental dysplasia of the hip (DDH) usually affects _____, will have limited ______, asymmetrical _______, ____ legs, ______ &_____ Signs.
|
girls; abduction; skin folds; short; Ortolani's sign; Barlows signs
|
|
|
XRay findings in a pt with DDH show delayed appearance of and small _____, _____ Acetabulum and _______ displacement of the femur.
|
ossific nucleus, dysplastic, proximal
|
|
|
Ortolani's sign is when....
|
the hip is dislocated at rest but when abduct and lift behind the greater trochanter it will pop back into place
|
|
|
Barlows sign is when..
|
the hip is dislocatable
|
|
|
What is the treatment for DDH in a pt age 0-1/2 yo?
|
Pavlik harness min of 6 weeks. once on can't take off
|
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|
DDH treatment for a pt aged 1/2-1 1/2 yo is?
|
closed reduction and casting
|
|
|
DDH tx for a pt aged 1 1/2-8?
|
open reduction, pelvic osteotomy
|
|
|
DDX tx for a pt over 8 yo?
|
leave dislocated. give a shoe lift. Pt will have a non painful limp
|
|
|
What are the best bets for a limping child aged 3-6?
|
transient synovitis, septic arthritis, flu, tonsillitis
|
|
|
If a child has transient synovitis, they will refuse to _____ because movement of the ____ is painful. They may have a ____, moderately elevated ___ and it will last........
Better dx tests= Tx= |
walk; hip; fever; WBC a few days;
CRP (normal) and sed rate (high) Usually goes away on own but give anti-inflammatories |
|
|
Transient synovitis is........
Usually follows.... |
inflammation that comes and goes;
URI |
|
|
In a pt with septic arthritis, the child will refuse to ____ because movement of the ____ is painful.
Most likely will have a _____ and elevated _____ Pt gets progressively worse with progressive __________. Mechanism: Xray should show _____. If the joint space is wide, it indicates..... |
walk; hip;
fever; WBC; joint destruction; bacteria and white blood cells release enzymes which destroy cartilage and cause the damage nothing; there is pus under pressure in the joint causing the capsule to expand=BAD |
|
|
Septic arthritis can cause (3):
|
destruction of articular cartilage, destruction of femoral head, and destruction of femoral neck
|
|
|
What is the treatment of septic arthritis?
|
antibiotics to kill the bacteria, incision and drainage to get rid of SBC (***Surgery)
|
|
|
Septic arthritis is a ____ problem and must be treated within ______
|
surgical; 48 hours
|
|
|
A pt with no fever is more likely to have _____ over _______.
If not sure, give motrin overnight. If better= |
transient synovitis; septic arthritis;
transient synovitis |
|
|
What are the 4 predictors of septic arthritis?
|
fever, refusal to wt bear, ESR >40 mm/hour; WBC>12,000
|
|
|
The best bet of the cause of a limping child age 6-10 is:
|
legg-calve'-perthes disease
|
|
|
Legg-Calve'-Perthes affects boys ___ than girls, pt has a _____ gait (older kids), have pain with _______, limited ______ and a positive _______ sign.
|
more; antalgic; passive motion; abduction; trendelenburg;
|
|
|
Trendelenburg sign is....
|
when a pt bears wt on the affected side, the other side drops down
|
|
|
Legg-Calve-Perthes disease Xray findings can include.....
|
nothing, irregular consistency, flattening, lateral bump/ridge, lateral hinging and AVN of femoral head
|
|
|
50% of pts with L-C-P disease need a ____ by age 50.
|
total hip replacement
|
|
|
The best bet of the cause of a limping child aged 10-14 is...
|
slipped capital femoral epiphysis (SCFE)
|
|
|
What is the most common adolescent hip disorder?
|
SCFE
|
|
|
When diagnosing a pt with SCFE, you always need to...
|
check the other side
|
|
|
SCFE is almost always a diagnosis associated with...
|
obesity
|
|
|
SCFE can be classified based on: (4)
|
acute vs chronic;
stable vs unstable; severity of displacement slip angle |
|
|
Stable SCFE patients usually are able to ___, the bone is _____ and shows _____ of the growth plate. In these pts, the treatment is=
|
walk; in one piece; plastic deformation;
no reduction, just place on screw in to keep it from getting worse |
|
|
In unstable SCFE the patient is unable to ____, the bone is ________ and you will see a ______.
Tx= |
walk; 2 pieces; physeal fracture;
closed reduction and two screws |
|
|
How common is bilaterally of SCFE pts?
|
30%
|
|
|
If a pt does not present with bilateral SCFE need to...
|
follow radiologically every 3 months for 18 months
|
|
|
XRay findings associated with a SCFE include (3):
|
anterior slightly superior displacement of the neck of the femur, decreased projected femoral head height, and signs of chronicity
|
|
|
Signs of chronicity associated with SCFEs include......(3)...
|
inferior new bone formation, superior rounding off of metaphysis and curved neck
|
|
|
When treating a SCFE, you don't want to push the femoral head back to its original position because....
|
you will almost always cut off the blood supply between the head and neck of the femur
|
|
|
What are the two most common fractures in kids?
|
greenstick and torus
|
|
|
Fractures require reduction when....
|
alignment of bones is not sufficient to provide cosmetic treatment and functional treatment
|
|
|
Childrens bones are less _____ and have more _____. Their ligaments are also _______ so the stresses that would normal tear a ligament in an adult will cause......
|
mineralized; vascular channels; stronger; the bone to break instead
|
|
|
Transverse fractures usually occur across the....
|
diaphysis of the bones
|
|
|
The 'physics' is the....
|
growing cartilage
|
|
|
The epiphysis is the...
|
articular surface next to the joint
|
|
|
The apophysis is the....
These are specialized _______ where... |
site of tendon attachment.
growth plates; big tendons attach |
|
|
In small kids, a lot of fractures are not seen on X ray because.....
Therefore, a dx of a fracture is more of a _____ dx and not ______ |
theres more cartilage and less ossification;
clinical; radiologic |
|
|
If a pt has a hx of trauma, swelling and pain over a bone, you want to do an Xray to get the _____ of the fracture and not....
|
nature; presence/absence
|
|
|
The metaphysis is the....
|
flare part of the end of a bone
|
|
|
Nonunion of a bone is ____. Childrens bones heal ____ than adults.
|
rare; faster
|
|
|
Clavicular fracture management includes......
alignment is... |
treating pain and allowing it to heal on its own ;
immaterial |
|
|
Tibia fractures in kids will heal in ___ weeks where as adults will take ____ weeks.
|
4; 20
|
|
|
The physiologic remodeling of bones depends on: (4)
|
number of years of growth remaining, proximity to physics, magnitude of angular deformity, plane of angulation
|
|
|
The closer the fracture is to the physis, the ____ it will heal
|
faster
|
|
|
The the plane of angulation of a fracture is in the plane of motion of the joint, it will heal ____
|
faster
|
|
|
What are the 5 zones of bone formation?
|
reserve of resting cartilage, cell proliferation, cell maturation and hypertrophy, calcification, ossification
|
|
|
The Zone of Reserve of Resting Cartilage has young small cells evenly distributed that appear as...
|
typical hyaline cartilage
|
|
|
The zone of cell proliferation has ____ that divide and form ____ columns.
|
chondrocytes; parallel
|
|
|
The zone of cell maturation and hypertrophy has cells that produce _____ and _____
|
collagen and ground substance
|
|
|
The zone of calcification has the septa of ____ that becomes ____ and the cells ____
|
cartilage matrix; calcified; die
|
|
|
The zone of ossification includes _____ that invade cavities to deposit....
|
osteoblasts; bone matrix
|
|
|
When you get a fracture through a growth plate, which zone is almost always affected and why?
|
cell proliferation;
a lot more water is here with less cellular material and is not calcified |
|
|
SH type 1 is a ___ Fracture that is located.....
Does not involve...... Will have localized ____ and ____, X rays will be _____ and usually has an excellent prognosis except for _____ fractures. |
transverse; through the entire growth plate;
any ossified structures; swelling and tenderness; negative; distal femur |
|
|
SH Type 2 fractures has fracture lines that pass through......
These are very common in the ________. If occur in the distal femur, what results? |
a portion of the growth plate and exits through metaphysis;
distal radius; growth arrest in 50% of pts. |
|
|
SH Type 3 fractures has the fracture line pass through.....
This actually involves the ____ Prognosis for growth is........ These almost always require ______ because....... |
physis and extends to the articular surface;
joint; more guarded/not as good; surgery; the joint surface needs to be lined up or it will cause arthritis and growth arrest |
|
|
SH Type 4 fractures has the fracture line that....
Small portion of the ____ is affected however there is a high risk of ______. _____ is needed to restore the ___ surface. This type is also through the ____ along with the ____. |
crosses all zones of the physics vertically;
physis; growth arrest; anatomic reduction; articular; joint; metaphysis |
|
|
SH type 5 fractures are _____ fractures that result from...
May not be apparent on _____ and _____ is common |
compression/crushing force applied to the growth plate;
XRay; growth arrest |
|
|
Growth arrest is caused by compromised ____ of the physics, damage to ____ and ____ formation across the growth plate
|
vascularity; germinal cells; bone bridge formation
|
|
|
What is the most frequently fractured bone in the body?
Which part of the bone does it usually occur in? |
clavical; shaft in kids, distal in adults
|
|
|
What is the mechanism of a clavicle fracture?
|
fall on shoulder
|
|
|
80% of length of the humerus is formed by the...
|
upper humerus growth plate
|
|
|
Proximal humerus fractures occur by the same mechanism as _________.
Is a ___ injury. Treatment is= |
shoulder dislocation;
benign; immobilization for 3-4 weeks |
|
|
Humeral shaft fractures can occur during _____. If you see them in children less than three that didn't occur during that process, think of _________.
In kids over 3, can happen from _______. Tx= |
birth/difficult deliver;
child abuse; blunt trauma; closed management, splint or cast |
|
|
Supracondylar humerus fractures are the most common ___ fractures.
Mechanism is ___________. Type 1: treat with... Type 2 or 3: Treat with.... |
elbow;
hyperextension load; long arm cast 3 weeks; closed reduction, pinning, LAC x 3 weeks |
|
|
Radial neck fractures are most common in kids aged ___-____.
Mechanism is.... The radial neck is within the joint capsule which results in ______ Tx with... |
7-12;
valgus stress with fall on extended elbow; stiffness; long arm cast x 2-3 weeks |
|
|
Monteggia is te fracture of the ____ and dislocation of the _____
|
ulna; radial head
|
|
|
Galeazzi is the fracture of the ____ and the dislocation of the ________
|
radius; distal radioulnar joint
|
|
|
Reduction of midshaft forearm fractures is done through.....
Internal fixation is used for ______ fractures or those that failed _______ Require _____ followup because ______ can occur In adults ____% are operated on. |
reversing injury mechanism;
unstable; closed management; weekly; refracture; 100 |
|
|
Distal radius physeal fractures are the ___ most common physeal injury
Growth arrest is _____. Tx- |
2nd;
rare; short arm cast for 3-4 weeks |
|
|
Distal radius and ulna fractures are common and are usually ___ or ___ Fractures.
Tx with= |
torus or buckle;
reduction and cast |
|
|
If kids are under age 1 and there is a midshaft femur fracture, need to think about _____. Tx with a ______
If age 1-4,can be caused by _____and treat with a ______; If age 4+ can be caused by ____ or ____ and treat with..... |
child abuse; splint;
minor trauma; hip spica cast; bike or car accidents; intramedullary nails |
|
|
Distal femur fractures are caused by _____. There is a ____ chance of growth arrest.
tx= |
considerable trauma;
50; closed reduction, fixation under anesthesia |
|
|
Proximal tibia fractures involving ____ are uncommon. Involving ____ are most common in 2-8 year olds.
mechanism= Results in ______ deformity that usually .... |
physis; metaphysis;
valgus force; progressive valgus; resolves spontaneously |
|
|
Nondisplaced midshaft tibial fractures are usually caused by ____ and are treated with a ____
Oblique and spiral midshaft tibial fractures are caused by ______ and treat with..... Transverse midshaft tibial fractures are caused by ____ and treat with _______. |
minor trauma; cast
rotational force; cast (knee flexed ankle plantar flexed) high energy trauma; intramedullary nails |
|
|
Non-accidental trauma infant survey is....
This is done when..... |
XRayign all long bone and bones of the skull;
you have one suspicious fracture |
|
|
What fracture is pathognomonic for child abuse?
|
corner fracture of radius
|
|
|
Joint swelling is _____ until proven otherwise
|
sepsis
|
|
|
Diagnosis of septic arthritis can be done via (4)
|
bone aspiration yielding pus, positive bone or blood culture, presence of classic sx, Xray changes consistent with osteomyelitis
|
|
|
Common bacteria causing septic arthritis in neonates include (3):
|
H flu, group B strep, staph
|
|
|
Anterior knee pain syndromes are common in ____ more than _____
Are ____ diseases that you treat with... |
teenage girls over boys;
self-limiting; rest, immobilization, aspirin, time |
|
|
Articular cartilage is located....
Provides... |
on the ends of long bones
smooth gliding surface for motion |
|
|
Articular cartilage is made up of (4)
|
chondrocytes, collagen, water held by the matrix and proteoglycans
|
|
|
What are some symptoms of hip disease?
|
wt bearing groin or butt pain; night pain/sleep disturbance; may radiate to same knee;
|
|
|
Pt expectations after total hip arthroplasty (what should they be able to do)?
|
90-100% pain relief, walk unlimited without support, ride bikes, bowl, golf doubles tennis
|
|
|
Minimally invasive THA reduces ___ and ____ and allows....
|
pain; blood loss;
a shorter hospital stay and quick recovery |
|
|
Why would you do a MIS or tissue sparing THA?
|
minimize fucntional tissue trauma for immediate postop recovery
|
|
|
Pain treatment before THA:
During THA: After THA: |
celebrex and oxycontin;
local rupivicaine; PCA pump for 24 hours then oral pain meds |
|
|
THA sutures should be removed after ___ days, DVT prophylaxis for ________, pain control and PT, progressing to cane within ___-___ weeks.
|
7-10; 6 weeks; 2-3
|
|
|
Bone sparing THA is reserved for ____________.
Involves.... |
the very young;
drilling a hole in the head of the femur using very little metal |
|
|
Cauda equina syndrome is when....
|
the vertebra press against the vasculature causing pressure
|
|
|
Lamellar bone is _____. Has ____ fibers arranged in ______
|
normal adult bone;
collagen; parallel layers |
|
|
Woven bone has _____ oriented collagen fibers. In adults, seen at sites of ____, _________ and in ______ conditions. Is weaker than _______
|
randomly;
fracture healing; tendon or ligament attachment; pathological conditions; lamellar bone |
|
|
Cortical bone is located.....
Provides the..... |
outside the shaft of the bone; strength of the bone able to withstand force
|
|
|
Cancellous bone, AKA _____, is inside of _____ and is _____-packed. It is able to absorb ____.
The trabeculae are oriented in the direction of.... |
trabecular/spongey; cortical; spongy-loosley;
greatest force |
|
|
Extracellular matrix of bones are made up of _____ and _______ chemicals
|
organic; inorganic
|
|
|
Organic components of ECM include type 1 ___ as well as ....
|
collagen;
a bunch of other stuff making up the ground substance |
|
|
The inorganic component of ECM is primarily...
|
hydroxyapatite
|
|
|
Intramembranous boen formation is the mechanism by which a long bone.......
Osteoblasts lay down seams of _____ |
grows in width;
osteoid; |
|
|
Endochondral bone formation is the mechanism by which a long bone grows in....
Chondrocytes _____, ____ and then _____. _____ of the cartilage occurs followed by _______ |
length;
hypertrophy; degenerate and calcify; vascular invasion; ossification |
|
|
_____ bone formation does not involve cartilage while ______ formation does.
|
intramembranous; endochondral
|
|
|
What 2 things are needed for bone healing?
|
adequate blood supply and mechanical stability
|
|
|
What are the three sources of blood supply in long bones?
|
nutrient artery (intrameddulary), periosteal, metaphyseal
|
|
|
Delayed union is when the fracture is _____ but is not....
|
healing; following expected timeline
|
|
|
Direct/Primary bone healing is seen when there is no ____ at the fracture site.
Bridging ______ callus and _____ callus re-establish structural continuity; This then undergoes _______. Process is fairly ____. |
movement;
periosteal; medullary; endochondral ossification rapid |
|
|
What are the 4 local regulators of bone healing.
|
growth factors, cytokines, prostaglandins/leukotrienes, hormones
|
|
|
What are some systemic factors that affect fracture healing?
|
malnutritoin, smoking, uncontrolled DM
|
|
|
How does smoking affect fracture healing?
|
inhibits osteoblasts, causes vasoconstriction diminishing blood flow
|
|
|
After closed reduction maneuvers, need to immobilize ...
|
the joint below and above the area
|
|
|
_____ and _______ are necessary to maintain most closed redcutions
|
three point contact and stabilization
|
|
|
What are 4 types of anesthesia for closed reductions?
|
hematoma block; versed, morphine or demerol
|
|
|
Hematoma blocks involve .........
Are less reliable but ___ and ___. They essentially convert a ____ fracture to an ____ one with no documentation of increased risk of infection |
aspirating hematoma and placing 10cc of lidocaine at the fracture site;
fast and easy; closed; open; |
|
|
Versed dosing used for closed reductions.
|
0.5-1mg IV q3min up to 5 min
|
|
|
Morphine dosing used for closed reductions.
|
0.1 mg/kg
|
|
|
Demerol dosing used for closed reductions.
Causes deep sedation so need to beware of...... |
1-2mg/kg for up to 150 mg;
resp complications |
|
|
Sugar tong splints extend around the _____ to provide ____ control.
|
distal humerus; rotational
|
|
|
Fracture bracing allows for early functional ____ and ____
Relies on intact soft tissue and muscle to maintain ____ and ____ Most commonly used for ___ and ___ fractures |
ROM, wt bearing;
alignment; length; humeral shaft and tibial shaft; |
|
|
What is used for humerus fractures that has decreased the incidence of fractures that need to be operated on a lot?
|
fracture braces at 10 days treatment.
|
|
|
The goal of casting is...
|
semi-rigid immobilization
|
|
|
When casting the knee, need to apply ___ the knee first with the knee flexed at a ___-___degree angle.
Need to mold the _______ for improved rotational stability and then add extra padding ....... |
below; 5-20;
supracondylar femur; anterior to patella |
|
|
Forearm casts/splints should leave the ____ free and you do not want to go past the ______
The thumb should be free to the base of the _____ so that...... |
MCP joints; proximal palmar crease;
MC; opposiition to the 5th digit is unobstructed |
|
|
What is the most common complication of casts/splints and why?
|
loss of reduction; swelling decreases
|
|
|
Traction allows constant controlled force for....
Aids in reduction during... |
initial stabilization of long bone fractures; operative procedures;
|
|
|
Bimalleolar fractures are....
|
fractures of both medial and lateral malleoli
|
|
|
What are three causes of persistent pain after ankle injuries?
|
talar dome fractures; lateral process fracture of the talus; impingement of the tibio-fibula ligament and the talus
|
|
|
The peroneal portion of the sciatic nerve is tethered _____ around the fibula head making it more vulnerable to ______.
If affected during hip fractures can cause foot ______. |
distally; a stretch;
drop |
|
|
AVN is likely in about 20% of ____ dislocations
|
posterior
|
|
|
Hemiarthroplasty is when only the ____ is replaced. the acetabulum is.....
|
femoral head; left alone
|
|
|
Total hip arhtorplasty involves replacing...
|
both he femoral head and acetabulum
|
|
|
The autonomous zone for sensory of the median nerve is the......
What is a function of the median nerve |
volar aspect of the index finger;
opposition of the thumb to the little finger. |
|
|
The autonomous zone for the ulnar nerve is the......
Motor functions include..... Way to test this is to have the pt..... |
volar aspect of the distal phalanx of the little finger;
adduction and abduction of the fingers hold a card between fingers |
|
|
What is the motor function of the radial nerve?
|
dorsiflex the wrist
|
