Em Ortho (Fractures)

Front 1

Ottawa Ankle Rules for Ankle radiographs

Back 1

Must have pain in the malleolar region AND any of the following 1. tenderness of post edge of distal 6 cm or tip of lateral malleolus 2. Tenderness of post edge of distal 6cm or tip of medial malleolus 3. unable to bear wt both immediately after the injury and at the time of evaluation

Front 2

Ottawa Ankle Rules for Foot radiographs

Back 2

Must have pain in the midfoot region and 1. tenderness of the navicular bone 2. tenderness at the base of the 5th metatarsal 3 Unable to bear wt both immediately after the injury adn the time of evaluation

Front 3

What are some of the limitations of the Ottawa ankle rules?

Back 3

- Intoxication - Multiple trauma - Head injuries - Decreased sensation/ neuro deficit

Front 4

What is an Avulsion fracture?

Back 4

- Bone fragment pulled from its normal position by a tendon or ligament

Front 5

What is an intrarticular fracture?

Back 5

- Fracture involves articular surface

Front 6

How to classify Open fractures?

Back 6

Grade I : wound < 1cm Grade II: wound 1-5cm w/o excessive contamination, crush injury or soft tissue loss Grade III: wound > 5cm or gross contamination, crush injury or excessive soft tissue loss

Front 7

Is an open fracture considered an orthopedic emergency?

Back 7

YES!!!!!!!! High risk of osteomyelitis

Front 8

What antibiotics are you going to give with open fractures?

Back 8

1st gen cephalosporin aminoglycoside for type II and III

Front 9

What are you concerned about with open fractures?

Back 9

COMPARTMENT SYNDROME neurovascular disruption hemorrhagic shock from blood loss

Front 10

What is the clinical presentation of compartment syndrome?

Back 10

pain paresthesias pallor paralysis pulselesness

Front 11

How is compartment syndrome diagnosed and what is the Tx?

Back 11

with manometry normal pressure near 0
Pressure >30 usually requires intervention
Tx: fasciotomy

Front 12

What are other complications of fractures?

Back 12

osteomyelitis fat embolism avascular necrosis RSD

Front 13

What is the management of fractures in the ED?

Back 13

NPO
Ice
elevation
analgesics
immobilization

Front 14

What are the 3 main options for management of fractures?

Back 14

Splint
close reduction and splint
open reduction and internal fixation

Front 15

Why splint instead of cast?

Back 15

keeps bone alignment maintained while allowing room for soft tissue swelling

Front 16

What are true orthopedic emergencies that require ortho to see pt in ED?

Back 16

compartment syndrome
open fracture
circulatory compromise
irreducible dislocation
injuries needing surgical repair

Front 17

What is a Greenstick fracture?

Back 17

An incomplete angulated fracture of a long bone

Front 18

What 5 ideas are used to describe a fracture to your consultant?

Back 18

1. Pattern (spiral, transverse, oblique)
2. Location (which bone, proximal / distal, diaphysis or bony prominence)
3. Angulation (in degrees)
4) Displacement (%)
5) Comminution (yes or no)

Front 19

Humerus Shaft Fracture: characteristics and splint?

Back 19

-Distal 1/3 of humerus location has high risk of radial nn injury (wrist drop)
-On Xray, tendon attachment site is a lump with thin cortex (may look like an abnormality, but its not)
-Coaptation splint (armpit to elbow wraps up around to go over shoulder)

Front 20

Hill-Sachs Fracture: characteristics and splint?

Back 20

-Posterior lateral fracture of humoral head after reducing an anterior dislocation
-No splint required

Front 21

Nightstick Fracture: characteristics and splint?

Back 21

-Isolated ulnar shaft fracture
-Think of a person sheilding their face from a nightstick
-Sugar tong splint

Front 22

Galeazzi Fracture: characteristics and splint?

Back 22

-Distal Radius with ulnar dislocation at the wrist
-ORIF and sugar tong splint

Front 23

Monteggia Fracture: characteristics and splint?

Back 23

-Distal ulna fracture and dislocation of the radius at the wrist
-Sugar Tong and ORIF

Front 24

Colles Fracture: characteristics and splint?

Back 24

-Distal radius fracture with an extra articular metaphysis and DORSAL angulation (more common than Smith)
-Sugar Tong Splint

Front 25

Smith Fracture: characteristics and splint?

Back 25

-Distal radius fracture with an extra articular metaphysis and VOLAR angulation (less common than Colles)
-Sugar Tong Splint

Front 26

Barton's Fracture: characteristics and splint?

Back 26

Volar or Dorsal rim of the distal radius is fractured with subluxation of the carpals
-Sugar Tong Splint

Front 27

Hutchinson's Fracture: characteristics and splint?

Back 27

-Fracture of the radial styloid
-Sugar Tong Splint

Front 28

Scaphoid Fracture: characteristics and splint?

Back 28

-60-80% of carpal fractures
-More proximal scaphoid region has poor blood flow & is at risk for avascular necrosis
-Hard to see on Xray acutely, may present on follow-up films
-If any pain in snuffbox region, then splint with Thumb Spica (hand in beer can grip position)

Front 29

Boxer's Fracture: characteristics and splint?

Back 29

-Metacarpal fracture (typically the neck of 4th/5th metatarsal)
-No surgery for 4/5th if angulation <40%
-No surgery for 2/3rd if angulation <20%
-Radial or ulnar gutter splint

Front 30

Mallet Finger Fracture: characteristics and splint?

Back 30

-Closed extensor tendon tear due to forced flexion or extended DIP (catching a ball)
-Metal finger splint with buddy wrap

Front 31

Hip Fracture: characteristics and splint?

Back 31

-Usually femoral neck or intertrochanteric
-Old women falling
-Displaced if leg is shorter and externally rotated
-Femoral neck at risk for avascular necrosis
-ORIF

Front 32

Femur Fracture: characteristics and splint?

Back 32

-Typically due to high energy trauma
-Not unusual for 1.5L of blood to drain into thigh
-ORIF

Front 33

Tibial Plateau Fracture: characteristics and splint?

Back 33

-Proximal tibia is squished
-Characterized by intrarticular (or not), medial or lateral, with or without depression of the fragments
-Long leg splint with crutches

Front 34

Tibial Shaft Fracture: characteristics and splint?

Back 34

-Can't walk (weight bearing bone)
-High risk for compartment syndrome
-Long leg posterior splint

Front 35

Lateral Malleolar Fracture: characteristics and splint?

Back 35

-Usually distal fibula
-Short posterior splint

Front 36

Medial Malleolar Fracture: characteristics and splint?

Back 36

-Usually distal tibia
-Sugar tong and long posterior splint

Front 37

Bimalleolar Fracture: characteristics and splint?

Back 37

-Distal tibia and fibula malleoli fractures
-Sugar tong and long posterior splint

Front 38

Trimalleolar Fracture: characteristics and splint?

Back 38

-Distal fibula, distal tibia, and posterior distal tibia fractures
-Sugar tong and posterior splint

Front 39

Maissonnueve Fracture: characteristics and splint?

Back 39

-Proximal fibula fracture and EITHER medial malleolus fracture or deltoid ligament tear
-Sugar tong and posterior splint

Front 40

Pilon Fracture: characteristics and splint?

Back 40

-Axial load fracture of distal tibia
-Usually comminuted and involves intrarticular surfaces
-Sugar tong and posterior splint

Front 41

Weber Classifications for Ankle Fracture & Splints for each?

Back 41

Weber A) Distal fibula fracture below talar joint line. STABLE. Boot or sugar tong.

Weber B) Distal fibula fracture extends into talar joint line. + /- STABLE. Sugar tong + Posterior slab splint.

Weber C) Distal fibula fracture compressed 3cm past the talar line up the shaft. UNSTABLE. ORIF

Front 42

Calcaneus Fracture: characteristics and splint?

Back 42

-Axial Load, usually fall from height
-Bulky dressing and posterior splint

Front 43

Jones Fracture: characteristics and splint?

Back 43

-Diaphyseal fracture of 5th metatarsal
-Extends into joint space between 4/5th metatarsal
-Posterior splint

Front 44

Tuberosity Avulsion Fracture: characteristics and splint?

Back 44

-90% of foot fractures
-Chipped tuberosity of the 5th metatarsal
-Heal very well with just a hard soled shoe

Front 45

LisFranc Fracture: characteristics and splint?

Back 45

-Displacement fracture of the metatarsals of the midfoot
-Commonly fractured distally and dislocated at the cuneiforms or cuboid tarsals.
-ORIF and leg cast afterwards

Front 46

All about pre-patellar bursitis?

Back 46

-The prepatellar bursa is quite superficial, lying between the skin and the patella, separating the patella from the patellar tendon and the skin.
-An occupation requiring excessive kneeling is a risk factor for inflammation.
-Prepatellar bursitis is more common in males than females.
-The bursitis presents as pain and tenderness over the inferior pole of the patella.

Front 47

All about pes anserine bursitis?

Back 47

-Pes anserine bursitis is an inflammation of the bursa which underlies the conjoined tendons and separates them from the tibial insertion of the medial collateral ligament.
-The incidence is highest among runners and obese middle-aged women with diabetes and osteoarthritis.
-Pain, tenderness, and local swelling are present over the medial portion of the knee (proximal medial tibia).

Front 48

All about popliteus tendonitis?

Back 48

Popliteus tendonitis is a tendinopathy seen in runners (particularly those who run hilly terrain) and is associated with lateral knee pain and a positive Webb test.

Front 49

All about plica syndrome?

Back 49

-Plica syndrome is caused by microtrauma to the mediopatellar plica which is a coronally oriented synovial structure which lies on the medial wall of the joint and inserts on the infrapatellar fat pad.
-Inflammation results in tenderness of the infermedial portion of the knee.

Front 50

What two motions typically cause meniscal injuries?

Back 50

Meniscal injuries can be related to repeated squatting or twisting and are usually associated with joint line tenderness and often an effusion.

Front 51

All about DeQuevain's Tensosynovitis?

Back 51

-De Quervain’s tenosynovitis is a stenosing tenosynovitis of the first dorsal compartment of the wrist.
-The APL and EPB tendons are included in this compartment. Therefore, patients who perform repetitive movements of the thumb are at risk for inflammation.
-The pain is located at the dorsolateral (radial) aspect of the wrist and the Finkelstein test is often positive.

Front 52

Definition and cause of Ileotibial Band Syndrome? Who gets it?

Back 52

-The iliotibial band is a thickened strip of fascia lata that functions to stabilize the knee in extension.
-Pain is aggravated by repetitive knee movement associated with running or cycling.

Front 53

Stability Test: How do you test the MCL?

Back 53

Valgus stress at 30 degrees of flexion. Also Valgus stress in extension (also test cruciate ligaments and posterior capsule).

Front 54

Stability Test: How do you test the LCL?

Back 54

Varus stress in 30 degrees of flexion. Also Varus stress in extension.

Front 55

Stability Test: How do you test the ACL?

Back 55

Anterior drawer sign. Also the Lachman test (like the drawer test, just hold the thigh up above the knee and jerk forward)

Front 56

Stability Test: How do you test the PCL?

Back 56

Posterior drawer sign.

Front 57

Stability Test: How do you test meniscal tears?

Back 57

Ege's Test: Pain or click on max knee rotation in squatting position
-External rotation = medial meniscus
-Internal Rotation = lateral meniscus

Front 58

Stability Test: How do you test for chondromalacia patellae?

Back 58

Pain with patellar compression (overuse syndrome, often in young women)