Orthopedic Surgery Unit 1

Orthopedic Surgery Lecs 1-2- Intro and General Management of Fractures

3 "Structural" Fnctns of Bones?

1 "Physiologic" Fnctns of Bones?

When osteoblasts become embedded in the calcified matrix they then become what?

What types of cells are responsible for bone resorption?

2 types of bones and their morphological structure?

Bone lengthening takes place via what process?

Bone widening takes plce via what process?

What is Wolff's Law?

What are the 4 zones of the epiphyseal growth plate?

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?

Define a fracture?

Fractures are ___ ____ injuries w/ _______

3 Most basic classifications of a fracture? (AKA: if you call him @ 3:00 in the AM, describe the fracture in these 3 terms)

Fracture:
Initial care consists of 2 things?

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

Fracture healing involves the formation of what?

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

Do the following heal fast or slow:
Sub-Q bones like the clavicle?

Metaphyseal Fractures?

Open Fractures?

Spiral Fractures?

Physician's Role In Fractures:

Physician Attempts to prevent _____ and NOT Prevent

Does bone "healing" leave a scar?

3 Benefits of a closed reduction?

3 Fnctns of a cast?

Post-Fracture Care:

Ice & _____

Observe for what?

You want to get what happening early?

X-rays may lag behind true "clinical" bone union by how long?

When rehabing, you must keep the joint _____

Fractures in kids are almost always treated how?

Are sprains common or rare in kids?

2 Types of epiphyses in an epiphyseal plate? Where are they? Contribute to what?

4 Zones in fractures?

4 FRACTURE TYPES IN KIDS -->
LOTS OFCOMPLICATIONS!?!?

With above kids fractures, what should you do?

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

4 Fracture type swhich should always be referred?

Orthopedic Surgery Lecs 3-4: The Hip & Thigh

1) Immediate tx of Muscle Strain involves what?

What are apophyseal avulsion injuries?

Greater than 1cm Ischial avulsion OR 1-2 cm lesser trochanter avulsion may require what to prevent what?

FYI: A Contusion is a ____

A contusion resulting from a "direct blow" to the iliac crest is called what?

3 s/s of an iliac crest "hip pointer?"

Tx for iliac crest "hip pointer"?

How does a person get a proximal thigh contusion?

What is the tx goal with a proximal thigh contusion?

Tx for prox thigh contusion?

What is myositis ossificans?

When should you tx MO?

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?

Hip dislocation is assoc w/ what 4 complications?

What is a "labral tear"?

Pt will present w/ what type of 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.

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?

Osteitis Pubis

Osteitis Pubis is the result of what?

c/o pain in _____ that radiates around hip and is exacerbated with kicking, jumping & running

Snapping Hip Syndrome

What are 2 types of Snapping hip syndrome?

SHS External Variety can be result of what 3 pathologies?

Often seen in who?

Dx w/ what test?

SHS Internal Variety

Result of dysfnctn of what?

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) 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?

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?

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) Avascular necrosis of the hip usually only involves what?

2) 2 things you want to do in PE?

3) What's the Tx goal?

Bursitis

1) 2 Types hip 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) Fractures of the hip are almost alwaus assoc w/ what?

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

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?

Hip fractures usually lead to how much blood loss?

The MAJOR complication of hip fracture is what?

1) What are the 2 major types of hip fractures?

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) Ankle sprains are usually in what direction?

2) Which 2 ligaments usually have damage?

The Ottawa Ankle Rules tell you what?

The Ottawa Ankle Rules say that you should get an x-ray if you have Ankle Pain + 1 of the following 3:

_____


_____


______

Ankle Sprain

To differentiate fracture from strain, what should you do?

What test(s) should you perform?

Ankle Injury

1 "interesting" tx?

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?

What is Cuboid Syndrome?

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?

Superficial peroneal nerve entrapment may mimic what other cond'n?

Jogger's foot is entrapment of what nerve? where?

What is morton's Neuroma?

Where is it?

Achilles Tendonitis

1) Positive or negative Thompsons?

2) Assoc w/ what 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?

What is plantar fasciitis?

When is pain the worst?

Pain is NOT caused by what?

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?

What is a bunionette?

What is Hallux Rigidus?

ROM will be decresed in which direction?

Hammertoe

What is hammertoe?

If it can be passively corrected it is considered what?

If it CANNOT be passively corrected it is considered what?

Frieberg's Dz:

What is Friebderg's Dz?

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

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?

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?

Metatarsal Fx are usualyl result of compression injury @ what location?

Subluxation of Radial Head

1) Result of what action?

2) How do kids present?

In what type of Fx do you need to beware of the Lis Franc and Tarso-Metatarsal Jts?

What are 5 Congenital Deletions

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?

congenital Elevation of Scapula

Congenital Absence of clavicle

1) Usually unilat or BL?

2) Hypermobility of _____

Congenital Radidal-Ulcar Synostosis

Failure of what 2 bones to separate?

Cannot perform what 2 actions?

Trigger Thumb

Trigger thumb --> Inability to perform what action?

How to tx?

What is Syndactyly?

What is Polydactyly?

Congenital Dislocation of Radial Head

The elbow will have what deformity?

Restriction of mvt in which 2 directions?

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 _______

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?

If a radial head subluxation recurs after its been reduced, it may require what?

2 Types of Supracondylar Fracs of Humerus?

If it's a displaced supracondylar fracture of the humerus, is it an emergency?

Fx of UE

1) Remember, sprains in kids are what?

2) MC Fx in kids?

Lec 9: Pediatric UE

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!!!!

In a potential Cervical Fx Situation, what is the 1st test you should order?

3 Atypical Vertebrae in the C-Spine?

The Vertebral discs get their blood supply from where?

Spinal stenosis is ______ or ______ narrowing of the _____

Spinal Stenosis Usually gets worse with _____

Spinal Stenosis is assoc w/ ____ onset of neurogenic ______ and occasionally neurogenic ______

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?

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?