Title: LMCC Orthopedic Review Lecture
1- LMCC Orthopedic Review Lecture
- April, 2004
- Back to Basics
- Dr. P.R. Thurston
2Syllabus
- 1. Diagnosis, Treatment Complications of
Fractures /Dislocations. - 2. Diagnosis Treatment of Arthritis.
- 3. Assessment and Management of Low Back Pain.
3 Dislocations
4Fractures
A discontinuity in the structural integrity of a
bone.
Definition -
A fracture occurs because the force
applied exceeds the breaking strength of the bone
so that the Load can no longer be transferred
across that zone of the bone.
5Fractures
- All fractures ultimately begin with kinetic
energy, released by misadventure and applied to
the human body. - Some of that energy is absorbed and some is
transmitted to the surroundings. - Absorbed energy must be dissipated, ie.
distributed, through the soft tissues and bones. - Fractures occur when the bone can not dissipate
all of the energy absorbed.
6Fractures
- Thus -
- 1 ) A fracture occurs when the energy
transferred to a bone exceeds the ability of the
bone to dissipate that energy. - 2 ) Further energy dissipation produces -
- - comminution.
- - soft tissue damage (open fractures).
- - displacement.
- - other fractures.
7Definitions
- Fracture- A discontinuity in the structural
integrity of a bone. - Infraction- An incomplete fracture.
- Dislocation- Complete loss of contact of the
articular surfaces of a joint. - Subluxation- Non-concentric joint surfaces.
- Reduction- Returning a fracture or dislocation
to an anatomical alignment. - Comminution- Multiple fragments.
8Fractures
Mechanical Properties of Bone
- Bone is a two-phase material -
- Calcium HydroxyApatite Ca10(PO4)6(OH)2
mineral -
- Osteoid Collagen type I and III
fibrous - Calcium is strong in compression, but weak in
tension. - Osteoid is strong in tension, but weak in
compression.
9Fractures
- BUT - (for adult bone)
- Calcium is stronger in compression than
Osteoid is in tension - And therefore -
- Bone always fails first in tension
10Fractures
For immature bone, this effect is reversed.
The Buckle or Torus fracture occurs because the
bone fails in compression first.
In children, the Osteoid is stronger than the
Mineral phase.
Generally, the dislocation in youth becomes the
fracture in the adult.
11Fractures
- A bone consists of three areas -
- the Diaphysis
- the Metaphysis
- the Epiphysis.
Each region has its own fracture characteristics.
12Fractures
- Bending
- Torque
- Direct
- Traction
- Compression
- Intra-articular
- Pediatric
Oblique
Diaphyseal
Spiral
Transverse
Metaphyseal
Epiphyseal
Mixed
13Bending
Fractures
- Bending produces a transverse fracture line, with
or without a lip. - When load is added, the lip becomes a butterfly
fragment. - With more loading, the fracture line becomes
oblique.
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15Torque
Fractures
- - Rotatory shear produces a continually changing
line of failure, giving the typical Bayonet
Spikes at the ends of the bones. - The greater the load the longer the fracture.
- These occur only in long bones and are referred
to as- - Spiral Fractures
16Torque
Fractures
- piral
- The butterfly segment is different from the
oblique bending fracture.
17Fractures
If no butterfly, then the ends are Bayonet in
appearance.
18Direct Blow
Fractures
- tapping fractures.
- Fractures of dying momentum.
- Tension produced on the opposite side of the
bone. - Comminution produced on the impact side of the
bone. - High energy injuries.
19Direct Blow
Fractures
Transverse Fractures Comminution on the opposite
side to a bending fracture, ie. at the point of
impact. The Nightstick Fracture.
20Metaphyseal
Fractures
Traction Avulsion.
- The Metaphysis is subject to all of the
diaphyseal patterns plus- - 1) Traction Avulsion.
-
- 2) Compression.
-
21Metaphyseal
Fractures
Traction-Avulsion
- are transverse since the tension is equal on
both sides of the bone. - are caused by ligament or tendon traction.
- always occur adjacent to joints.
22Fractures
Traction Avulsion.
23Compression
Fractures
- Crush fractures
- Impacted fractures
- Usually comminuted
- Usually axial skeleton
- - Vertebrae
- - Calcanei
24Epiphyseal
Fractures
- The Epiphysis is subject to all of the diaphyseal
and metaphyseal patterns
plus- - 1) Intra-articular Fractures.
-
- 2) Pediatric Fractures about the Epiphyseal
plate. -
25Epiphyseal
Fractures
- Intra-articular Fractures
- Always require accurate reduction.
- Usually require surgical treatment.
- Are often comminuted.
- Frequently threaten Post-traumatic Osteoarthritis.
26Epiphyseal
Fractures
- Pediatric Epiphyseal Fractures
- Produce fracture patterns specific to children.
- Always require accurate reduction.
- Can produce growth abnormalities.
- Salter-Harris Classification.
27Salter-Harris Classification
Fractures
I
II
III
IV
V
28Salter-Harris Classification
Fractures
1) Fractures interfering with growing
bones. 2) Worse prognosis with increasing
number. 3) Probability of surgery increases with
number.
29Fractures
- A fracture can occur in -
- normal bone subject to abnormal forces.
- Traumatic Fractures.
- abnormal bone subject to normal forces.
- Pathologic Fractures.
- normal bone subject to cyclic forces.
- Fatigue or Stress Fractures.
30Description
Fractures
- 1) Displacement - Angulation
- 2 ) Closed or Open.
- 3 ) Simple or Comminuted.
- 4 ) Fracture Pattern eg. Spiral, Transverse etc.
- 5 ) Anatomical Area.
- 6 ) Mechanism.
31Fracture Description
- This fracture is angulated laterally, since it
points laterally. - The distal fragment is tilted medially
32Description
Medially Displaced Closed Comminuted Short
Oblique Fracture of the Proximal Humerus Caused
by a direct fall
33Fracture Description
- 1) The distal fragment is always described with
relation to the proximal segment. - 2) Displacement Translation of bone ends.
- 3) Angulation Orientation of bone ends.
- 4) Angulation identifies to where the fracture
points. - 5) For clarity, the tilt of the distal fragment
is often used to describe angulation.
34The Periosteal Bridge
- The Periosteal Bridge is intact on the concave
side of the fracture. - Reversal of the mechanism of the fracture
tightens the bridge and stabilizes the fracture.
35The Periosteal Bridge
- Tightening the periosteal bridge locks the
fracture together. - Holding the bridge tight requires three point
fixation. - It takes a bent cast to produce a straight bone
- J. Charnley
36Treatment
- Closed or Open ( Surgical ).
- - Both require an understanding of fracture
healing. -
- - Closed requires reversal of mechanism of
injury.
37Indications for Closed Reduction
- There is significant displacement.
- Reduction is possible.
- The reduction, if gained, can be held.
- The fracture has not been produced by a traction
force.
38Indications for Open Reduction
- 1 ) There is a significant Displacement.
- 2 ) Open Fractures.
- 3 ) Intra-articular Fractures.
- 4 ) Un-reducible Fractures
- 5 ) Reductions that cannot be maintained in a
cast. - 6 ) Comminuted or Segmental Fractures.
- 7 ) Floating Joints.
- 8 ) Fractures with Neurovascular damage.
39Open Fractures
- Classification -
- 1. lt 1 cm., inside-out, little soft tissue
damage. - low potential for infection.
- 2. 1 cm. 10 cms., outside-in, requires
debridement, but no flap or skin graft. - moderate potential for infection.
- 3. gt 10 cms., outside-in, high energy,
devitalized muscle, comminution or bone loss,
soft tissue loss.
40Open Fractures
- Classification -
- 3A. No loss of soft tissue cover, no flap
required. - 3B. Flap required due to soft tissue stripping.
- 3C. Associated vascular injury.
41Type 1. Open Fracture 6 mm, extend debride
42Degloving Mechanism
Degloving Mechanism
43Type III C Injuries Vascular Injury
Note pallor of the ankle No pulses
44Fracture Complications
- 1. Pulmonary Fat Emboli
- 2. Compartment Syndromes
- 3. Cast Disease
- 4. Stress Fractures
- 5. Pathologic Fractures
45Pulmonary Fat Emboli - A.R.D.S.
- - Long bone fractures, burns, contusions.
- - Interstitial pneumonitis due to free fatty
acids - - S.O.B. confusion in young adults.
- - Axillary Subconjunctival Petechiae.
- - Serum lipase elevated.
- - pAO2 reduced if lt 50 20 mortality.
- - Ventillatory support
- - Dexamethazone.
- - 5 day course.
46Compartment Syndromes
- - increased interstitial tissue pressure.
- - fractures, burns, tight dressings.
- normal pressure lt 25 mm. Hg.
- when the tissue pressure gt venous capillary
pressure, but less than the arteriolar pressure. - 5 Ps
- - pain.
- - pallor.
- - pulselessness.
- - paresthesias.
- - paralysis.
47Compartment Syndrome
Symptom Pain out of proportion to that
expected for the injury. Signs 1. Loss of
function of muscle due to ischemia within
the compartment. 2. Pain with passive
stretch 3. Numbness etc. are LATE findings! 4.
If neuro symptoms present, potential
for full neuro recovery is only 10
48Rx Compartment Syndrome
Release all compressive dressings / plaster.
Elevate extremity to heart level.
Fasciotomies.
49Rx Compartment Syndrome
Increased girth. Pallor of the foot. Recent
surgery.
50 4 compartment fasciotomy
51Compartment Syndrome
Careful monitoring. Recognise it - 5 Ps
Call Orthopaedic Surgeon Pressure measurements
52Stress or Fatigue Fracture
- Repeated loading below acute
- failure threshold.
- Eventual fatigue failure.
- Military recruits, runners, aerobics.
- Tibia, metatarsals, femoral neck.
- Initial x-ray can be negative.
- Bone tenderness Bone scan.
53Pathologic Fractures
- Failure through abnormally
- weakened bone
- Minimal trauma BEWARE
- Osteoporosis
- Metastasis
- Tumour- Benign, Malignant
(Myeloma). - Metabolic Bone Disease
54Pathologic Fractures
55Fractures
Ultimately, the treatment of fractures requires
- an understanding of the mechanism that produces
them,
56Fractures
An understanding of the diagnostic tools
available,
57Fractures
And the current technologies used in their
treatment
58Dislocations
- The articular surfaces are no longer in contact.
- Commonly affects -
- Shoulders gt PIP joints gt Elbows gt Ankles.
- Often associated with fractures.
- Often associated with neurologic injuries
59Shoulder Dislocations
- 95 anterior
- 1 posterior
- Luxatio erecta
- Medial
- Axillary nerve injury
- Rapid reduction
60Shoulder Dislocations
- Conscious sedation.
- Traction reduction.
- Immobilization.
- Recurrent.
- Voluntary
- Habitual.
- Multiaxial instability.
61Elbow Dislocation
- Posterolateral.
- Median nerve injury.
- Ulnar nerve injury.
- Rapid reduction.
- Early mobilization.
62Back Pain
63Classification Mechanical (MacKenzie)
- Postural syndrome
- normal tissues become painful by the application
of prolonged stresses (sitting, bending etc) - Dysfunction syndrome
- soft tissues are shortened and stiff. Usually gt30
year old, poor posture, under exercised, reduced
mobility - Derangement syndrome
- Disc derangement (tears and herniation)
64Causes and Classification of Back Pain McNab
- Spondylogenic
- Osseus
- Trauma
- Infection
- Neoplasms
- Inflammatory
- Metabolic (eg.Pagets)
- Deformities
- Soft tissues
- Muscles
- SI joints
- Disc
- Facets
- Viscerogenic
- Vasculogenic
- Neurogenic
- Psychogenic
- Spondylogenic
65Non operative Treatment of Back Pain
- Do nothing
- Activity modification
- Medications
- Exercise and physiotherapy
- Braces
- Manipulation
- Massage therapy
- Traction/inversion therapy
- Vitamins/Supplements/Diets
- Weight control
- Every Suzanne Summers sponsored abs exerciser
66Degenerative Conditions of the Lumbar Spine
- Congenital
- Disc herniation
- Degenerative Disc Disease
- Spinal Stenosis
- Degenerative Spondylolisthesis
- Degenerative Scoliosis
And when did you first notice that your back had
gone out?
67Congenital Anomalies
Arthrogryposis
68Congenital anomalies
69Anatomy
Extension
Flexion
70Three joint complex(Kirkaldy Willis, Farfan)
Instability
Lateral n. ent
Central stenosis
71Disc herniation
Ms J.H. 25 y.o. female presented with cauda
equina syndrome
72Spinal stenosis
- Symptoms
- unilateral radicular pain
- bilateral claudication
- better with forward flexion of trunk
- better walking uphill
- rare bowel/bladder involvement
- Signs
- usually no neuro signs
- look for pulses
- stress test
- Investigations
- XR
- CT
- Myelo-CT
- MRI
73Spinal stenosis
Post myelogram CT
AP
lateral
myelogram
74Degenerative Spondylolisthesis
- Most common cause of spinal stenosis
- More common in women, hemisacralization of L5,
diabetics and women with BSO - OA of hip also in 11-17
75Isthmic spondylolisthesis
76Severe spondylolisthesis
77Time for a 10 minute break!
78Pediatric Orthopedics
- 1. Developmental Dysplasia of the Hip.
- 2. Legg-Perthes Disease.
- 3. Slipped Capital Femoral Epiphysis.
- 4. Club Feet.
- 5. Osteomyelitis.
- 6. Septic Hip.
791. Talipes Equinovarus is the proper name for -
- Flat feet
- In-toeing
- Club feet
- Knock knees
- Wry neck
80Talipes Equinovarus is the proper name for -
811. Talipes Equinovarus is the proper name for -
- Flat feet
- In-toeing
- Club feet
- Knock knees
- Wry neck
Pes Planus
Metatarsus Adductus
Genu Valgus
Torticolis
82Talipes Equinovarus
- congenital deformity of the foot
- Equinus, Inversion, Adduction, Supination
- 2 per 1000 live births
- 50 bilateral
- M gtF 21
- Serial corrective casts at birth
- Surgery if resistant
- EARLY TREATMENT IS ESSENTIAL
832. Trendelenburg refers to -
- Leg length discrepancy
- Gait abnormality
- Knee recurvatum
- Scoliosis
- Hip Contracture
842. Trendelenburg refers to -
852. Trendelenburg refers to -
- Leg length discrepancy Apparent vs Real
- Gait abnormality
- Knee recurvatum straightens past 1800
- Scoliosis lateral curvature, lordosis, kyphosis
- Hip Contracture Thomas test
863. All of these are signs of D.D.H. except -
- Limited Abduction
- Ortolani Sign
- Asymmetric Skin Folds
- Galeazzis Sign
- McMurray Sign
873. All of these are signs of D.D.H. except -
883. All of these are signs of D.D.H. except -
Dislocated
- Limited Abduction
- Ortolani Sign
- Asymmetric Skin Folds
- Galeazzis Sign
- McMurray Sign
Reducible
Dislocated
Knee height
Torn Meniscus
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91Developmental Dysplasia of the Hip
- Acetabular dysplasia
- Femoral anteversion
- Adduction Contracture
- 50 bilateral, F gt M 81
- Test ALL newborns at birth
- Conservative Rx at birth Pavlik, D.diaper
- Surgical Rx if resistant
924. The most common congenital Spinal abnormality
is -
- Scoliosis
- Spina Bifida
- Torticolis
- Klippel Feil Syndrome
- Multiple Hereditary Osteochondroma
934. The most common congenital Spinal abnormality
is -
944. The most common congenital Spinal abnormality
is -
- Scoliosis
- Spina Bifida
- Torticolis Wry Neck
- Klippel Feil Syndrome Congenital Fusion
- Multiple Hereditary Osteochondroma
95Spinal Bifida
- defect of neural tube closure
- Lumbar spine, commonly low
- 2 per 1000
- myelodysplasia
- Mild to complete paraplegia
- Occulta, meningocoele, Myelomeningocoele
- Bowel and bladder dysfunction
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98Polydactyly
5.
99Syndactyly
6.
1007.
101Sprengels Deformity
Omovertebral Bone
1028. A 6 year old boy with delayed physical
development, convulsions, tetany, weakness,
blue sclera and bony deformities is most likely
suffering from -
- a. Physical Abuse
- b. Ehlers Danlos Syndrome
- c. Osteogenesis Imperfecta
- d. Multiple Hereditary Exostoses
- e. Myositis Ossificans
1038. A 6 year old boy with delayed physical
development, convulsions, tetany, weakness,
blue sclera and bony deformities is most likely
suffering from -
- c. Osteogenesis Imperfecta
1048. A 6 year old boy with delayed physical
development, convulsions, tetany, weakness,
blue sclera and bony deformities is most likely
suffering from -
- a. Physical Abuse
- b. Ehlers Danlos Syndrome
- c. Osteogenesis Imperfecta
- d. Multiple Hereditary Exostoses
- e. Myositis Ossificans
1059. A 6 year old boy with delayed physical
development, a rachitic rosary, weakness and
bony deformities is most likely suffering from -
- a. Physical Abuse
- b. Rickets
- c. Scurvy
- d. Osteitis Deformans
- e. Myositis Ossificans
1069. A 6 year old boy with delayed physical
development, a rachitic rosary, weakness and
bony deformities is most likely suffering from -
1079.
1089.
109Etiology Alkaline
Calcium Phosphate Urea
Phosphatase Vita
min D Up Down Normal
NormalDeficiency Rickets
Renal Up
Down Up UpInsufficiency (Renal
Rickets) Renal Up
Down Down NormalTubular
Insufficiency (HypoPhosphatemia)
11010. This is -
- a. Osteomyelitis
- b. Osteomalacia
- c. Osteoporosis
- d. Osteitis Deformans
- e. Leprosy
11110. This is -
11210. This is -
- a. Osteomyelitis
- b. Osteomalacia
- c. Osteoporosis
- d. Osteitis Deformans
- e. Leprosy
113Osteitis DeformansPagets Disease
- 4 of pop. Over 40 yrs.
- accelerated bone turnover
- often assymptomatic
- monostotic gt polyostotic
- loss of stature
- AV shunting
- pathologic bone
11411. A child with knee pain has a ____ problem
until proven otherwise.
- a. Knee
- b. Femoral
- c. Tibial
- d. Hip
- e. Patella
11511. A child with knee pain has a ____ problem
until proven otherwise.
Obdurator Nerve
11611. All of the following are part of the
differential of hip pain in a 6 year old, except
-
- a. Femoral Osteomyelitis
- b. Septic Hip
- c. Transient Synovitis
- d. Legg-Perthes Osteochondritis
- e. Slipped Capital Femoral Epiphysis
11711. All of the following are part of the
differential of hip pain in a 6 year old, except
-
- e. Slipped Capital Femoral Epiphysis
11811. All of the following are part of the
differential of hip pain in a 6 year old, except
-
- a. Femoral Osteomyelitis
- b. Septic Hip
- c. Transient Synovitis
- d. Legg-Perthes Osteochondritis
- e. Slipped Capital Femoral Epiphysis
119Ages for Hip Disease
- D.D.H. Birth
- Septic Hip Birth 11
- Legg-Perthes 3 11
- Transient Synovitis 3 11
- S.C.F.E. 11 - 16
12012. Osteomyelitis in children is produced by
what route of infection?
- a. Direct extension from another focus
- b. Hematogenous spread
- c. Perforating wounds
- d. Lymphatic spread
- e. Septic hip
12112. Osteomyelitis in children is produced by
what route of infection?
122Osteomyelitis
- Acute infection,metaphyseal
- 90 Staph.,20 mortality
- 100 growth abnormality
- Periosteal elevation, osteolysis
- Sequestrum, Involucrum
12313.
12413.
Paronychia
12514.
12614.
Felon
12715. All of these are findings of a Herniated
L5-S1 disc, except -
- a. Absent Achilles reflex
- b. Lateral foot numbness
- c. Sciatica
- d. Low back pain
- e. Extensor Hallucis Longus weakness
12815. All of these are findings of a Herniated
L5-S1 disc, except -
- e. Extensor Hallucis Longus weakness
12915. All of these are findings of a Herniated
L5-S1 disc, except -
- a. Absent Achilles reflex S1
- b. Lateral foot numbness S1
- c. Sciatica S1
- d. Low back pain
- e. Extensor Hallucis Longus weakness L5
- f. Knee jerk L4
13016. Avascular necrosis of the femoral head is
associated with all of the following except -
- a. Steroid use
- b. Alcohol
- c. Deep sea diving
- d. Lipid storage disease
- e. Diabetes
13116. Avascular necrosis of the femoral head is
associated with all of the following except -
13216. Avascular necrosis of the femoral head is
associated with all of the following except -
- a. Steroid use
- b. Alcohol
- c. Deep sea diving
- d. Lipid storage disease
- e. Diabetes
13317.
8 year old boy
What is the Diagnosis?
13417.
8 year old boy
Legg Perthes Osteochondosis
135 Legg-Perthes Disease
- Osteochondrosis (avascular necrosis)
- Proximal Femoral Epiphysis
- Necrosis, revascularization, fragmentation,
healing - 3 11 yrs., M gt F 41, 15 bilat.
- Subluxation laterally, Coxa plana, Coxa magna
- Osteoarthritis 50 yrs.
136 Osteochondroses
18.
- Freibergs Disease
- Osgoode-Sclatters
- Scheuermanns
- Kienbocks
- Osteochondritis Disecans
2nd Metatarsal Head
Tibial Tubercle
Spine
Carpal Lunate
Lateral Femoral Condyle
13719. Diagnosis?
13819. Gout
139 Gout
- Urate crystalopathic arthritis
- Crystals in periarticular tissues
- Inconsistant elevated serum urate
- Allopurinol and colchicine
- Tophi in periarticular soft tissues
- Deposits in non-articular cartilage
- Juxta-articular erosions
14020.
L4
L5
Spondylolytic Spondylolisthesis
141 Spondylolisthesis
- Lumbosacral junction defect
- Spondylolysis of Pars Interarticularis
- Traumatic or congenital
- Acute immobilize
- Chronic - surgery
14221. The Salter- Harris Classification is used
to assess the severity of -
- a. Epiphyseal Fractures
- b. Developmental Dysplasia of the Hip
- c. Legg Perthes Disease
- d. Club Foot
- e. Osteomyelitis
14321. The Salter- Harris Classification is used
to assess the severity of -
144I
II
III
IV
V
14522. What is this deformity?
14622. A Diner Fork Deformity
Probable Diagnosis?
147- Colles Fracture
14822. Colles Fracture
- distal radial fracture
- FOOSH
- occurs at all ages
- commonly 60 yrs.
- osteoporosis
- intra-articular
149CR K-Wires
150External vs Internal Fixation
15123. The common complication of this fracture
is -
15223. Proximal pole Avascular Necrosis
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15424. This is a -
a. Buckle Fracture b. Greenstick Fracture c.
Stress Fracture d. Pathologic Fracture e. Growth
Arrest line
15524. This is a -
a. Buckle Fracture
15624.
This is a -
a. Buckle Fracture b. Greenstick Fracture c.
Stress Fracture d. Pathologic Fracture e. Growth
Arrest line
15724.
Greenstick Fractures
15825. Is this fracture treated by Closed or Open
Reduction?
159ORIF
25.
16025. Fractures of Necessity
16126. What is the Diagnosis?
16226. Posterolateral Dislocation of the Elbow
16326. Reduction by traction.
TRACTION
16427. What is the Diagnosis?
16527. Anterior Dislocation of the Shoulder
16627. Reduction by traction
16728.
This is a -
a. Supracondylar b. Olecranon c.
Dislocation d. Forearm e. Radial Head
16828.
This is a -
a. Supracondylar
16928. Supracondylar Fracture
17029. The complications of a Supracondylar
fracture in children include all of the
following except -
- a. Malunion
- b. Volkmanns Ischemic Contracture
- c. Compartment Syndrome
- d. Cubitus Varus
- e. Peripheral Nerve Injuries
- f. Pulmonary Fat Embolus
17129. The complications of a Supracondylar
fracture in children include all of the
following except -
17229. The complications of a Supracondylar
fracture in children include all of the
following except -
- a. Malunion
- b. Volkmanns Ischemic Contracture
- c. Compartment Syndrome
- d. Cubitus Varus
- e. Peripheral Nerve Injuries
- f. Pulmonary Fat Embolus
17330. The only sign of a Compartment Syndrome
that is always present is -
- a. Pain
- b. Pallor
- c. Pulselessness
- d. Paresthesias
- e. Paralysis
17430. The only sign of a Compartment Syndrome
that is always present is -
17530. The only sign of a Compartment Syndrome
that is always present is -
- a. Pain
- b. Pallor
- c. Pulselessness
- d. Paresthesias
- e. Paralysis
17631. Compartment pressures indicating the need
for fasciotomy -
- a. 0 15 mms. Hg
- b. 15 25 mms. Hg
- c. gt 25 mms. Hg
- d. gt 50 mms. Hg
- e. gt 75 mms. Hg
17731. Compartment pressures indicating the need
for fasciotomy -
178Compartment Syndrome
- fractures, crush injuries, burns
- collapse of venous return compartment pressure gt
25 mms. Hg - engorgement of muscle within
- necrosis of muscle tissue
- Volkmanns Ischemic Contracture
- Fasciotomy
17932. A 20 yr. old male with a fractured femur
has findings of confusion, tachypnea and
conjunctival petechia. The most likely diagnosis
is -
- a. Pneumonia
- b. Pulmonary Fat Emboli
- c. Cerebral Contusion
- d. Cardiac Contusion
- e. Transient Stress Reaction
18032. A 20 yr. old male with a fractured femur
has findings of confusion, tachypnea and
conjunctival petechia. The most likely diagnosis
is -
18132. Pulmonary Fat Embolus
- 2 - long bone s 10 - multiple s
- tissue thromboplastin ---gt extrinsic cascade VII
- A.R.D.S. - aterial hypoxemia
- petechia across chest, in axillae and conjunctiva
- early fixation decreases PFE, but increases
infection rates - no current lab tests or treatment protocol
18233. Name the Fracture -
18333. Monteggia Fracture
18433. Monteggia Fracture
18533. Monteggia Fracture
18634. Name this fracture -
18734. Name the fracture -
Galeazzi Fracture
188GaleazziFracture
34.
18935. The commonest complication of this
fracture is -
19035. A Radial Nerve Palsy
19136. Does this fracture require surgery?
19236. Does this fracture require surgery?
Yes
19337. Does this fracture require surgery?
19437. Does this fracture require surgery?
No
19538. This patient most likely has a fracture
of the --------.
19638. This patient most likely has a fracture
of the --------.
Hip
19738. This patient most likely has a fracture
of the hip.
External Rotation Shortening Hip Flexion
19838.
19939. Whats the Diagnosis?
20039. Sub-Capital Hip Fracture.
20140. All of the following are complications of
this fracture except -
a. Malunion b. Avascular necrosis c. Fat
emboli d. Non-union e. Thrombophlebitis
20240. All of the following are complications of
this fracture except -
c. Fat emboli
20340. Blood Supply of Femoral Head
20440. Save Head versus Replacement
20540. Subcapital Hip Fractures
Garden Classification
1. Abduction 2. Minimally displaced 3. 50
Displaced 4. Completely Displaced
20640. Subcapital Hip Fractures
Properties
1. Avascular Necrosis - 30 2. Malunion -
30 3. Non-union - 30 4. Surgery required 5.
Older population 6. Pathologic - Osteoporotic
20741. Whats the Diagnosis?
20841. Intertrochanteric Hip Fracture
20941. Intertrochanteric Fractures
21041. Intertrochanteric Fractures
Properties
- 1. Varus deformity
- 2. Well - Healing
- Traumatic Osteoporosis
- Surgery required
- Mid-range Age population
21142. What is the Diagnosis?
21242. What is the Diagnosis?
Subtrochanteric Hip Fracture
21342. Subtrochanteric Fractures
Properties
- Non-union
- Traumatic
- Surgery required
21443.Surgery or not?
21543.Surgery or not?
Yes
21644. Surgery or not?
21744. Surgery or not?
Yes
21844. Ankle Fractures
Eversion Injuries
21944. Ankle Fractures
Inversion Injuries
22045. What is the approach to this fracture?
23 y.o. male Basketball injury Open fracture
Numbness dorsum toes
22145.
Reduce dislocation Sterile dressing Splint
extremity Re-check NV status IV Antibiotics
Tetanus Surgery
22246. Surgery or not?
22346. Surgery or not?
Yes
22447. Surgery or not?
22547. Surgery or not?
Yes
22647. Surgery or not?
Yes
22748. A 45 yr. old male, who was previously in good
health, has sudden onset of transverse low back
pain and right sided sciatica to his foot, after
chopping wood at the cottage. Upon arising the
following morning, he notices numbness on the
outer border of his right foot and some
weakness in the right leg. He has no bowel or
bladder problems. The most likely diagnosis
would be-
- a. Lumbar Muscular Strain.
- b. Herniated Lumbar Disc.
- c. Herniated Lumbosacral Disc.
- d. Cauda Equina Syndrome.
- e. Spinal Stenosis.
22848. A 45 yr. old male, who was previously in good
health, has sudden onset of transverse low back
pain and right sided sciatica to his foot, after
chopping wood at the cottage. Upon arising the
following morning, he notices numbness on the
outer border of his right foot and some
weakness in the right leg. He has no bowel or
bladder problems. The most likely diagnosis
would be-
- c. Herniated Lumbosacral Disc.
-
22949. Your initial approach to this problem would
include some or all of the following-
- a. Bedrest.
- b. Anti-inflammatories.
- c. Muscle Relaxants.
- d. Spinal X-rays.
- e. Physiotherapy.
- f. Orthopedic/Neurosurgical referral.
- g. CT-Myelogram or MRI
- h. Discectomy
23049. Your initial approach to this problem would
include some or all of the following-
- a. Bedrest.
- b. Anti-inflammatories.
- c. Muscle Relaxants.
- d. Spinal X-rays.
- e. Physiotherapy.
- f. Orthopedic/Neurosurgical referral.
- g. CT-Myelogram or MRI
- h. Discectomy
?
23150. During the work-up for this problem, the
patient complains that he has unaccountably
soiled his underwear, without knowing it. Your
response to this would be to-
- a. Reassure the patient that this is not serious
- b. Order an urgent MRI
- c. Get an urgent referral to Neuro/Orthopedics
- d. Place the patient on immediate bedrest.
23250. During the work-up for this problem, the
patient complains that he has unaccountably
soiled his underwear, without knowing it. Your
response to this would be to-
- c. Get an urgent referral to Neuro/Orthopedics
23350. During the work-up for this problem, the
patient complains that he has unaccountably
soiled his underwear, without knowing it. Your
response to this would be to-
- a. Reassure the patient that this is not serious
- b. Order an urgent MRI
- c. Get an urgent referral to Neuro/Orthopedics
- d. Place the patient on immediate bedrest.
23451. A lumberjack felling a tree is unfortunately
struck on the back by the tree, knocking him to
the ground and injuring his left lower extremity.
In the ER, his left hip is in flexion, adduction
and internal rotation. The most likely diagnosis
is-
- a. Fracture of the Hip.
- b. Fracture of the Femur.
- c. Anterior Hip Dislocation.
- d. Posterior Hip Dislocation.
- e. Fracture of Pelvis.
23551. A lumberjack felling a tree is unfortunately
struck on the back by the tree, knocking him to
the ground and injuring his left lower extremity.
In the ER, his left hip is in flexion, adduction
and internal rotation. The most likely diagnosis
is-
-
- d. Posterior Hip Dislocation.
-
23652. Which of the following signs and symptoms
are consistent with a torn medial meniscus of
the knee-
- a. Inability to squat
- b. Pain on descending stairs
- c. Locking
- d. Recurrent effusions
- e. All of the above.
23752. Which of the following signs and symptoms
are consistent with a torn medial meniscus of
the knee-
- a. Inability to squat
- b. Pain on descending stairs
- c. Locking
- d. Recurrent effusions
- e. All of the above.
238A 35 yr. old male falls jogging and sustains an
undisplaced lateral malleolar fracture of the
ankle. He is treated in a Below-knee Walking
cast, but returns to the ER 24 hrs. later
complaining of increased, persistent, burning
pain at the ankle. Your response to this
situation would be to-
- a. Re-X-ray the ankle.
- b. Remove the cast.
- c. Measure the compartment pressures.
- d. Instruct the patient to elevate the limb
and prescribe an anti-inflamatory.
23953.. A 35 yr. old male falls jogging and sustains
an undisplaced lateral malleolar fracture of the
ankle. He is treated in a Below-knee Walking
cast, but returns to the ER 24 hrs. later
complaining of increased, persistent, burning
pain at the ankle. Your response to this
situation would be to-
240A 35 yr. old male falls jogging and sustains an
undisplaced lateral malleolar fracture of the
ankle. He is treated in a Below-knee Walking
cast, but returns to the ER 24 hrs. later
complaining of increased, persistent, burning
pain at the ankle. Your response to this
situation would be to-
- a. Re-X-ray the ankle.
- b. Remove the cast.
- c. Measure the compartment pressures.
- d. Instruct the patient to elevate the limb
and prescribe an anti-inflamatory.
24154. The most common dislocations of the shoulder
are-
- a. Medial.
- b. Posterior.
- c. Luxatio Erecta.
- d. Anterior.
24254. The most common dislocations of the shoulder
are-
24355. Metastatic lesions to bone, of the
following tumours, usually produce lytic
defects except-
- a. Thyroid.
- b. Pancreas.
- c. Prostate.
- d. Kidney.
- e. Lung.
24455. Metastatic lesions to bone, of the
following tumours, usually produce lytic
defects except-
24555. Metastatic lesions to bone, of the
following tumours, usually produce lytic
defects except-
- a. Thyroid.
- b. Pancreas.
- c. Prostate.
- d. Kidney.
- e. Lung.
246Th - Tha Thats all folks!