Ortho Exam 1 Study Guide

Orthopaedics Exam 1 Study Guide This ‘study guide’ is not intended to be all inclusive but, I hope this will help aid your studying focus. Just about all of the information here can be found on the lecture powerpoint presentations. If you have any questions, or need something clarified, please email me at rwepac216@gmail.com. Exam composition: All are multiple choice questions. 50 questions in total. General  General anatomy – Be able to identify skeletal bones and how they grow, their blood supply, hyaline cartilage composition and layers, synovial fluid. Osteoclast: stem cell, develops into osteo blast Osteoblast: responsible for making new bone and mending, secretes material Osteocyte:L former blasts that are in the matrix they produced Osteoclast: Bone reabsorption Wolfs Law: - Bone GROWS on compression side Bone THINS on tension side Nutrient Artery enters at the diaphysis – stops at metaphysis Metaphysical and epiphyseal arteries enter at capsular structure around the joints where they articulate - Osteomyelitis is likely to intrastate where nutrient artery ends and metaphysical blood supply begins Hyaline Cartilage - Mostly Type II cartilage No blood supply, cannot heal Layers! o Superficial- articulates o Middle o Vertical- deep o Calcified- transition to bone Synovial fluid - 5 mLs Nutrition for articular surface/articulate cartilage Lubrication  General orthopaedic definitions: Proximal, distal, volar, dorsal, coronal, sagittal, supine, prone, volar, distal, medial, lateral, dorsiflexion, plantarflexion, abduction, adduction, etc. Volar = ventral = anterior Orthopaedics Exam 1 Study Guide   Know how to describe fracture and/or bone positioning – varus or valgus, medial or lateral, anterior or posterior, radial or ulnar. o Remember:  Displacement of fractures is always the distal segment in relation to the proximal segment.  Anterior or posterior displacement and/or angulation can only be viewed on lateral imaging  Medial or lateral displacement and/or can only be viewed on AP/PA imaging  Remember: For this course, we describe angulation by looking at the APEX, or apex angulation (draw the arrow) Know the general different types of fractures – transverse, oblique, spiral, comminuted, open, etc. Orthopaedic Emergencies  Know the different types, how they would present, how you would make the diagnosis. For example, compartment syndrome: know the Ps, physical exam findings (nerves), pressure measurement, and treatment (week #2&6 lectures). For septic joint: how does it present, how would you make diagnosis. For dislocations: how do they present, what important physical exam findings would you be sure to check (neurovascular?)… and so on Compartment syndrome - Ps o Pain o Parenthesis’s Orthopaedics Exam 1 Study Guide - - - PE o Paralysis o Pulselessness o Pallor o Tense compartment o Tight shiny skin o Pressure measurement o Intracompartmental pressures/Stryker o Normal 0-10 o Elevated 10-30 o Ischemia 30-60 o Delta pressure > 30 indicates immediate decompression!! Treatment o Urgent Fascitomy Septic Joint - How it presents o Bilateral o Knee is most common o Hip is most common in children o Pain, swelling, warmth, erythema o Decreases ROM active and passive - Diagnoses o Aspiration  Cell count  Culture  Crystals  Gram stain o Elevated ESR, CRP o Elevated Leuks - Tx o I and D Dislocations - Be sure to check neuromuscular exam and x-rays BEFORE and AFTER reduction Shoulder dislocation – axillary nerve Posterior hip is most common – Internal rotation Anterior hip – External rotation Cause equina Syndrome - Saddle Anesthesia – sensory deficit Orthopaedics Exam 1 Study Guide Pediatrics  Review the following pediatric conditions. o Intoeing  Tibial torsion – 30 deg is normal  Asses medial and lateral malleulous o Metatarsus adductus  Flexible  Can be passively corrected  No Treatment necessary o Skew foot  “Z” appearance  Rigid  Surgical o Cllubfoot  Rigid/semi rigid  Equivinus deformity  Serial ponsetti casting  Boots and Bars until 4 o Flat feet  Expected until 5  Most often painless  Genetic  Ask child to go on tip toes to assess rigidity  No tx, no imaging o Genu varum  Bowing of legs  Rule out Blounts and rickets  Will improve with growth o Genu valgus  Knock kneed  Normal age 3-4  Consider renal osteodsytrophy or skeletal dysplasia o Pediatric hip – Legg Calve Perthes, o SCFE Orthopaedics Exam 1 Study Guide o o o o o o o o o o  Early dx. Is crucial  Most common hip disease in kids  During a growth spurt  Obesity  Immediate NWB and pinning DDH  Breech and family hx  Female gender  Barlow and Ortolani test  Tx with Pavlik harness Torticollis  SCM shortened and contracted  Intra uterine packing, or acquired from trauma/infeciont  Structural deformity of C1/C2  PT is mainstay Scoliosis  Neuromuscular vs. Idiopathic  Screening: adams forward bend  Standing spine xx ray  Bracing 20-40 deg  Surgery 40+ Nursemaid’s elbow  Pulling kid up by arm  Likely wont show on x ray  Reduction with supination and flexion Torus/Buckle fractures  Commonly seen in distal radius  Immobilize for 4 weeks Supracondylar fractures  Types II and III require pinning  Usually from FOOSH  Posterior fat pad!!!!!!!!! Toddler’s fracture  9 month – 3 yrs  Non displaced spiral fracture in distal 1/3 of tibia  Tx. Immobilize Toe walking  Normal children under 2  First neurological problem sign  Diagnose underlying cause Osgood – Schlatter  Over use and traction apophysitis  Growth spurts  Regain flexibility Musculoskeletal neoplasias  Osteochondroma Orthopaedics Exam 1 Study Guide  Teens  Lump/bump  Risk of turning malignant in adulthood  Tx. Observation and excision  Osteoid osteoma  Night pain !!!!!!  Definitive Dx =. CT  Long bones  Less than 2 cm  Chondroblastoma  Benign tumor of cartilage  Commonly in empiphysis of tibia or fur or  Tx. Curettage and bone grafting o Non-accidental trauma  Long bone fractures in non ambulatory children  Remove clothes and look for nursing  Bruising over non bony prominences?  Multiple fractures in various stages of healing Hip  Basic anatomy – muscles, muscle groups for range of motion (I will not ask you to identify muscles, but may ask you how many muscles in the hip extensor group, etc.) Flexion 9 – 9/10 Extension 5 – Tense Adduction 5 – adam 5 months to propose Abduction 3 – ABD=3 External rotation 8 – 8 letters Internal rotation 3 - INT 3  Hip exam - special maneuvers (testing), Leg length measurement – true vs apparent True Leg length: ASIS and medial malleulous Apparent: Umbilicys and medial malleulous Leg roll - Passivly internally and externally rotate hip  Presentation, imaging findings, treatment options for: o DJD of the hip  Groin and anterior thigh pain  Weakness, limited ROM  X-Ray: osteophytes, loss of space, sclerosis FABE FADIR (impingement) SCOUR (immpingment) OBERs – ITB tightness Orthopaedics Exam 1 Study Guide  Tx- NSAIDS, injections o Labral tears  Sharp and dull GROIN pain  FAI:Crossover sign  Dunn lateral 90deg Flexion 20 deg abduction o Hip fractures (know the different types)  Subcapital  Femoral Neck  Intertrochanteric  Subtronchaeric  EXTERNALLY ROTATED and SHORTENED o AVN  Disruption of blood supply  Femoral Neck Fx  ROM pain  Lateral head loses rounded appearance o Trochanteric bursitis  Tenderness over bony porminiese  NO GROIN pain  Can’t sleep on side  NSAIDS, PT, injections Knee  Basic anatomy – muscles, ligaments ACL PCL  Knee exam – special maneuvers (testing) - Pivot shift Lachman!!! Anterior Drawer - Posterior sag sign Posterior drawer test Orthopaedics Exam 1 Study Guide Chondromalacia - Patellar grind test Patellar inhibition test  Presentation, imaging findings, treatment options for: o DJD of the knee  Achy pain with weight bearing  Getting out of chairs, walking up stairs  Weight bearing X ray!!! – osteophytes, loss of joint space, sclerosis  TX - NSAIDS, PT, braces, injections o ACL, PCL, MCL, LCL o Meniscal tear  McMurray +  Apley grind +  Twisting and pivoting  Unstable  MRI most sensitive  NSAIDSm injections, surgery if needed o Patellofemoral disorders  Quadripceps tear or ruptures  Eccentric loading of the knee – walking down a hill  Anterior knee pain, palpable  Can’t straight leg raise when full tear  Imaging – patellar baja  Tx- knee imbolize, surgery  Patellar tendon rupture  Can’t straight leg raise  Tenderness  Patella Alta  Surgical  Chrondromalazia  Patella alta  Females young  Anterior knee pain  Pain with flexion and standing up  Patellar grind test  Patellar inhibition test  Sunrise X ray  Stretching - TX  Plica  Extensnon of protective capsule of knee becomes irritated, enlarged, inflamed  Patellar dislocation  Sudden blow or twist  Intense pain and swelling Orthopaedics Exam 1 Study Guide o Hamstring injuries  Sprinting, stopping, starting athletes  Muscle overload  Sudden pain mid run  Tender at defect o Osteochondritis dissecans  Children and adolescence – bone or cartilage loses blood supply  Painful swollen joint o Bursitis: pes anserine, prepatellar  Pes Anserine  Slow developing main on medial side 2-3 in from knee  Increase with exercise/stairs  Incorrect training techniques  Prepatellr bursitis  Inflammation of bursa in your knee  Constant kneeling  Can be bacterial o Fractures: just know how you would identify the different types: o tibial plateau  Just below knee joint o distal femur o Patellar Lower leg, Ankle Foot   Physical exam and special maneuvers Presentation, imaging findings, treatment options for: o Pilon fractures  Swelling, ecchymosis, Fracture blisters  X ray – AP, lateral, Mortise, full length tibia and fibula  Tx. RICE or surgical o Ankle sprains  Inversion  ATFL  PTFL  Calcaneofibular  Eversion  Deltoid – medial  Anterior inferior tibulofibular, posterior inferior tibulofibular (Syndesmosis)  Always check MORTISE  Rest, ice, immobilize, PT, brace o Maisonneuve fracture  Caused by eversion  Deltoid and syndesmosis Orthopaedics Exam 1 Study Guide o o o o o o o  Laterla knee pain  Xray- Mortise widening, proximal fibula fracute  Tx- non weight bearing Ankle fractures – understand the Weber classification  A – inversion, below  B – Eversion, above  C - Above ankle joint Plantar fasciitis Achilles tendinitis and Achilles rupture 5th metatarsal fracture - Jones Lisfranc injury – Plantar bruising Toe fracture Bunions``